“I was so depressed I didn’t go out of the house all weekend,” Liz says, her mouth pinched, her eyes downward, staring at her hands.
“I’m so alone. No one cares about me. No one cares if I live or die.”
Rather than feeling compassion for my obviously unhappy patient, I’m aware of feeling immediately annoyed. There are reasons I could feel compassion. Liz’s husband Bob decided he wanted a divorce after almost 45 years of marriage, leaving her adrift at age 65, never having lived on her own, never having been involved with any man but her husband. Still, I feel annoyed. This tells me two things: one, I have a hard time with someone who remains stuck in the victim role because it’s a role I can’t tolerate myself and, two, underneath her depression, Liz is angry and is unconsciously communicating that anger to me.
I remain silent.
Liz continues. “Bobby went to see his father again this weekend. He was just there for Father’s Day. You’d think he could have stopped by.”
“So you’re angry that your son saw your husband again and not you.”
“I guess.”
“What do you mean, you guess?”
“I wouldn’t have called it anger, more like disappointment.”
“Can you feel both?”
“I suppose. I just don’t know why I don’t see more of him. He obviously has time for his father and for the girls he’s always chasing. I don’t see why he can’t squeeze a little time in for his mother. He’s all I have left in the world and I never see him.”
I consider and reject various responses: What about your daughter and her three children? What about your sisters? What about the friends you’ve been trying to develop? Although all these are all realities, they are irrelevant to Liz at this time. For the moment all that matters is that her son saw her husband instead of her.
“When was the last time you saw your son?” I ask although I fear that even that question veers too far from Liz’s feelings and her present state of mind. Still, her answer surprises me.
“He took me to dinner earlier last week.”
My unspoken response is, I thought you said you never see him, but I recognize the futility of going down that path. Instead I said, “I think you really are angry at Bobby, Liz, angry that he sees your husband despite how much Bob hurt you.”
“Well he did hurt me horribly. And he didn’t even leave for another woman. He left because he couldn’t stand me anymore. How do you think that makes me feel?”
“Of course it’s hurtful, Liz. Of course you feel lousy. But I wonder if you’re also feeling angry with me right now?”
“With you? Why should I be angry with you?”
“Perhaps because you don’t feel I’m being sufficiently understanding. Perhaps because when you get angry your anger gets bigger and bigger until it’s hard to find anything good or positive about anyone. It’s like you see the world in black and white with no shades of gray. It’s like when you’re angry at Bobby, you forget all the positive or caring or loving things he’s ever done. And then your anger keeps expanding until it encompasses everyone in your life and you’re left with only blackness, you’re left feeling all alone.”
“I definitely do feel all alone.”
“I know you do. But I wonder if you really are as alone as you feel or if it’s your anger that erases all goodness. It is possible – and I know this is very difficult for you – but it is possible to be angry with Bobby or with me or with anyone and still love them and care about them and know they care about you.”
“That’s really hard for me. I don’t even know that I’m angry until you point it out.”
“Well that’s a problem too. Instead of recognizing your anger, you tend to turn it on yourself and feel worthless and depressed. So, yes, first you have to recognize your anger as anger. And then we have to work on your being able to hold anger and more positive feelings at the same time.”
“So you’re not giving up on me?”
“Why would you think I’d be giving up on you?”
“I don’t know. Sometimes I think you’re impatient with me.”
“Maybe you’re right. Maybe sometimes I do feel impatient. But that would be a good example of my being able to feel something negative like impatience and still hold on to caring about you and being committed to our work together.”
“I understand. I just don’t know if I can do it.”
“That’s what we’re here for.”
“I really appreciate your seeing me again. I didn’t know who to turn to. I’m so scared, so, so scared.”
Across from me sits Jennifer, a patient I have not seen for over eight years. We’d worked intensively for a five year period, until Jennifer gave birth and decided that she’d like to try it on her own. I’d questioned her timing. The victim of childhood sexual abuse by an uncle she’d kept secret from everyone but me, I’d wondered what feelings might resurface with the birth of her daughter. But she was insistent and I had to respect her decision.
“I saw Samantha masturbating in the living room a couple of weeks ago. It freaked me out, but I talked to myself, said it didn’t mean anything happened to her, just a kid exploring her body. So I told her those were things we do in private. She seemed to accept that and I let it be. It still bothered me – I even started to have my scary dreams again – but I dropped it with Samantha. Then it happened again and I got more scared.
“So I tried to talk to her about it. I reminded her what I had said before about that kind of stuff being private, but this time I asked her if anyone else had touched her down there. She didn’t say anything, just looked away from me. I panicked. I told her I wouldn’t be mad at her, but she needed to tell me if anyone else was touching her. Then she nodded and I thought I would die. Not again I wanted to scream. This can’t be happening to my daughter too,” Jennifer says, crying, tearing at her hands. I feel my own anxiety rise along with hers.
She continues. “I asked her if she could tell me who it was and she pointed to the house next door. That confused me because there’s no man next door, just a divorced Mom with kids. She has a daughter, Emma, who’s the same age as Samantha and they play together sometimes. Then I thought maybe the Mom was dating someone, or was it the Mom herself, all these thoughts racing through my head. Then she almost whispered, ‘Howie.’ For a second I didn’t even know who that was and then I realized that was Emma’s brother who’s probably ten. Is that abuse? He’s ten. What were they doing? Was anyone with them? Where was Emma? I asked the last question. Samantha just shrugged. So I stopped. And I called you.”
“I’m glad you called, Jennifer, I know how very difficult this is for you. It would be difficult for any Mom, but it sets off so many old terrors for you.”
Jennifer’s tears cascade down her face. Her agitation decreases. “I knew you’d understand. I talked to my husband, Bill. He said I was over-reacting that they were just kids, doing what all normal kids do. Maybe he’s right. I don’t want to terrify Samantha. I don’t want to give her the message that sex is bad and dirty. I’ve had more than enough of that to deal with myself. Please tell me what I should do.”
Thoughts have been swirling through my mind during Samantha’s panicky recitation. I always believed that her daughter’s sexuality would present problems for Jennifer, but the possibility of sexual abuse raises those issues a hundredfold. On the other hand, Jennifer comes in with a good deal of insight. She knows she has to rein in her fears to avoid terrorizing Samantha, although children easily intuit their parent’s underlying and unspoken feelings. And there are the practical questions. What should Jennifer do? What did actually happen? Although the facts do matter in a case such as this, how one understands those facts will vary greatly depending upon the lens through which they are viewed.
“There a lot going on here, Jennifer. Are you asking me what you need to do about your feelings, about how to deal with Samantha, about what actually happened?”
Jennifer stares at me. “I don’t know. I can’t even think straight. All of the above, I guess.”
“You’re feeling overwhelmed by your feelings and you can’t think straight. Is it possible for you, for example, to talk with Bill again about your feelings, to talk with the Mom next door, have the two of you talk with the Mom?”
“I can’t,” Jennifer wails.
I remember that forlorn cry. “You still haven’t told anyone but me about your abuse, have you?” I ask.
Jennifer shakes her head sobbing.
“I’m sorry. I’m sorry you still feel so much shame you can’t speak. Let’s see if you can come in again tomorrow. I don’t want to leave you feeling so distraught.”
“I can’t believe I’m going to do it,” Paula says sobbing. “It feels impossible. It’s like I’m killing Robert. But I can’t be killing him because he’s already dead. Why? Why is he dead? Why am I doing this? Why is Karen moving? I can’t. I just can’t. Robert and I lived in that house almost our whole married life. How can I sell it? I just can’t.”
For those of you who read my book, you might remember Paula. She’s the depressed widow I treat during the winters when she leaves her home in Park Slope, Brooklyn to spend time in Florida. Depression has been with Paula most of her life; her husband’s death only made it worse. She hates leaving her home in Brooklyn, even for the winters, venturing south only at the insistence of her daughter, Karen, who, as Paula says, probably had enough of her, and sends her off to her other daughter in Florida. But Karen is now moving to Los Angeles. The plan is for Paula to return north this spring, to put her house on the market and to make a permanent move to south Florida.
“Maybe I shouldn’t,” Paula continues, still weeping. “Maybe I should just stay there by myself. I’ll just have to force myself to get out more, to make friends. I know I’m not very good at that, but I could try,” she says plaintively. “I know that’s not what my daughters want, but it’s my life. I get to do what I want.”
“It is indeed your life, Paula. This is a huge decision for you either way. But I’m glad to hear you say you get to decide for yourself what you want to do.”
“But I can’t. I couldn’t not do what my daughters want. They’d worry about me. I don’t want them to worry about me.”
“I wonder if that’s true, Paula. I suspect you’d kind of like your daughters to worry more about you.”
“That wouldn’t be nice.”
I sigh inwardly. Paula and I have covered this ground more times than I care to remember. “You don’t have to be nice all the time, Paula. And you don’t have to have only good thoughts and good feelings.”
“I guess.” She pauses. “But do you think it’s practical? Do you think I could stay in Brooklyn by myself?”
I smile. “So now you’re going to ask me rather than your daughters what you should do. As you said, you’re an adult. You can make your own decisions. You need to weigh how it would feel to stay in Brooklyn without one of your daughters, as opposed to how it will feel to sell your home.”
“I can’t. I can’t do either one.”
Sadness washes over me. Although Paula’s dependency, indecision and complaints often make working with her difficult for me, this time I feel Paula’s dilemma on a deeply personal level. I remember the tremendous pain I felt about leaving my Michigan home and relocating to south Florida. When my husband’s health tipped the scale in the direction of moving, I remember the questions I asked myself over and over: “How will I walk out of this house for the last time? How can I be making a decision that causes me such intolerable pain?”
Remembering, I say, “With the exception of your husband’s death, leaving your home may well be the most painful loss you’ve ever experienced. It’s nothing to make light of. Home represents your and Robert’s relationship. Home represents a place of safety and security. It’s “home.” Whether home will be enough without Robert or your daughter, no one can decide but you. You often feel very alone. I don’t know if that aloneness will feel intolerable once Karen has moved. That’s something you’ll have to decide. But if you do decide to move, don’t minimize the pain you’ll feel and don’t get angry with yourself for feeling it.”
“I want Robert,” she says beseechingly. “I want Robert to be here and help me.”
“I understand, Paula. I wish he could be here for you, but unfortunately that’s not possible.”
“I hate it when you say that. I know it’s true, of course, but I still hate it.”
“I know, Paula. It feels too real when I say it. But it is important for you to hold onto that reality because when you don’t, you’re surprised again and again that he’s dead and it’s like having to begin mourning for him all over again. And right now you have a huge decision to make and you need to make it knowing that Robert isn’t around to help you.”
For what seems like the twentieth time today, but is actually only the fourth I say, “I’m not going to be going on vacation, so we’ll be able to meet the next two weeks.”
“Oh,” Terri says, smiling. “That’s great for me. Feels like a gift. I’ve been feeling really scared about your leaving. Almost like I couldn’t make it without you.” Then her smile vanishes, her eyebrows knit. “Is everything all right? You’re not sick or something?”
For me, in situations that involve my life and directly impact my patients, full disclosure is the preferred response.
“I’m fine. I have a very sick dog and there’s no way I could leave her.”
Terri clenches her jaw. “You’re canceling your trip because of a dog?”
Terri’s anger brings me out of my self-preoccupation with my own feelings of sadness. I feel a flash of anger, surprised by her total lack of empathy. And then I remember. Of course, one of the many traumas of Terri’s childhood. My anger vanishes.
“Seems like you’re thinking about the time your parents went to Japan and left you with the babysitter when you were so sick and ended up in the hospital.”
“They didn’t give a shit about me. All they cared about was each other and having fun. I was like the third appendage no one wanted. They probably would have preferred if I died in that hospital. The aloneness. The total aloneness I felt. I think that’s what’s made it impossible for me to be all right being alone. Why I’m always with these losers. Just to be with someone.”
“That experience is the metaphor of your childhood – alone, isolated, scared, unloved.”
“You got it.”
“So, Terri, what does it mean for you that I’ve given up my trip to stay home with my dog?”
“It makes me mad.”
“I understood that, but could you say more about it?”
“A dog is getting more than I ever got. A dog’s got a better like than me.”
“So you feel angry with my dog, jealous. Do you also feel angry with me? After all, I’m staying home to take care of my dog. I wasn’t going to stay home to take care of you, so that might feel like I’m doing the same thing to you your parents did.”
“Yup! Same thing. I don’t get it, I don’t understand how people can get so attached to their dogs. They’re only dogs.”
A mixture of feelings flood me, sadness, anger, fear. I struggle to separate my concern about my dog, from my need to stay focused on my patient’s needs and issues.
“There’s lots going on here, Terri, and I think it’s important that we look at all of it. First, you feel jealous of my dog and angry with me for behaving in a way that feels rejecting of you, like I’m choosing my dog over you.”
“Well you are, aren’t you?”
“The caring and concern I feel for my dog is different from the caring and concern I feel for you. That doesn’t negate my feelings about you, but I do understand that’s how it feels to you, so you can feel however you feel, including really angry. And maybe dealing with your anger at me can be helpful to you and to us.”
Terri sits impassively, staring off. I can’t read what she’s feeling.
“What’s going on Terri?”
“I wish you had been my mother. I bet you would have been the perfect mother. I bet you’re staying home for your dog means you would have stayed home for me too.” Silent tears trickle down Terri’s face.
Sadness fills the room, both Terri’s and mine. But I don’t want to neglect her anger.
“What happened to your anger?” I ask.
“I don’t know. I guess I can still feel angry when I think about your choosing your dog over me. But really, I had shitty parents. And you would have been a great parent. And it’s sad that you weren’t.”
“There are lots of feelings churning around for you and I think it will be important for us to stay attuned to all of them.”
“I hope your dog gets better,” she says as she heads for the door.
Although I suspect even this statement is not unambivalent, all I say is, “Thank you.”
“I’ve decided I’m going to break up with Tim,” Allison announces at the beginning of her Monday session.
“Really?” I say, obviously surprised. I see Allison three days a week. On Thursday there was no intimation of her breaking off the relationship. “I thought you and Tim were doing very well.”
“Wow! I finally got to shock you,” she says laughing, passing her fingers through her curly, brown hair. “Yeah, we were. But, I don’t know, I think he’s too boring for me.”
“Too boring,” I repeat.
Allison is a 30 year old drug rep who came into therapy because she made repeatedly poor choices in men. We came to understand that Allison chose men who were similar to her grandiose and narcissistic father, a man who was always too busy and self-involved to attend to Allison. By choosing boyfriends who were like her father, she hoped to win in the present the love she couldn’t achieve in the past. Such a strategy never of course works, since choosing a narcissistic boyfriend will lead yet again to disappointment and pain.
“Yeah. I don’t know, the relationship is just too predictable, maybe too easy.”
“Too easy,” I say.
Allison laughs. “I’ve clearly thrown you for a loop. I love it!”
“So maybe our therapy sessions were also too boring and you’ve just spiced them up.”
“I never thought of that, but maybe,” Allison replies, still gleeful.
“Okay, so here are my questions: What’s wrong with easy? What makes easy uncomfortable? And what happened in the last four days?”
“It’s just not exciting. There’s no spontaneity. He’s always there – trusty, reliable Tim.”
“And you could say the same of me.”
“Yes, that’s true, you’re trusty and reliable, but I kind of like that from you.”
“Except you liked ‘throwing me for a loop.’”
“Yes. But that was like I kind of one upped you, like you know so much and sometimes it seems you can even read my mind and here I am able to surprise you. It makes me feel like I got you!”
Thoughts race through my mind. Allison feels she has just won a competition. With her father? More likely her mother. Allison and I have spent so much time dealing with her father, that her mother is a more shadowy figure to me. Still, my sense is that she too was fairly narcissistic and definitely intent on receiving as much of her husband’s meager supplies as possible. And there’s still the question of what changed in four days. Was the weekend break difficult for her? Was I too know-it-all in our last session?
“Did you have a hard time with our weekend break, Allison?” I ask.
“This has nothing to do with you! Why do you always want to make it about you?” she says angrily.
“I guess that makes me feel like your parents.”
“Now that you mention it, yes! I think you just wanted to deflate me because I surprised you.”
I consider Allison’s accusation. “I’m not consciously aware of competing with you or wanting to deflate you, but I am aware of being disappointed in your so easily discarding Tim and what seems like such a good relationship. Perhaps it made me feel you were discarding our work together and perhaps that made me want to reassert my presence.”
“Wow! There’s a lot of stuff in there. You certainly think a lot about why you do what you do.”
“I try to. I think it’s very important that we try to understand as much as we can about ourselves and our motivations. Doesn’t mean we always succeed. We all have an unconscious – including me – and by definition the unconscious is unconscious.”
“I guess you’re saying I should try to understand why I want to break up with Tim.”
I nod. “Yes, I guess that’s what I’m saying.”
“He’s so much not my father. I know, I know, that’s a good thing. But it doesn’t always feel like such a good thing. It feels like I’m giving up so much.”
“You are. You’re giving up hope. You’re giving up the hope of ever getting the father you needed and deserved in both the past and the present and that’s very painful.”
“But you’re saying I should do it?”
“I’m not saying you should stay with Tim, but I am saying that until you mourn the father you never had and give up chasing him in the present, you’re going to face a lot of painful breakups in your life.”
“I don’t know what Pete wants from me,” Jackie says in her high-pitched voice, dissatisfaction oozing from every word. “I’ve already seen him through his surgery and now there’ll be chemo. And I’ll be there, picking up the pieces, as always.”
“You sound so angry, Jackie,” I say, stating the obvious.
“Look, he smoked for 30 years. Yes, he finally quit but, guess what, his years of being an ass came back to bite him. And guess what again, just when we get the kids launched – that’s the word these days, isn’t it? – he goes and gets lung cancer. So he’ll probably die and I’ll be left on my own to go looking for a new man at this not so young stage of my life.”
I squirm in my seat, rubbing the thumb nail on my left hand. Jackie continues.
“I’m still being the good wife. I make his meals, I serve him, I clean up, same as always. I look at him sitting there just staring into space. But, yes, all I feel is anger.”
And all I feel is sadness. Images of my husband’s illness and death flash through my mind – doing “laps” around our living room with his walker for exercise, determined to stay with me as long as possible; his final days, loudly proclaiming, “I love you, Linda” before going into hospice. Our love never wavered. My love still doesn’t waver, six years after his death. But perhaps I’m feeling not only my sadness, but the sadness Jackie cannot allow herself to experience.
“No sadness, Jackie?” I ask.
“What, I can’t feel angry?”
Oops. I guess I followed my feelings instead of hers.
“Of course you can feel angry,” I say backtracking. “But I’m not sure I understand the intensity of your anger. Do you feel angry for the things Pete did in the past, or because he’s sick, or because he’s going to die or for some other reason?”
“Well, he wasn’t such a great husband, that’s for sure. He was a good provider, I’ll give him that. But once he got home all he wanted to do was to be catered to. Me and the kids didn’t matter. Just give him his dinner and let him relax and watch TV, no talking about anyone else’s day or, heaven forbid, any problems. And in the bedroom? Forget that. It was what he wanted and when he wanted it. That’s one advantage to his being sick and coughing all the time. I got to move into one of the kid’s bedrooms and he couldn’t give me too much grief about it.”
I shudder internally. Jackie’s hostility is almost too much for me to bear. “What about when you got married, Jackie? What did you love about Pete then?”
“That was a lifetime ago.”
“I understand, but what did you love about him?”
“Why?” Jackie asks, staring at me defiantly.
I blink, knit my brow and look back at her. I’m beginning to think that it wasn’t only my sadness I was feeling after all. “That doesn’t seem like such a strange question. Why are you asking me why?”
“You don’t like me being angry. That’s what I think,” she says crossing her arms over her chest.
“Perhaps,” I admit. “And perhaps you don’t want to risk feeling sad.”
“Why should I?”
“Well, remember what you said about Pete’s cigarette smoking coming back to bite him in the ass? That’s what can happen with feelings too. If you only feel your sadness and not your anger, you could, for example, end up being depressed. If you feel only your anger, in addition to missing out on a lot of love and closeness in your life, at some point you could be overwhelmed by your sadness or perhaps get physically sick, for example.”
“Sounds like a lot of psychobabble to me.”
“You know, Jackie, it seems like it’s not only Pete you want to stay angry at. It seems like you want to stay angry with me too.”
“I think you just can’t take my anger.”
“How about if I mull over that possibility and you consider whether you’re keeping your sadness at bay so you don’t have to deal with how scared and vulnerable you feel. Maybe we’ll be able to meet somewhere in the middle.”
“My grandfather died last week,” Melinda says as she settles herself into the chair.
“Oh, I’m so sorry. I know how important he was to you.”
“Yes, it’s hard. I know he was 95 and failing, but I loved him so much. He was always there for me. And I always knew he loved me.”
As she talks, childhood images of my own grandfather pass through my mind: his joy at baking my birthday cakes; our walking for what seemed like miles to find my wished-for record, “I’m a Lonely Little Petunia in an Onion Patch;” his traveling roundtrip by subway almost every weekend to pick me up in Brooklyn and bring me back to my grandparent’s apartment in the Bronx; the twinkle in his blue, blue eyes whenever he saw me. He’s been dead for over 40 years, but he lives with me still.
“His funeral was Sunday. My sisters came in which was good, but there just aren’t many people left. He used to have so many friends, but they’re all gone. And my uncles have been dead for years. Some of my friends came, but having so few people made it feel even sadder, emptier. My parents, of course, and Ron and the kids, but when we got home everyone left.”
“Everyone left?” I ask surprised.
“Yeah. The kids wanted to go be with their friends and my sisters are staying at my parents and Ron went to play basketball.”
“How did you feel about Ron leaving, about being alone?”
“That’s just how Ron is. He can’t sit with his feelings. He loved Pop too and he can’t just sit around and be with his feelings. He has to keep moving. He has ADHD. I get it.”
“But how did you feel about his leaving?” I persist. I “get it” too, but having known profound loss myself, I cannot imagine being without kind, loving people after the death of a loved one. Am I being overly sensitive? Am I imposing my experience and values onto my patient? Regardless, I feel angry with Ron and wonder if I am feeling Melinda’s anger as well as my own.
“That’s Ron. Would I have preferred if he was able to cuddle with me on the couch? Sure. But if he sat there playing with his phone, that would have driven me crazy. Better that he not be there. It’s like a month or so ago when Haley had her appendectomy, and he couldn’t sit in the waiting room. I told him to go.”
I remember Melinda and I discussing that incident and my being equally incredulous – and angry - that a parent wouldn’t have needed to be present during a daughter’s surgery. There again I found it hard to believe my patient’s apparent equanimity.
Now I think about my anger and say, “Melinda, do you notice that when I ask you how you feel, you tell me how you understand why Ron is doing whatever he may be doing. I think it’s great that you’re able to be compassionate towards your husband, but that doesn’t tell us what you’re feeling.”
She sits thoughtfully. “That’s what I always do, isn’t it? I focus on Ron or the kids or whoever else, rather than on me. I always thought it was because I was such a caretaker, but maybe I’m just avoiding what I feel.”
“And what do you feel?”
“Sad. I feel sad. Here I just lost Pop and my own husband can’t even be there for me.”
“Sounds like there’s some anger there as well.”
“Yes, there is. But mostly it’s sadness. We’ve talked about this before. I’m the third girl, the unwanted child, everyone too busy for me, except for Pop - and Grandma. And then I pick a man who’s there and not there. I mean I know Ron loves me and he’s there for me sort of, but he has his own problems, and that limits what he can give me.”
“You’re starting to move back towards focusing on Ron. What happens if you stay with your own feelings?”
Her eyes tear. “It’s way too painful,” she says quietly.
“You’re carrying around lots of pain, from the past as well as the present. I know it hurts, but it is important that we look at it and that you try to stay focused on you. Otherwise you’re treating yourself the same way you’ve been treated, not giving yourself and your feelings enough importance.”
“Wow! That’s true. What I feel matters. I’ll work on it.”
