Taking a Break

“I know we only have a few minutes left in our session,” Martha says interrupting her complaints about her work and her marriage, “But I wanted to tell you I’m planning on taking a break from therapy.”

Feeling immediately angry at this sudden pronouncement with almost no time to discuss it, I ask, “What led you to that decision?”

“I’ve been thinking about it for a while. We just don’t seem to be getting anywhere. I come in every week and complain about either Mitchell or my boss, my boss or Mitchell. It doesn’t change anything.”

I happen to concur with Martha’s assessment, but my sense is that my attempts to engage Martha in greater self-reflection, as opposed to her litany of complaints, has been mostly unsuccessful. 

“Martha, could you at least come for one more session to talk about what you think hasn’t worked and why, as well as giving us a chance to say good-bye should you decide to end.”

“I’m not ending. Just taking a break. Besides, I’m on vacation the next two weeks.”

Another surprise. Martha obviously had planned her leave-taking for a while, even neglecting to mention her upcoming vacation.

Aware we have no time left this hour I say, “Well, what if you come in three weeks from today so that we have a chance to talk and in the meantime maybe we can both think about why you chose to tell me about your break at the very end of a session right before you were going on vacation?”

Martha sighs. “I guess. This seemed like a natural break point, but if you want me to come in once more I guess I can do that.”
“Thank you. I’ll see you in three weeks and have a good vacation.”

I am definitely annoyed, feeling dismissed and discarded. I have no idea whether Martha will show for her session in three weeks and whether or not she’ll continue. I feel obliged to keep Martha’s time available even though she’s made no commitment to the continuation of our relationship. 

Martha does show in three weeks. She is, however, uncharacteristically late, leaving me again off-balance and unsure of her intentions.

“Well, I’m here,” she says. “What do you want to talk about?”

“Maybe we should start by talking about your anger at me,” I suggest.

“I’m not angry at you. I just don’t think we’re getting anywhere.”

“You tell me the last few minutes of an hour that you’re leaving, you’re late to this session and you seem annoyed about being here.”

She shrugs.

Here I am again, angry. My anger. Her anger. My anger. Her anger. Maybe that’s what’s going on.

“You know, Martha, I think what you’ve been trying to do – unconsciously of course – is help me to feel your level of anger, dissatisfaction, and powerlessness, whether those feelings are directed towards me, your husband, or your boss. Things aren’t going the way you want them to in any aspect of your life and you feel powerless to change them.”

“That’s exactly right!” Martha says brightening.

“But I wonder if you’re really as powerless as you feel,” I continue. “Or if you don’t know how to ask for what you want or don’t know how to make it happen. For example, I want you to stay in treatment. I do understand that simply complaining about what’s not working in your life isn’t helpful; that we have to figure out ways in which you can get what you need here as well as in other parts of your life.”

“But how am I supposed to know what I need? You’re the doctor, you’re supposed to know.”

“There’s an awful lot in what you just said, Martha. First, there’s a request to be taken care of and anger at not being taken care of. But there’s also a lot of passivity in your statement which only increases your feelings of powerlessness and makes you less likely to get what you want.”

“But I don’t know what I want! I just know I’m not getting it.”

“That’s a great insight, Martha. And it makes a lot of sense. When you were a kid, no one cared what you wanted. They were too busy with what they wanted. You don’t know what you want. But you do know you feel dissatisfied. And when you’re dissatisfied you complain or leave. I’d say we know what we need to work on, assuming you’re willing to stay and work on it.”

“I was sure I was going to take a break. But, yeah, I’m willing to give it another try.”

“Good,” I say smiling. 

The Mask

Elaine, burying her head in her hands, begins sobbing as soon as she sits down. Struggling to speak she says, “Baxter has cancer. That’s why he hasn’t been eating. I may have to put him down. I can’t believe I’m carrying on like this! I didn’t even shed a tear when my grandparents died.”

Sadness floods me as I feel for both Elaine and myself, thinking immediately of Pippin, the regal black and white cat my late husband and I adopted shortly after we moved to Florida. Putting her down two years after my husband’s death was beyond painful.  “I’m so sorry, Elaine, I know how attached you are to Baxter, how much he’s meant to you.” 

“And this is supposed to be good? Feeling like a wreck, feeling like my heart will break?” she says sarcastically.

I know what Elaine is referring to. I remember when she first walked into my office four years ago. Although attractive with tasteful make-up, Elaine looked like a doll, her face mask-like. Her mother died when she was three, her father when she was seven. She lived with her step-mother until their conflicts became unbearable, then moved to her paternal grandparents, who saw her as an unavoidable inconvenience. Listening to Elaine’s story I felt overwhelmed by sadness, while Elaine seemed devoid of feeling. 

Elaine came into therapy because she couldn’t maintain a relationship. She had no difficulty finding men but the relationships never lasted. The men said she was unconnected, unavailable, that there was no passion. Sex wasn’t the problem, it was something else, but she didn’t know what. I suspected I knew. It’s impossible to connect to a doll. Our job would be getting behind the mask. It wouldn’t be easy. She had spent years fending off the pain of all her losses. The mask would have to be peeled off slowly.

“I have no memory of my mother or my father,” she told me. “Just pictures I’ve seen and what my step-mother was willing to tell me, which wasn’t much since she preferred not to talk to me. Of course my grandparents didn’t like to talk to me much either. Besides, they were old, they didn’t want to be reminded of their son’s death. I can imagine that would be painful for them.”

“And you don’t think it would be painful for a three year old, for a six year old?”

“I can’t feel what I can’t remember.”

Finding Elaine’s memories would be crucial to her growth. 

While we focused mostly on Elaine’s difficulties with relationships in both her personal and professional life, over the years I asked questions about the past: “Do you remember your first day of school? Who took you? Do you have an image of the house you lived in with your father? Do you remember moving from your step-mother’s to your grandparent’s? Did you have to change schools? Leave friends?”

One session when Elaine came in she looked different. There was a crack in the mask. “I had a dream,” she began. “There was a child standing in an empty field. She was holding someone’s hand, a man’s. They were looking down. When I woke up I felt incredibly sad. I didn’t think the child was me. But then I wondered if it was me with my father standing at my mother’s grave. Could I possibly remember that? I was only three.”  

“Let’s stay with your feeling, Elaine,” I say softly. “What is it like to feel that sadness? What does it bring up for you?” 

“I don’t know,” she says starting to cry. “I guess I’m sad for that little girl. Standing by her mother’s grave, not knowing that in three more years her father will be dead too. It’s really awful. I guess I never thought of it like that. I guess I never thought about it at all.”

“You didn’t want to think of it, Elaine. You didn’t want to deal with your pent up sadness. But today you’ve taken a big step forward.”

Two years separates the session of Elaine’s dream and her telling me she might need to put down Baxter.   

Returning to the present session I say, “I know you’re feeling tremendous pain, Elaine, not only for your beloved Baxter, but for all the losses you’ve endured in your life.”

She sobs. “Please tell me this pain is worth it.”

“It’s worth it, Elaine. If you can’t allow yourself to feel your sadness, you can’t feel joy either and, most importantly, you can’t be truly alive.”