Risk Averse

 “I was talking to my friend Cindy last night,” Jenny begins. “She said she came across this quote from Eleanor Roosevelt ‘Do something every day that scares you.’ I was blown away. That’s just what we’ve been talking about, right?”

“Yes,” I agree nodding. “That’s a very profound quote.”

“But I thought you said you have to feel safe in order to take risks.”

“That’s also true. But if you wait until your last, last drop of fear and anxiety is gone you might stay stuck forever.”

“I know,” Jenny says dejectedly. “That’s why I’m here,”

“You’re 25 years old Jenny, I don’t think you can say you’re stuck forever.”

“I know. But we’ve been working for a while now and there are still so many things I’m terribly, terribly afraid of. Meeting new people is a total, complete trauma for me. I hate the first few weeks of school. There are so many new people, new faces, new expectations, new, new, new.” 

“And what is it that you’d say you’re afraid of?”

“That’s no secret. The wicked step-mother! What a cliché.”

“Except your step-mother was a little more wicked than most.”

Jenny seems to fade away and soon starts visibly shaking.

“Jenny, where are you? Can you come back?”

“I’m here. I didn’t dissociate. At least I don’t think I did. I knew I was here with you in your office.” Pause. “But perhaps part of me was back there, back in that basement,” she says starting to cry. “Why, why did she hate me so much? What did I do that was so terrible?”

“Jenny…”

“I know. You’re going to say I didn’t do anything. That she hated me because I took my Dad away from her, because she couldn’t have him every minute of his life. But maybe that means I was too demanding, wanted too much!” she adds sobbing.

“Is that how it feels, how it felt?”

“Yes, that I was just a greedy child who would suck her father dry unless Darlene stepped in to protect him! After all, I had killed my mother, why wouldn’t I kill him?!”

“Do you feel you killed your mother?”

“Of course!” Pause. “No, no I didn’t kill my mother, she died of cancer!”

“Jenny, it sounds like the rational you knows that you didn’t kill your mother, but perhaps there is a piece of you that feels you did.”

“She died so soon after I was born, before I was one. I don’t remember her at all,” she says sobbing. “Is that killing her? Not remembering her?” Pause. “Maybe I infected her when I was inside her. Maybe there was something so bad about me I contaminated her.” 

Although the rational me, yearns to counter Jenny’s assessment of her culpability, I wait to see what more primitive material Jenny may unearth. 

“Darlene would always tell me I was a bad seed, destined to do nothing but hurt and destroy. I fought her, screaming, yelling, thrashing, but she only hurt me more, left me starving in the freezing cold basement. It gets cold in Vermont in the winter. But, truthfully, I believed her. I believed I was a bad, bad person. I had killed my mother. She gave up her life for me. Even neighbors said that. ‘Your mother loved you so much. She gave up her life for you.’ She gave up her life for me and I was so, so angry with her. If she was going to have me, she should have stayed with me!! If she was going to leave me she should never have had me!” Jenny says, sobbing.

I want to go her and hold her and tell her nothing was her fault and that everything will be all right. Instead, I sit calmly in my chair. 

“I never said that out loud before,” Jenny says between sobs. “It feels good to say it out loud.”

“What feels good about saying it out loud?”

“I’m not sure. Sort of like I can examine it in the light of day.”

“And what do you see when you examine it in the light of day, in the light of an adult day?”

“Yes, that’s it. Saying it out loud brought it into the present, into me as an adult – sort of. It’s like a child fantasy that I’ve carried around my whole life and in the light of day – in the adult light – it doesn’t feel as real or as powerful.”

“It’s time for us to stop for today, Jenny, but you’ve done amazing work here today. I hope you’re able to be proud of yourself.”

Yes, yes I am,” she says smiling for the first time. “Thank you.”

“Thank you,” I say.

The Truth, the Whole Truth, and Nothing but the Truth

Maxine sits comfortably in my chair, runs her hand through her curly brown hair and begins. “I came to therapy because I keep having fantasies about killing my daughter.”

Oh oh, I think, remaining silent and neutral. Maxine seems a bit taken aback by my silence. What she doesn’t know is that I am immediately on guard, unsure if I am about to hear a story that is truly every therapist’s nightmare, or one that is completely fabricated. A colleague told me she saw a new patient who told her a similar story and then admitted it was only a test for the therapist.

“I don’t know why I’m having these fantasies,” Maxine continues. “I love my daughter. We’ve always been close.”   

Not wanting to accuse a truly troubled person of lying, I decide to go along and see what develops. Of course, a woman who goes from therapist to therapist fabricating a story, must be pretty troubled as well. “What’s your guess?” I ask. “Why do you think you have been having these fantasies? How long have you been having them?”

“It was right after Barbara’s – that’s my daughter – right after her thirteenth birthday, about six months ago. I don’t know why I’m having the fantasies. If I knew I wouldn’t have come here. What do you think?”

I think this is a sham, but I’m still reluctant to confront Maxine.

“It’s pretty hard for me to have any idea since I know next to nothing about you.”

Maxine sighs, seeming exasperated.

I’m rather annoyed myself, but try to return to my more neutral tone. “Can you tell me about you?  What’s your present life like? Married? Other children? Working? And what was it like for you growing up?”

“I’m a stay at home Mom. My husband is an entrepreneur. He travels a lot. I was thinking I should probably go back to work. With Barbara growing up there’s not that much for me to do.”

“What are your feelings about Barbara growing up.”

“Mixed. I’d like my little girl back and I’m looking forward to seeing where my life takes me.”

“Where do you want it to take you?”

“I’m not sure yet. I think that’s one of the reasons I feel so dissatisfied with myself.”

I find myself liking Maxine more, yet feel entirely confused about what’s going on in the session or what’s real and what isn’t. I decide to take the plunge.

“Maxine, what of what you’ve told me today is true and what isn’t?”

“You figured it out! You’re the first one. Oh good, now you can be my therapist.”

“I had a rather big clue. One of my colleagues told me she’d seen a patient who told her a pretty similar story and that it was supposed to be a test for the therapist.”

“Oh! What a disappointment. Now I can’t tell if you’re really smart or not.”

“Maxine, you must by now know from therapists’ reactions that it’s quite insulting and infuriating to be tested by a series of lies. But I’d like to know the underlying reason you found it necessary to go through this charade.”

“I didn’t think I could trust someone who wasn’t smart enough to figure me out.”

“Well, I’d guess that you definitely feel you can’t trust people and I’d also guess that you see yourself as very troubled and in need of someone who can not only understand you but handle you as well.”

“You are smart. You can be my therapist.”

“But this is a two way contract. There’s the question of whether I feel I’m up to being your therapist.”

“Please, please, I’ll be good.”

“You sound like a scared little girl when you say that.”

Maxine starts to cry.

“Maxine, I know this is unusual for a first session, but this has been an unusual first session anyway. I want you to tell me what the secret is.”

“No, no, I can’t. Not yet.”

“I’m sorry. That’s my condition for us starting therapy. And if you tell me another lie you’ll only be hurting yourself. There’s something you’re terribly afraid of or guilty about, something you need to start dealing with even though you want to keep it hidden.”

“I killed my sister.”

“Is that another lie?”

“No, no, it isn’t. I wish it were. I didn’t do it deliberately.” Maxine’s next words are flat, expressionless. She stares straight ahead. “A group of us were playing soft ball. I was at bat. I swung. I lost control of the bat. It hit my sister in the head. She died. My parents sent me away.”

“I’m so sorry, Maxine. What a horrible accident. How traumatic. And then to be sent away on top of it. I’m really, really sorry.”

“So you’ll be my therapist?”

“Yes,” I say, although I realize that it will take me some time to totally trust what Maxine tells me.  Hmm, I think, Maxine has led me to feel the distrust she feels in the world.   

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.”

The Ones Left Behind

March is a difficult month for Lillian. It has been over 20 years since her first husband killed himself, but the anniversary invariably brings up feelings of guilt, pain, remorse, and anger.  

Today she seems depressed, distracted, not quite in the room with me. 

“My daughter called last night. Told me she started having her nightmare again – a loud noise, a blood splattered room, people screaming. I know she never saw that. Dave didn’t kill himself at home. And she was only a baby.” Lillian sighs, tears beginning to well in her eyes. “I can’t understand how he could do that to her, to us. Billy won’t talk about his Dad; he won’t even acknowledge him. Says that Philip is his father. I know he’s angry. They’re both such good kids.”

“And you?” I ask gently. “How are you doing?”

Lillian shakes her head. “I don’t know. I’m sad. I wonder if there was any way I could have stopped it.” She pauses.  “I’m such a liar,” she suddenly exclaims. “I can’t stand myself. I told myself I was going to tell you today. I was going to come clean. Clean! I don’t think I can ever be clean! I don’t deserve the life I have. I don’t deserve Philip. I don’t deserve anything!” Lillian says, shifting from side to side in the chair.

“The grieving widow, right?” she continues. “That’s what you always thought? That’s what I’ve always portrayed! Except it’s not true. I killed him. It’s my fault. It’s as much my fault as if I had fired the damn gun myself!”

I breathe. For a moment I thought Lillian was actually confessing to murder. Now we’re on safer ground. Lillian, I assume, is again caught up in her guilt. But then a patient I had seen much earlier in my career makes her way into my mind, a patient who often came into my thoughts when I was seeing Lillian. 

My earlier patient, who I saw only briefly, wanted to divorce her husband who she described as depressed and withdrawn. She was involved with another man who was vibrant, alive, exciting. She wanted out. I asked what kept her in her marriage. The children, she said, as well as her mother. They’d disapprove. Given her description, I asked if her husband was suicidal. She didn’t know.

In fact, her husband did kill himself. She came to see me one last time. There were no tears, no guilt. She was free. She destroyed the suicide note, she told me. It wasn’t a nice note. I never saw her again.

I suspected Lillian would tell me a similar story. And she did. Similar, but not identical. 

“Dave was a good man,” she begins. “He was a good provider. But we’d married so young. Our life had become boring, routine. Sex was a chore – for both of us I think. I’m not trying to defend myself. I know what I did was terrible. I started having flings. One of the flings turned into something more. Were we in love? Who knows. I didn’t think Dave knew. I thought I was careful and he never said anything. And then he killed himself. I stopped seeing my fling immediately. I never told anyone. I never thought I’d be with anyone ever again. But then there was Philip. He’s more than I deserve.”

“I’m really glad you told me, Lillian. What a tremendous amount of guilt you’ve been carrying around.”

“Yes, but it’s a burden I deserve to carry.”

I think about my earlier patient, about her cavalier reaction to her husband’s suicide and contrast it with the burden of guilt Lillian has carried with her for so many years. Am I looking for a way to lighten Lillian’s burden? No doubt.

“I can’t take your guilt away, Lillian, but I wonder if you haven’t suffered enough. Do you ever get to forgive yourself?”

Lillian stares at me intently. “You don’t think I’m evil,” she says matter-of-factly.

“No, Lillian, I don’t think you’re evil. Many people have affairs. I’m not saying that’s right or wrong. It’s not up to me to make that determination. But I do know that not everyone who has an affair has a spouse who commits suicide. It was Dave who pulled the trigger, not you. But I’m sure we’ll have lots to talk about in the coming weeks.” 

Inching Forward

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.”

Shamed

“I feel as though I’m getting worse!” Jason says desperately. “It’s getting so that I can barely get myself to class. All I want to do is stay in my room and play computer games.”

“I think that’s because we’ve just started talking about the abuse.”

“I hate that word. If I told my friends they’d say I was one lucky guy, that they only wish they could have been in my place.”

“But you haven’t told your friends, Jason,” I say gently. “You’ve never told anyone but me. Why is that?”

Jason drops his head. He’s a tall, gangly 20-year old. With his red hair, freckles, and dimples, he’s cute rather than handsome.

“You know why,” he mumbles.

“Yes,” I nod, “I do. You feel ashamed. And you feel ashamed of

feeling ashamed. You think you should be happy, thrilled even, that your high school algebra teacher picked you to initiate into sex. But that’s not what you feel. You feel ashamed. And it’s important that we understand why that feeling haunts you. Can you tell me what did happen, Jason? How it started? Where it took place? What it felt like for you?”

“You’re joking, right? You want me to tell you all the details!!”

I have to be careful. I don’t want Jason to experience me as yet another abuser. “I understand this is difficult for you. I think you’ll eventually feel less shame if you can speak about your experience, but you can do it in your own time, however feels least uncomfortable.”

“I’ll try,” Jason says, turning red. “It started as kind of a dare. Miss Johnson was young, for a teacher I mean. And she wasn’t bad looking either. My friends and I joked around, talking about who could get in her pants. It was just joking. But then we started to create scenarios about how we could actually do it. I don’t think any of us had been with a girl. Well, maybe one or two, but certainly not me. So I started to think up a plan. I actually was good in algebra, but I started to get not so good. I’d make mistakes on tests, ask simple questions in class. Eventually, I asked Miss Johnson if I could come after school one day, if she could tutor me, that maybe she could help me out. Oh God! I can’t stand hearing myself say this out loud! I planned the whole thing. It’s my fault!”

“You feel guilty, Jason, because what you supposedly wanted to happen, happened. Except that Miss Johnson was the adult and you were the child and it was her responsibility to maintain the limit.” I think of all the patients I have said this to over the years – patients abused by one or both parents, by various relatives, neighbors, clergy, teachers. The list goes on, but the child always ends up blaming him or herself. As painful as guilt may be, it is preferable to feeling powerless in the hands of demanding, capricious, insatiable adults who are supposed to be your caretakers.

I continue, “And it’s still a long way from a deceptive prank to a sexual encounter.”

“I went back a few times. And of course I improved since I knew all the stuff to begin with. Miss Johnson was so pleased that one day she asked if I’d like a soda as a reward. I told her I didn’t know how I’d get home ‘cause I had to catch the last bus. She said she’d drive me.”

Jason speech quickens, “So we had our soda and then she drove me, except she drove me to her house, and I couldn’t do anything and I felt horrible and she took me home and told me it would be all right. Then we did it again and I was hardly any better. And then she never asked me again and that was the end of it.”

“So not only did you feel it was your fault for wanting Miss Johnson, you felt inadequate because you weren’t a good enough lover.”

“I was shit! And she knew it!” Jason says.

Again, memories of previous patients of sexual abuse flood me. Just as guilt is invariably a part of the aftermath, so are feelings of inadequacy. I look surreptitiously at the clock. Only a few minutes left. I need to close this in a way that doesn’t leave Jason feeling intolerably raw.

“Jason, you’ve talked about a lot of hard stuff today and it’s almost time for us to end. What you’re feeling - the shame of not being good enough, of not being adequate. You have to remember that you were a child. Children aren’t supposed to be sexual. They’re supposed to be children. I know my saying this doesn’t automatically make you feel better but we’ll work on it. I promise.”