Judgment

“It happened again,” Stephen says staring down at his hands. With his wavy, sandy brown hair, broad shoulders and muscular physique, 36 year old Stephen is an attractive man.  

He glances up at me and continues. “I didn’t hit Jake or anything, but I just sort of lost it. I guess what he did wasn’t such a big deal, but I snapped, started yelling. He stood there staring at me and then started crying. That made me angrier. I told him he was seven years old and to stop being such a baby. Then Marie came in and started yelling at me and that made the whole thing worse. Now we’re screaming at each other while Jake is crying even harder. Then she took Jake and left. I stomped around the house cursing until I finally got hold of myself and then, you know, I feel like an ass.”  

“Can you say what made you so angry, Stephen? Can you say what made you lose your temper?”

He shrugs. “I don’t know. I guess his disrespecting me. I just told him to put his toys away. He didn’t have to give me a smartass answer.”

“But what happens to you, what do you feel inside when Jake gives you a smartass answer?”

“Inside? I don’t know. It just happens.”

“I don’t know if you’re aware of it, Stephen, but you tend to talk about your temper as “it,” as though it’s something removed from you.”

Stephen stares at me, his eyes narrowed, his jaw clenched, his mouth tightly shut. “You hate me, don’t you? You think I’m a piece of shit?”

Uh oh, I think to myself, lots of land mines: Jake’s anger, a breach in the therapeutic alliance, and, of critical importance, Jake’s question. As far as I know, I don’t hate Stephen. I understand that he himself had an angry, abusive father who made him feel like “a piece of shit” and that, as a result, he has a fragile sense of self that is easily wounded. 

On the other hand, I am definitely affected by Jake’s descriptions of his explosive behavior. I, too, had an angry, out-of-control father whom I feared. I stood up to him, but shook inside. Those childhood feelings are also with me in the consulting room.

These thoughts go through my mind in seconds, as I prepare to respond to my patient.

“No, Stephen, I don’t hate you. I’m sorry if my asking you if you knew you referred to your temper as “it” gave you that impression.”

“Well it did. You had this tone, like you were looking down at me, like you saw me as worthless.”

“I’m sorry. That couldn’t have felt good. You probably felt that I was disrespecting you, just as you felt with Jake. And when you feel disrespected you feel like you did as a kid with your father, ‘like a piece of shit,’ and that makes you angry.”

“Yeah, yeah, that’s right. I hadn’t realized it, but yeah, that makes a lot of sense.” He pauses. “But if you weren’t disrespecting me, why did I feel that way?”

“That a very good question, Stephen, and the answer isn’t so simple. First, I think it’s because your father put you down so much, that it’s easy for you to go back to that place, that place of being a scared little boy and needing to defend yourself against anyone else who might make you feel small or worthless.”

“So are you saying that I go around feeling attacked by people even if they’re not attacking me?”

“I’d say the answer to that is yes and no. Yes, you may sometimes feel attacked even when no one is attacking you. But there may also be times that you’re picking up on other people’s anger. Like when you told Jake to pick up his toys he might well have been angry and you might have heard that anger in his response.”

“And with you?”

“Well, I definitely don’t hate you, Stephen, but sometimes it is hard for me to listen to you describe your going off on Jake. It’s like I want to protect him and perhaps sometimes I do feel angry with you. I wasn’t aware of feeling angry today, but that doesn’t mean I wasn’t and since I’m sure you’re exquisitely attuned to other people’s anger you might well have picked up something from me that I wasn’t even aware of.”

Stephen stares at me thoughtfully. “Thank you,” he says. “I appreciate your honesty. You’ve given me a lot to think about.”  

The Holidays

Arlene is feeling better today. She’s just coming out of a bout of depression, a depression that has plagued her throughout her life and about which she has little insight. Since her father was bipolar, she sees her depression as biological, something that comes over her, an external force that descends upon her and torments her. Although I don’t dispute the biological component of her depression, I do encourage her to try and understand the trigger for any given episode which seems to me related to her feelings of anger and guilt. These interpretations make sense to her, but they fade over time, leaving her again feeling like the helpless victim of her “curse.” 

Today, though, her mood has lifted. She feels “better,” describing herself as being in a holiday mood, excited about getting ready for the holidays. Although she feels somewhat overwhelmed by last minute shopping and wrapping for her three children, as well as preparations for Christmas dinner, she feels she can “handle” the stress and is generally upbeat.

“Do lots of people get depressed during the holidays?” she asks.

I’m surprised by the question. She’s not usually interested in people outside of herself or her family. “Some,” I reply. “Why do you ask?”

She ignores my question and perseveres. “What makes them feel depressed?”

I decide to see where this will take us. “Well, some miss their families or remember childhood Christmases or past Christmases that are no longer.” My mood begins to darken, as I remember the large, festive Christmas parties my husband and I used to give. 

“You mean like people who live alone?” she continues.       

Arlene is one of my patients who read my book. She knows I’m a widow. She knows I live alone. Is she needling me? Is she concerned about me? Is she trying to hurt me?

I proceed gingerly. “Yes,” I reply, “Some people who live alone have a hard time.”

“I can see how that would be depressing,” Arlene responds.

“Arlene, are you asking me whether I’m depressed, whether I’m going to be alone for the holidays?”

She’s immediately flustered. “Oh no, I would never get so personal. I would never ask you about your life.”

“But you read my book. Which was fine. I wrote it, you certainly have every right to read it. So you do know quite a bit about me. And now you’re asking these questions about people who are alone and depressed for the holidays. Are you sure you’re not asking about me?”

Arlene squirms in the chair, her eyes shift downward, then turn to look out the window. Silence fills the room. Arlene seems to be floating away. I find myself becoming anxious, concerned that she’s again moving towards feeling depressed.  

“Arlene,” I say, “I’m not your father and you don’t have to be either. He was a disturbed man who moved between very severe depression and flights into mania. When he was depressed he put a pall over your entire household. It was as though no sunshine could get through. I’m not depressed and I’m not going to be alone for Christmas. And you don’t have to be depressed either. But I think it would be helpful if we could look at why you started to drift towards depression when I asked you to consider whether you were asking about me.”

“You know,” she says, “I didn’t even know I was getting a little depressed right then, but you’re right, I was. I guess I felt I had done something wrong, that you were mad at me for asking questions about you that I shouldn’t be asking.”

“So you’re saying that you felt guilty?” I ask.

“Yes. As always.”

“I won’t dispute that you felt guilty, Arlene, but I also wonder if you felt angry with me, angry that you were being concerned about me, and that I was cross-examining you about your motives.”

“I wouldn’t say I felt angry at you. Maybe a little annoyed.”

I smile. “Anger is a difficult emotion for you. It was hard for you to feel angry at your father, hard to feel angry with me, hard to feel angry with pretty much everyone. But I’ll accept that you felt annoyed, as long as you try to recognize that annoyance and accept it without having to turn it against yourself and end up feeling depressed.”

“I’ll try,” Arlene says.

“Good deal! And have a very happy holiday.”