The March

“I finally went to dinner at my parent’s,” 19 year old Bethany says dejectedly. “It was pretty bad. They just won’t let up. ‘I can’t believe you lied to us, going to the Women’s March on Washington without even telling us. If we hadn’t called and talked to your roommate we would never have known. What if something had happened to you? We didn’t even know you were gone.’ Blah, blah, blah. As if that was the issue. I bet if I went to the Trump Inaugural they would have been thrilled – even if I hadn’t told them. It’s such bullshit. They did do a bit of, ‘How could you be our child and believe those people have a right to marry.’ Or, ‘Didn’t we teach you that every life is sacred, especially the unborn, those most vulnerable?’ I thought I’d puke. I couldn’t wait to get out of there.” Pause. “I suppose you’re thinking, ‘I told you you should have told them.’”

“I don’t remember telling you you should have told them,” I say, surprised.

“You asked me why I didn’t tell them, didn’t you?”

“Yes, but that was a question meant to help you look at why you do or don’t do whatever.”

“Well, the answer’s pretty obvious. If I tell them I get all this shit. Just like I did.”

“And what did you say when you got all this shit?”

“Nothing.”

“Nothing?”

“Yeah. What am I going to say? You can’t argue with them. I just sit there, trying to tune them out, hoping they’ll stop sooner than later.”

“And why do you feel you can’t argue with them?”

She raises her eyebrows and snorts. “I don’t mean to be nasty, but how long has it been since you were 19?”

I smile inwardly. Although it’s been quite a while since I was 19, I do clearly remember the arguments I had with my parents, most especially my father. Not about politics. There are values were pretty similar, but often about psychology and science. My father was angry, dogmatic and unrelenting. For years, I argued and argued with him about dreams, about the cause of mental illness, about the unconscious, until I finally gave up. Then I was like Bethany, sitting at the table saying nothing, hoping he’d stop sooner than later. On the other hand, I never, ever stopped battling my father’s vicious temper, trying to put a clear limit how he could treat me. I bring myself back to my patient. “I get that it can be difficult to argue with your parents when you’re 19, but I’d like to understand specifically why YOU can’t argue with your parents, even at 19.”

She sighs. “First, they have the money. If they get mad enough, there goes college, plus whatever else.”

“Would they do that? They sound pretty determined for you to get an education, pretty invested in it.”

“They are.” Pause. “Especially my Dad. But sometimes I think my Mom believes I’m being corrupted by college, too liberal you know. And, I don’t know. This may sound weird, but I’m not sure that my Mom really wants me to succeed, like maybe she’s jealous or something. Like she never went to college, so why should I.”

“So are you saying you’re afraid your mother might undermine you?”

“I never thought of it that way, but I guess so. If I gave her any ammunition. Like the Women’s March.”

She pauses.

“I need to ask you something. What did you think about the Women’s March?”

“I’ll answer that in a minute, Bethany, but first I want to ask you something. Why did you ask that question right at this moment?”

She shrugs. “I don’t know. I’ve been thinking about it and just felt I had to ask.”

“Well, I have a thought as to why you had to ask right then. You were talking about your mother feeling threatening, dangerous and I wonder if you suddenly felt I might be dangerous too and had to check that out.”

“Are you?” she says quietly.

“No, Bethany, I’m not dangerous.” I could tell Bethany I was at the Women’s March too, but decide that might too greatly diminish the tension around the issue of whether difference between two people, perhaps especially two women, is inherently dangerous. “I suspect that our politics might be pretty similar, but even if it wasn’t, I’d still be on your side, still wanting you to have your own voice and make your own way in the world.”

Near Death

I open the door to my waiting room and see Ben sitting there, perhaps a little thinner, perhaps a bit more gaunt, but basically looking like his old self. I blink back tears. He’s alive. He looks up and smiles at me. “I made it,” he says, echoing my own thoughts.

“I want to start by saying how much it meant to me that you came to see me at the hospital.”

A near fatal heart attack. Quadruple by-pass. Multiple infections and his first words are about my visiting him at the hospital. “Of course I’d come to see you.”

“It didn’t feel like an ‘of course’ to me. It felt like you cared about me. That I wasn’t just a patient.”

I think about Ben’s angry, rejecting mother and reflect on how difficult it is for people who weren’t cherished by a parent to take in that they’re cared about. “Ben, we’ve known each other for a long time. I’ve watched you become so much more of a feeling, related person, but it’s still hard for you to believe that I – or others - care about you.”

“This experience did show me how many people care about me. And my wife, she was amazing. I know it’s impossible, but it felt like she never left my side, that every time I opened my eyes she was there looking at me, squeezing my hand, smiling at me.”

Suddenly I’m besieged by images of my late husband lying in a hospital room with me sitting beside him. Many years, many images. Waiting for the results of his angiogram; the terror of his first angioplasties; the pain of a double knee replacement; the horror of discovering he had undiagnosed heart damage perhaps fatally complicating a minor heart attack after his first chemotherapy; his miraculous survival; his deterioration …  

My patient interrupts my reverie. “You look sad. I’m sorry. You must be thinking about your husband. “

Ben began working with me about a year before my husband’s death, now over seven years ago. It was an agonizing and vulnerable time for me, a time I revealed more about myself than was typical of me.

I say, “You’ve just demonstrated to yourself how much our patient-therapist relationship is a human relationship, how two people who have known year other for years, come to understand and care about each other. And you’re right, I was thinking about my husband, but I apologize for distracting you from your appreciation of your relationship with your wife.”

“Do you think being near death brings people closer?”

“What do you think?”

“I think it does. It makes you appreciate what you have when you see how it can all be gone in a second.  I actually thought about you when I saw how attentive and scared my wife was. I knew you would have been like that.”

“Ben, when you comment on your wife’s love and caring, when you reflect on your sense of me, I hope you can see how much you’ve changed, how much easier it is for you to genuinely connect to your wife, to me, and I’m sure to others as well.”

Ben nods his head, “Definitely. I feel like I’m a different person than the one who first came here.”

“And yet you’re still surprised by my coming to visit you in the hospital.”

“Yes. I don’t know. Is it because I feel I don’t deserve it?”

“Well, why wouldn’t you deserve it?”

“Because …,” he shakes his head. “I don’t know. I’m a pretty good person. And I do know …” Ben hesitates. “I do know you care about me.”

“Sounds like that was hard to say.”

“It was.”

Silence.

“I suddenly feel sad. You’d think it would make me happy to feel you cared about me.”

I remain silent, giving him a chance to reflect.

He continues. “I just got this picture we’ve talked about many times, when my mother beat me in front of my friends because I didn’t take the garbage out the minute she asked. It’s like I don’t know how to reconcile the two. How could she treat me like that if you and my wife care about me?”

“I think what you’re saying, Ben, is that if you’re deserving of love and caring today, you were deserving of it then, but your mother couldn’t give it to you. And if you realize that was her shortcoming, not yours, you have to give up hope that you could ever have gotten her love, regardless of what you did.”

Ben rubs tears from his eyes. “I think that’s right. But I am grateful for the love I have today.”

“I’m really glad to hear that,” I say as the hour ends.

      

My Blog

Many of my friends, colleagues and readers have expressed an interest in my blogs: how and why I write them, where I get my ideas, how I maintain confidentiality, how I feel about having to turn out weekly material, and so on. So I decided that I would write a blog about my blogs and, hopefully, many of these questions will be answered. 

When I first started blogging I was tremendously intimidated, not by the writing itself, but by the idea of tackling social media. To say the least, this was not my area of expertise. My foray into this arena was due to the prodding of Alia, the public relations person I hired after the publication of my book, Love and Loss in Life and in Treatment. She thought it would get my name “out there” and, hopefully, help promote my book. Has it? I have no idea. My guess is, not much. But I’m still blogging. And I still hear Alia’s admonition to write shorter, clearer, simpler, in a way that will engage readers.  

I get mostly positive feedback on my blogs and, of course, that in itself is gratifying. But I suspect there’s another reason I keep blogging, a reason related to my need for someone to hear me, to listen to me now that my husband is no longer present in that role. He’s been deceased for over six years now. My ever constant supportive and appreciative audience is no more. So I blog instead, to a more anonymous audience who can’t of course replace all his love and warmth. Still, I’m drawn to my computer every Friday. 

Yes, I write on Fridays, every Friday. That’s when I wrote my book; that’s when I write my blogs. Friends know not to call me on Fridays. I don’t answer the phone. I don’t find that discipline difficult. I love to write and even if I’m having a not-so-productive day, I stay at my computer. Sometimes having to produce weekly blogs can feel burdensome and I do occasionally give myself a vacation break. Basically, however, as I said, I appreciate having an audience.

Sometimes I’m asked how I can reveal so much about my patients in such an open a forum. I want to again offer the reassurance that I never violate my patients’ confidentiality. Most of the patients presented in my blogs are composites of various patients I have seen over the years; sometimes they are entirely fictionalized, springing seemingly unbidden from somewhere in my unconscious; very occasionally they are patients - still disguised - who have given me permission to write about them. 

Some readers will then question how my blogs can have any clinical relevance if the patients presented are composites or fictional. My answer is that I always try to remain true to the patient or concept that I am attempting to portray. I also hope that my 40 plus years of clinical experience adds weight to my ability to paint an authentic clinical picture.

Others ask how I can be so self-revealing in my blogs, since present, past or future patients can potentially learn so much about me. I struggled with this question when I wrote Love and Loss which intertwines memoir with clinical material. I couldn’t write that book, the book that memorializes my husband and our relationship, without providing autobiographical material. It was a risk I chose to take and, as far as I can tell, it has had minimal consequences. Most patients seem not to know about my book – or my blog. Of those who do, some have chosen to read it, others have not. Those who read it have told me either that they felt enriched by getting to know me on another level or have seemed relatively unaffected by the content.

I have read and written about self-disclosure a good deal during the course of my career and have come to the conclusion that patients can fantasize as much about what they know about their therapist, as what they don’t know. For example, patients who know that I’m a widow have as much of a subjective spin on that fact, as those who don’t know. They can create whatever transference scenario that fits their own internal dynamics. I know I have colleagues who will disagree and say that I’m rationalizing my self-disclosure. Perhaps they are correct. I can only say that my experience has been that my self-disclosure has often deepened the treatment, as opposed to derailing it.

Please ask whatever further questions you might have about my blogs and I will attempt to answer them. Perhaps in another blog. 

George

Today is my late husband’s birthday. In honor of that day I have decided to relate my experience of presenting my book, Love and Loss, to my professional organization a few weeks ago. Many in the audience were friends and colleagues. Many had known George.

In my presentation I discussed my motivation for writing the book – to memorialize George and our relationship - as well as to illustrate my now staunch belief that a therapist’s present life circumstance greatly affects her work and her patients. I discussed issues of confidentiality and, at length, the question of self-disclosure. I am far more revealing in my book – and in my blogs – than is usual for a therapist, and an audience of professionals would understandably be interested in this question.

During the break, several people – mostly friends who knew George well – came up to me and related how present I had made George feel, how much his aura permeated the room. One related his experience of their first meeting, his wit and sardonic humor; another spoke of his kindness and humanity; and still another about his satisfaction with his life and his inability to feel envy. I felt warmed. I had accomplished my goal. I carried George with me and was able to bring him to life for others.

I resumed my presentation. At the end, in the course of the discussion, I mentioned an experience I had with a young woman patient about three years after George’s death. She asked me three questions: Where was I from? Was I married? Did I have children? As she and I talked about why she was asking these specific questions, at this specific time, my own mind remained fixated on the question, Am I married? Assuming I answered her questions - and I have become more comfortable with answering patients’ questions as opposed to deflecting them – I realized there was no way I could answer that question in the negative. To say that I was not married felt to me like a denial of George and my relationship, a relationship that still very much existed for me. So, when I answered the question I said my truth, “I’m a widow.” The patient burst into tears, opening up a new avenue of exploration.

All this I told to my audience. A lively discussion ensued. One friend and colleague asked if rather than lying to my patient, I could have said that her questions were certainly legitimate and important, but rather than answering them, I would like to understand what they meant for her. I hastened to explain that I would never lie to a patient, that the issue for me was that to say I wasn’t married felt like a disavowal of George and our relationship and that I couldn’t possibly get the word “no” out of my mouth. Another colleague said that regardless of what we tell our patients, they will see us how they need to see us.

Then the man who had brought up my lying to my patient, raised his hand again. He said that he realized that he himself had just fallen victim to such a distortion: He saw me as married. I was married to George. And since I was married to George I honestly could not tell my patient I wasn’t married. I smiled. I loved it! My connection to George was so strong, I had succeeded so well in taking him with me in my mind, that others still experienced me as married as well.

And this man wasn’t the only one. Another friend assumed that when I brought up that experience with my patient, I was talking about a time before I had ever known George, before I was indeed married. And when I related the entire experience to yet another friend, he too was surprised, saying of course I was married, I was married to George.

And so my beloved husband lives on within me and within those who knew and loved him. I am extremely fortunate to have had this very special man in my life. And on this day, his birthday, I express my deep love and devotion.