Failure to Thrive

“I’ve decided to write a book,” Karen announces at the beginning of her of session. Dressed in casual jeans, no make-up with her hair pulled back in a ponytail, Karen looks younger than her 48 years.

Although her declaration leads me to think, ‘Oh no, not another idea that goes nowhere,’ I take a more supportive approach. “In art history?” I ask, Karen’s area of specialty.

“I don’t know. I haven’t decided yet. I have to do something. I can’t go on just being Dr. Thomas Hartfield’s wife. It’s too boring. I don’t want to have to get all dressed up and hang out at the club playing bridge, gossiping with the women.”

“Weren’t you recently talking about wanting to open an art gallery?”

“Yes. I still think that’s a good idea, but I don’t know, there’d have to be so many people involved, people I’d have to manage. It seems overwhelming. Writing is something I can do on my own, at my own time, in my own space.

“Of course, I haven’t written anything since I was in college. I was pretty good back then. I think I considered majoring in English. But then again I thought about majoring in lots of things. I’m not even sure how I ended up with a major in art history. I guess because I hung around college for so long and had so many credits, they told me it was time for me to graduate and art history was it.”

“So it seems, Karen, we’re back to talking about how difficult it is for you to make a decision and to carry a plan through to fruition.”

She sighs. “You don’t think I’d write that book do you?”

“Well, I don’t have a crystal ball, but when you say that you don’t  know what you want to write about, it seems you could get stuck right there. I’d be concerned you could think endlessly about what you did or didn’t want to write and never be able to move beyond that point.”

“How did you know what you wanted to write?” Karen asks me.

I don’t introduce my book into my therapy sessions, but many patients Google me and find it online. Now I wonder if there’s some relationship between my book and Karen’s sudden interest in writing. “Before I answer that question, Karen, can I ask you how you feel about my having written a book?”

“Envious. You were able to follow through and do it. But maybe also inspired, like if you can write a book maybe I can too.” She hesitates.

“What just happened there?”

“Nothing. I guess I got anxious. There are so many choices. I don’t know how anyone ever decides on one path over another. I don’t know how you pick. I don’t know how you pick one and give up the others. So how did you decide what to write about?”

I wonder about Karen’s anxiety. Does she worry I’d feel angry or vindictive if she wrote a book? Does making one choice over others bring up fear of loss? Keeping these questions in mind, I answer Karen. “I felt compelled to write about my relationship with my late husband. I think there’s often an emotional press in writing; you have something you have to say. It’s like being in therapy. It’s sharing a vital part of yourself that you want to be known.”    

“Do you think I don’t want to be known?”

“That’s a very interesting question. What do you think?”

“Well declaring myself, taking path A rather than path B would be a way of being more known.”

I’m silent, intrigued by Karen’s train of thought.

“But why wouldn’t I want to be known?”

“I was just asking myself the same thing.”

Silence.

“Weird. The words, ‘You’re a moving target’ just went through my head.” Pause. “Who did I think would shoot me?”

I wonder if it’s me, but I remain silent.

“My oldest sister for sure. She was horribly jealous of me. I was the pretty one, although I made myself as unattractive as possible until she left for college. She’d cut up my clothes, steal all my panties. One time she even cut off part of my hair in the middle of the night.”

“That’s called abuse, Karen,” I say, surprised by this revelation I had not previously heard.

“You think?”

“Definitely. What did your parents do?”

“I don’t know. I don’t remember telling them. Maybe I did. Maybe they said we had to work it out. That part of my childhood is a bit fuzzy.” Pause. “Do you think this is relevant?”

“I definitely think this is relevant, Karen. We have to stop now, but we definitely need to spend more time understanding how your sister affected your life.”

Defeated

“What brings you here?” I ask Peter, a handsome young man I am seeing for the first time.

“My father.”

I wait for further elaboration. He offers none.

“Can you say more?” I ask.

“Nothing more to say. I’m here because of my father.” 

“So I gather you don’t want to be here.”

“You got that right.”

“And you don’t feel you need to be in therapy.”

“Right again.”

“And you’re angry that your father insisted you come.”

“You’re batting a thousand.”

Ignoring his sarcasm, I ask, “So why did you feel you had to do what your father wanted?”

He snickers. “You don’t know my father.”

“That’s true. Why don’t you tell me about him?”

He snickers again. “Sneaky. You’re going to get me to talk. Okay, might as well. My father’s paying for it. My father pays for everything. He’s rich. Developed his own company. Made a fortune. And never lets anyone forget it. He’s smart, a good businessman. My brother works with him. Me, I can’t imagine sitting in an office all day. Just like I can’t sit in class all day. I’m 24 and still bouncing from one college to another. I guess that’s why my father wants me in therapy. He wants you to motivate me.”

“Are you angry with your father?”

“Yeah, I guess you could say that. He’s always on my case. Always wants something more from me. Always bugging me to make something of my life.”

“And what do you want for your life, Peter?”

He shrugs.   “Don’t know. Don’t know why I have to want anything. I like hanging out with my friends, surfing, hand gliding, sitting around getting high. Why should I have to work? Daddy will leave me more than enough money.”

I find myself empathizing more with my patient’s father than with Peter himself, making me uncertain how to respond, concerned that I will sound critical, like his father. I decide further exploration is preferable to any comment about the patient’s current life. “Did you always feel this way, Peter? What about in grade school or even before?”

Peter sits silently, but exudes less defiance. “My Dad was my hero,” he finally says. “He played baseball with us, took us to games. And even when he stared making money, and wasn’t around as much, I knew that he was doing it for us. And then he started making more money. And there were stories about him, interviews with him, he was making a big name for himself. And there was me. My brother was a straight A student. I couldn’t measure up. I never liked to read. I was lousy in math. There was nothing I was good at. Except baseball. And I wasn’t good enough at that. My father climbed up and up and I went nowhere but down. So I gave up. Why bother.”

“Sounds pretty sad.”

“I guess,” he says, shrugging, his defensive tone returned.

“Where was your mother in all this?”

“That’s another story. Nothing was ever enough for my mother. She criticized all of us – especially my father. I never understood why he took it, why he didn’t get out. I thought he probably had women on the side – who could blame him – but I don’t know that for sure. I once asked him. He slapped me across the face.”

“Was that typical of him? To hit you?”

“I wouldn’t say that. He hit me a few times. But that time was a surprise. I didn’t get why my question made him so angry. But I never asked again. And I guess I stopped caring.”

“So when you feel angry, you turn yourself off, you ‘stop caring.’”

“I guess.”

“I wonder if the problem with that Peter is that without being able to tap into your anger, your aggression, it’s very hard to find your competitive spirit, your desire to win, perhaps even your desire to beat your father.” 

 “I could never beat my father. I could never even come close.”

“The problem, Peter, is that you gave up trying. You were so sure you’d lose, that you’d never come close, that you were defeated before you began.” 

“But I couldn’t come close.”

“Maybe. Maybe not. I wonder what you might be able to accomplish if you didn’t feel so defeated, so shut down. I hope you’ll give yourself and us the chance to find out.”

Welcome Home

Thea, a woman in her mid-thirties, with porcelain skin, curly red hair and deep blue eyes, glares at me from across the room, her brows knitted, her arms folded tightly across her chest. We have been sitting in silence since she entered my office and threw herself into the chair. Only a few minutes have elapsed, but the time hangs heavily in the room. 

Concerned that we fall into a power struggle of who speaks first, I decide to break the silence. “You’re obviously having lots of feelings, Thea. Can you talk about what’s going on for you?”

“Why should I?” she retorts.

“Well, that is usually what we do here. You tell me what you’re thinking and feeling and we try to better understand you.”

“Don’t be a smart ass! You know goddamn well what I mean.”

Thea is correct. I do know what she means. She is a therapist herself and someone I have seen in treatment for several years. “OK,” I say. “So this is our first session back since I returned from vacation and you’re clearly angry with me. But that doesn’t help me understand if this break in our schedule was particularly difficult for you and if so, why.”    

“I ran into Cathy in the grocery store. She knows that I see you – and obviously knew you were away - but why she found it necessary to tell me that you were presenting a paper I have no idea.”

Cathy is a colleague who did in fact know that I presented a paper during part of my time away, although I too have no idea why she needed to give Thea that information. However, she did, and it is now our job to understand the feelings churning inside Thea. Although I’m always eager to treat other therapists, they do present their own unique set of difficulties, particularly in a small therapeutic community where you don’t always know who knows whom. 

“So what did it mean to you that I presented a paper?” I ask.

“You could have told me!” Thea replies, her voice still sharp and raised. “It was embarrassing that Cathy knew more about you than I did.”

I keep my face impassive, although I’m immediately puzzled. Certainly Thea knows that Cathy would know more about me than Thea herself. I say nothing, hoping that Thea will continue her self-exploration.

“What?” she says. “You’re not going to say anything?”

This whole session feels like a land mine. If I stay silent, Thea might well experience me as withholding and provocative, much as I am experiencing her. If I confront her on what seems an extremely unlikely reason for her anger, she could experience me as both challenging and negating. If I guess at what I think might be going on here, I am doing her work for her.

Perhaps the most productive course is to follow Thea’s direction. “I thought you might say more about what was embarrassing about Cathy knowing I was giving a paper while you didn’t.”

“Isn’t it obvious?”

“Thea, I know that you’re angry with me and I’m not trying to be dense here, but you’ll need to say more before I can understand what it meant for you not to know I was presenting a paper. You also didn’t know where I was going in my absence, if Cathy told you that would you have been equally angry?”   

“She did tell me. And, no, I didn’t care about that. Oh!” Thea’s pale skin turns scarlet.

I think of how difficult Thea has made this session. I think about her being many years my junior in terms of professional experience. I think about her highly successful older sister, Emily. I have a sense of what’s going on here, but realize how important it is for me not to be the wise, all-knowing therapist.

“Now I really am embarrassed,” Thea says, dropping her eyes, her anger fading. “I’m mad that you got to give a paper and I didn’t, just like with Emily, who got to read her reports in school and get into the best universities and snare the best academic job in the country. I’m sorry. I was behaving like a brat.”

“You have nothing to apologize for. You had feelings. You brought them here and you figured them out. I’d say you did just what you needed to do.”

“But it’s not right if I put my feelings about Emily onto you. And I’m sure I put them on other people too.”

“Perhaps what you’re saying is that we still need to work on your feelings about Emily, as well as feeling competent and capable and good about yourself.”

The Push for Success

I’ve only seen Sergio for a few sessions. Originally from Columbia, he and his wife risked all they had to come to the United States, seeking a better life for themselves and especially for their unborn children. They have four children now and it’s because of them he came to see me. 

“My wife says I push them too much. And that it got worse after Mother’s Day. You know, school’s about to get out. I tell them, I don’t want any presents, save your money. What I want is all As on your report cards. I work hard. I carry bedpans, wash people’s butts, put up with not nice people. I smile. I don’t complain. It’s a steady job. I’m lucky to have it. I’ve taken my kids to that nursing home. I show them what their father does all day. Is this what you want, I ask them? And my wife, she’s cleaning people’s houses. All we do is work.”   

“Do you think you might be pressuring them a bit too much?” I ask gingerly.

“No!” he replies emphatically, “My wife and I struggle every day. Every day we work to give them a better life. So why shouldn’t they get all As? That’s their work.” 

I like Sergio. I admire his grit, his determination. Yet conflicting and complex emotions course through me. The immigrant experience, I think warmly to myself, flashing on my beloved grandparents who only wanted “better” for their children and for me. I think of being five and sitting at their kitchen table and my grandmother telling me I was going to be the next Madame Curie. That’s the warm side, the good feelings. But then there was my father. He was contemptuous of his immigrant parents, wanting only to distance himself from them, avidly pushing education and success for both himself and me, his only child. The pressure often felt unbearable. 

“And did all you children bring you straight As?” I ask.

“No!” he says angrily.

“And you were obviously angry. How did you show your anger?”

“I wouldn’t talk with them all Father’s Day.”

Ouch! I think to myself, feeling the press to protect his children, as I wish I too had been protected.

“Sergio, is it possible that not all of your children are capable of getting straight As in every class, every time?”

“Why shouldn’t they be?”

“Well, different children have different strengths. Some are good in math and not good in English or the other way around. And sometimes if you’re too strict with children, they rebel, they try to get back at you by not doing well, even if they’re not aware of it.”

“No!” he exclaims, shaking his head from side to side. “That will not happen!”

This isn’t working. In my eagerness to protect the children, I’ve lost sight of my patient. 

“Sergio, how do you feel when say – what’s the name of your eldest?”

“Eduardo.”

“When Eduardo doesn’t get straight As?”

“Angry. He’s not working hard enough! Too much time on the computer.”

“I understand, but what does it mean for you that he’s not working hard enough. In addition to anger, what do you feel?”

Sergio sits thoughtfully. “I don’t know how to say it. It makes me feel bad. It makes me feel, I don’t know. I can’t find the words.”

“Do you think it makes you feel sad for you, for your life? You’ve made so many sacrifices. You continue to make so many sacrifices – a job you barely tolerate, long hours, no time with your wife – that it’s really, really important that your children make it all worthwhile.”

“Yes, that’s it,” he says smiling.

“I know this may be hard for you to believe, Sergio, but you can’t expect your children to make your life worthwhile. You can make your own life worthwhile. Wait! Wait!” I say, seeing that he’s about to interrupt me. “Of course you want your children to do well. But hopefully you want that for them, not for you. Hopefully you want them to do what will bring them good feelings about themselves and their lives, not necessarily what you want for them. What if Eduardo was really good working with his hands? What if he wanted to be a mechanic or a carpenter?”

“I don’t know,” he says hesitantly.

“I know,” I say. “That was a long speech.” Directed, I think to myself, to both you and to my father. “You can think about it and we’ll talk more next week.”