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.”

Compassion

“You don’t understand!” Morgan screams at me through clenched teeth, hitting the sides of her head with her fists. “I hate myself! I hate myself! I’m stupid and ugly and awful. Bad! Bad! Bad!”

“Stop it, Morgan,” I say raising my voice. “You know you’re not allowed to hurt yourself in my office. Stop and try to calm down.”

Morgan brings her fists in front of her eyes and bursts into tears. I silently breathe a sigh of relief. She continues to sob.

“I’m here, Morgan,” I say gently.

She nods, still crying. 

“She’s such a bitch,” Morgan manages to say through her tears. “But why am I such a mess? I should know it by now. She’s the golden child. Everything good comes to her. And me? I’m just bad and deserve everything I get.”

“Morgan, is there even a little part of you that knows that’s not true, that knows you were a small, helpless child who deserved to be cherished, not beaten?”

“Nope! You just said it. I was small and helpless, by definition that made me bad.”

“But all children are small and helpless, Morgan.”

“But not all children are illegitimate.”

“That was hardly your doing.”

“Tell that to my mother. I was born, ergo it’s my fault. And then Prince Charming comes into the picture and the golden child is born and I’m even more worthless than before. And now not only does Mom get to beat up on me, but my sister does too. You should have heard her gloating. Gloating! I mean I get it. She’s happy she’s pregnant. I should be happy for her. But gloating. Like it was a contest. I can’t even get a relationship and she and Rob are going to be the ‘happiest people in the world. You’ll know what I mean when it happens to you.’ Gag! I thought I’d throw up. But that’s because I’m bad. Because I can’t love my sister, because I can’t be happy for her.”

“It’s very hard to be happy for someone who smiled sweetly after she got you in trouble and watched you be beaten.”

“But I deserved it! I did pull her hair, or steal her doll, or punch her. I hated her! I still do. And that makes me really, really bad.”

“Does it?”

“Doesn’t it? Aren’t you supposed to love your sister? Aren’t you supposed to turn the other cheek?”

“Your rage at your mother had to go somewhere.”

“See, that’s exactly what I mean. I was a rageful brat. And if I couldn’t rage at my mother, I turned it on my sister. Charming!” 

I sigh. “I always feel as though I’m arguing with you, Morgan, always trying to convince you that you need to have compassion for yourself…”

Morgan interrupts me, snorting her disdain. I continue talking.

“…that you need to have compassion for yourself as the scared, helpless child you were and understanding for yourself as the angry adult who keeps turning that anger on yourself.”

“Compassion doesn’t exist is my vocabulary, let alone in my experience.”

“If you read about a child who was beaten with a belt, who was locked in a closet, who was repeatedly sent to bed without food, wouldn’t you feel compassion for that child?”

“Maybe. But for me, for me I feel only hatred. I was bad. My mother was trying to beat the badness out of me. If my mother was bad she would have beaten my sister too. But it was only me, only me who needed to be beaten.”

“I do understand, Morgan, that you have to hold on to the belief that you were the bad one because as long as you’re the bad one you still have hope you can be different and win your mother’s love. But if she can never love you – perhaps because of the circumstances of your birth, perhaps because you reminded her too much of her – then the hope of her loving you is gone and you’re left in mourning, without the only mother you ever had. And that’s sad, Morgan. Very sad. And you need to find compassion for yourself.”

“There’s that word again. You don’t get it. There’s no word like that for me. It’s as though you were speaking Chinese.”

“I do understand that compassion feels entirely foreign to you. But you need to find your compassion for yourself, perhaps by first taking in my compassion for you. Your life has been terribly painful and unfair and you need to be able to feel sad for you.”

Losses

“I couldn’t wait to get here today,” Carol says, practically breathless. “I had the most awful dream. It’s not as though anything so awful happened in the dream, but it felt awful.”

I have been seeing Carol in intensive treatment for many years. She entered therapy her mid-40s, terrified of being depressed and non-functional like her mother. She felt overly anxious and unsure of herself and although by all external appearances she had a successful life, inside she felt like a scared little girl.

“In the dream,” she says, “I was back in the apartment I grew up in as a child, which of course was awful in itself. I was sitting at the same shabby kitchen table I sat at as a child. We were having dinner. It was just me and my parents. I don’t know where my sister was. Maybe she had a fight with my father and stormed out. My mother was her usual depressed self, beaten down, defeated. My father was stuffing his mouth, but I had the feeling he was fuming. Of course he was always fuming, so that’s no surprise. I felt terrified. I don’t know if I was waiting for my father to explode. I don’t know, but I hated it! I hated that I was dreaming of that place again.” 

“What comes to mind about the dream?” I ask.

“I don’t know. It seemed to come out of nowhere. You know I’ve been feeling really sad since Thanksgiving. I would have thought I’d be dreaming about that, all the losses. You remember, sitting around my daughter’s table and thinking of all the people who weren’t there.”

I did indeed remember. Thanksgiving brought up similar feelings for me, an awareness of all the absences, all the people who had died. 

She continues. “My husband dead of pancreatic cancer, my son killed in Iraq, so many of my friends. I’m only 50, how can there be so many people in my life already dead. I mean I love my daughter and she made a beautiful Thanksgiving, but the losses, the losses overwhelm everything.” 

She pauses, dabbing tears from her eyes. “So what am I doing dreaming about my childhood apartment? That’s one thing I don’t mind having lost. I guess I felt sad when my mother died, but in many ways I thought she welcomed death. Now at least she could be at peace. And my father, I know it’s terrible, but truthfully his death was a relief.”

“So why do you think you’re dreaming of your childhood apartment at this time?” I ask, a thought forming in my mind. I also used to dream of having to leave my idyllic home and adult life and return to the apartment of my childhood. For me those dreams were about my fear of loss, of losing what I so cherished in my present, adult life. For Carol many of the losses have already happened. 

“I wish I knew.”

“Is there a connection between the losses you felt so acutely at Thanksgiving and the dream of returning to your parent’s apartment?” 

“What I just thought is, maybe there’ll be no one left, maybe everyone will die, maybe there’ll be no place to go. If there’s no one left, maybe the only place I can go is to go back to them! I mean I know that doesn’t make logical sense because they’re dead too, but maybe that’s how it feels. If everyone leaves me, I’m back to being an abandoned child, a helpless, dependent child who has to go back to my parents.” She starts sobbing. “No,” she whispers. “No, that won’t happen. I have you. And as long as I have you, I don’t ever have to worry about going back there. You’ll remind me I’m not that helpless, dependent child. And if I do slip into that helpless place, you’ll be here to help me back up.”

I hesitate. We’re near the end of the hour. This has been a difficult session for Carol. But… “Carol, I wonder if you realize how much you’ve been your own therapist this hour, how much of me you’ve taken in over the years…”

“You’re not leaving are you?” she interrupts, panicked. “You’re not retiring? You’re not dying?” Her fear is palpable.

“I have no plans to go anywhere. But as you well know, we never know what life has in store for us. I do know I won’t live forever. And I also know that you’ve taken in so much of me. Did you recognize, even just in this session, how much you were able to do your own therapeutic work?”

“But…” she begins.

“We’re not ending, Carol. I’m not going anywhere. And it is also important that you recognize your own strengths. They don’t reside in me. They live in you.” 

There’s Something Wrong With Me

Staring down, Cristina pulls at the fingers of her hands. She has been unable to say anything since entering my office.

As Cristina’s silence continues and her tears fall silently from her eyes, her pain becomes palpable. “I can see how much pain you’re in, Cristina. Can you tell me what’s wrong?”

She shakes me head. But then she practically whispers, “Me. I’m wrong. I’m all wrong.”

Although I have no idea what Cristina’s referring to, I feel the heaviness of her burden.

“I’m sorry you’re in so much pain, Cristina. Can you tell me what’s causing your pain?”

“There’s something wrong with me,” she replies, barely audible.

“Can you say what makes you feel there’s something wrong with you?”

Tears pour down her cheeks. She makes no attempt to wipe them away.  

“I can’t love her,” she says looking up at me beseechingly. “What normal mother can’t love her child?” She pulls harder at her fingers. “They said it was post-partum depression. And maybe it was. But no one has post-partum depression for two years. And, besides, I didn’t feel that way with my son. Peter was my precious baby. I couldn’t stop holding him and cooing at him. I loved him instantly. And I still do. But with her, it’s different. It was different from the start. And it hasn’t gotten any better.”

“So your daughter is two and your son is …?”

“Five.”

“And her name is …?” I ask, aware that she spoke her son’s name, but not her daughter’s.

“Caroline. I want to love her. I do. But it’s not there.” Pause. “Can you help me? Can you cure me? Can you make me normal again?”

“I can certainly help, but it isn’t like you have a disease, Cristina. I understand that you want to love Caroline, but perhaps first we have to understand why your feelings about Caroline are different from your feelings about Peter. And if you could try to understand what you feel rather than beating yourself up for your feelings, that would be really helpful.”

Cristina shakes her head empathically. “It’s not normal. I’m not normal.”

“Is anyone telling you you’re not normal?”

“Oh, yeah. My mother. She’s told me I’m not normal my whole life.”

“Because?”

“Because I’m not like her. My mother is one of these brash, strong, outdoorsy types who won’t take anything from anybody. And me, well today’s not a great example of how I usually look, but I’m usually pretty well put together. People tell me I’m pretty. I care about clothes and my nails, kind of a girlie girl. My mother couldn’t stand that about me.” Pause. “The truth is she wanted another boy, boy number four, but she got me instead. Unfortunately for both of us.”

“Do you think there’s a connection between how your mother felt about you and you feel about Cristina?” I ask.

Cristina looks at me blankly. “In what way?”

“Well, your mother didn’t like you because you were a girl and it sounds like you’re saying it’s much easier for you to love Peter, your boy, than Caroline, your girl.”

“You’d think I’d love Caroline all the more because I know how awful it feels not to be loved.”

“Well, rationally that may be true, but we humans don’t always act on the basis of rationality. There’s our unconscious to consider. There’s, for example, identifying with the parent who hurt us and then despite our best intentions behaving like them. I’m not saying that’s what’s going on for you, but it does sound as though your feelings about your daughter are similar to your mother’s feelings about you.”

“But I don’t know if Caroline is going to turn out to be a girlie girl.” Pause. “But she is tiny. And she seems so vulnerable.” Crying, Cristina adds, “My mother hated vulnerable. I think that’s what she hated more than anything. She hated when I cried. She hated that I cried. Said I wasn’t normal to cry so much. I guess I’m proving her right.”

“No, you’re not proving her right. You’re proving that you’re human. There’s nothing wrong with crying. And there’s nothing wrong with feeling vulnerable. We all feel vulnerable. And children feel most vulnerable of all.”

“You know, that is one of the things that bothers me about Caroline. She seems so fragile. And for some reason rather than being drawn to that fragility and wanting to protect her, I want her to get it together and be strong.” Pause. “You’re right! I sound like my mother. That’s awful. I never wanted to be like my mother. Now I have something else to hate myself for.”

“You’ve brought in a lot of material today, Cristina, and we’ll have plenty of time to work on it, but the more you could wonder why you do or feel what you do, rather than judging yourself, the easier it would be.”

Anger: Expressed and Repressed (Part II)

“You know, I’ve been thinking,” Jacquelyn begins. “I’ve been thinking I should take a break from therapy for a while.”

Internally, I scream, ‘What!? I thought you said you were going to think about your anger?’ To Jacquelyn I say, “And why is that?”

“I don’t know. I’ve been doing this for over a year, seems like it’s time for a vacation.”

“Does your desire for a vacation seem connected to last week’s session when you realized you were angry at your mother for not protecting you as a child?” I ask.

“I didn’t say that.”

“Not exactly, but you did want the woman in the TV show who reminded you of your mother to be killed by the serial killer.”

“I didn’t say that either.”

Disappointed that Jacquelyn has moved so far away from her more open, insightful stance of last week, I ask, “What’s your sense of what’s going on between us right now?”

“Nothing special.”

Feeling increasingly exasperated, I ask, “Can you say what you think is going on between us even if it’s not anything special.”

“You’re mad at me. You’re mad at me because I want to stop therapy.”

“I am annoyed with you, Jacquelyn, because I felt so hopeful last week, hopeful that we’d made a breakthrough, that you experienced your anger at your mother and that although you were scared of the repercussions, you went away wanting to think about it.”

“It was too scary.”

“I do understand that, Jacquelyn,” I say, thinking that perhaps she’s put one toe back in the water.

“But why were you angry at me if you understood?”

Hmm, I think to myself, I wonder if Jacquelyn wanted me to feel angry so that I could feel what she feels – angry but thwarted in its expression. I decide to keep that thought to myself. “I can understand and still be angry. Anger is a feeling. We can’t control what we feel, although we can control what we say or what we do.”

“So you don’t feel scared when you feel angry?”

“No, I don’t feel scared when I feel angry. Except some times.”

“Like when?”

Although repeatedly answering a patient’s questions is unusual for me, I feel that in Jacquelyn’s case it is a helpful form of modeling, perhaps making her own anger less frightening. “Well, I guess like in that TV show you talked about last week, I’d probably be scared if I got angry at the serial killer because I’d be afraid if my anger showed he might immediately kill me.”

“That’s it!” Jacquelyn says staring at me, her eyes wide open. A second later she’s sobbing, pulling at her hair.

“It’s ok, Jacquelyn,” I say quietly. “There’s no serial killer here and your father is long dead.”

She continues crying, but seems calmer. Through her tears she haltingly says, “I never even knew I was afraid he’d kill me. Like he could read my mind. Like he’d know I hated him. I was always so scared, so scared, so scared,” she says cradling her body in her arms and rocking in the chair.

“I’m so sorry, Jacquelyn. I’m so sorry that you had to go through all that. You were only a powerless, dependent little girl. You were so scared.”

I can see Jacquelyn bristle. She stops crying and lifts her head. I went too far.

“I’m sorry, Jacquelyn,” I say, “I know it’s very hard for you to be aware of how powerless you were as a child. It makes you feel all the more frightened.  It’s more than you can bear.  

“Maybe it is time to take a break from therapy.”

I look at Jacquelyn tenderly. “No, it isn’t,” I say. “I know I went too far. You were back there being that little girl and I so terrified you that you had to come back to your adult self, had to go back into a defensive mode. Will you forgive me?”

She is again crying. “I don’t think in my entire life anyone asked me to forgive them. I used to dream about that. I used to dream that one day both my mother and father would take me aside and apologize for all the bad things they’d done to me. But of course that was ridiculous. Except it’s kind of like you made my dream come true, even though you didn’t do anything nearly as bad as they did.” Pause. “Yes, I’ll forgive you,” she says crossing both her hands on her lap and staring directly at me.

Anger: Repressed and Expressed

Thirty year old Jacquelyn looks unusually pensive as she settles herself into the chair across from me.

“A weird thing happened this week. Kind of disturbing ,” she begins. “You know how I tell you that I always watch those gruesome  shows like Criminal Minds or CSI, but that I have to cover my eyes during the particularly gory scenes?” she says grimacing.

I nod.

“Well, one of those gory scenes came on, and instead of covering my eyes I felt sort of compelled to watch it. And I – this is kind of embarrassing. I, umm, I actually felt kind of excited and found myself rooting for the serial killer. I wanted to watch him kill that, that, umm, that woman.”

“What did you first think of, Jacquelyn, before you said ‘woman?’”

Jacquelyn lowers her head. “First I thought to say ‘bitch,’ then ‘sniveling baby,’ or ‘coward’ or ‘idiot.’ But they sounded too negative, so I settled on woman.” Pause. “You know, you’re always telling me that I have lots of anger, but that I keep it buried inside me.” Pause. “I didn’t feel angry, not even when I was wanting him to kill her.” Pause. “That doesn’t make sense when I say it out loud.”

Jacquelyn’s last comment is encouraging. Although I’m sure she’s at least of average intelligence, she tends to be quite concrete, has difficulty with self-reflection, and is often unable to take in what seems to me the most obvious of connections.

“Was it that you wanted this particular man to kill the woman or did you want this particular woman dead?” I ask.

“Do you think I’m terrible for thinking about this?”

“Not at all. You weren’t killing anyone, you were watching a TV show.”

“I guess,” she replies dubiously.

Silence.

“You want me to answer your question.”

“Yes.”

“I wanted this woman dead.”

“And can you say more about that? Why did you want her dead? Who did she remind you of?”  

“I don’t know.”

“Well, how about thinking about it now.”

Silence. Jacquelyn squirms in her chair.

“Can’t she just be a woman?”

“If you think about a woman, what woman comes to mind?”

“She wasn’t like my mother.”

“Does that mean your mother was the first woman you thought of?”

She nods, looking down.

“And what’s the similarity between your mother and this woman in the TV show?”

Still not looking at me she says, “They were both housewives.” Pause. “They had children.” Pause. “Umm. Umm. They couldn’t stand up to their husbands.”

Thinking to myself, ‘now we’re getting somewhere,’ I ask, “How did the woman in the TV show not stand up to her husband?”

She looks up. I suspected that it would be easier for her to talk about the TV character than her mother.

“There’s this scene at the breakfast table where her husband is screaming his head off at both her and the kids. You know he’d be cursing in real life but of course they can’t show that on TV. He goes off on the little girl when she spills a glass of milk, calling her an idiot and worthless. The little girl starts to cry and the woman tells her husband to calm down and that does it, now he’s really off the wall, screaming at the woman and even looking as if he might hit her. She cowers and turns back to washing the dishes while the father starts screaming at the girl to stop crying and when she doesn’t he slaps her across the face. The woman doesn’t do anything.”

“Does that sound familiar, Jacquelyn?”

Tears roll down her face. “I didn’t want to kill my mother. Oh my God, I hope not. I hope I didn’t wish her gone, because then I would have been left with him.” Pause. “We were both such cowards,” she says now sobbing.

“What do you mean?” I ask.

“Both of us. Neither of us could stand up to him.”

“Jacquelyn, you were a little girl. How were you going to stand up to him?”

She shakes her head and continues sobbing. “Cowards. We were cowards. We should have done something.”

“You’re angry at both yourself and your mother for not being able to fight back.”

“We were cowards.”

“You can’t accept your own vulnerability, Jacquelyn.”

“No! I can’t!”

“So you wanted to kill the woman in the TV show because of her ‘weakness,’ because of her vulnerability.

“I didn’t want to kill her, I wanted her dead.”

I think Jacquelyn has had enough for today and decide to back off.

“You’ve done a lot of good work today,” I say. “I wonder how you’re feeling.”

“Scared.”

“Scared of?”

“I’m not sure. Being slapped across the face like the girl in the TV show. That’s silly. I feel bad, like I did something wrong and I’m going to be punished.”

“I understand, Jacquelyn. You’ve gotten closer to your anger than you’ve ever been and I think that’s frightening you.”

“You think so?”

“Yes, I do.”

“Okay. I’ll try to think about that.”