Two women occupy my office chairs today. I have seen Georgia, a tall, stately, perfectly coifed 49 year old woman on and off for 14 years. When I first began treating her, her daughter Tricia was seven years old. Now a beautiful 21 year old sits across from me, a straight A pre-med junior at the University of Florida.
Tricia’s success has been Georgia’s obsession. Through the years we have worked at diminishing her anger at her accountant husband for not being sufficiently successful to send Tricia to an Ivy League College. Although I always thought I came from an overprotective family that relentlessly pushed me to succeed, working with Georgia introduced me to a whole new definition of relentless, coupled with a rule-bound, rigid household.
It’s unusual for me to agree to see a patient’s family member, but Georgia pleaded with me and I thought the situation sufficiently alarming to agree.
“It’s a pleasure to meet you, Tricia,” I say smiling. “I’ve certainly heard a lot about you over the years.”
“I bet!” she replies. “Sometimes I think I’m the only person my Mom ever thinks about.”
Good insight, I think to myself. “And how do you feel about that?” I ask.
“It gets old. I tell her I’m a big girl now. I can take care of myself.”
“Sounds like you’re getting right to the point of your mother’s concern, having unprotected sex.”
“I know the guys I’m sleeping with. It’s not like I’m hooking up with one-night stands. I know who they are, who they’ve slept with.”
“You don’t know, Tricia,” Georgia says, her voice tense and annoyed. “You can never know. I don’t understand why you’re being so reckless, playing Russian roulette with your life.”
“Maybe that’s a good question. Why do you think you need to be reckless, Tricia?”
“I’m not being reckless. I told you I know who these boys are.”
I remember stories from Tricia’s early teen-age years when she would sneak boys into her room at home, often managing to get caught. I definitely understand her need to rebel, to break the shackles of her mother’s iron grip, but I don’t think Tricia is aware of the motivation behind her own behavior.
“What were the messages you got from your mother regarding sex?” I ask.
“You’re kidding, right? No sex before marriage. Sex is holy. Only meant for a married man and woman. We’ll leave the same-sex part of that out completely.”
“What?” Georgia shrieks. “Have you had sex with a woman?”
“No comment,” Tricia replies snidely.
“That’s an interesting statement Tricia. Because it seems to me you’ve made many comments – directly and indirectly - about your sex life and I have wondered why that is. How does your mother know you’re having unprotected sex? How come she knew you were having sex as a teenager? And why did you just casually throw out the possibility of lesbian sex?”
“She asks me.”
“Tricia, I know you’re a very smart young woman. Yet you seem determined not to consider the meaning of either your statements or your behavior. For one, you already said you don’t think your mother thinks of anyone but you and that you don’t like that, but you manage to increase her thinking about you by being provocative. And, while you’re reeling her in on the one hand, you’re rebelling against her and everything she believes in on the other.”
“I don’t know what you mean.”
“I think you’re not sure how close you want to be to your mother. You tell her everything to stay close and then rebel against her to move away. I do understand, Tricia, that your Mom has held onto you very tightly and that makes the process of separating more difficult.”
“So now it’s my fault,” Georgia says angrily.
Always the problem with introducing a family member into an ongoing treatment, the patient ends up feeling dismissed and betrayed.
“It’s not a question of fault, Georgia. It’s a problem that exists for both of you today. I know you want Tricia to be healthy and happy and have a full life and in order to do that she needs to separate from you in a way that’s not destructive to her.”
“She always makes it about her,” Tricia says, exasperated. “Of course, you’re making it about her too.”
I smile. “You really are a very insightful person. There’s no way I as your mother’s therapist is going to be able to help you separate. But I do think it would be a good idea for you to go into your own therapy, with your own therapist. As you said, you’re a big girl now and you need to take care of yourself.”
I return in this blog to Kevin, the man who had difficulty feeling much of anything and who angrily rejected my compassionate remark. Consciously he experienced my response as pitying, as an indication of my seeing him as weak. Unconsciously my positive voice threatened the angry, critical voice of the father he carries around in his head, a voice he would have to relinquish and mourn if he was able to take in more positive voices.
Progress with Kevin has been slow. He remains unemotional, distanced, reserved, and quick to criticize. For my part, I am often overly cautious, carefully weighing what I say, trying to avoid his attack, an attack which expresses the critical voice of the internalized father that both he and I carry in our minds.
Today, however, Kevin appears quite different. He is unshaven, dressed in shorts and a T-shirt and looks stricken. Even so, I’m reticent, reluctant to ask if he’s all right, preferring to wait to hear what he’ll say.
“I’ve had one hell of a night,” he begins. “My daughter’s appendix burst. She was screaming in pain. We had to rush her to the emergency room.”
“I’m so sorry, Kevin,” I say. “Is she all right?”
“Yeah, they operated on her and they say she’ll be fine.”
“It must have been terrifying,” I say, despite worrying that my expressing too many vulnerable feelings may result in a backlash from Kevin. But he feels so different today, so much more raw, that I’m willing to take the risk.
I’m still surprised, however, when Kevin starts weeping. “My poor little girl. She was scared and hurting and I couldn’t do anything! I don’t think I’ve ever been so terrified in my entire life!”
Images go through my head: the trauma of my own childhood tonsillectomy, the terror of so many of my late husband’s hospitalizations, the pain of watching my elderly cat become sicker and sicker. All images associated with despair and powerlessness. This is what Kevin is also feeling. But they are feelings quite alien to him and I’m still unsure how far he’ll be willing to go with them. I wait.
“I bet you never expected me to be bawling in here,” Kevin says, his sarcastic edge returning.
Despite the sarcasm, his vulnerability has made me feel less tentative. “How do you feel about your crying in here or, for that matter, crying at all? And how do you feel about the feelings you obviously have for your daughter?”
“I don’t know about the crying in here part, but I’m actually glad that I could feel so much for Tracy,” Kevin says, more softly than usual. “I know I’ve talked about my feelings about my kids, about how I wasn’t sure that I really felt what I should feel about them. Well, last night did away with that concern. I don’t know what I would have done if anything had happened to Tracy. I felt like my heart would break for her last night. And I was glad to be able to feel.”
“I’m glad you could allow yourself to feel and that the feelings were not only tolerable, but actually felt good.”
“I even felt closer to my wife last night. Beth was stronger than I thought. She didn’t fall apart even though I could see how scared she was and how much she loved Tracy. I don’t think it’ll fix everything between us, but it felt good, if only for last night.
“I had some other thoughts, too,” Kevin continues. “I thought about my mother. We don’t talk about my mother much. My father always seems to be in the foreground. I remember when I’d get injured playing sports, especially football. Once I even broke my arm. She did what she was supposed to do. She took me to the hospital, gave me my medicine, asked if I was doing all right, but she wasn’t there emotionally. I could tell how different she was from Beth or even from me – if you can believe that! Yeah, I could tell that I felt more on an emotional level for my daughter than my mother felt for me. That was a revelation.”
“So you had an angry, attacking father and an unemotional, distant mother. It’s no wonder that emotional closeness is so difficult for you.”
“Yeah, I guess that’s true. So am I cured, Doc?”
“I’d say that last remark is an indication of your beginning to feel uncomfortable with the closeness between us and your need to pull back.”
“Come on, now. I didn’t mean anything by that.”
“Think about it. What does it sound like to you?”
“I guess you’re right. It’s sort of a smart-ass, off-hand remark.”
“And that’s fine. You can’t expect that one experience, no matter how terrifying, no matter how eye-opening can make everything different. But it obviously has affected you and it will affect you and us as we go forward.”
