Choose Me

“I don’t understand!” Marcy shrieks at me, continuing the stalemate we have been have been in for weeks. “Why won’t you just tell me I’m your most favorite patient? You know that I am. You know that you care about me more than anyone else, that you love me, so why don’t you just say it!”

Thoughts race through my mind as my patience runs thin: ‘You’re upping the ante. Now you want to be the person I care most about in my life, the person I love above all others. You’re certainly not being very loveable right now.’ I remain silent.

“Why don’t you say something?” Marcy yells.

I sigh. “Truthfully, I don’t know what to say. We’ve been arguing about this for weeks. We know that your mother abandoned you to the care of her sister. We know that your aunt clearly favored her own daughter over you, that you felt like a second class citizen, like Cinderella, as you say. And all these things are horribly sad and painful for a child, but there’s no way I or anyone else can make up for that. If I told you you were my favorite patient, that wouldn’t take away your pain about your mother or your aunt.”

“Then what good are you?”

“I’m here to help you mourn the past, to be sad and angry, sad and angry, sad and angry about what you didn’t get as a child and then to be able to accept what was and to move on, able to take in the good from others in the present.”

“Is that a script you read? You say the same stupid shit all the time,” Marcy responds, crossing her arms in front of her chest, chin raised, staring at me defiantly.

I’m pissed. I remain silent while I try to collect myself.

“What?” March says.

“You know, Marcy…” I begin before she interrupts me.

“Oh,” she says sarcastically, “here comes the lecture.”

I ignore the interruption. “It’s interesting to me how much your behavior is counterproductive.”

“What’s that supposed to mean?”

“You say you want to be my favorite patient, but you behave in a way that would make you anything but my favorite patient.”

“Oh! So now I’m supposed to be Miss Goody Two-Shoes. I thought you always told me – for years and years in fact – that I was supposed to say everything I was thinking, not censor anything.”

“I’m not suggesting that you censor what you say. I’m suggesting that what you say has consequences.”

“So now you’re threatening me?”

‘Stay calm’ I tell myself, knowing Marcy wants to provoke me. “The more you angrily demand that someone care about you, the less likely that person – me in this instance – is going to respond the way you want. So the question becomes why do you behave in a way that is least likely to get you what you want?”

“Don’t change the topic,” Marcy demands.

“I’m not…” I stop myself. “That last comment, for example. You know I’m not changing the topic. You’re just being provocative and trying to not consider what I’m saying.”

“OK, smarty pants, why don’t you tell me why I behave this way. I know you have some nice little theory floating around in your head.”

“Let me ask something else first. What would happen if I did tell you you were my favorite patient?”

“I’d ask if that meant you loved me.”

“And what would you feel if I told you I loved you?”

“I’d need you to prove it. Like, would you see me for free?”

“So you’re saying you’d add more and more demands until you got to a place where you could again feel unloved and unchosen.”

“Why would I do that?”

“Good question. Why would you?”

“I don’t know.”

“I suspect you unconsciously want to be rejected so that you can stay connected to your rejecting mother and aunt who walk around in your head. If you take in the good, the caring in the present, then – here’s my script again - you have to mourn what you didn’t get in the past. You have to give up the hope of getting the love you needed and deserved as a child from the people in your life who were supposed to care for you but never came through.”

“That sounds way too hard.”

“I wonder if it’s any harder than repeatedly demanding love from people in the present in such a way that you insure you’ll never get it.”    

Disgruntled

“I had this unbelievably horrible day yesterday,” 76 year old Joan Green begins. With dyed red hair and raised eyebrows penciled to match, she challenges everyone around her and looks perpetually amazed by their response. She is my patient only because a psychologist colleague of mine begged that I see her. She had moved to Boca Raton, Florida a year ago after her daughter who lives in Phoenix could no longer tolerate her and feared her mother would destroy her marriage. Her son, my colleague, was not faring much better and told his mother that he would no longer have anything to do with her unless she went into therapy.

She continues. “I spent my whole afternoon in the pain doctor’s office and didn’t even get everything done. The pain is terrible. Everything hurts me – my back, my hips, my neck, even my feet. I can’t take it anymore.”

“Did anything go well yesterday?” I ask, perpetually trying to find something positive in Mrs. Green’s constant tales of woe. I doubt I’m the best therapist for this patient. Constant complaining is not my forte, especially when someone is so resistant to looking at her part in the interaction.

“I liked the doctor.”

My eyebrows shoot up in surprise. “Well that’s important. And positive.”

“Well, he was nice, but I don’t see why he couldn’t give me an injection yesterday and not make me come back.”

“Did he tell you why?”

“He needed me to get an MRI first. And he couldn’t do it in his office – I guess he doesn’t have the equipment. That wasn’t good either. And he said I had to call for an appointment. I don’t know why they couldn’t call for me. I don’t carry my phone with me. It’s way too heavy. I didn’t want to have to go all the way home and then go out for an MRI another day. I’m in pain! Obviously or I wouldn’t be in his office. I told them – I was in the waiting room by then, arguing with the office staff - I’d be willing to sit wherever and wait until they could take me.”

“Mrs. Green, does it seem to you that you have lots of expectations of other people, expectations that might be impossible to fulfill?”

“What! What expectations?”

“Well, what are your thoughts about that?”

“Why should I have any thoughts about that? You’re the one who brought it up. You should be the one telling me.”

Annoyed at this constantly demanding patient, I try to step back. “I wonder if you feel so un-given to, so lacking in nurturing that you have a profound need to be taken care of, whether that’s me answering your question rather than your thinking about it yourself or wanting a doctor to have every possible piece of machinery  available in his office, or needing others to make phone calls for you.”

“That’s just stupid psychobabble. Probably because you can’t answer your own dumb question.”

Feeling angry, I’m silent, trying to figure out what I want to say next.”

“What? Cat got your tongue?

“I wonder what you get out of being so difficult and demanding. I know that it can’t possibly get you what you want. Your daughter didn’t want you in the same city as her. Your son won’t deal with you unless you’re in therapy. But therapy is about looking at yourself. And if you’re not willing to look at yourself instead of blaming everyone else for their insufficiencies, we’re not going to get very far.”

“And that would be my fault?! How about your looking at you?”

“I’m happy to look at how I may be contributing to the difficulty we’re having, but that means you’ll need to look at how you might be contributing to the difficulty too.”

“Okay. So tell me. Both sides.”

“I’m going to answer that question, Mrs. Green, but I want to point out that you’ve again issued a demand and as a result of that demand I don’t really want to answer the question. I am going to answer the question, but I suspect that most people who aren’t therapists wouldn’t. They’d see you as an entitled, demanding, angry, embittered woman. And, from my perspective, that’s all true. But I do think there’s a reason you’re that way and I’m willing to work on us trying to figure out what that reason is which might help you to make some changes.”

“And what’s your part?”

“I think it may be particularly difficult for me to have people make demands on me without my wanting to resist their demands and that might make our work together more difficult.”

“So should I find someone else?”

“That’s certainly your choice. I’d be happy to give you some referrals if that’s what you decide.”

“You’re probably all alike. I’ll stick with you for a while and see what happens.”

“Okay. Fair enough.”

The Opponent

I open my waiting room door to meet James Harrison for the first time. He rises, hand outstretched to shake mine. I’d guess he’s in his mid-forties. A good-looking man, tall, thin, seemingly comfortable in his own skin. We make the brief walk to my office and I gesture him to the sage chair across from mine.

“So,” he says, “Why should I be here?”

I inadvertently jerk my head back while, at the same time, stifling the urge to laugh. He’s certainly wasted no time throwing down the gauntlet. Still, it’s so startling, that I find it almost funny. Perhaps that’s a defensive reaction on my part.

I think about commenting on his provocativeness, but decide that would only escalate what is already a fencing match between us.  “Well, since I’ve never laid eyes on you before,” I respond, “I have no idea why you should be here. Perhaps it would be helpful if you told me.” Too hostile, I tell myself. It’s hard not to meet aggression with aggression.

“At least you didn’t go into that bullshit about everyone can benefit from therapy, it’s always good to understand yourself better, etc., etc.”

Do I need this? I think to myself. We haven’t even said hello and we’re already adversaries. Actually that’s not a bad interpretation. “Mr. Harrison, I wonder why we’re already adversaries. As far as I know you voluntarily came into my office. I’m not forcing you to be here. There must be some reason you’re seeking the help of a therapist.”

“Ah ha. So you’re the try the gentle approach type of therapist.”

I am definitely getting pissed. Which must be what he wants. “I suspect it’s important for you to keep relationships on an adversarial basis. Perhaps that’s why you’re seeking therapy. Perhaps you have difficulty getting along with people.”

“Perhaps,” he says grudgingly.

Silence.

“OK. So now what?” he challenges.

I really do not need this. I want to tell this man that I don’t think we should work together, that I’m not the best person for him. Maybe that too would be a good interpretation. Or would it just be acting-out on my part?

“Why don’t you tell me a little about yourself?”

“Why would I want to do that if we’re not going to work together?”

“Have you decided that we’re not going to work together?” I ask.

“Have you?” is the rejoinder. 

“I don’t know,” I answer truthfully. “I do know that I’m not willing to spend every session fighting with you when I have no understanding of why you need to fight. And I’m also not prepared to convince you that you should be in therapy with me.”

“But you do think I should be in therapy?”

“Yes,” I reply definitively.

“Why?”

“Because you are clearly someone who needs to fight which means that you either have a lot of anger or need to keep people at a very far distance or both.”

“You see. You were able to tell me why I needed to be here.”

“And I suspect that you could have told me that yourself far more quickly.”

“But then I wouldn’t have known if you’re smart enough to handle me.”

“So I suppose I should assume that you’re going to be continually testing me?”

“Perhaps.”

“Mr. Harrison…”

“James.”

“James, I do know that how you are in the world, is how you are in here with me, but I want to again say that I think it is very unhelpful for us to be continually sparring and that one of my goals for you, is going to be to find the James Harrison behind your defensive posturing.”

“You don’t like me much, do you?”

“I would say that you insure that no one likes you much. But I would very much like to learn to like you. And I hope you’ll allow that to happen.”

“Touche!”

I groan internally and wonder why I didn’t refuse to take him on as a patient. “Can you tell me what you’re feeling, James?”

“Satisfied. I think you’re the right person for me.”

“Can you say how you felt when I said I thought you insured that no one liked you, but that I’d like to learn to like you?”

“I told you, satisfied.”       

“Did you feel anything else? Hurt? Relieved? Angry?”

“No. Just satisfied. I accomplished what I wanted to accomplish.”

“So you feel satisfied with yourself. Do you have any feelings about me?”

A slow smile spreads across his face. “I’ll tell you what came to mind. That’s what I’m supposed to do, right?”

I nod.

“I feel you’re a worthy opponent.”

Perhaps, I think to myself, this treatment will be about whether a worthy opponent can become a stalwart ally. If so, it’s going to be a slow slog through.   

I’m Nothing

Loretta Fischer has come into my office for the first time. She is an impeccably dressed, slender woman, who sits primly across from me, fidgeting slightly in the chair, staring at me expectantly.

I oblige. “What brings you here?” I ask.

“I’m just not happy,” she replies. “I’m alone. My husband died five years ago, my children are scattered all over the country. They call fairly regularly, but they’re not going to be keeping me busy on Saturday night. You know, I do the usual things women my age do, I play cards three days a week, go to the gym, go out to dinner and to the movies with friends.” She sighs. “It’s boring. I used to be an administrative secretary. My boss really relied on me. I was important. Now I’m nothing.”

“Now you’re nothing?” I say. “That’s a pretty dismal assessment of yourself.”

She shrugs. “That’s how I feel. I’m not a wife, not a mother, not a worker. I’m nothing.”

“What about your friends? The women you go out with?”

“They’re just women to go out with. They’re not really friends. Women my age don’t make friends.”

“How old are you?” I inquire.

“That doesn’t matter. What matters is that I’m unhappy.”

I’m startled. Loretta alludes to her age twice in a brief period of time and then refuses to tell me her age when I ask. Is she provoking me? “Is there a reason your age is a secret?” I ask.

“You know it’s not polite to ask a woman her age. How would you like it if I asked you your age?” 

This is beginning to feel like a minefield. In a matter of minutes, what is usually the friendly getting to know you beginning of therapy has evolved into a confrontation. I suspect that Loretta is not only unhappy, but quite angry as well. “Well,” I respond gingerly, concerned that I’m moving too quickly, “I actually wouldn’t object if you asked me my age, but I think the more important question is whether your manner of responding reflects both your need to protect yourself and your anger at having to give anything of yourself.”

“What are you talking about?” Loretta says sternly, knitting her brows. Then she sighs and shakes her head. “They told me you were an excellent therapist, not like the others I’ve seen. They said you were more real. And here you are spouting the usual kind of nonsense. Your whole field is ridiculous.”

I feel scolded, diminished and angry. As these feelings wash over me, I realize that in very short order, Loretta has enabled me to feel exactly what she feels, “like nothing.” I’m torn about how to proceed. I wonder how many therapists she’s seen before me. I wonder if her age is a particularly sensitive issue or if she unconsciously needs to bate me. Regardless, I need to mend the breach in our relationship if this therapy is to have any chance of succeeding. “I’m sorry, Loretta,” I say. “I am getting way ahead of myself. But let me ask you something, you say you feel like nothing because you’re not a wife, a mother or a worker, what did you feel before you were wife, mother and worker? Did you feel like nothing then too?”

“Are you trying to get me to go back to my childhood? Another piece of nonsense. I suppose everything is my mother’s fault?”

I feel my anger rise. But maybe she does think everything is her mother’s fault. Her anger and criticalness and feeling like nothing have to come from somewhere. “Loretta, my sense is that you’re angry. I don’t know yet what or whom you’re angry at, but I do know that it took next to no time for us to be at odds with each other. I get that you’re unhappy and I’m sure it feels awful to feel like “nothing,” but I do think it’s important for you and for us to understand where that feeling comes from in both the past and the present.”   

“So you’re assuming I’m coming back?” she says smugly.

“I don’t know if you’re coming back, Loretta. That’s something you’ll have to decide. But I do know that most everything you say feels like a provocation to me and I can’t imagine that would be helpful to you in your life.”


“I’ll make another appointment and we’ll see.”

I bite back the answer that comes to mind, “We’ll both see,” and settle for, “Seems fair. We’ll meet again and see what develops.”