Money Matters

I’m not good about money. I never have been. Managing my own finances has never been a problem, but setting patients’ fees is an entirely different matter.  

Early in my career I was treating Sharon, an artist, who told me how much she made yearly from her art. It wasn’t much. My regular fee wasn’t much in those days either. Still, I reduced my fee. Several months passed. In the course of one session she began to talk about the apartment buildings she owned that had been left to her by her now deceased parents. I was shocked, and angry, too angry to say anything at the time. The next session I was ready. 

“Sharon,” I said, “Last session you talked about being a landlord. Can you say why you didn’t tell me you owned apartment buildings when we first discussed your income and your fee?” 

“It never came up,” she replied. “We were talking about the money I made from my art.”

“That’s true. But don’t you think not mentioning your other income was dishonest?” I asked. 

“No,” Sharon replied blithely. 

“Really? You don’t feel you were hiding your rental income so that I’d reduce your fee?”

“My father used to say never offer any information you’re not asked for,” she said.

“You experienced your father as a ruthless, indifferent, uncaring man. And now you’re modeling yourself after him?”

“I never thought of it that way. It’s not something I decided to do. I guess I just do it automatically when I deal with something business related. I’m sorry. You’re right. It wasn’t fair of me.”

So that situation had a satisfactory ending both financially and therapeutically in that we were now able to explore Sharon’s identification with her father.  

More recently, the result wasn’t as positive.

I receive a call from Jackie, referred to me by a former supervisee. We set up an appointment and as we are about to get off the phone she asks my fee. Although I prefer to discuss fees in person, I answer her question and tell her my regular fee is $250 a session. She gasps. Without a moment’s hesitation, not knowing anything about her finances, I offer to see her for $150. She agrees and comes in at the designated time. 

Jackie sought treatment because she and her husband just learned that he is sterile and are now wrestling with whether or not to adopt. Jackie is also trying – not very successfully - to not be angry with her husband for a medical condition beyond his control. Being a mother has always been Jackie’s dream. Her mother died when she was only a year old, leaving her to be raised by rigid, rejecting grandparents. We discuss her desire to give her own child an experience she herself cannot remember ever having. She understands, but remains focused on her anger at her husband and his failure to give her what she has always wanted.

As the therapy progresses, I learn that their marriage has never been fulfilling for her. She describes her husband as both withholding and an inadequate lover. She stays in the marriage because she’s dependent on him. And for financial reasons. She has a seven-bedroom home on three acres of land, horses, a cook, and a housekeeper.

I am not happy. I reduced my fee for a woman with huge financial resources! And it’s my own doing. She hadn’t lied to me. She hadn’t withheld information about her wealth. All she had done was gasp and I lowered my fee! 

As we approach the new year, I tell Jackie that come January I will be raising her fee to $250. I understand that a $100 increase is a lot, but given her financial circumstances, it doesn’t seem unreasonable.

“Well,” she says, “I was planning on stopping anyway. All this talking isn’t getting me anywhere. My husband is still sterile and I just have to stop being angry at him and decide whether or not adoption will work for me.”

“Do you think your decision to stop is related to my talking about increasing your fee?” I ask.

“No, not at all. You’re right. I can afford it. But I don’t think this is helping. So why should I bother continuing?”

“Can you say, Jackie, how you felt about my raising your fee or, for that matter, how you felt when I lowered it when we talked on the phone.”

“I don’t know. I didn’t think about it.”

“Can you think about it now?”

She shrugs.

“Do you think you felt given to when I lowered your fee, given to in a way you haven’t experienced much in your life and that now you feel I’ve deprived you yet again?”

“You’re making too much of this. You always do. You over analyze. It’s just time for me to leave.”

And so I lost Jackie. As a result of my difficulty dealing with money.   

A Therapist’s Mistake

Philip is a new, reluctant patient. He hasn’t been in therapy before, isn’t sure “how it works,” and doesn’t know for sure why he called. He’s getting into disagreements with people at work. He’s not sure why. Yes, he does tend to be a bit obsessive. Maybe his coworkers are put off by his insistence on perfection. And yes, he does worry about making a mistake. It makes him anxious. What if he did something “wrong” and “something bad” happened as a result? 

In our first several sessions I’ve focused on the harsh voices that exist in Philip’s head telling him that danger lurks around every corner. I’ve also tried to explore what feelings exist underneath his anxiety and his need for perfection – anger, sadness, fear? He steps gingerly into those feelings – perhaps he is angrg that he was passed up for promotion – but scurries quickly away.

Today he knows exactly what he wants to talk about. “I had a huge fight with my wife. She got mad at how I punished our 10 year old daughter. Samantha opened up a mouth to me and I spanked her. I didn’t beat her, for heaven’s sake, I just gave her a spanking.”  

“What did Samantha say to you?” I ask as neutrally as possible.

“She raised her voice and told me I was making her nervous and not helping her at all with her math homework.”

“And that’s why you spanked her?” I ask, the neutrality slipping from my tone.

“What? You don’t think that’s a smart-ass comment that needs to be nipped in the bud?”

“Is that what your father would have done to you?”

“You bet! That and more.”

“And you feel how about your father and what he did?”

“He was trying to teach me right from wrong.”

“But can you tell me how you feel?”

“I feel like he was being a father.”

“A particular type of father,” I say, ignoring that Philip has not told me how he felt.

“What do you mean by that?”

“Well, he’s the type of father who made you into the man you are today, someone who has a rigid sense of right and wrong and who is terrified of making a mistake.”

“So we’re on to blaming the parents. And I suppose I’m doing the same thing to my daughter?”

Throughout this interaction I’ve been thinking of my father. He never spanked me, but his explosive temper terrified me. He didn’t so much have a rigid sense of right and wrong, but an uncompromising conviction that only his ideas and beliefs were valid and that everyone else was “wrong” and “stupid.” 

“I don’t know,” I reply. “It depends if your daughter capitulates to you or resists. It depends if you break her spirit like your father broke yours or if she’s able to fight back.” I fought back. And I’m routing for his daughter.

“You think I’m breaking my daughter’s spirit?”

“I think when you’re sure that you’re right and you try to foist that belief on someone else, yes, you’re trying to break their spirit.”

“That’s a lousy thing for a therapist to say.”

I stop. Philip is right. He’s my patient, not his daughter. I’ve gotten into a debate with him, trying to convince him of my way of thinking, rather than trying to understand his. I’m being just like him, his father and my father, trying to convince him of the correctness of my point of view. My past, my relationship with my father has affected my ability to be the good-enough therapist. 

Not trying to minimize my contribution to this interaction, I also realize that I have re-enacted a scenario typical of patients with this harsh, rigid conception of right and wrong. They are often battling the voices in their head – is this right or wrong? am I right or wrong? – and those battles can get projected into interactions with others. The fight then becomes externalized and is played out with me, coworkers, wife, daughter, or whomever.    

“You’re right, Philip. That was a lousy thing for me to say and I apologize. I should have been asking you what you felt when your daughter responded to you as she did, not trying to convince you to be different.”

Silence.

“What are you thinking?” I ask.

“I was wondering if I should be seeing you if you can make a mistake like that.”

I can feel the pull to try to persuade him, to ask him if he can’t forgive me, if he can’t allow me to be less than perfect. I resist. Besides, the hour is almost up. “I understand. But I hope you will come back next week so we can look at how you felt about my making a mistake and about my apologizing.” 

Stop!

I am sitting with Lila – or L as she insists on being called – in uncomfortable silence. A tall, heavy woman in her mid-twenties, with disheveled hair and wrinkled clothes that look as though they’ve been purchased at a thrift shop, L stares at the floor, occasionally glancing up to glare at me. We have been here many times before. I know I need to say something or L will leave, looking back at me with undisguised contempt.

L doesn’t want to be here. Her father insisted. Despite her obvious intelligence, she barely made through college and has done nothing since she graduated but sit glued to the TV or her computer. Her father, a wealthy businessman, insists that I “fix” his daughter. He travels for his company so isn’t home much, but hears from the servants that his daughter does nothing with her time. His ex-wife, he told me, is entirely out of the picture. She left with another man when L was a baby, leaving him to hire a succession of nannies.

“What are you feeling right now?” I ask lamely.

She sneers at me. “Five minutes of silence and you can’t do better than that?”

Although I agree with L’s assessment, I’m again becoming angry, a feeling that often plagues me in L’s sessions.

“What would you like me to ask?”

Another sneer. “What? So now you want me to do your job for you?”

“Okay,” I say. “Let’s start over. We both know if we continue along this path, we’ll both end up being angry and then you’ll leave.”

“Good guess.”

“Do you like to make me angry, L?”

She shrugs.

Silence.

“I can see that you might want to make me angry, that you might want me to feel what you feel.”

“So I’m angry. So what?”

“I can’t imagine that it feels good to be angry all the time.”

Another shrug.

More silence.

“Can you tell me why you’re angry, L?”

“Why don’t you tell me,” she snaps back.

Trying to keep the conversation going, I reply, “Well, at the very least, you’re angry about being here.”

“Wow what a brilliant insight! Give the lady a gold star! And you’re considered a great therapist because…?”

“You succeeded, L. I’m angry. But I still don’t know what purpose it serves you. Is it a way to keep me away, to make sure we never form a relationship? Is it a way to keep yourself safe?”

“Why don’t you just figure it out,” L says as she starts to leave.

Without thought, I’m up against the door barring her exit. “Stop it, Lila!” “Sit down.” 

Towering over me, her eyes fill with fury. I wonder what compelled me to place myself in such a precarious situation.

“Why’d you call me Lila?” she says angrily. “My name’s L.”

Why did I call her Lila? I wonder. “No,” I say, “Your name is Lila and I’d like to know Lila. I’d like to know the person you were before you felt you had to rename yourself. I’d like to know you and I’d like you to stay.”

I watch the fury drain from Lila’s eyes. In its place I see surprise and confusion. She stumbles back to her chair.

“I can’t believe you did that,” she says. “I could have hurt you. Why did you do it?”

“I didn’t think much before I reacted. I know I was angry. And I know I wanted you to stay. And what I said is true. I do want to know you, Lila. I know there’s a sad, lonely kid underneath all that anger.”

“How do you know?” she asks, some of the defiance returning to her voice.

“Well, your mother abandoned you. Your father was never terribly interested in you. And you had a series of nannies who came and went. I can’t see how you could be anything but sad and lonely. And angry, of course.”

“So you think everything’s going to be rosy from now on?”

I smile. “No, I certainly don’t. And even if I did I know you’d show me very quickly I was wrong. No, Lila, I think we have a long road ahead of us. You’ve been hurt again and again and you’ve used your anger to wall yourself off from relationships and any more pain. But maybe we made a small inroad today.”

Lila nods. “It matters that you put yourself in danger because you wanted me to stay.”

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.”

Year’s End

“Well,” I say, aware that Fran and I have just finished our last session for the year, “I hope that next year will be a better one for you.”

“Yeah, right,” she says, as she gets up from the chair. “Except we both know it won’t be,” is her exit line.

I sigh. I feel sad for Fran. Sad and frustrated. I don’t seem able to help her. She’s an angry woman: angry at her husband Gary for dying, angry at her in-laws for having little to do with her since Gary’s death, angry with her brother-in-law for cheating her out of what she sees as her fair share of the business. 

I get it. These are legitimate reasons to be angry. But Gary has now been dead for eight years. Is there no statute of limitation on anger? Of course I know that there isn’t. Some adult children remain angry with their parents forever. Some married couples can never forgive their spouse for a hurt suffered twenty years earlier. I even know why letting go of this anger is so difficult. To do so involves intense mourning, dealing with all the hurt of what one didn’t get, of the disappointment, unfairness, and sorrow involved in the loss. Without doubt, a very hard, painful process. I get it. But why can’t I help Fran to move towards that process of mourning? And why do I find her being stuck in her anger so difficult to tolerate? I reflect back on the session. 

“So I spent another Christmas alone,” Fran said. “Big surprise, right? And of course I didn’t hear from you know whom! Like it would have killed them to send a card. And guess what? I’ll spend New Year’s Eve alone too.”

“But why, Fran?” I ask. “Why did you spend Christmas alone? And why will you spend New Year’s Eve alone? What about your siblings? Or the friends you’ve made over the past few years?”

She shrugs.

“Did you call any of them? Can you call any of them?”

“I don’t see any of them calling me,” Fran replies.

I feel defeated, powerless. No matter what I say, Fran remains stuck in her anger. I think about her childhood. Her mother was angry and critical, her father passive and uninvolved. The house was overrun with six children and an insufficient amount of both emotional and financial support. Fran learned to capitulate, to surrender, to accept whatever was given to her. And then she met Gary, her knight in shining armor. He carried her away from the barrenness of her childhood home and showered her with more love than she could have ever imagined. Until he was diagnosed and dead of acute leukemia in four weeks. And then there was no one, again.

Fran was abandoned to the nothingness of the world she had known before Gary. What a sad and helpless place to be. Except that it was I who experienced the helplessness, while Fran experienced the anger. No, that wasn’t quite right. I did feel powerless to help Fran, but I also felt angry at her inability to move forward. Her mother was the angry parent, her father the passive victim. As a child Fran identified with her father, unable to fight for what she wanted. But her relationship with Gary had given her a sense of being valued, perhaps enough of a sense of being valued that she could allow herself to fight for what she wanted. No, that wasn’t quite right either. She didn’t fight for what she wanted, she fell back into the victim mode.

Fran’s inner world exists of only two ways of being – the angry parent or the helpless child – and she alternates between them in an instance. She’s angry with Gary for abandoning her, but helpless to make her life different, partly because the intensity of her anger is itself inhibiting. At any given time, I also experience one or the other of Fran’s self-states, that is, I feel powerless to help her or angry at her unwillingness to be different.

So where has all this self-reflection led me? Perhaps my New Year’s resolution in relation to Fran needs to be to stay focused on the way in which the feelings of powerlessness and anger are constantly switching, both inside Fran and between us. Perhaps that will help her to see how her anger defends against her feelings of loss, sadness and helplessness. Perhaps that will help her to see how her anger itself keeps her stuck. Perhaps it will help Fran to have a better New Year after all.   

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.”

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.”