Meeting the Family

“Well, I started World War III,” Patrick says sighing deeply, as he settles into the chair across from me. “I knew Vi wouldn’t go down easily with my parents, but I didn’t think it would be that bad. My mother literally gasped and my father’s rage permeated the entire dinner. He didn’t say a word to her the whole time, but he had a lot to say to me afterwards. I guess I shouldn’t have just sprung her on them, but she surprised me by coming down for the weekend and I was supposed to go to my parents for dinner so, I guess I just decided to bring her along.”

“Wait, Patrick. You mean you hadn’t told your parents that Vi is African American? And then you just showed up with her for dinner?”

“Yeah. You know, she teaches law at Columbia University in New York, I’m down here in Florida, I knew my parents, particularly my father is very prejudiced, so I guess I kind of avoided the whole thing until I couldn’t anymore. Vi wasn’t very happy with me either. Obviously the dinner was awkward for her.”

Internally I find myself yelling at Patrick, ‘Awkward? That’s an understatement! She must have been consumed by anger she had to swallow. How could you have allowed this to happen? To everyone.”

Wondering if I’m feeling not only my anger, but Patrick’s as well, I ask, “Who are you feeling angry at Patrick?”

“Angry? Well, I’m angry at my parents, particularly my father. He really let me have it. He guessed no nice white woman would want me since I was such a loser; had to go looking in the gutter for some black chick.”

“And you felt and said what?”

“I hung up on him.”

“And felt?”

“Angry. Disgusted. Vi is this incredibly accomplished, smart, beautiful woman. I’m honored that she’d want me. And all he can see is her black skin. Except I don’t know if she still wants me. She’s pretty angry with me too. She didn’t know I hadn’t told my parents she was African American. She kept saying we’re not children, we’re in our 30s, what gives them the right to think they can decide our lives.”

“And can they? Can they decide your lives?”

Patrick hesitates before saying, “No, not exactly.”

“What do you mean, not exactly?”

“Well, I couldn’t figure out the long distant part of Vi and my relationship anyway. I mean, it would hard for me to start all over again as a financial planner in New York and to say that there are no law schools down here equivalent to Columbia would be putting it mildly.”

“You’re confusing me Patrick. Are you thinking of breaking up with Vi? Were you thinking of breaking up before the dinner with your parents? Is your parent’s reaction influencing your decision about breaking up?”

“I don’t know. I love Vi, but I can’t figure out the logistics. I couldn’t figure out the logistics before the dinner and I can’t figure it out now.”

“Have you talked to Vi about your concerns? I know you hadn’t talked with me about it.”

“No.”

“Did you set Vi up, Patrick?” Realizing my anger is seeping through, I try to temper my question. “I mean, did a part of you think taking Vi to dinner with your parents would precipitate World War III, as you said, and might lead to her breaking up with you?”

“I hadn’t thought of that at the time, but now that you mention it … I mean, she’s such a perfect woman for me, I can’t see how I could break up with her. Except she lives in New York and I don’t see how that’s workable.”

Now I feel more sad for Patrick than angry. “You know, Patrick, it’s difficult for you to take charge of your life, to decide what you want for you and make it happen. You don’t talk with Vi about your concern about living in two different cities and whether that can be worked out. I suspect you haven’t even looked at the possibility of becoming a financial planner in New York. You don’t confront your father about your feelings about what he said to you.”

“I guess I always take the coward’s way out. I run.”

Now that I am no longer angry with Patrick, I realize that I had been reacting to him much as his father did. “I wonder, Patrick, if you’ve heard your father call you a loser your whole life and if you’ve come to identify yourself as a loser, despite your obvious success and accomplishments. You feel you can’t do it, whatever it is, and so you don’t, you opt out.”

“I think that’s true. But it’s a hard pattern to break.”

“Yes, it’s a hard pattern to break, but we’ll work on it.”  

Family Connections

“I’m kind of in a state of shock,” Sheila begins. “My sister was arrested for shoplifting. A lipstick for heaven sakes! She could have bought a million lipsticks! I don’t get it. And she doesn’t seem to be able to explain it. At least not to me.”

“You’ve never talked much about your sister,” I say to Sheila. “What’s your relationship like?”

Sheila sighs. “Pat’s two years younger than me, 36. I guess we’ve never been close. Not as kids, not now when we live less than a half hour apart. She was always difficult, always getting into trouble, creating some drama in the house. She’s very pretty. My father liked that. I guess I was jealous of her. I was the good girl, the one who always did well in school, the one who obeyed the rules. I got points for that, but her looks made her popular with the “in” girls and always got her dates with the most desirable boys. And then she married Cliff, married into all that wealth. She calmed down after that. I thought she was happy. Who knew?”

“Do you still feel jealous of your sister?”

“I guess. It seemed she was always creating problems, but still got everyone to love her. But I don’t know about this time. My parents are definitely not happy. And I can only imagine how Cliff’s family will react.”

“Does that bring you some satisfaction?”

“I wouldn’t say that to anyone but you, but yes, it does. Except she’ll probably get out of this too. And I really shouldn’t complain. I have a great career, a wonderful husband and a lovely daughter. You can’t ask for much more than that.”

“Do you feel less than your sister?”

“That’s a good question. It’s like if I think about my adult self and my adult life, I have absolutely no reason to feel less than Pat – except for her money, but that’s really not the issue for me. It’s these feelings from the past that creep in and suddenly I’m the one who gets to stay home on Saturday night, who watches my father look adoringly at my sister and, yes, I feel less than. Silly, right?”

“Not silly at all, Sheila. Our unconscious is timeless and the experiences and feelings we had at five and ten and fifteen, are as much with us, as our present day experiences and feelings.”

“Makes sense.”

“You haven’t talked at all about your mother’s feelings about you or your sister.”

“I guess that’s because I never knew how my mother felt. About anything. She was always efficient and proper and did the things she needed to do, including taking care of us, and I suppose loving us, but there was a shallowness to her feelings. Or maybe it’s that feelings were too messy. She did what she needed to do, her feelings on the shelf.”    

“So in relation to your mother, your sister and you were equal, neither of you getting very much.”

“Oh, I wouldn’t say that. I mean we may have been equal, but it’s not that we didn’t get very much.”

“Emotionally?”

“Are you saying you think we were emotionally deprived?”

“You were the good girl, your sister acted out. Maybe you were both trying to get more love and attention.”

Pause.

“I wonder if that’s why I sometimes get depressed out of the blue. It’s like everything is going along fine and suddenly there’s this black cloud.”

“That a great insight, Sheila. What you’re saying is that those childhood feelings we were talking about earlier catch up with you and suddenly you’re a kid again feeling needy and ungiven to and depressed.”

“That’s exactly right!” She pauses. “You know, that also makes me feel more sympathy towards my sister. I like that. It’s a new feeling.” Another pause.  “Do you think she shoplifted because she felt needy and thought the lipstick would make her feel better?”

“You’re saying she was trying to nurture herself with a material object, because she didn’t feel given to emotionally. That’s certainly a possibility. And I imagine there’s some anger thrown in there as well. Probably for both of you.”

“Hmm. I’ve never seen myself as an angry person, but I guess we’ll have to talk about that next time.”

“Okay. We will.”  

In Search of Contentious Relationships

“Big surprise,” Tricia says, sighing, “Billy broke up with me. I told you he would. I told you he was nothing but a big baby who needed more and more reassuring and couldn’t tolerate arguing or sticking up for himself. Same old story again and again. I don’t know, don’t they make any 35 to 45 year old men who are men anymore?”

I’ve been thinking about Tricia and my relationship. I’ve been thinking about how quickly I find myself sucked into what is indeed her argumentative style. I’ve been thinking about why she needs to make all her relationships so contentious. And I’ve been thinking about why I’m so easily engaged in her argumentative style, as opposed to staying in my role as the therapist who seeks to analyze and understand.

My mind runs quickly through the responses that first come to me: Say nothing, which she’d experience as withholding and therefore maddening; Say, “Why do you think you keep finding men who are so wishy-washy?” which she’d hear as attacking; Say, “Why do you think you need to make your relationships so contentious?” probably the most important question which she would immediately dispute. For the moment, I settle for the most innocuous response possible, a typical therapist question.

“How do you feel about his breaking up with you?”

“Boy, there’s a typical therapist question if I ever heard one!”

I should have known she’d get me on that one, I think to myself.

“I felt like, well, I knew it.”

“But what did you feel?” I persist.

She shrugs. “Not much.”

“Tricia, can I ask you what you feel about our relationship?”

“Wow! That’s a change of topic. Where did that come from?”

“Well, we’re talking about relationships and you and I certainly have a relationship. We’ve been seeing each other for almost a year now.”

“Yeah, and I’m no further along than I was to begin with”

I’m beginning to feel dismissed and demeaned. Although I certainly take responsibility for the lack of progress in any treatment, Tricia’s inability to look at herself and her role in thwarting her own growth is more than annoying. Are my feelings similar to the ones I had with my father who knew everything, argued about everything and called me stupid if I ever dared to disagree with him?     

I persevere. “Tricia, have you ever felt close to anyone, ever?”

“You’re all over the map today,” she snaps back.

“Can you tell that you’re trying to bait me into an argument? It’s like you’re sparring with me as opposed to experiencing us on the same side, as trying to help you to better understand yourself and get to the place where you say you want to be, in a relationship with a man.”

“Where I say I want to be? What do you mean by that? Don’t you believe me? How can we be on the same side if you don’t even believe me?”

“Tricia, this is impossible,” I say clearly angry. “It’s as though you listen to everything I say looking to pick out the one thing that you can argue with me about and zoom right in on it.”

“Ah ha,” she replies, with a slight smile and a sparkle in her eyes, “I got you pissed off.”

“And why does that feel good to you?” I ask. “Does it give you a feeling of control over me? Does it keep a distance between us that’s more comfortable?”

“It shows you’re strong enough for me. That you can fight with me. That you can take what I have to dish out.”

“Who did that to you, Tricia? Who wanted to make you tough enough to fight back?”

In an instant, Tricia’s face becomes expressionless, frozen, her eyes staring blankly ahead. I’ve seen that look many times before, the look of an abused child.

“Who did that to you, Tricia?” I ask again, much more gently.

Tricia blinks and focuses back in on me. “My mother. I’ve never told anyone. I hate being a victim. She used to beat the shit out of me. She’d beat me and beat me until I stopped crying, until I was no longer a baby, until I could take it. She thought she was helping me. I thought she hated me. Except I think I have love and hate all mixed up.”

“I’m so sorry that happened to you, Tricia. You were a helpless child. A helpless child can’t be anything but a victim. There’s no shame in that, although I’m sure you do feel a lot of shame. And I’m sure you’re right, love and hate is all mixed up for you. We have lots to work on. But I’m really glad you told me Tricia. I know it wasn’t easy.”   

Stop!

I am sitting with Lila – or L as she insists on being called – in uncomfortable silence. A tall, heavy woman in her mid-twenties, with disheveled hair and wrinkled clothes that look as though they’ve been purchased at a thrift shop, L stares at the floor, occasionally glancing up to glare at me. We have been here many times before. I know I need to say something or L will leave, looking back at me with undisguised contempt.

L doesn’t want to be here. Her father insisted. Despite her obvious intelligence, she barely made through college and has done nothing since she graduated but sit glued to the TV or her computer. Her father, a wealthy businessman, insists that I “fix” his daughter. He travels for his company so isn’t home much, but hears from the servants that his daughter does nothing with her time. His ex-wife, he told me, is entirely out of the picture. She left with another man when L was a baby, leaving him to hire a succession of nannies.

“What are you feeling right now?” I ask lamely.

She sneers at me. “Five minutes of silence and you can’t do better than that?”

Although I agree with L’s assessment, I’m again becoming angry, a feeling that often plagues me in L’s sessions.

“What would you like me to ask?”

Another sneer. “What? So now you want me to do your job for you?”

“Okay,” I say. “Let’s start over. We both know if we continue along this path, we’ll both end up being angry and then you’ll leave.”

“Good guess.”

“Do you like to make me angry, L?”

She shrugs.

Silence.

“I can see that you might want to make me angry, that you might want me to feel what you feel.”

“So I’m angry. So what?”

“I can’t imagine that it feels good to be angry all the time.”

Another shrug.

More silence.

“Can you tell me why you’re angry, L?”

“Why don’t you tell me,” she snaps back.

Trying to keep the conversation going, I reply, “Well, at the very least, you’re angry about being here.”

“Wow what a brilliant insight! Give the lady a gold star! And you’re considered a great therapist because…?”

“You succeeded, L. I’m angry. But I still don’t know what purpose it serves you. Is it a way to keep me away, to make sure we never form a relationship? Is it a way to keep yourself safe?”

“Why don’t you just figure it out,” L says as she starts to leave.

Without thought, I’m up against the door barring her exit. “Stop it, Lila!” “Sit down.” 

Towering over me, her eyes fill with fury. I wonder what compelled me to place myself in such a precarious situation.

“Why’d you call me Lila?” she says angrily. “My name’s L.”

Why did I call her Lila? I wonder. “No,” I say, “Your name is Lila and I’d like to know Lila. I’d like to know the person you were before you felt you had to rename yourself. I’d like to know you and I’d like you to stay.”

I watch the fury drain from Lila’s eyes. In its place I see surprise and confusion. She stumbles back to her chair.

“I can’t believe you did that,” she says. “I could have hurt you. Why did you do it?”

“I didn’t think much before I reacted. I know I was angry. And I know I wanted you to stay. And what I said is true. I do want to know you, Lila. I know there’s a sad, lonely kid underneath all that anger.”

“How do you know?” she asks, some of the defiance returning to her voice.

“Well, your mother abandoned you. Your father was never terribly interested in you. And you had a series of nannies who came and went. I can’t see how you could be anything but sad and lonely. And angry, of course.”

“So you think everything’s going to be rosy from now on?”

I smile. “No, I certainly don’t. And even if I did I know you’d show me very quickly I was wrong. No, Lila, I think we have a long road ahead of us. You’ve been hurt again and again and you’ve used your anger to wall yourself off from relationships and any more pain. But maybe we made a small inroad today.”

Lila nods. “It matters that you put yourself in danger because you wanted me to stay.”

The Specter of Death as Ever-Present

I am returning in this blog to Leslie and Harvey, the couple who was dealing with Harvey’s diagnosis of lung cancer. They had never spoken about their fears of Harvey dying, leading to his pulling away in order to protect her from the pain of his possible death.

Before continuing, however, I would like to clarify that just as in my book, Love and Loss, most of the patients in my blogs are composites of individuals I have worked with over the years, although I do try to remain true to the patient or idea I am presenting. Similarly, the dialogue, which I use extensively to bring the patient/therapist relationship to life, flows from my mind, not from verbatim transcripts. 

I return now to the couple. Although Leslie is my patient, Harvey has asked to come in for another joint session, a request his wife Leslie is more than happy to accommodate.

“I appreciate you agreeing to see me, to see us again,” Harvey says, smiling a bit as he switches the “me” to “us.” “I guess you’d call that a Freudian slip, ‘cause I do think this session is more for me than for Leslie.” He looks pensive. “I’ve been thinking a lot about what you said last time I was here, how the awareness of death can provide an opportunity for greater closeness, for a chance to live life to the fullest.”

I nod.

“It’s never been like that for me. I mean not only since I’ve been diagnosed with lung cancer, but forever. I’ve always been terrified of loss, of death.”

“Really?” Leslie says, clearly surprised. “I never knew that.”

“I’m not sure I really knew it either until that last session. But then I realized it’s always been this way, even as a kid. I’d like go to the drug store to get some candy, there was this one guy behind the counter who was always nice to us kids, and I’d leave and wonder what would happen if I never saw him again and how terrible that would be. Or if one of my kids got sick, even like a cold or something, I’d wonder how I’d survive if they died, like I didn’t think I would survive. And then when I got sick, it’s like, wow! I’m going to lose everyone, everything, how horrible is that?”

The session is suffused with a heavy sadness.

“Harvey,” I begin tentatively, aware that he is not strictly my patient, “Hasn’t Leslie told me that your father died of cancer when you were quite young?”

“Yeah. I was seven. It was terrible. My mother was a wreck, depressed – not that I blame her – and us kids were pretty much left to fend for ourselves. I don’t know what we would have done without my grandmother, my father’s mother, although she wasn’t in such great shape either.”

“So your whole childhood became filled with sadness and loss and death.”

“Yeah, and my dog died right about then too.”

“I’m so sorry, Harvey. What a lot for a little boy to bear. You lost everyone who was dear to you, everyone who you needed to depend on, to rely on. And, not surprisingly, it’s still a sadness you carry with you.”

“But I guess that’s what I’ve been thinking about. Even though I’d constantly have these thoughts about loss or death almost whenever I met someone, even if they weren’t someone close to me, I’m not sure I felt the sadness.”

I look at him quizzically. “You certainly seem to be feeling the sadness now, right here in this room.”

“Yes, I definitely feel it now and I’ve been feeling it more, but I realize that I’ve protected myself from those feelings my whole life. I mean even though I really, really love Leslie and my kids and even though I think I’ve been a loving husband and father…”

“You have been!” Leslie interjects.

“But not completely,” Harvey continues, sadly shaking his head. “I think I’ve always kept a piece of myself back. And I don’t want to stay at this place. I don’t want to get to the end of my life and feel that I’ve cheated myself and the people I’ve loved because I haven’t been able to totally let myself go, let myself love to the fullest and get the very most out of life.”

Leslie is crying. “I’m so sorry, Harvey. I’m so sorry I didn’t know.”

“I didn’t know myself, Leslie, so it’s hardly your fault.”

Tears fill my eyes, as I think of the good-fortune of my intensely loving relationship with my husband and, of course, the pain of his loss.  

I’m not sure where Harvey will go from here, but he’s clearly taken a big step towards greater love and connection.

To Tell The Truth

An acquaintance asked me the other day how I knew if patients were telling me the truth. I gave her the response I usually do: It doesn’t really matter. I can only know the world through my patient’s eyes, so whatever he or she presents is what matters. Besides, I added, none of us ever know if we’re telling “the truth,” we’re only telling our version of what we assume the truth to be.

After I left, however, I began to think more about my answer. Did I really believe it didn’t matter if a patient deliberately lied to me? Since I believe in the crucial importance of the therapist/patient interaction, certainly a patient’s deliberate lie has meaning. It’s not that the patient is “bad” for lying or that the content of the lie is important in and of itself, but rather that the patient’s need to lie says something about what is happening in the relationship.

I thought of a patient I saw many years ago who had been raped. After I returned from a vacation, she told me that she had been raped again by the same man. A look of doubt must have passed across my face, because she angrily proclaimed, “You don’t believe me!”

Oops. I remember hesitating, feeling uncomfortable. “Well,” I said, “I certainly wouldn’t say it’s not possible, but I wonder about the timing. Is it true that you were raped again, or are you saying that you’re angry with me for leaving you and that you felt much more unsafe while I was gone?”

She burst into tears, told me I was correct, and then started yelling at me for abandoning her. 

Despite our difficulties, that patient and I had a solid relationship and her lie made sense in the context of that relationship.

And that led me to think of Jessica, the adolescent I saw who just lied – all the time, for no apparent reason, regardless if her lie would be discovered. 

Her parents, who seemed concerned and caring, had no idea what to with their daughter.  My initial assumption was that Jessica lied like all adolescents lied. I’d been an adolescent. I remembered. Lies about where you were, who you were with, what time you got home. 

Jessica did tell those “normal” lies, lies about going to school, about showing up for soccer practice, about spending the night at the home of one of her girlfriends. And she was good at it. She’d look you straight in the face and you’d believe her. Except now her parents checked on her. They called the school, the coach, the friend’s mother. She was always found out. She’d shrug and move on.

She also told stories. Some of them might even have been true. “On my way to school today I saw a man on a motorcycle hit a deer. He was hurt. I ran to the house near-by and they called an ambulance.”

Realizing that questioning everything Jessica said was getting us nowhere, I tried to understand the meaning behind the story.

“How did you feel being able to help that man, Jessica?” 

“I don’t know. Good, I guess.”

“Was the man grateful to you?”

“I couldn’t wait around. I had to get to school.”   

Or, “I was home alone and some guy knocked on the door asking directions. When I opened the door he looked kind of dirty. I got scared. I started to shut the door. He tried to push it open, but I managed to close it. I called the police. They came and talked to me. I gave them a description of the guy. They said they’d look for him.”

“That must have been scary,” I say, again deciding not to question the validity of the story.

“Yeah.”

“And how do you feel being home alone, Jessica?”

“I don’t know. No problem, I guess.”

“Will this incident make you more afraid?”

“Maybe. Maybe not. I just won’t open the door.”

Trying to talk with Jessica more generally about her stories also got us nowhere.

“Jessica, do you know why you make up stories? Does it make you feel smart, creative, like you can out smart other people?”

“I don’t know. I’m not so smart.”

“Is it that you don’t feel smart? That you feel bad about not feeling smart?”

“I don’t know. I guess I’m smart enough.”

This isn’t a story that has a miraculously happy ending. Jessica and I never formed a relationship. I was never able to help her. In fact, I wasn’t even able to understand her. Sometimes I wonder what became of her. Did she become a thief? A politician? Or is she just someone who always lies? 

Forever Together

Theirs was a storybook romance. Living in separate cities, their relationship began on the telephone: long conversations about her first two disastrous marriages, uncertain that she’d ever want a new man in her life; his pain about caring for two wives and having them both die. He quoted poetry to her. She told him about her life as a psychoanalyst. A nurse and administrator by profession, he had read all of Freud. He studied philosophy and spoke German. By the time he flew down for them to meet for the first time, they were already in love. He wanted more. She was frightened. He persevered. In time she realized how supportive he was of her professional life, of her connection to her women friends. He wanted to add to her life, not take her over.

This love story is neither about me nor any of my patients. It is about my very good friend Emily and her new man, Paul. When Emily first met Paul she told me he looked like George, my deceased husband with whom I too had a storybook relationship. When I met Paul for the first time, I didn’t think he looked that much like George – except for the same strikingly blue eyes – but I thought he was a lot like George, eager to proclaim his admiration, love and devotion for Emily to anyone who would listen.

So, after much trepidation on her part, a year ago Paul moved into Emily’s house. Emily basked in Paul’s love, her radiance and happiness obvious to all. And Paul couldn’t stop talking about his good fortune. It was a joy to be with them, a joy to see them glow in each other’s presence. After more trepidation and uncertainty, Emily agreed to marry Paul. Their wedding date was set for the last Saturday in June.

In April we spent four days together at a psychoanalytic meeting in Boston with another friend and colleague, Donna, continuing to celebrate their most wonderful connection. Not too long after returning home, Paul was hospitalized. Pneumonia. Not a big deal I thought, I know lots of people who’ve been hospitalized with pneumonia, many much older than Paul. There was some concern about his arrhythmia, but nothing to be alarmed about. Time passed. Emily told me Paul had been admitted to ICU. I was shocked. What happened? His pneumonia was unstable. What did that mean? They didn’t know what was causing it. His breathing wasn’t improving despite four different intravenous antibiotics. I started to feel sick. 

More time passed. Then Emily called to tell me Paul was on a ventilator, that they’d put him in a medically induced coma and had found blood in his lungs. The cardiologist told Emily he might die. The pulmonologist said to wait and see. I called all our friends. We cried together. It was so impossible to comprehend. We mourned for Emily, for Paul.

And so began the vigil, the up and down of his condition, the roller coaster ride of being buoyed by apparently good news, only to be followed by the sickening drop of more negative information. I knew about this roller coaster ride. I’d lived it with George for sixteen months. Images flashed before me – his agonizing pain from metastatic prostate cancer, his heart attack after his first chemotherapy treatment, the cardiologist suggesting I call his children, his determination to survive, his subdural hematoma resulting from a fall, his becoming jaundiced, his final giving up – “It’s enough already.” But as awful as it had been, as awful as it still was, I had George for twenty-nine years. Emily had Paul for only two! It was incomprehensible. It couldn’t be!      

But like their storybook romance, this story has a happy ending. The bleeding in Paul’s lungs was being caused by his blood thinning medication. They took him off, but the drug remained in his body for almost a week. And so the vigil continued, but the hope increased. Finally Emily called and left a message – Paul was off the ventilator, his lungs were improving, he could speak. I burst into tears, tears of relief, of pure joy. I called. Emily put Paul on the phone. He couldn’t speak well, but he could speak! I cried again.

And so, on June 29, 2013 Emily and Paul will be married on Hollywood Beach. And we will all rejoice in their extra-special relationship and good fortune and we will all remember how fragile life is.    

Escape!

A colleague told me that a patient of his had stopped treatment the previous day without any warning and that he felt hurt and angry. I both understood and commiserated. I also began thinking about some of the patients I’ve had over the years who quit without notice and how well I remember at least some of them, even those I saw over thirty years ago. 

There was a man I saw for several years who came in one day and said he wasn’t getting anywhere and was leaving. When he left, I started crying. Was I crying because I would miss him, because I had failed him, because I was narcissistically injured by my failure? Probably all of the above.  As I look back on that treatment today I know that he was a man who was terribly afraid of his own feelings of neediness and vulnerability and that he dealt with his fear by keeping everyone at bay.  He wasn’t going to get anywhere near me; he wasn’t going to let me in. I still remember that he told me that all he dreamed about was alternating screens of black and white. As a young clinician, although I understood the barrenness of his internal landscape, I had no idea that he was terrified of getting close. 

Another patient – perhaps even earlier in my career – was a woman who so feared closeness that she had sex only three times in her twenty year marriage. She wanted children so she thought she would try three times and take whatever she got. She had two children! When she announced one day that she was leaving, I tried to persuade her to come in through the end of the month so that we could both deal with our feelings about her leaving. Although she had no idea what feelings I was talking about, she agreed. During those final sessions she felt less anxious and uptight. Even then I knew that having a clear way out, an exit strategy, made it possible for her to be more relaxed and related. I didn’t then understand why. Today I get it. People who are afraid of their own dependency can never get too close for fear that they might be too greedy and want too much.

Probably my oddest termination occurred with a patient I saw only a few times. I was a more experienced clinician by then. I knew that this woman had difficulties with closeness and intimacy, but we were early in the treatment and I wasn’t making any grand interpretations. We had our session and she left. Under the chair I noticed a letter which I assumed she’d forgotten. When I retrieved it I saw that it was addressed to me. In it was a check and a letter that said today was our last session! I was stunned. We had spent an entire session and she gave not the slightest hint, at least not to my awareness, that she didn’t plan to continue. Seasoned clinician or not, she definitely got by me. I’d like to know why she left. I’d like to know why she chose to leave a letter as opposed to talking with me about her decision. But I’ll never know. Among the many things that remain unknowable to me forever.

So what’s the lesson here? Neither love nor caring nor empathy are, in and of themselves, enough.  And the therapist, despite all her knowledge and years of experience might still not understand what is going on with a patient.

Born to Suffer

While seeing a patient today I thought, not for the first time, about my aunt. They’re both elderly, originally from New York, long widowed, and burdened by the loss of their only child. Despite being anxious, perfectionistic worriers they have, over the course of their long lives, shown great strength and a capacity to endure. 

Unfortunately, however, each sees herself as a person who has suffered greater hardship than any other human being; each sees herself as continually singled out by the powers that be to endure unimaginable pain.  Although both have suffered great pains and losses, their view of themselves as the one who suffers the most, makes it impossible for them to enjoy their day-to-day lives, makes it impossible for them to take joy from life’s simple pleasures.

In today’s session, for example, my patient Rose and I had the following interaction.

“They changed the place of my card game tonight. I don’t know why they had to do that. They’re always doing things that make my life more difficult,” she says anxiously. “We’ve always played at Barbara’s house. Now we’re playing at this new girl’s house. They said it’s easy to get to, but it’s dark and I’m afraid I won’t find it. I drove by to see where it was, but that’s in the daylight. What if I can’t find it at night?”

With my patient, I am understanding and empathetic.  She is, after all, not a young woman. She feels alone, vulnerable, unsure of herself.

“I understand that it’s scary to drive someplace new at night. Perhaps you could go with someone,” I add trying to be helpful.

“Phyllis did offer to drive. But she sometimes drinks too much. I wouldn’t want to be in a car with her if she was drinking. We could get in an accident.”

Fighting a bit of exasperation, I point out to Rose how she is spoiling her own pleasure. “You look forward to this game all week. You say what good players they are and how you always end up having a good conversation. I wonder if by worrying so much about finding the place or if Phyllis might get in an accident, you’re spoiling the whole evening for yourself.”

“I’m not spoiling it. They spoiled it by changing the place we’re playing. And now I have to suffer for it.”  

It is at this point I think about my aunt. At 93 my aunt who has emphysema and heart disease underwent abdominal surgery, choosing surgery over hospice when given only those two options, displaying the grit and determination she is so often capable of. She came through it beautifully. After a few days some fluid settled in her lungs making it more difficult for her to breathe. The problem was resolved relatively quickly. 

While she had the breathing problems, however, every time I saw her or spoke with her she bemoaned her fate. “Why does everything always happen to me?” Or, “Somebody up there doesn’t like me.” Or, “What did I do to deserve all this trouble?”

I finally lost all patience. “You’re 93! You just survived abdominal surgery! You should be celebrating, shouting for joy! This is just a blip along the road. You’ll be fine.”  

So the question is, why am I so much more accepting of my patient’s complaints and worries than my aunt’s? Yes, I can become a bit exasperated by my patient, but in general I am far more tolerant and understanding. I could say the answer is simple: when I’m wearing my therapist hat I’m expected to be more tolerant so I am. And there is probably some truth in that. But I think the answer is more complex.

This aunt is my father’s sister, the father I always hoped to change and make different. He had the same doomsday approach to life, the same conviction that he was marked to suffer, that life was all about suffering. So probably, although I don’t consciously think of my father when I’m with my aunt, his ghost stays with me as I continue trying to fix that which has always been and always will be unfixable.