“I never expected to be in a therapist’s office,” Darlene says, pulling at her fingers, glancing anxiously around the room. “I like all your windows. It makes your space feel larger, but still cozy.” She laughs self-consciously. “I’m an interior designer. Space matters to me. I’m sorry, I’m just rambling. I guess it’s hard to begin.”
“Take your time,” I say reassuringly. “It’s hard to open up to someone you’ve never met before.”
“It’s hard to open up to anyone. I’m 37 years old and except for my husband and my best friend I never talk to anyone about my sister. Or her death. That’s how I got to you. My friend sent me your blog about your husband’s death and I looked on your website and saw that you wrote a book about it and I thought, wow, here’s someone who can talk about her loss, maybe she can help me talk about mine.”
Darlene is talking rapidly now, as if in a rush to discharge years of pent up words. “I was seven when she died in a car accident. She was 16, the golden girl. Literally. She had beautiful long blond hair. And she was very smart, in her senior year of high school, with her pick of all the best colleges. Even her name was special – Lily, like the flower. Me, I kind of faded into the background – skinny, brown curly hair, a bit of a tomboy back then, okay in school but nothing exceptional. I was the tag along little sister, kind of a pest.
“Then she got killed. Of course my parents were devastated. Everyone was. I know now that my mother became majorly depressed, but then all I knew was that she vanished into her bedroom. I would hear her crying. I’d want to go in and comfort her but the door was always locked. Sometime I’d curl up on the floor outside the room and just wait for her to come out. My father threw himself into his work. He’d tell me not to bother my mother, not to upset her any more than she was already upset.”
I’m aware of the sadness I feel for Darlene as the lost, frightened child. I’m also aware of Darlene’s envious feelings towards her sister and wonder how that has affected her mourning.
She continues. “I don’t know how long it was before things became normal again. Except they weren’t normal. All the pictures of Lily disappeared. And no one could mention her name again. I never really understood how Lily died. I mean I knew she died in a car accident, but I don’t know who was driving or who was at fault or any of the particulars. I still don’t know. No one talks about her. It’s as though she had never existed. It’s weird.”
I shudder internally. I can’t imagine a more unhelpful way to mourn. And I can’t imagine the message Darlene received about death and mourning when a child goes from being loved and adored to being vanished and unspoken. There’s so much that Darlene needs to work on.
“How did you feel about Lily’s death?” I ask.
“Scared. I couldn’t understand how someone could be here one day and gone the next. It was frightening. I still feel that way. Death scares me. It’s one of the reasons I keep putting off having a child. My husband really wants children. But I worry. How would I cope if the child died?”
Darlene has stated her conscious concern about having a child. I wonder about possible unconscious reasons such as fear that her negative thoughts magically killed Lily and might similarly kill a child or that a child would become a competitor for her husband’s affection just as Lily was for her parent’s. But these are just speculations on my part and very far from where Darlene is at the moment.
She continues. “I still miss Lily. And I imagine losing a child would be way worse. Can I ask you something?”
“Sure.”
“Is there something wrong with me that I still miss Lily after 30 years, that I still want to talk about her?”
Sadness fills me as I think about my two October losses - my husband now dead for seven years and my grandmother for 44. I carry them with me always, aware of the richness they brought to my life.
“Absolutely not,” I say. “Your parents never gave you or themselves the chance to mourn Lily, to tell stories about her, to remember her so that you could take Lily inside yourself so that it wouldn’t feel as though she had never existed. Taking the person who’s died inside us is a way to bring ourselves comfort, as well as a way to keep that person alive in the only way possible.”
Darlene’s eyes fill with tears. “You will work with me, won’t you?” she asks plaintively.
“It will be my privilege.”
In honor of this day, my late husband George’s birthday, the following is a small excerpt from the book I wrote to memorialize George and our relationship, Love and Loss in Life and in Treatment, which was published by Routledge in 2013:
In August of 2008, ten months after George’s death, I hear the following message on my answering machine: “I’m Molly Callahan. I need to see someone. I lost my husband, Mitch, six months ago and I’m having a hard time.” Her soft but determined voice wavers towards the end. She leaves her number. I sit staring out my window at the darkening sky, shades from light gray to black, trees whipping wildly in the wind, all warnings of the storm headed our way. I think about this woman I have not met. The timbre of her voice suggests that she’s young, certainly younger than me.
The question now is: Am I ready? Am I ready to hear another widow’s pain? Will I be able to put aside my own grief to work effectively with hers? Or perhaps I should ask if I could use my own grief to hear hers more deeply, communicating on an unconscious, as well as a conscious level. I decide that I’m up to the task and that is how Molly becomes my patient.
Molly is a striking, curvaceous, dark-haired forty-two year old woman, with big, sad eyes. She immediately plunges into her story.
“I lost, Mitch, my husband, in February. I can’t believe it’s been six months,” she says, shaking her head. “I miss him so much. We had such a great relationship. He was my best friend. He would have been 47 on October 14.” Her voice is strong, determined, as if she is willing herself to tell her story without breaking down.
Goose bumps appear on my arms, as I keep my face impassive. How is this possible? What are the chances that the deceased husband of the first widow I see after George’s death would share his birth date?
“He died of a heart attack. He wasn’t feeling well that day. In fact he hadn’t been feeling well for several days, but he continued working. He was a construction supervisor.”
Is this some sort of a cosmic joke, I wonder? [George was a construction contractor I met 30 years earlier when I hired him to remodel my small home on a lake outside of Ann Arbor, Michigan.]
Molly continues. “He didn’t take good care of himself. There was a lot of heart disease in his family and the last time he saw his doctor – maybe two years before – he was supposed to get all these follow-up tests, but of course he never did. But that Saturday he seemed to be feeling especially lousy. I offered to take him to the hospital, but he wouldn’t hear of it. I was supposed to go shopping with my best friend and he told me to go. I said I’d stay, but he said, no, I should go, that he’d be fine.
“When I got home he was slumped over on the floor in the living room. I don’t even know if he was still alive then. I called 911 and they came over and started working on him and then they took him to the hospital and they wouldn’t let me go back there and then they came out and told me he was gone,” she says in a rush to get her words out. And then, much more slowly, more quietly, she adds, “Then they let me go back. He was cold, so cold.”
[I feel as though] I’m back in the hospice room staring down at George’s body. He isn’t cold. I’m glad. I wouldn’t want him to be cold. I wouldn’t want my last experience of him to be cold. Not cold. Warm. Warm, like always.
“This is our ninth session,” says Penny, a petite, anxious 29 year old, adjusting the pillow behind her back as she settles into the chair across from me.
“And that means…?” I ask.
“We only have one session after today.”
Startled, I ask, “Why is that?”
“That’s all the insurance company allows.”
“I’m confused, Penny. I thought I explained to you that I’m not on any insurance panels and that you decided to see me anyway.”
“For 10 sessions,” she says, squirming in her seat. “That’s what my husband said I could do because you were so highly recommended. He said I could see you for the same 10 sessions the insurance company allowed and if you were as good as they said you should be able to help me in the same amount of time.”
Thoughts swirl through my head: I’m not on insurance panels because I don’t believe therapy can work in 10 sessions; you were sexually abused by a brother-in-law as a child, have to force yourself to endure sex and want to be “cured” in 10 sessions; you’re a scared, passive woman with three small children at home and have no one in your life to talk to other than me; I wanted to see you at least twice a week and we compromised on once, but I’m not a miracle worker.
I settle on a far more mundane response. “How would you feel about us ending after ten sessions?”
“That’s what my husband said I could do.”
“I understand, but how do you feel?”
“I don’t want to. Talking about all that childhood stuff, I don’t know, it’s brought it all back up. Now I really can’t stand to have my husband touch me. He’s not happy about that either.”
“Have you told your husband how you feel?”
She shakes her head, morosely.
“Can you?”
“It won’t make any difference.”
Penny’s passivity is difficult for me, but I know that’s always been her way of being in the world, the obedient little girl who did what adults told her – including her brother-in-law – and now the obedient adult who follows her husband’s dictates. I’m in a bind. I don’t want to become another person who tells Penny what to do, but I also can’t help her if she doesn’t stay in treatment.
“What are your options, Penny?”
“I guess I’ll just have to stop after next week.”
“You wouldn’t consider talking to your husband about what you want? After all, he must also want you to become more comfortable with sex,” I say, aware that I am coaching her.
“Do you think that’s possible?” she asks, more brightly.
“It would certainly be my hope, but I know we can’t accomplish that overnight.”
“Would you talk to him?” she asks, plaintively.
Oops, I think, I should have seen that coming. “Penny, why do you think my talking to your husband would have more weight than your talking to him?”
She shrugs. “I don’t know. It just would.”
“But maybe it's important for us to understand why you feel he'd listen to me more than to you.”
“I just know he would.”
“Let me ask this, how are you and I different?”
“What?” she says, giggling, “In every way. You’re smart, educated, a doctor. You know what you’re talking about. There’s nothing about us that’s the same.”
“It’s impressive how much you put yourself down, Penny, how little you think about yourself, how you so easily give up your power. If you think so little of you, I understand that it would be difficult to present what you want in a convincing manner to your husband or anyone else.”
“So you’ll talk to him?”
I groan inwardly. “Is the answer for me to talk to your husband or for you to feel better about yourself and to be able to stand up for what you want?”
“But we’re running out of time,” she says.
“You definitely have a point,” I say, glad to be able to support her statement. “It would be difficult for us to sufficiently help you feel better about yourself in one remaining session.”
“So you’ll talk to him?”
I remain reluctant to step into the role of the authority who might save the day – assuming, of course, that her husband would listen to me which is clearly uncertain. Instead I say, “How about this idea, Penny? How about if you ask your husband to come in to a session with you and you can tell him how your feel and I can be here to support you?”
“What if he won’t come?”
“I guess we won’t know until you ask.”
Today I return to Melinda whom I wrote about several months ago. She’s the woman whose 95 year old grandfather died and whose husband left her alone to deal with her grief. As we explored that experience, it became clear that Melinda needed to focus on others as a way to avoid her own feelings of anger and sadness. As the third girl in her family of origin, she had felt unwanted and unloved and carried around a reservoir of hurt, painful feelings.
“I feel as though I’m being torn in a dozen different directions,” Melinda begins. “The kids are a handful themselves – getting them ready for school, getting Elizabeth to tennis and dance and Mathew to softball and soccer, helping them with homework. But that’s all right. I expect that. But sometimes I think my husband is another kid. He’s so disorganized. I have to help him with our bills, get his clothes to and from the cleaners, do the laundry, remind him to take care of our cars and whatever chores he’s forgotten to do around the house. I even have to tidy the house before our cleaning woman comes. I know she’s supposed to be helping me and I guess she is, but I still have to tell her where to put things and straighten up before she comes. And my friends – I mean I love them all – but they’re always having crises – Bonnie broke up with her boyfriend, Charlotte’s mad at her husband again, Tina’s worried about her mother. And I have to get myself here as well.”
“Sounds like you’re feeling overwhelmed, Melinda, and not having any space for you.”
“Me? No, there’s no time for me. I’m too busy taking care of everyone else.”
“But I wonder if you also need to avoid you. Remember we talked about your treating yourself as you’d been treated and not allowing yourself and your feelings to matter?”
Melinda sighs. “I guess. I guess you’re right,” she says, her speech slowing.
“I notice you just slowed down a bit. That’s probably a good first step – giving yourself some time to think and feel.”
“It’s hard. I feel all this pressure, all these people making demands on me.”
“So who fills your needs, Melinda?”
“No one I guess. Makes me sad to realize that.”
“What about me, Melinda? I noticed before when you were listing all the people who were making demands on you, you said that you had to get yourself here as well. Sounds like you feel I’m another person who’s taking from you rather than giving to you.”
“I suppose that’s true. You’re someone else I have to fit into my schedule.”
“But why is that, Melinda? Why is it that you can’t experience me as giving to you, why can’t you experience your time with me as nurturing?”
“I don’t know.” She pauses, thinking. “I don’t know why, but I suddenly thought of the time my mother forgot to pick me up from school and it felt like I waited for hours, although I’m sure I didn’t. Everyone in the family thought it was funny. It didn’t feel very funny to me.”
“I wonder if you’re saying, Melinda, that you’re afraid to allow yourself to need me because you’re afraid I’ll let you down like your mother and then laugh at you for needing me.”
Melinda’s eyes fill with tears. “I was about to say, no, I know you wouldn’t do that, but obviously that really hit a chord in me.”
“Being needy makes you feel vulnerable.”
“That’s true. I hate feeling vulnerable. It’s scary. And weak.”
“So you run around taking care of everyone else so you don’t have to feel your own need to be cared for. You get to be the ‘strong one,’ the one who doesn’t having any needs.”
“Yup! That’s me.”
“And in the meantime, I suspect the feeling of neediness inside you gets bigger and bigger, making it even scarier for you to acknowledge, so that you have to try even harder to keep it hidden and stuffed safely away.”
“So what do I do about it?”
“Well, one thing we can do is keep a careful watch on what goes on between us. How you feel about being here, what you do or don’t do to keep me at bay and what happens if you begin to allow yourself to want or need from me.”
“That sounds hard. I can already feel myself wanting to head for the door.”
“I understand. But I will try to keep us focused on what’s going on between us, without making it too, too uncomfortable for you.”
“What do you mean you’re going to charge me for last week’s session? I cancelled!” Carly says indigently.
I’ve been working with 22 year old Carly for well over a year. She knows that my cancellation policy is 48 hours’ notice or she gets charged for the session. There was a time that therapists allotted various time slots to their patients and that the patient paid for that time whether or not they came. It was as if someone paid a fee for a semester of classes. The person would pay that fee, regardless of how many classes were attended. Some therapists still follow that procedure, believing both that it increases the patient’s commitment to the process and insures that the therapist’s income is not subject to the whim of a particular patient. Still, that line of thought has been waning and I’m more comfortable with my 48 hour policy.
Except that I’m not always good at enforcing it. On the positive side, I could say that I’m flexible and willing to take my patients’ individual needs and circumstances into account. There can, however, be negative consequences as well. A patient might feel more unsafe about other boundaries in the treatment room – or in life in general - if I’m unable to be firm about my own policy. Or not standing firm, might lead a patient to feel increasingly entitled and therefore to become more demanding both in and out of the treatment room.
Either way, Carly knows that I won’t always stand firm. Her mother fell and had to go to the hospital. I didn’t charge her. Her car broke down on her way to the appointment. I didn’t charge her. She woke up with an attack of vertigo and was afraid to drive. I didn’t charge her. But this cancellation crossed my line. “My friend Charise came into town and needed someone to play tennis.”
“You know that my cancellation policy is 48 hours, Carly,” I say evenly.
“But you didn’t charge me when I got dizzy that time and couldn’t come!” she says.
I sigh inwardly. The problem with not following my own rules is that I’m then in a position of having to pass individual judgments on what I deem worthy or not worthy of a forgiven cancellation.
“Does it seem to you Carly,” I ask, “that there’s a difference between being dizzy and unable to drive and going to play tennis with your friend?”
“But I see her so infrequently,” she exclaims.
“I understand that, but you could have played tennis with her later or earlier or on a different day,” I say. Even while speaking, I realize this is a ridiculous conversation. Although Carly is young and somewhat immature, she’s smart and clearly knows the difference between sickness and tennis.
I think about what might be going on here. Was there something that happened in our session before the cancellation? Is there something in Carly’s past that’s being repeated with me in this room? Nothing springs to mind, so I decide to ask Carly herself.
“How did you feel about us not meeting last week?”
”What do you mean?”
“How did you feel about cancelling last time?”
She glances out the window and down at her hands. “I liked it. I felt like I was playing hooky from school.”
Now we’re getting someplace, I think.
“And you wanted to play hooky because…?”
“Because I could. I never could as a kid. My parents would have killed me. And besides I would have felt way too guilty. Always have to be good, especially when it comes to school.”
I get that. I so internalized my family’s attitude towards education that I too could never have imagined playing hooky. But I rebelled in other ways, allowing me the separation from my parents that was necessary for my growth. Carly has been pretty much the consistently good kid. Now I’m in a bind – both wanting to support her need to pull away, while enforcing the consequences of her rebellion.
“I understand, Carly,” I say. “I understand that you’ve been the all-too-good kid and that playing hooky can be an important step for you towards independence. But I suspect if you were able to come in here and talk about your desire to play hooky with me, we could help to be your own person in relation to your family where it really counts.”
“You’re still going to charge me, aren’t you?”
“Yes, I’m still going to charge you. And I’m definitely going to want us to continue talking about how you feel about that and what it means to you.”
“It means I’m being punished for being my own person,” Carly says angrily.
“I hear you, Carly. It’s fine for you to be angry and we will continue to talk about it.”
“Big surprise,” Tricia says, sighing, “Billy broke up with me. I told you he would. I told you he was nothing but a big baby who needed more and more reassuring and couldn’t tolerate arguing or sticking up for himself. Same old story again and again. I don’t know, don’t they make any 35 to 45 year old men who are men anymore?”
I’ve been thinking about Tricia and my relationship. I’ve been thinking about how quickly I find myself sucked into what is indeed her argumentative style. I’ve been thinking about why she needs to make all her relationships so contentious. And I’ve been thinking about why I’m so easily engaged in her argumentative style, as opposed to staying in my role as the therapist who seeks to analyze and understand.
My mind runs quickly through the responses that first come to me: Say nothing, which she’d experience as withholding and therefore maddening; Say, “Why do you think you keep finding men who are so wishy-washy?” which she’d hear as attacking; Say, “Why do you think you need to make your relationships so contentious?” probably the most important question which she would immediately dispute. For the moment, I settle for the most innocuous response possible, a typical therapist question.
“How do you feel about his breaking up with you?”
“Boy, there’s a typical therapist question if I ever heard one!”
I should have known she’d get me on that one, I think to myself.
“I felt like, well, I knew it.”
“But what did you feel?” I persist.
She shrugs. “Not much.”
“Tricia, can I ask you what you feel about our relationship?”
“Wow! That’s a change of topic. Where did that come from?”
“Well, we’re talking about relationships and you and I certainly have a relationship. We’ve been seeing each other for almost a year now.”
“Yeah, and I’m no further along than I was to begin with”
I’m beginning to feel dismissed and demeaned. Although I certainly take responsibility for the lack of progress in any treatment, Tricia’s inability to look at herself and her role in thwarting her own growth is more than annoying. Are my feelings similar to the ones I had with my father who knew everything, argued about everything and called me stupid if I ever dared to disagree with him?
I persevere. “Tricia, have you ever felt close to anyone, ever?”
“You’re all over the map today,” she snaps back.
“Can you tell that you’re trying to bait me into an argument? It’s like you’re sparring with me as opposed to experiencing us on the same side, as trying to help you to better understand yourself and get to the place where you say you want to be, in a relationship with a man.”
“Where I say I want to be? What do you mean by that? Don’t you believe me? How can we be on the same side if you don’t even believe me?”
“Tricia, this is impossible,” I say clearly angry. “It’s as though you listen to everything I say looking to pick out the one thing that you can argue with me about and zoom right in on it.”
“Ah ha,” she replies, with a slight smile and a sparkle in her eyes, “I got you pissed off.”
“And why does that feel good to you?” I ask. “Does it give you a feeling of control over me? Does it keep a distance between us that’s more comfortable?”
“It shows you’re strong enough for me. That you can fight with me. That you can take what I have to dish out.”
“Who did that to you, Tricia? Who wanted to make you tough enough to fight back?”
In an instant, Tricia’s face becomes expressionless, frozen, her eyes staring blankly ahead. I’ve seen that look many times before, the look of an abused child.
“Who did that to you, Tricia?” I ask again, much more gently.
Tricia blinks and focuses back in on me. “My mother. I’ve never told anyone. I hate being a victim. She used to beat the shit out of me. She’d beat me and beat me until I stopped crying, until I was no longer a baby, until I could take it. She thought she was helping me. I thought she hated me. Except I think I have love and hate all mixed up.”
“I’m so sorry that happened to you, Tricia. You were a helpless child. A helpless child can’t be anything but a victim. There’s no shame in that, although I’m sure you do feel a lot of shame. And I’m sure you’re right, love and hate is all mixed up for you. We have lots to work on. But I’m really glad you told me Tricia. I know it wasn’t easy.”
“I got into a ridiculous argument with my ex this past weekend when I went to pick up the kids. She greeted me with, ‘Are you a narcissist?’ I knew she’d read about that study that said you could identify narcissists just my asking them if they were narcissists. Of course I said, ‘No.’ Then I asked her the same question and she said no too. But she is a narcissist. So then we got into this whole argument.”
Spencer is probably my fourth patient who has brought up that study which I had also read about. Defining a narcissist as someone who is egotistical, self-focused and vain, the researchers found that asking the one question, “Are you a narcissist?” was as effective as identifying a narcissist as a 40 item diagnostic test. Although I have seen neither the study itself nor the 40 item test, my experience – both clinically and personally – leads me to question whether narcissists will so readily identify themselves.
“It’s so ridiculous. I can’t see how someone who has had all the plastic surgery she’s had, who takes hours to get ready to go out, can call me a narcissist. It takes me five minutes to get ready for work and if I never looked in a mirror again that would be fine.”
“Why did Bonnie think you were a narcissist?”
“She said I never think of anyone but myself, throw a fit when I don’t get my own way, and am very superficial. Superficial! Look who’s calling who superficial. She’s never done anything worthwhile in her life. I’m the one who busted my ass to get my doctorate, to become a tenured professor, to provide the home that’s now hers, the life-style that she’s grown accustomed to. Superficial, my ass! And I also don’t call that thinking only of myself. I did it for her, for them.”
“Is that true, Spencer, did you do it for them, or did you do it to prove to yourself – and to your father – that you were smart and worthwhile and accomplished?”
“And that makes me a narcissist?”
“I didn’t say that, Spencer. I think there’s always some self-interest in what we do. I was just questioning your saying that you did it for them.”
“That’s beside the point. I was just refuting Bonnie’s argument. I can’t believe I’m wasting my time – and my money! - talking about this. Do you have anything worthwhile we can talk about?” he asks, sarcastically.
I’m instantly flooded with feelings – anxiety, anger, fear. I feel both challenged and diminished. Not for the first time, I’m aware that Spencer reminds me a great deal of my father – angry, demanding, short-tempered and, yes, narcissistic. I’m also aware that the fear and anger are feelings both Spencer and I experienced as children in relation to our respective fathers. This awareness doesn’t make my feelings vanish, but it does help me to remain in my role as therapist.
“Well, I think it’s very important, Spencer, that we look at what’s going on between us right now, because I think you’re treating me just as your father treated you as a child. You’re being challenging, angry, and dismissive towards me just as your father was toward you. And that leaves me feeling both angry and less-than, just as you felt with your father.”
“So now I’m a less-than narcissist,” is Spencer’s retort.
“I can see how tough your father was, Spencer; how he never gave you an inch; how he didn’t listen to what you said; how he always had to come out ahead. I’m not your father, Spencer. I’m not trying to diminish you. I wonder if you could take off your father’s glasses and see me through your own eyes.”
“So do you think I’m a narcissist?” Spencer persists.
“You’re unrelenting, Spencer,” I say shaking my head. “You know when you said before, that you’re a less-than narcissist? Well, there’s a lot of truth in that, not especially for you, but for many people who have some narcissistic characteristics. They’re people who feel less-than, but who have developed a way of feeling better about themselves, of keeping that less-than feeling at bay. I think you do it by being angry, by shutting down alternative opinions and, probably most importantly, by trying to convince both yourself and others of your accomplishments and specialness.”
“So you’re saying a narcissist looks like someone who thinks a lot of himself, but actually doesn’t think much of himself at all.”
“That’s exactly what I’m saying.”
“I don’t know. I’ll have to think about it. And I’ll have to think about whether it applies to me.”
“I appreciate your being open to thinking about it.”
