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.”

Murder on Her Mind

Gina smiles at me, sashaying into my office from the waiting room in her short, tight, floral dress.

“Like my new dress?” she asks, settling into the chair, trying unsuccessfully to both cross her legs and cover them. “My friends tell me 45 is too old to wear a dress like this. But I don’t care. I’ve got it, I’m flaunting it. They’re just jealous. What do you think?”

I silently agree with her friends and wonder if she wants me to be another jealous woman. I say, “You get to wear whatever you want to wear.”

“It makes me feel alive. Of course, I’ve been feeling pretty alive these days anyway. Nothing like an affair to spice up one’s life. New man, new compliments, new sex. I love it when I get on top of him and all the lights are on and he looks at me while stroking and pinching my nipples. We can go for hours.”

Gina and I have talked a lot about her affair. I remain silent.

She pauses and then continues, “You know how I like to read all these mysteries – some old, some new – Agatha Christie, John Grisham, Patricia Cornwell, Scott Turow…?”

I nod, unclear where Gina is headed.

“Well, ever since I’ve read that Presumed Innocent book about the wife trying to get back at her husband by framing him for his girlfriend’s murder by using his semen, I’ve been fantasizing about how to kill you know whose wife and set my husband up to take the fall.”

My anxiety spikes. “Actually I don’t know who,” I blurt out, “since you continue to refuse to tell me who he is.”

She laughs. “It’s just an expression. We’ve been over this a million times. She’s in your field. I’m afraid you’d know her, or even him. End of topic.”

“It can’t be ‘end of topic’ if you’re considering killing her!” 

“You’re being so silly today,” she says dismissing me with a wave of her hand. “I didn’t say I was going to kill her – I couldn’t do that – I’m just fantasizing about it.”

I think about what she just said. It’s true. She was talking about fantasy, not action. I’ve listened to many patients over the years talk about their murderous and/or suicidal fantasies without assuming they were going to act on them. What’s different here, I ask myself.

Gina is speaking, “..it wouldn’t even be hard. My husband and I even have a better sex life these days. I guess I’m so turned on all the time, I’ve been more sexy with him too. See, he’s enjoying my affair too. But I can’t figure out how I’d get him to use a condom. So far my fantasy hasn’t helped me with that one.”

And do you find your murderous fantasies a turn-on?”

She taps her lips with her left index finger, considering my question. “I guess. But the turn on is having the power to figure something like this out – not dummy Gina after all. It’s exciting.” Pause. “Don’t you think it’s exciting?”

Suddenly I’m convinced that everything that’s happened in this room today is about Gina and my relationship. 

“Gina, I wonder if we can step back for a minute. It feels to me that you’re trying to one up me..”

“What are you talking about?”

“Well, I think you’ve tried to make me jealous, tried to titillate me with your sexual stories, dangled withheld information in front of me, and terrified me with talk of murder.”

“You have one warped mind if you think I’m trying to turn you on!”

Interesting comment, I think to myself. “I didn’t say that you were trying to turn me on. I think you’re trying – and I’m not saying it’s conscious – that you’re trying to make me feel less than you, trying to win over me, just as you tried to win over your mother to be closer to your father.”

“I’ve told you, I did win! My father called me ‘the beauty.’ It’s me he wanted to twirl around in my new clothes. It’s me he took to breakfast on Sunday morning, just me, not my mother, not by brothers.”

I think, but reject saying, ‘but who went into the bedroom at night?’ a remark that feels both premature and hostile. “Let’s go back to us for the moment,” I say instead. “You started the session talking about your friends being jealous of you. Seemed as though you wanted me to be jealous too, like you’re flaunting your beauty, your sexuality.”

Gina looks at me coyly. She drops her head for a second and then looks at me defiantly, “I don’t want to be mean, but you’re not a worthy opponent. You’re too old.”

“Wow!” I say. “You’re correct. I’m considerably older than you. But the way you just said that, sounded like you were intent on delivering a death blow. I guess I’m another murder victim.” 

The Dream

“I had a dream last night,” Justin begins, squirming nervously in his chair. “I can’t remember any of it, but I feel haunted by it. I know that doesn’t make much sense, but it’s like I woke up scared, like something terrible is going to happen, like something or someone is going to get me. I kind of want to keep looking over my shoulder. Even here, I wonder if there’s someone else in the room, although I know that’s ridiculous.”

Justin, a 45 year old accountant, has been my patient for several years and, as far as I can remember, has never before spoken about a dream.

“Well,” I respond, “the dream obviously affected you, so maybe you can talk about your feelings and what those feelings bring to mind.”

“You’re charging your phone,” he says.

“Yes,” I say, surprised. It’s not unusual for me to charge my cell phone while patients are in the office.

“How do I know you’re not recording me?”

Justin can sometimes be a bit paranoid, but his question is beyond anything I would expect. “I guess you are feeling frightened, Justin. Your world suddenly feels very unsafe so even innocuous things can feel threatening."

"You didn’t answer my question.”

I’m taken aback, perhaps even a little frightened myself. Hmm, I imagine Justin is unconsciously inducing his feelings in me. “No, I’m not recording you. You’ve seen me charge my phone before, so I’m assuming that your concern is being triggered by your fear.”

Justin stares at me. My fear builds.

“Would you like me to unplug my phone?” I ask.

“I’d like you to turn it off,” he replies woodenly.

“Okay,” I say as I lean to my left, pick up my phone and turn it off.

The silence that ensues is deafening.

Finally, Justin drops his head in his hands, shakes his head and mumbles, “I’m sorry, I don’t know what’s wrong with me.

I breathe a sigh of relief. “So let’s see if we can figure out what’s going on, perhaps what triggered the dream, what might have led you to feel so frightened.”

“It’s such a terrible time of year. Tax time you know. Some days I’m working 5AM to 10PM at night. And everyone wants a piece of me. My ex-wife’s mad because I haven’t taken the kids. My older son says he needs money for college. My clients are driving me crazy. Everyone wants their taxes last week. I keep telling them it’s no big deal if we have to file an extension. But, no, that’s not good enough.”

“When you say everyone wants a piece of you, what comes to mind?”

“That’s it!” he says excitedly. “That’s what was happening in the dream. Everyone was pulling at my skin, like they were trying to rip me apart. I know there was more after that but …” He stops. “I think there was like a monster there. Maybe like a monster waiting to eat the pieces of me that they threw to it.”

I grimace internally. “That does sound terrifying.”

Silence.

After a few moments I ask, “What’s going on in your head?”

“I don’t know. I sort of feel I used to have that nightmare as a kid. A lot.”

“Any thoughts about it?”

Silence.

“I’m sorry,” he says after a few moments. “I suddenly felt frozen. Like I couldn’t move. And… I know this is ridiculous, but you seem menacing again.”     

“What is it that you’re afraid I’ll do?”

“I know this is crazy, but what jumped into my head was, eat me.”

“Like in the dream.”

He nods.

“Any thoughts?” I ask, although I have a pretty good idea of the answer.

He nods again. “Yeah, my mother. I used to say she loved me to death. But I guess I meant that literally. She wanted all of me. She didn’t want me to have anyone else in my life. She didn’t do that to my sisters, just me. They hated me, thought as the boy I got all of my mother. But I didn’t want all of her! And I sure didn’t want her to have all of me! Yuck! I feel beyond creeped out. I mean, I know we’ve talked about all this before, but having that dream made it so much more real.”

“The dream actually brought you back to the feelings you had as a child, the terror of being eaten, of being swallowed up.”

“Stop! I can’t deal with any more today.”

“Of course. Whatever feels comfortable for you.”

Justin looks at me with tears in his eyes. “I wish my mother could have been concerned about my comfort. And I’m sorry I thought you were recording me.”

“Nothing to apologize for. Totally understandable given what you were feeling.”

Choose Me

“I don’t understand!” Marcy shrieks at me, continuing the stalemate we have been have been in for weeks. “Why won’t you just tell me I’m your most favorite patient? You know that I am. You know that you care about me more than anyone else, that you love me, so why don’t you just say it!”

Thoughts race through my mind as my patience runs thin: ‘You’re upping the ante. Now you want to be the person I care most about in my life, the person I love above all others. You’re certainly not being very loveable right now.’ I remain silent.

“Why don’t you say something?” Marcy yells.

I sigh. “Truthfully, I don’t know what to say. We’ve been arguing about this for weeks. We know that your mother abandoned you to the care of her sister. We know that your aunt clearly favored her own daughter over you, that you felt like a second class citizen, like Cinderella, as you say. And all these things are horribly sad and painful for a child, but there’s no way I or anyone else can make up for that. If I told you you were my favorite patient, that wouldn’t take away your pain about your mother or your aunt.”

“Then what good are you?”

“I’m here to help you mourn the past, to be sad and angry, sad and angry, sad and angry about what you didn’t get as a child and then to be able to accept what was and to move on, able to take in the good from others in the present.”

“Is that a script you read? You say the same stupid shit all the time,” Marcy responds, crossing her arms in front of her chest, chin raised, staring at me defiantly.

I’m pissed. I remain silent while I try to collect myself.

“What?” March says.

“You know, Marcy…” I begin before she interrupts me.

“Oh,” she says sarcastically, “here comes the lecture.”

I ignore the interruption. “It’s interesting to me how much your behavior is counterproductive.”

“What’s that supposed to mean?”

“You say you want to be my favorite patient, but you behave in a way that would make you anything but my favorite patient.”

“Oh! So now I’m supposed to be Miss Goody Two-Shoes. I thought you always told me – for years and years in fact – that I was supposed to say everything I was thinking, not censor anything.”

“I’m not suggesting that you censor what you say. I’m suggesting that what you say has consequences.”

“So now you’re threatening me?”

‘Stay calm’ I tell myself, knowing Marcy wants to provoke me. “The more you angrily demand that someone care about you, the less likely that person – me in this instance – is going to respond the way you want. So the question becomes why do you behave in a way that is least likely to get you what you want?”

“Don’t change the topic,” Marcy demands.

“I’m not…” I stop myself. “That last comment, for example. You know I’m not changing the topic. You’re just being provocative and trying to not consider what I’m saying.”

“OK, smarty pants, why don’t you tell me why I behave this way. I know you have some nice little theory floating around in your head.”

“Let me ask something else first. What would happen if I did tell you you were my favorite patient?”

“I’d ask if that meant you loved me.”

“And what would you feel if I told you I loved you?”

“I’d need you to prove it. Like, would you see me for free?”

“So you’re saying you’d add more and more demands until you got to a place where you could again feel unloved and unchosen.”

“Why would I do that?”

“Good question. Why would you?”

“I don’t know.”

“I suspect you unconsciously want to be rejected so that you can stay connected to your rejecting mother and aunt who walk around in your head. If you take in the good, the caring in the present, then – here’s my script again - you have to mourn what you didn’t get in the past. You have to give up the hope of getting the love you needed and deserved as a child from the people in your life who were supposed to care for you but never came through.”

“That sounds way too hard.”

“I wonder if it’s any harder than repeatedly demanding love from people in the present in such a way that you insure you’ll never get it.”    

Infidelity

Jeffery throws himself in the chair across from me looking more disheveled and distraught than his usually calm, poised presentation of a mid-forties successful financial advisor.  

“I couldn’t wait to get here. I almost called and asked if you had a double session available today or any more sessions available today at all. Do you?”

Thinking about how reluctant Jeffery has been to increase his therapy sessions to more than once a week, I say, “I’m sure I can see you later this afternoon, but first why don’t you tell me what’s going on.”

“My wife told me she wants us to have an open marriage.”

Many thoughts go through my mind, including the sarcastic, ‘so now the shoe’s on the other foot.’ Instead I say, “Her request obviously disturbed you.”

“Hardly difficult to figure that out. Can you imagine?! My wife! The prissy little woman who left me begging for sex.”

“Jeffery, what’s so disturbing about her asking for an open marriage?”

“That’s a dumb question.”

“You could look at her request as freeing you to see as many women as you wanted without having to sneak around.”

“But she could also see as many men! In fact, she already has. She told me at first she wanted to get back at me for all the women I saw on the side – even though I never admitted to seeing any other women. So she went online and started going out on dates when she knew I’d be out. And then she’d have sex with them. It almost made me throw up to hear that. And then she told me she’s come to enjoy it and wants to be able to do it openly. Ugh!”

“Jeffery, I know you might think these are dumb questions, but why is a man who never followed his marriage vows, so disturbed about his wife wanting the same freedom?”

“It’s not the same. She said she did it because she wanted to get back at me, meaning she must have been angry at me.”

“And does that give you an idea about your own motivation?”

“I wasn’t angry at my wife.”

“’A prissy little woman who left me begging for sex’ doesn’t sound not angry, but maybe it’s more than just your wife you’re angry at.”

“That theory again. I’m angry at my mother for dying and leaving me and therefore I’m angry with all women. I don’t buy it.”

“Can you think seriously for a moment why you might not buy that theory?”

“It’s just a cliché.”

That’s not a moment’s worth of thought, I think. Then I realize I’ve had several sarcastic thoughts this hour. Am I angry with Jeffery for being unfaithful? But I’m not angry with other unfaithful patients. Am I feeling Jeffery’s conscious or unconscious anger at me? Certainly a possibility. Am I angry with Jeffery for not accepting anything I offer be it a question, an interpretation or a request? Another possibility.

“Have you ever noticed Jeffery that you rarely take in anything I offer?”

“For heaven’s sake, my wife just told me she wants an open marriage and you want to talk about us.”

I think, ‘well, there’s an example,’ but I swallow that sarcastic response and say, “Perhaps there’s a connection between the two, Jeffery.”

“What!?” he says, roiling his eyes towards the ceiling.

“I wonder, Jeffery, if the reason you feel angry with women is that you’re afraid of being dependent on them, of needing them.”

“That’s ridiculous.”

“Again, I’m going to ask you to think about what I just said and to try and take it in.”

“It doesn’t make sense to me,” he responds immediately.

“Okay. Let me ask you something else. Do you still want that second session today?”

“What!? You’re more scattered than I am. If it’s going to be like this, no, no I don’t want it.”

“I think you’re afraid of having to rely on women – particularly your wife and me - because either you’re afraid you’ll lose us or become so dependent on us that you’ll feel the extent of your own neediness. And if you reject my idea without considering it you’ll have proven my point.”

Jeffery laughs. “I guess I can’t win.”

“It depends what you want to win,” I say very seriously. “If you want to get to the place where you can have close, meaningful relationships with women, you can definitely win.”

“And what would I need to do to make that happen?”

“I guess you could start by accepting that session later this afternoon.”

“That was a trick.”

“No, it wasn’t a trick. When you were extremely distressed you wanted to see me as much as possible, but once you were here, you had to reject your desire to rely on me by refusing the second session, just as you’ve rejected coming more than once a week.”

“Okay, okay. I’ll come in later this afternoon.”

“I’m glad.”   

Seeking Protection and Connection

I smile at my new patient, Eileen, as I greet her in the waiting room, extending my hand in introduction. She doesn’t return my smile, but does warily shake my hand. Settling herself stiffly in the chair across from me, she looks slowly around the room.

Oh oh, I think, seems like a pretty disturbed woman, at best distanced and removed, perhaps paranoid, maybe a trauma survivor.  

“I like your office,” she says. “All the windows. Feels free, like floating in space.”

“Thank you,” I say, not sure how to take her comment. An attempt to relate to me? A fear of being confined? A desire for freedom? Hopefully not a wish to jump.

A few moments pass in silence.

“What brings you here?” I ask in traditional therapist mode.

“I have no friends.”

“Can you say more?” I ask, while thinking that her demeanor would certainly make having friends difficult.

“I’m 36 years old. I live alone. I work at home. I’m an IT person, a computer geek.” She shrugs. “There’s no one in my life.”

“Sounds sad.”

“I guess.”

“How do you feel about not having friends?”

“It doesn’t seem normal. People are supposed to have friends.”

“Eileen, what made you decide to come into therapy right now?”

“I found you online. You had a kind face. I liked your website.”

“Like maybe you hoped I’d be your friend?”

“Maybe.”

“Eileen, can you tell me a little about your background, your childhood, your family.”

“It was messed up. My parents divorced when I was two. They’re both alcoholics, drug addicts, both with so many different partners I lost count. And a ridiculous number of so-called siblings. I’d go from one household to the other. Sometimes there would be six, eight of us in a small apartment. I hated it. Felt like I couldn’t breathe. I just wanted everyone to leave me alone. And basically they did.”

“So you learned to put up a wall that said ‘stay away.’”

“Yeah, that’s a good way to put it,” she says nodding. I have the sense she’s pleased by my understanding, although there’s no obvious change in her demeanor.

“Have any idea what’s behind that wall?”  

“What do you mean?”

“Well, when you construct a wall, there’s usually something behind it, something you’re wanting to protect, perhaps something that feels vulnerable or scared.”

“I don’t do vulnerable or scared.”

“So it feels pretty scary to be vulnerable or scared,” I say smiling compassionately. I find myself liking Eileen, feeling sad for the deprived, needy child who must exist behind what feels like an impenetrable barrier.

“I didn’t say that,” she says, stiffening.

“Sorry,” I say, backing off. This is going to be slow, slow going. I need to be careful not to push to glimpse behind that wall too quickly. Her defenses are there for many reasons. They need to be respected, not ripped away.

“You said earlier that there’s no one in your life. Do you see your parents?”

“Not if I can help it. Maybe once or twice a year. Christmas time, Easter. Maybe not.” She shrugs. Doesn’t much matter to me.”

“Was there anyone in your life who did matter to you when you were a child?”

“Like who?”

“A grandparent, a teacher.”

“A math teacher in middle school. She thought I was more than a dumb oaf. She encouraged me. Maybe she was like my friend, except she was my teacher so she couldn’t be my friend. But she’s the one who helped me make something of myself. I don’t know where I’d be if it weren’t for her. Probably just like my parents. Except without the drugs. I’ve never touched drugs in my life. Swore I never would and I haven’t.”

“That’s pretty amazing determination, Eileen, given where you came from and what you’ve been through.”

“Mrs. H – that’s the teacher – she’d say things like that.”

“And when she or I say things like that, you feel a sense of warmth, of being understood and appreciated.”

She looks down. “Yeah, I guess that’s right.” She pauses. “So are you going to help me learn how to make friends?”

“Yes, Eileen, I am. But we have a lot of work to do before finding friends becomes our focus. First we have to help you find you. We have to find the person behind your wall and that’s going to take time. You’ve been hiding from that person for a long time and a sledge hammer isn’t going to work here. And I suspect it’s going to be painful and scary for you. I’ll be here with you and hopefully that will make it easier, but I’m sure there are times it will be tough going.”

“I’ve been through tough before.”

“Yes, I’m sure you have.”