Looking For Love

Ben is a shy, anxious, good looking man in his mid-thirties. Although we’ve working together for several months, Ben continues to feel uncomfortable around me, as he does around most women. He has difficulty looking at me directly, often staring out the window or at the floor. When I try to address his discomfort, he shakes his head, indicating his unwillingness to pursue this avenue of exploration.

Not surprisingly, Ben has never had a girlfriend, although he desperately longs for someone to be with. I’ve tried to ask if he’s ever kissed a girl, but even this feels too intrusive. I want to ask if he masturbates, but I can’t manage to get the question out of my mouth. I have, in fact, become as inhibited as Ben in our sessions – anxious, careful, not wanting to offend, not wanting to cross an unspoken boundary.

That this constrained interaction has developed between Ben and myself is not all that surprising. Ben’s parents divorced when he was five. His father, always a womanizer, saw Ben only occasionally, leaving him to the welcoming embrace of his mother, who turned to Ben for solace after the divorce. Ben became her “little man.” She hovered over him, over-protected him, and preferred that he never leave her side. She interrogated him whenever he left the house, even to go to school, particularly interested in whether he talked to or was interested in a girl. She drank more and more heavily, Ben increasingly becoming her caregiver. She died when he was in his twenties, leaving him bereft, relieved and guilt-ridden.     

“There’s something I haven’t told you,” Ben says. “I go to strip clubs.”

Of course, I think, not a surprise; a “safe” way to meet women who are not easily confused with mother.

“I met this girl, Crystal,” Ben continues. “She’s different. She has kind eyes. She’s sweet, not harsh or loud like a lot of them. And she likes me. She told me she likes me. I think she even implied that she’d meet me outside the club. But I’m kind of scared to do that. I mean, I’m not sure what I’d do, what she’d expect me to do. Like would I need to pay her? I’d rather not pay her. I’d rather we went out like on a regular date. Do you think she’d do that?”

“I don’t know, Ben. I don’t know what she’d do. Can you tell me what you and Crystal have done so far?”

“What do you mean? I’ve watched her dance. She has a beautiful body, but I try not to look too much. I’ve bought her some drinks. She’s sat and talked to me. She’d had a sad life. She’s been an orphan since she was a baby and grew up in foster homes.”

I’m aware that I want to push. I want to ask Ben if he’s taken her into the back room, if he’s had sex with her, if he knows she has sex with men all the time and that she plays men like him every minute of every night. And then I’m surprised at myself, at the obvious cruelty and sadism of these unasked questions.  I would be being with Ben as his mother was with him. What’s going on here?

For my part, I’m angry at Ben’s presentation of himself as a victim. Although I have tremendous compassion for the scared, vulnerable child he carries within him, I have a hard time with victims. I prefer that someone fight for themselves, fight against the odds, fight as I fought against the tyranny of my father. So that’s the part I bring to the interaction. But I think that by presenting himself as the victim, Ben is also eliciting this sadistic response from me, from his mother, from Crystal. It’s as though he’s saying, beat me, take advantage of me. It’s the only way he knew love in the past and it’s the only way he understands love today.  

Too complicated for an interpretation. I say nothing. I wait.

“Why aren’t you saying anything?” Ben finally asks.

“How do you feel about my not saying anything?”

“I don’t know.”

I have a glimmer. “How do you feel about my not saying anything?” I repeat.

“I already said, I don’t know,” Ben says slightly raising his voice.

“It sounds like you feel angry.”

He shrugs. “Annoyed, maybe, not angry.”

So this is part of Ben’s contribution to the interaction. He plays the victim so that others will feel the anger he cannot allow himself to feel. He will be the victim, the suffering child who feels nothing but kindness and compassion while others, like myself, feel angry at his passivity.

We haven’t solved Ben’s difficulties, but I understand more and have a better handle on myself.

Cancer

As soon as I open my waiting room door, I can tell that Marsha isn’t doing well. Usually a warm, bubbly woman with a ready smile, today she seems sad, subdued.

“It’s been a bad week,” she says. “I’m not sure I even mentioned this to you before because Bruce was so sure it would be nothing and you know me, I’m more than happy to ignore things until they slap me in the face. Well, I got slapped in the face. Bruce has prostate cancer.”

Oh no, I think to myself, trying to keep my face impassive. My husband had prostate cancer. He died of prostate cancer. Memories flood me. When he first told me. When the radioactive seeds were implanted. When he started hormone injections. The years of the cancer being under control. Until it wasn’t.

“I’m not sure I understand all the details,” she says, “but I guess it’s past the stage of watchful waiting. So now we have to make all these decisions. I mean, I know they’re Bruce’s decisions, but obviously he wants my input. He’s only 58 years old. He’s scared of the surgery, the possibility of impotence or incontinence or both. I don’t much like the idea either. We’ve always had a great sex life. That’s been the glue through our ups and downs.”

58. A long time for the cancer to have to be kept under control. George was in his early 70s when he was first diagnosed. We didn’t want the surgery either. Not only for the reasons Marsha mentioned, but because George had recently had some heart difficulties and I was especially anxious about him having general anesthesia. It was a decision I often regretted. I remember my aunt saying, “Take it out! Take it out! Take it out!”

But this is not my decision. Neither my experience nor my bias should influence Marsha. I think about my book, Love and Loss. Marsha has never mentioned it, so I doubt she’s read it. If she had, she’d certainly know about my experience. Would if influence her? Perhaps. It’s one of the difficulties I considered before writing a book so filled with self-disclosures.

“You look sad,” Marsha says, bringing me out of my reverie.

Obviously my feelings are showing. “Yes,” I say. “I’m sad, sad that you and Bruce have to deal with this pain.”

It’s true. More accurately, it’s half true. I feel sad for Marsha and sad for me. Although I don’t need Marsha’s misfortune to remind me of George’s cancer and its progression, Bruce’s cancer does bring those memories and feelings to the fore once again.

Marsha begins to cry. “It’s so unfair. We’ve just gotten our kids off to college and all the problems we had with Lawrence. I never thought he’d straighten out. But he did. And there’s taking care of our parents who aren’t doing so great either. The sandwich generation! Except now we’re being eaten!”

This is the other side of Marsha. As she said, she’s usually able to ignore difficult things. But when they hit her in the head she’s blind-sided, her defenses fall away, and she’s left drowning in misery.

“It isn’t fair, Marsha. But life isn’t. We never know what will happen. You’re not someone who’s constantly worrying about all the terrible things that might happen and that’s good. But now you’re faced with a very scary, painful situation where it’s not at all clear what path you want to take and what the consequences of that path may be.”

“What would you do if it was your husband?”

Danger, I think to myself. “Well, first I think I’d talk to your doctors. Maybe more than one of them. Get their opinions. Find out what your options are. Weigh them.”

“But what would you do?”

Is Marsha unconsciously picking up that I do have an opinion? Am I stonewalling if I say nothing? Am I stepping outside the bounds of my therapist role if I say anything? Then I realize that prostate cancer is the only disease that would place me in this dilemma. With other cancers I wouldn’t have an opinion. I’m relieved. I feel clearer.

“Marsha, I wonder why you keep asking me for my opinion. I know you’re scared and maybe that makes you feel more in need of an authority figure to tell you what to do. But I’m not an authority here, I’m not an oncologist. I’m certainly here to listen to your pain, your fear, your indecision, but I can’t tell you what to do. I don’t know.”

And I realize that’s true. My husband’s cancer doesn’t make me an expert. I don’t know what Marsha should do. My experience is irrelevant. 

Who Loves Whom and Why?

Last week’s blog was “Who Dislikes Whom and Why?” This is the companion piece: “Who Loves Whom and Why?”

Many similar questions can be asked. Perhaps instead of asking whether a therapist should work with a patient she loves, the question becomes whether that love can itself create blind spots or other difficulties? Is the love immediate or does it grow over time? Or does it lessen as the person reveals himself to be less loveable than initially thought? Is the love about the patient? The therapist? Both?

Why we love someone – in or out of the treatment room – is multi-determined by our unconscious, our early caretakers, our past relationships, our present life circumstances and by the other person’s response to us. When two people meet, whether it be in a therapist’s office or at a party, each person brings this complexity of history, needs and wants to the interaction that invariably affects both parties.

For me, patients with whom I form an immediate connection that grows into love, are young women who present with a tough front but are vulnerable, fragile, and often quite disturbed underneath. They also form strong, immediate attachments to me and, during the course of the treatment make huge strides. The best example is Alyce, the woman I present in the first two chapters of my book, Love and Loss in Life and in Treatment. From the first she was determined that I be her therapist, formed an immediate attachment to me and, despite her excessive, angry demands, blossomed into an incredibly bright, talented, accomplished woman.

I was hooked by Alyce’s vulnerability covered by a fierce determination. Although I do not believe I was ever as disturbed as Alyce, I think that dynamic - vulnerability covered by determination - is also who I am. I fought my father although I was terrified of him. I became a psychologist and psychoanalyst over his strenuous and critical objections. I admire grit and I understand the terror that lurks underneath. So in giving to and loving patients like Alyce, I am also giving and loving that child within me.

Although I didn’t know at the time, there was a period in the treatment when my love became too frightening for Alyce, perhaps threatening her sense of self. Unbeknownst to me, she began seeing another therapist. When she finally told me, I was hurt and shocked. I had been trying so hard, and all my efforts were deemed insufficient. Actually, I had been trying too hard. I had to be willing to let Alyce go. She had to choose. She couldn’t see two therapists. Once I was willing to let her go, she could choose to stay. Our work could then continue.

I don’t remember ever moving from love to dislike of a patient, but there have been treatments where I believed an intense connection would develop, only to find my expectations dashed. Vanessa is such a patient – warm, caring, sensitive, introspective. I thought our relationship would become closer over time. But that was not the case. When I asked myself what was missing, I concluded that Vanessa could not allow herself to feel vulnerable. She had experienced too much trauma and loss in her early life to risk opening up that pain or to risk another relationship in which loss was inevitable. She made progress in treatment, but never allowed herself to fully love. And loving a patient who does not love back is difficult, at least for me.

In contrast, there is Caroline, another patient presented in my book. I did not feel an immediate connection to her, but over the course of her analysis we definitely grew to love each other. She became far more open, vulnerable, and aware of the needy, despairing child within her. She could speak her feelings in beautiful metaphoric language, almost poetry, touching an unconscious core in both of us. Additionally, there were major changes in my life as I dealt with my husband’s illness and eventual death. Those changes brought our present day lives ever closer together, as well as increasing my own vulnerability and desire for connection.   

   

So I will end this blog as I did the last one. Who loves whom and why? The answer, as always, is complex, determined by both people in the consulting room, by their experiences of each other, by their past histories and by their present life circumstances.                

Who Dislikes Whom and Why?

When I refer a person who is new to psychotherapy to a colleague, I always say that if for any reason he isn’t comfortable with the therapist, he should call me back and I will give him another name. My clear message is, never work with a therapist you don’t like.

But what about the other way around? Should a therapist work with a patient she doesn’t like? And what does it really mean to not like a patient? Is the dislike immediate or does it grow over time? Or does it lessen as the person becomes better known and, hopefully, more engaged in the process? Is the “not liking” about the patient? The therapist? Both?

In my 35+ plus years of doing therapy, there have been very few patients I have disliked and almost none I felt an immediate antipathy for or felt that I couldn’t work with. The exceptions have invariably been angry, paranoid men. One such man, in the middle of his second session, went on a tirade about the manipulative evils of women and demanded that I prove to him I was an exception. I felt instantly frightened and said that I wasn’t the best therapist for him and that perhaps he would work better with a man.  Would any female therapist have felt the way I did? I suspect not. This patient immediately brought forth memories of my paranoid, explosive father and I was back to being a frightened child rather than a competent adult therapist.

Less dramatic, as detailed in my book, Love and Loss, when I first moved to Boca Raton, Florida from Ann Arbor, Michigan, my experience of many of my early patients was not so much that I disliked them, but rather that I often didn’t like them. They seemed foreign to me; so much more superficial, concrete, narcissistic than my Ann Arbor patients. I didn’t know how to help them, almost as though I had forgotten how to be a therapist. They often didn’t remain in treatment for very long. I wondered at the time if they sensed my own feelings of ineptness or my too great need to build a practice and have them as patients. Years later, when I was writing my book, I realized that my difficulty had been more related to the fact that I hadn’t yet disconnected from my life in Ann Arbor - my friends, my home, my patients – making it impossible for me to really connect to my life in Boca Raton, including my patients.

There are also patients I like as patients, but doubt I’d like as a friend and, vice versa, patients I like as people, but don’t much enjoy as patients. In the first category there are patients like Pat who I discussed in last week’s blog – an angry, vengeful person who fought against mourning the loss of her unfaithful husband and her own sad, loving feelings. I like working with her. I can see a way to be helpful to her. In time I hope that she will be able to mourn and will become a more likeable person both in and out of the treatment room.

In the second category there is Betty, a bright, articulate, cultured woman who has an interesting job as a museum curator. I think we could have been friends if we had met before she became my patient. But as my patient I find her extremely frustrating. Despite her obvious intelligence, she is very concrete, not at all psychologically-minded and despite years of treatment, is unable to think about herself in a more introspective, psychological manner. She cannot wonder why she thinks or feels or behaves in a particular manner, she just does. I do understand that her concreteness stems from an overly rigid and strict background, but this does not help me experience her sessions more positively. I also understand that I am replaying the role of her parents in wanting her to be the way I want her to be, rather than accepting who she is. I hope I can come to accept Betty as she is, for she might then feel freer to explore and find her own mind.

So who dislikes whom and why? The answer, as always, is complex, determined by both people in the consulting room, by their experience of each other, by their past histories and by their present life circumstances.