Wanting to Flee

Trevor sits quietly in the chair across from me. After a few moments he says, “It was an okay week. Nothing special happened.”

I wait. There is silence. I’m puzzled. I have seen 26 year old Trevor for many years. I might even say I helped him grow up. When he first came to me he described himself as shy. During those years long silences were commonplace. But as he moved away from his fear and self-loathing he’s been far more engaged with me and, to a lesser extent, with the world outside my office. He acknowledged his gayness and was able to come out to his family and some of his friends. He’s still never been in a love relationship, a problem that we’ve been working on. But today his silence confuses me.

“Is something going on, Trevor?” I ask. “You seem particularly quiet, uncomfortable.”

He shakes his head and looks away from me.

I wait. I think about our last session. Did something happen that distressed him? We’d been talking about Thanksgiving with his family, but that had seemed to go fairly well despite his father’s usual blustering. Was there some tension between us? Nothing that comes to me. Don’t be impatient, I tell myself, just sit with him.

After a while he says, “I’ve been thinking maybe I should cut back to once a week. I’m doing pretty well and, like today, I don’t have much to say.”

I’m stunned. In all the years, Trevor has never asked to come less frequently and, in fact, has often asked for additional sessions. Something must have happened between us.

“Trevor, you need to tell me what’s going on. Did I say something last session that distressed you?”

“Why does something have to be wrong? Why can’t I just want to cut back?”

“Because you know as well as I do that there’s always a reason – usually more than one – for everything we do.”     

He sighs. “Why did that psychiatrist retire?”

“What psychiatrist?”

“The one next door.”

The light dawns. He asked me last time what had happened to my neighbor. When I told him he retired, he obviously became fearful that I might follow a similar path. “He retired because he wanted to travel, have more time to himself, pursue other interests. And, no, I have no plans to retire, ever. I love what I do and as long as my mind is still with me I plan to stay right where I am.”

“And why is the sign on your door different? What happened to the other therapists? The ones who’d worked here? Did they retire too?”

Now we’re in more difficult territory. I’ve been surprised by how few patients have asked me about the change of signage on the front door. “No, Trevor, they died.”

His already pale skin blanches further.

“Okay,” I say in a calm voice. “I understand that you’re frightened of losing me. First you were afraid I might retire and now you’re afraid that I’ll die. And of course I can’t make guarantees about my dying, but it’s certainly my hope to stick around for a long time.”

“I have to cut back to once a week. I have to become less dependent on you. Right now if something happened to you I don’t think I’d survive.”

“Trevor, the idea is that our work together will help you to be able to be more and more engaged with people other than me, but we can’t accomplish that by your cutting the frequency of your sessions. You’ve been doing very well lately, going out to lunch with people, meeting friends for dinner and a movie …”

“But that’s because of you!” he says. “I wouldn’t be able to do that without you.”

“Then we’ll have to understand why you feel you can’t do those things without me and help you to feel more comfortable being in the world.”

“Did they know they were going to die?”

Loathe to provide too many details, I say, “Yes, they both knew they were ill.”  

“So they could tell their patients?”

“Yes, their patients knew they were ill.”

Trevor starts to cry. “I couldn’t stand it! I couldn’t stand it if you died! I couldn’t watch you die.”

“I understand, Trevor, but I’m not ill and I’m not planning to die any time soon. Obviously none of us know when we’re going to die and it’s always sad to lose someone we love, but what we need to do is focus on helping you to be fully in the world, to embrace life and enjoy it.”

“Can we talk about this again next week?”

“Of course. I’ll see you Monday.”

Welcome Back

Annette smiles wanly when I open the waiting room door, walks slowly into my office, and lowers herself gently into her usual chair.

“Welcome back,” she says with little enthusiasm.

“Thank you,” I reply, surprised by Annette’s distance and reserve. Although this was the Annette who began therapy with me many years ago, our close enduring relationship had allowed her to deal with her childhood sexual abuse and to transform into a warm, open, engaged woman. Now forty-five, she worked as a para-legal and had a full, satisfying life. Although she never married, she had several long-term relationships and a network of close friends. She was usually especially glad to see me after my return from vacation, eager to catch me up on her life.

After a brief silence I ask, “What’s wrong, Annette?”

“I have some really bad news,” she says, her voice barely audible. “I have metastatic colon cancer.”

My eyes widen, tears immediately filling them. “Oh Annette,” I say. “I’m so, so sorry. When did you find out?” I was only gone two weeks I think to myself, aware that I feel guilty I wasn’t here for her.

“Just yesterday. I guess I’m still in shock. I wasn’t feeling well, had some bloating, discomfort. I wasn’t hungry which, as you know, is unusual for me. I thought maybe it was just my usual stomach stuff, but I went to my GI doctor. He examined me and suggested a colonoscopy and a CAT Scan. I was too happy about that. And then the diagnosis, cancer. They want to start chemo. I don’t know. I don’t know what my chances are and if I’m going to die anyway, I’d rather not prolong the agony.”

I’m overwhelmed by sadness, sad for this woman who fought so hard in her therapy to get through the pain of her past, only to now be forced to confront a dire illness and the possibility of death. My own losses flash in front of me as well, my husband to metastatic prostate cancer, numerous friends to pancreatic cancer, liver cancer, breast cancer. The list seems unending.

“I’m sorry, Annette,” I say. “I know I’m not being helpful to you.”

There again is her wan smile. “No, you are. I can see how much you’re affected by my news. That means a lot to me. I know you care for me. I know I’m not just one in a long line of patients.”

“We’ve worked together a time long, Annette. Of course I care about you. And I’ll help you through this however best I can.”

“Will you support whatever decision I make about whether or not to get chemo?”

“I will, but there’s a “but” to that statement. I want you to be sure you’ve explored all your options and know what the doctors think of your chances.”

“I am going to see an oncologist.”

“Good. I’m glad. And I also think you need to give yourself some time. You just found this out yesterday. It’s overwhelming. It’s overwhelming to me, it must be more than overwhelming for you.”

“You’re the first person I told.”

“You didn’t call any of your friends?” I ask, surprised.

“No. I knew I’d see you today. I was afraid if I told anyone I’d totally fall apart. I called in sick to work. I couldn’t bear telling everyone there and I didn’t know if I could fake it. They know I haven’t been feeling well.”

“Do you feel you can tell your friends now?”

“I don’t know. I’ll see.”

“Annette, does this feel like part of the abuse all over again? Like an unwanted, foreign thing invading your body?”

“Oh my God, I hadn’t thought of that! But it’s true. I mean I know it’s not the same thing, but it does kind of feel that way. How did you think of that?”

“I guess because today you’re more like the self I knew when we first started seeing each other – removed, defended, isolating. I know it could be shock, but for you I thought it might be more. And it’s not only the cancer itself, but all the tests you had to take and will continue to have to take. So we’ll need to be sure that your decision about treatment isn’t contaminated by your desire to avoid what might feel like more abuse.”

“You’re right. I wouldn’t want that bastard to destroy me in the end.”

“I wouldn’t want that either. Go see the oncologist, tell some of your friends and hopefully you’ll have  time to decide what to do.”

“See you Thursday.”

“See you Thursday,” I repeat, aware of the now increasing importance of time. 

Absence

In the five years that I have been treating Patricia she has come a long way. Although professionally accomplished and successful, outside of work she had been withdrawn, isolated, and friendless. As she came to rely more on my consistency and trustworthiness, she was able to venture out of her cocoon, making friends and, recently, to begin living with Derrick, a man who seems both sensitive and loving. Still, there is a limit to her capacity for closeness. I experience it in the consulting room; Derrick complains about it at home; and she herself continues to be aware of her tendency to draw back. My understanding of Patricia’s reticence is that she both seeks to protect herself from further hurt, as well as trying to prevent unleashing the hungry, insatiable child within her.  

“I’ve been having a hard time lately,” Patricia says. “I know how fortunate I am. Derrick is such a kind man. And I love him. But, I don’t know, sometimes I just feel smothered. I feel I want to run away. I know you say it’s because I’m afraid of being too needy. And maybe that’s true because I’m also feeling those old feelings of emptiness, of being apart, of loneliness. I want to reach out to Derrick and sometimes I even do, but it doesn’t matter, the feelings don’t go away. I feel weary. I’m so tired of dealing with all this. It feels as though it never ends.”

“When did these feelings resurface, Patricia?”

“They’re always there at kind of a low level, but I guess maybe it was while Derrick was away on business.”

“And his being away came right after I had been away on vacation, right?”

“Yes, I thought of that. But I really don’t know if that matters or not. The feelings are the same I’ve always had. The ones I had as a child when I was afraid all the time, when I didn’t want to go to summer camp, when my parents argued, when they yelled at me for hiding out in my room or reading too much or never bringing friends home. There was never quiet. I wanted to hold myself very still so that nothing bad would happen.”

I have heard Patricia make similar statements over the years. Today as she speaks, however, I feel bereft. It is as though I have become her as that scared, isolated child. Then suddenly, totally unbidden, I think of being in my grandparent’s apartment, sitting with them at the kitchen table and my spirits lift. My grandparents and their apartment had always been a place of love, warmth, and safety for me. And suddenly I have a new insight.

“Patricia, it just occurred to me that there was no one in your early life who offered you a feeling of being cherished, of being safe and secure and loved. Not your parents, no grandparent, no aunt or uncle, no one,” I say, again feeling sad as I put into words this absence in Patricia’s life.

“That’s true,” she agrees.

“So perhaps that’s what your feelings of emptiness and loneliness are about. You don’t carry within you images of warm, caring people who help you to feel loved and not alone.”

Patricia starts to cry. “That’s true. There’s no one kind up there. No one at all. That makes me sad for me.”

I nod. “I’m glad you can feel sad for you.”

“But what do I do with that?” she asks. “How does it help?”

“Well, first it gives you greater understanding of your feelings so that they’re not as so overwhelming. And obviously it enables you to have compassion for yourself which is always a good thing. And from that place of greater understanding and compassion, it will hopefully be easier for you to take in warm, caring, loving people in the present – Derrick, me, your friends – so that you will have kind people to take with you in your mind.”

“But it can’t make up for what I didn’t get in the past.”

“No, it can’t. All we can do about what we didn’t get in the past is to mourn the absence and try to fill ourselves up with the people who can give to us in the present.”