In A Quandary

 “It’s kind of weird starting therapy on FaceTime,” my new patient, Leah, begins. “But I’m a therapist myself, getting used to working virtually, so I figured it was time to get myself back into treatment. I certainly could use the help.”

“And how can I help you?”

“I guess the big push for me to start treatment again is my father, but of course like everyone else in the world, I have problems and problems and more problems.” She sighs. “I’m 45. I’m married, my husband, Ed, is an IT guy working from home. I have two kids, girls, 12 and 14, who are in school virtually. So there we all are at home, each in a separate room, learning, seeing patients and solving computer problems. Sometimes it works, sometimes it doesn’t. It’s a problem if one of my girls doesn’t understand something she’s being taught and thinks she can just interrupt me in a middle of a session. I’ve tried to explain she can’t just do that, but if she goes to Ed, well, he just doesn’t have the patience, so she’ll end up interrupting me anyway. I’ve tried locking my door, but Elisa – she’s my youngest – gets really scared if I do that, so that doesn’t work either.”

“Sounds like you’re being pulled in every direction.”

“That’s for sure. And then there’s my father. My Mom died three years ago and at first I thought my Dad would be okay but now I can see he’s starting on the road to dementia – actually getting worse faster than I would have expected - and I’m worried about him being alone. Sometimes he calls again and again to ask the same question. He told me he’s burned a couple of pots forgetting he had the fire on. He’ll sometimes forget which apartment is his. And, of course, like many people during Covid, he’s lonely and, because he’s who he is, he’s angry. So I’m trying to decide if I should move him into the house with us.”

“Wow! Sounds like you have a tremendous amount on your plate.”

“Yeah. And the added problem is that I don’t like my Dad. I mean I love him – I guess – but I don’t like him. He’s angry, opinionated, narcissistic, dogmatic and intrusive. And that was all my life, not just since my Mom died or since the dementia.”

“So what was it like for you growing up?”

“Well, I’m a therapist, that should give you a big hint,” she says with a small smile. “It was hard. I was the oldest of three girls. My Mom was this really sweet person who didn’t have a backbone. She accepted anything and everything my father did, worshipped him really, and left us to fend for ourselves. Which usually meant I was the one arguing with him. My middle sister was the good girl, kind of like my mother, and my youngest sister just sort of floated through life, which is kind of what she’s still doing. I think she just ended marriage number three and career number … I don’t know. Too many to remember.”

“So what do you think it would be like with your father in the house?”

“Awful. I know it would. My youngest daughter is scared of him, always has been; and my oldest, at 14, she’d probably be arguing with him just like I used to. But I don’t know how they’d do with his dementia.”

“You haven’t said much about your husband.”

“I know,” Leah says sighing. “It’s hard. I mean I love Ed and I know he loves me, but even after all my previous therapy, I still think I married my father. No, that’s not really fair. Ed isn’t an angry bully like my father. But he is self-centered and not inclined to go out of his way to be patient or helpful, like I was saying before about his not helping my youngest with her schoolwork.”

“I notice you keep referring to your children as ‘yours’ rather than ‘ours.’

“That’s true. They’re very much my responsibility. I mean he loves them and he’s great about playing with them as long as it’s something he enjoys. But he’s definitely the fun parent and I’m the one who keeps after them to do their homework, pick of their rooms and so forth.”   

“So you always end up in the role of the responsible one. Any idea why?”

“First response, I was the oldest. Second, it’s the only way I’m sure things will get done.” Pause. “Maybe it’s the only way I feel safe.”

“There’s certainly a lot there for us to explore there.”

“I want to ask you before we stop if I should take my father in, but I know you can’t answer that.”

“Maybe we first need to look at why you only feel safe when you carry all the weight of responsibility.”

I Have to See You

“I’m sitting in your parking lot,” Laurie says barely whispering into the telephone.

I consider asking her why, but I know the answer. Instead I say, “I’m sorry.”

“Not even your car is here. I thought maybe I’d at least see your car.”

“You know I’m working from home, Laurie.”

 “I know. But I thought maybe I’d get lucky.” Pause. “How long is this going to go on?” she asks, plaintively.  

“I don’t know. No one knows the answer to that.”

“But you could see me. We’re not under lockdown. I can eat in restaurants. I can have my hair done.”

“That’s all true, Laurie, but it doesn’t feel safe to me for us to be behind a closed door in a small space without a mask.”

“I know. I know. We’ve been through this a hundred times before. But I have to see you! I have to! I have to know you’re really here!”

“We did try FaceTime.”

“That’s worse. That’s like you’re here and not here. I don’t know. That totally spooked me. Then you really aren’t real. It’s almost like you’re a figment of my imagination. Like I willed you onto my phone. Flat. Way too flat.”

“Flat or dead?”

“I know you keep going back to that.” Pause. “Maybe. I don’t know. I went off to school, came home and my mother was dead. I’m sure that did a number on me. Oh yes, and by the way, she killed herself.”

“You’re talking about that horrible time almost like it happened to someone else.”

“I don’t want to feel that now! I’m too sad, way too sad, why would I want to start feeling about my mother offing herself?”

“Maybe because you are feeling it. Maybe because every time you pour over the statistics about how many people have died and how old they were and where they lived, you’re actually mourning your mother again and again.”

“Don’t I ever get to have mourned enough?”

“I think there are always times that losses in the present trigger past losses, especially when that loss was so primal.”

“How about if I met you in the parking lot for a session? At least that way I could see you.”

“And what? We’d both sit in our cars and …” I stop myself. Giving Laurie the practical reasons why her suggestion won’t work is not what’s needed here. “You know, Laurie, it strikes me that you’re trying to undo your mother’s death. It’s as though if you figure out a way to see me, to erase the missing, to erase the absence, then that will magically make everything all right including bringing your mother back to life.”

Silence.

“What do you feel if you accept that we’re not going to see each other for some indefinite period of time?” I ask.

“Angry!! Angry, angry, angry! Because it’s only an indefinite period of time because you’re making it an indefinite period of time. It’s you, you, you!! You’re doing this.”   

“Just like your mother killed herself.”

“Right! Who the fuck has the right to kill themselves and leave behind a six year old child? It’s not right! It’s not fair,” Laurie says sobbing.

“No, Laurie, it’s definitely not fair,” I say softly.

“Okay, so I’m mourning now, are you happy?”

“I’m definitely not happy you’re in pain, but you know I always think it’s best for you to feel whatever it is you’re feeling.”

“I want to see you! I want to see you! That’s what I’m feeling.”

“I’m sure that’s true. And I’m sure that’s what you were feeling as a child as well.”

“Fuck you! Leave me alone.”

Silence.

The silence continues.

I hear Laurie crying.

“I’m here Laurie,” I say quietly.

“You sure?” she whispers.

“I’m positive.”

“I used to make believe that I was talking to my mother on the phone, like she’d taken a trip somewhere and was missing me and couldn’t wait to get home to see me. Isn’t that pathetic?”

“No, Laurie, that’s not pathetic at all. It’s totally understandable and very, very sad. Don’t you feel for the little girl who was you who wanted her Mommy to come home?”

“I guess. Sometimes.” Pause. “And sometimes I just want her to stop being such a baby. I guess like I should stop being a baby when it comes to wanting to see you.”

“You’re not being a baby. You’re yearning for what your mother took away from you and what you feel I’m taking away from you too.”

“But you’re really here, right? I’m not just imagining you and I will get to see you again sometime?”

“Yes. I’m here. And we will see each other again.”

Starting Therapy Remotely

“Hello,” I say to an attractive, dark-haired woman who appears before me on FaceTime. “I’m glad to meet you.” And so begins my first experience beginning therapy remotely.

I practice in Florida, one of the states that is seeing a sharp uptick in Covid-19. Although I have toyed with the idea of returning to in-office sessions, I continue to find myself reluctant to do so. During the initial phase of the pandemic, I turned away new referrals, uncomfortable starting treatment with anyone I could not meet at least once in person. But as my time away from the office continues, I decide I need to go beyond my comfort zone.

“Hi,” Jennifer replies. “This already feels weird. I’ve been in a lot of therapy, but obviously in person. I kept thinking I’d wait until I could go to your office, but who knows when that will be, and I’m having a really hard time.”

“It feels strange to me too,” I say, “But why don’t you tell me how I can help you.”

I watch her take a deep breath. “I’m 49, I’m alone, I’m terrified of the virus and I just found out that my ex-husband has lung cancer. And that he hasn’t told our daughter yet. I’m so anxious I can’t stand myself.”

“That is a lot.”

“I’ve always been afraid of being alone and now I’m alone all the time. I mean, I talk to my daughter, but she’s in New York and she’s had a really hard time so I don’t want to lay all my stuff on her. And I worry about how she’ll respond to the news about Greg, that’s my ex.”

“Lots of people have been struggling with their aloneness during the pandemic, can you talk about what it’s like for you.”

“I’ve always hated being alone, ever since I was a little girl. I was the kid who was afraid of monsters under the bed, always had to have a light on, and would run into my parent’s room in the middle of the night. That’s why it took me so long to leave Greg, even though I knew about his affairs for years. And when he moved out I put way too much pressure on my daughter to be my companion, just as my Mom did to me. I mean, my parents stayed married, but they had a lousy relationship and I was my mother’s confidant. My Mom’s still alive. She remarried after my father died and she’s much happier now. We’re close, but not like it was when I was a kid.”

“Are you saying you miss your childhood relationship with your Mom or that you’re relieved?”

“I don’t know. Maybe both. When I’m happy, I’m relieved. But now that I’m so anxious, I guess I want my Mommy. I know that sounds silly.”

“Not at all. I totally understand.”

“I did tell my Mom about Greg, but she didn’t get it at all, thought I’d be happy that something really bad happened to him.”

“And is a part of you happy?”

“Oh no! I mean he certainly wasn’t a good husband but I could never be glad he got cancer.”

“So you’d feel guilty if you felt glad?”

“Definitely. I was brought up to be the good girl and the good girl I remain.”

“Can I ask you how this is feeling to you right now?”

“I guess it still feels weird. And I’m still anxious. I’m used to having my anxiety get better when I’m in

a therapist’s office. But I guess I’m not in your office. It’s like you’re here and not here. It’s similar to how I feel talking to my New York friends on the phone. They don’t feel really present to me so I’ve pretty much let most of those relationships kind of peter out.”

“Oh oh,” I say. “Does that mean you’re likely to do the same thing with us?”

She shrugs. “I don’t know.”

“Maybe you yearn for relationships that duplicate the early connection you felt with your mother, perhaps that’s the connection that reduces your anxiety, makes you feel safe, and that without that kind of connection you feel afraid.”

“I guess that’s true. But I thought I wanted to get away from my mother.”

“I suspect that a part of you does want to get away, but the scared little girl part of you still yearns for what you experience as safe.”

“I suppose.”

“I feel as though you’re less engaged with me right now.”

“Yeah. It’s not you. I just don’t know if this is going to work.”

“I suppose the question is whether you’re willing to give it a chance. We’ve actually talked about quite a bit today: anxiety, guilt, your need to be a good girl and, I suspect, although we haven’t talked about it, your difficulty allowing yourself to feel angry.”

Jennifer brightens. “That’s right! I feel really bad when I get angry.” Pause. “But right this minute I feel a little less anxious.”

“Maybe it helped that I figured something out about you, and that made you feel more connected, less alone.”

“Could be.”

“I can’t guarantee I’ll do that every session, but if you’re willing to give this a try, maybe our work together could be helpful, despite not being in person.”  

Loss: Past, Present or Future?

Chelsea, a relatively new social worker, is talking about her work at the local hospital. “It’s scary being there right now, even though there isn’t all that much to do since our census is so low. Still, having to deal with families who are deciding where to place their elderly relatives is hard, even harder than usual. Who would want to put someone in a nursing home right now? But some families just can’t take them home – small kids, home schooling. It’s a challenge. And it’s worse since I have to do it all by phone or video conferencing.”

“Interesting, Chelsea, since that’s how we have to work too.” I have been seeing Chelsea for several years now, beginning when she was in college, through her Master’s program in Social Work and now as a beginning professional. We have a strong, caring bond. But switching to teletherapy has been difficult for us. Something is definitely missing. I even suggested we switch to FaceBook, hoping that might recapture our connection. But it’s still not the same.

She sighs. “Yeah. But the problem I have with the families isn’t the same as the one I’m having with you. I don’t know the families, so not seeing them in person makes it harder for me to have a sense of who they are as people. I mean if someone is sobbing about the thought of putting their mother in a nursing home, I certainly get how they feel. But if they’re more neutral, is it because they don’t care or because they’re just trying to hold it together. I can’t tell.”

“But that’s not true for us?”

“Not at all. I most definitely know who you are.” She smiles. “You’re my savior. I don’t know where I’d
be if it wasn’t for you. I mean I know I have a mother transference to you. How could I not, with my mother dead by the time I was nine and no one else really caring about me? But this not in person stuff just isn’t working for me. I even considered asking you if we could take a break from our sessions until we could meet in person again.”

“Really? I’m surprised.”

“Yeah, I know. But I chickened out. It would feel like too much of a loss.”

It would feel like a loss to me too, but I keep that feeling to myself.

“Maybe it would be helpful, Chelsea, if we really tried to figure out what the difference is for us, because I agree with you, something is different, something is missing.”

“I just don’t know,” she says shrugging. “I have wondered whether it’s somehow related to my mother’s death, but I’m not sure exactly how. Sort of like how she faded away from cancer and whether us not being in person makes me feel as though you’re fading away too.”

“That’s a really good thought.”

“But you know, just saying that made me really anxious. Like, my God, are you fading away? Are you leaving me? Are you dying? That’s so terrifying to me I can hardly stand to think of it. I mean, here we are in the middle of a pandemic and you have to be in the age group that’s most at risk. But I never thought of that. I never thought I might actually lose you!” Chelsea says bursting into tears.

“I understand that would be really scary. And sad. And of course I can’t tell you I won’t get Covid, although I’m trying my best not to.”

Still crying, Chelsea looks up at me, stricken, shaking her head. “So many thoughts just went through my head. I think I’ve been mad at you. I think I’ve been mad that you weren’t seeing me in person, like you were rejecting me. But that’s not true at all. You weren’t rejecting me, you were taking care of me, trying to stay here for me. I mean not just me, for yourself and for your other patients too. But I think I’ve been mad and scared and sad and I didn’t know about any of it! What’s wrong with me!?”

“Nothing’s wrong with you, Chelsea,” I say smiling. “This is a scary, unknowing time for us all, including not always knowing what’s going on inside of us. And death is all around us. It’s hard not to worry about loss, or to defend against acknowledging it.”

“I feel so incredibly sad. I truly don’t know how I’d deal with losing you.”

“I understand. And I hope you won’t have to deal with it for a very long time.”

“You know what, though? I feel closer to you right now.”

“I agree. Defending against fears of loss meant we lost each other in the present. And that’s even worse than losing each other in the future.”

Why

“I can’t stand it!” Marilyn yells into the telephone. “Why did this have to happen? I can’t stand being all by myself. There’s no one here, no one. I’m totally and completely alone.”

“I’m here,” I say quietly.

“No, you’re not! You’re not here. I don’t even know where you are but I know I’m not with you. I have to be near you. I have to imagine being able to touch you, even though we never do! And that’s what I want right now. I want you to touch me! I want you to hold me!”

Like most therapists these days, I am ‘seeing’ my patients remotely from home. Since for most of my career I have used the telephone when patients cannot be in my office, I am more comfortable using this modality than facetime or video conferencing. Most patients have been able to adapt to this new reality.

“Sounds like you’re feeling alone and desperate and wanting me to take care of you.”

“Now there’s a therapist response if I ever heard one! What good are you? You’re just a disembodied voice floating out there somewhere in space. You can’t give me what I need.”

“I understand that you’re feeling alone and uncared for, just as you felt as a child,” I say. “I understand that you want me or someone to save you, just as you did as a child. We’re all scared, Marilyn. We’re all in the same frighteningly unknown scary position.”

“But not everyone’s alone.”

“No, not everyone’s alone,” I agree. I want to add that many people are alone. I want to suggest that she call friends, reach out to family. I want to suggest that she start some of the projects she’s been wanting to do around her house, anything that will help her to feel more adult. But I know Marilyn will not, at this point, be able to hear such suggestions. She feels far too scared, back to being a child with an explosive, alcoholic father and a depressed, absent mother.

“Is there someway I can be helpful to you, Marilyn,” I ask.

“You can tell me when this is going to end! You can tell me why this is happening to me! You can tell me why only bad things have happened to me my entire life! It’s not fair!! I hate it!! I hate it!!”

Although I can feel my patience fraying, I try to retain my image of Marilyn as the frightened and vulnerable child. “I hear you, Marilyn. And I’m sorry you’re in so much pain.” I refrain from saying that this isn’t only happening to her and that she has known good times in her life. I know the futility of such word.

“I know,” she says suddenly. “I know how you can help me. You can tell me your address and I can come by and give you a hug and we can sit in your living room and visit.”

I am taken aback by the outlandishness of her request. At first I begin to respond directly, “You know that’s not something…” Then a thought comes to me and I stop myself. “Marilyn, have you just set yourself up? Have you just asked for something you know I won’t do so that you can continue to feel that I’m just one more of the long list of people who aren’t there for you, who don’t care about you, who can’t save you?”

She bursts into tears. “But you don’t!! You don’t care. Why can’t I come see you? Why can’t I come hug you?”

“Marilyn, can you try to answer those questions yourself,” I ask gently.

She sobs on the other end of the telephone. “You don’t care about me! I’m just a patient to you.”

I again consider responding directly and then decide against it. “What if you allowed in that I do care about you? What if you allowed in that I care about you and still can’t tell you when this will be over or why it’s happening? What if you allow in that I can care about you without being able to save you?”

Marilyn is sobbing uncontrollably on the other end of the line. “That can’t be! That can’t be!” she says between sobs.

I am silent and then say quietly, “It’s very hard to give up the hope of being saved, of being saved in the present and of being saved in the past.”

“I want you to hold me, I want you to hold me.”

I imagine Marilyn hugging herself and rocking back and forth in her chair. “I know, Marilyn,” I say, “I know.”