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.”

Lost and Perhaps Found

I’ve been working with Marvin, a 72 year old depressed widower for nine months. His sessions – like his life - are boring and repetitive. He refuses to discuss the past – says he’s too old for that – and complains bitterly about the emptiness in his life. “Nothing’s better,” he says today. “I still sit alone in my apartment staring at the beautiful weather and wondering why I can’t get myself out there, even to take a walk. There’s no place to go. I’m just lost. When Esther was around, even if we did fight all the time, at least there was someone there. Now there’s nothing.”

I ask myself, not for the first time, why I don’t feel more empathy for this man. After all, I too am a widow. I know the pain of loss, the feeling of aloneness. It’s his passivity that I find difficult. I want to shake him, tell him to find some hobby, some activity, a friend, a girl-friend. But I do none of that, knowing full well that he would find reason to rebuff any suggestion I might make. Today, I take a different track.

“How do you feel about coming here?” I ask.

“I come,” he says, averting his eyes.

Although his answer is the typical passive, uninvolved response, I sense a certain discomfort and wonder if more is going on than he’s saying.

“But how do you feel about coming?” I ask again, more persistently.

“What do you mean?” he says, even more flustered.

“How does it feel for you to come here?” I repeat. “To see me?”

“I…I don’t know,” he says, squirming in the chair.

I remain silent.

“Maybe I shouldn’t come. Is that what you’re telling me?” he says petulantly.

“I didn’t hear myself say that.” 

He sighs. “Everyone gets tired of me. Even my children tell me if I don’t stop complaining they won’t call any more. Not that they call that much.” He pauses. “You think I complain too much, don’t you?” 

“Well,” I say, trying to be diplomatic, “I understand you’re feeling miserable and unhappy and wanting to talk about your feelings. But you don’t really talk about your feelings. Instead you present as a forlorn, helpless person stuck in your misery. Yes, Esther died and you’re alone and you can’t bring her back. But you can try, ever so slowly to make a life for yourself.”

“I love you,” he blurts out.

I’m stunned. And speechless. I flash on the story a well-known psychoanalyst, Dr. Glen Gabbard, told about himself when he was first starting out in the field. When a female patient told him she loved him, he responded first by saying, “No you don’t” and then by trying to convince her that what she felt was not “real” love, but transference from earlier loved figures in her life. I knew what not to do. What to do was more difficult.

“I’m flattered…” I say.

He interrupts, more animated than I’ve ever seen him. “You mean you love me too?” he asks hopefully.

Oh dear, I think. “I’m flattered that you think that much of me,” I continue. “And I’m really glad you’re able to feel so alive.”

“You don’t love me,” he says, immediately deflated.

“I care about you, but I don’t love you as you want and need to be loved.”

“Nobody ever loved me,” he says. “What a fool to think someone like you could love me.”

“I don’t think you’re a fool at all. I’m glad you’re able to engage in life sufficiently to feel love for me. Now we have to help you find someone who can love you back.”

He shakes his head. “That’s impossible. No one ever loved me, no one ever will.”

“I would really like to understand why you feel so unlovable.”

“Why don’t you love me?” he asks challengingly. 

“I’m impressed,” I say truthfully. “You can be assertive when you want to be. But by looking to me for love, which I suspect you know wouldn’t be appropriate, I’d guess that you tend to look for love from people who can’t love you back, probably like the people who couldn’t love you in the past.”

Marvin slumps further down in the chair.

“You know,” I say, “now that I know you can have that spark, I’m going to be more insistent that you engage with me in therapy. We need to talk about the past. We need to talk about how you feel right this minute. We need to reintroduce you to life or perhaps introduce you to life for the first time.”

“You think that’s possible?” he asks.

“I detected a bit a hope in that question. I say we go with that hope.”