Saying Good-bye

“Well,” Arlene begins, “We have three sessions left including today.”

“How do you feel about that?” I ask.

“Good. I’m happy. I never thought I’d be able to say that. When I started with you three years ago I was totally miserable. I’m sure part of it is being on medication, but you’ve been so helpful to me.”

I’ve been seeing 65 year old Arlene in therapy for three years. And she’s right. She’s made excellent progress. She’s no longer depressed, can speak up for herself with her husband, and is more accepting of her grown children’s need for their own lives.

She continues. “Even last night, Larry took the remote and started flipping channels when I was right in the middle of watching ‘Madame Secretary.’ For a second I sat there and said nothing, but I could feel myself shutting down and I knew – because of you – that’s the first step to my becoming depressed. So I told him that wasn’t considerate of him and that I wanted to finish watching my program. I could see he wanted to give me an argument, but he didn’t and he did put my show back on.”

“And how did you feel about that?”

“Good.”

“Only good? Didn’t it feel like a victory, like you wanted to jump up and shout for joy?”

“I wouldn’t go that far. But I did give myself a kind of pat on the back.”

“Good for you!”

Silence.

“I don’t know what else to talk about. I’m happy.”

“I glad you’re happy but can I ask you again how you feel about ending?”

“Like I said, good. I feel that I’ve accomplished a lot and that we’ve talked about my big issues - my fear of my father and my dependency on my mother - and that we’ve been mostly rehashing for months and that I don’t need to be here anymore.”

“I agree with you, Arlene, that you don’t need to be here, but I still wonder, we’ve had a long relationship. Do you feel any sadness about leaving?”

“No. I don’t feel I need to be here.”

I’m taken aback by Arlene’s response. I know that she has been quite attached to me during the time we’ve worked together. I also know that I almost always feel some sadness at the ending of a treatment. How is it possible she’d feel no sadness? I persevere.

“I agree you don’t need to be here. And you can feel a terrific sense of accomplishment and satisfaction about being ready to leave. But you can still feel sad about saying good-bye. I do. That doesn’t mean you shouldn’t leave. Let me ask you this, will you miss me?”

“No. I hope I’m not hurting your feelings, but I don’t think I’ll miss you and I don’t feel sad. I feel too happy to be depressed. Maybe the medicine keeps me from feeling sad.”

“I wonder if you’re saying you’re afraid to feel sad for fear of becoming depressed again.”

“I just don’t feel sad.”

Increasing confident that Arlene is defending against her sadness I ask, “What does make you sad?”

“Nothing.”

“I know that’s not true, Arlene. You were certainly sad when your granddaughter went into the hospital or when your friend Miriam died.”

“That’s different. That was about death. I was scared for Haley and Miriam’s death was a big loss.”

“You look a little sad now, thinking about Miriam’s death.”

She nods.

Silence.

“Maybe we shouldn’t terminate,” she says suddenly.”

“You know, Arlene, it is all right to feel sad and still terminate.”

“There’s no reason we have to end.”

“I think what you’re saying, Arlene, is that you don’t want to feel sad. If you’re going to say good-bye you have to keep yourself from feeling sad and if you start to feel sad you have to keep yourself from leaving.”

Arlene shakes her head. “If I feel sad maybe it just means I’m not ready to leave.”

“I wonder, Arlene, if you’re feeling with me as you did with your mother. In order to be your own person you felt you had to cut off your feelings about her, to feel nothing, or separating from her would have been too painful. And that’s what you’re doing with me as well.”
 
“Well, if I’m still doing that maybe I’m not ready to terminate.”

“Or maybe in our two remaining sessions we need to deal with your allowing yourself to feel sad and still say good-bye.”

Near Death

I open the door to my waiting room and see Ben sitting there, perhaps a little thinner, perhaps a bit more gaunt, but basically looking like his old self. I blink back tears. He’s alive. He looks up and smiles at me. “I made it,” he says, echoing my own thoughts.

“I want to start by saying how much it meant to me that you came to see me at the hospital.”

A near fatal heart attack. Quadruple by-pass. Multiple infections and his first words are about my visiting him at the hospital. “Of course I’d come to see you.”

“It didn’t feel like an ‘of course’ to me. It felt like you cared about me. That I wasn’t just a patient.”

I think about Ben’s angry, rejecting mother and reflect on how difficult it is for people who weren’t cherished by a parent to take in that they’re cared about. “Ben, we’ve known each other for a long time. I’ve watched you become so much more of a feeling, related person, but it’s still hard for you to believe that I – or others - care about you.”

“This experience did show me how many people care about me. And my wife, she was amazing. I know it’s impossible, but it felt like she never left my side, that every time I opened my eyes she was there looking at me, squeezing my hand, smiling at me.”

Suddenly I’m besieged by images of my late husband lying in a hospital room with me sitting beside him. Many years, many images. Waiting for the results of his angiogram; the terror of his first angioplasties; the pain of a double knee replacement; the horror of discovering he had undiagnosed heart damage perhaps fatally complicating a minor heart attack after his first chemotherapy; his miraculous survival; his deterioration …  

My patient interrupts my reverie. “You look sad. I’m sorry. You must be thinking about your husband. “

Ben began working with me about a year before my husband’s death, now over seven years ago. It was an agonizing and vulnerable time for me, a time I revealed more about myself than was typical of me.

I say, “You’ve just demonstrated to yourself how much our patient-therapist relationship is a human relationship, how two people who have known year other for years, come to understand and care about each other. And you’re right, I was thinking about my husband, but I apologize for distracting you from your appreciation of your relationship with your wife.”

“Do you think being near death brings people closer?”

“What do you think?”

“I think it does. It makes you appreciate what you have when you see how it can all be gone in a second.  I actually thought about you when I saw how attentive and scared my wife was. I knew you would have been like that.”

“Ben, when you comment on your wife’s love and caring, when you reflect on your sense of me, I hope you can see how much you’ve changed, how much easier it is for you to genuinely connect to your wife, to me, and I’m sure to others as well.”

Ben nods his head, “Definitely. I feel like I’m a different person than the one who first came here.”

“And yet you’re still surprised by my coming to visit you in the hospital.”

“Yes. I don’t know. Is it because I feel I don’t deserve it?”

“Well, why wouldn’t you deserve it?”

“Because …,” he shakes his head. “I don’t know. I’m a pretty good person. And I do know …” Ben hesitates. “I do know you care about me.”

“Sounds like that was hard to say.”

“It was.”

Silence.

“I suddenly feel sad. You’d think it would make me happy to feel you cared about me.”

I remain silent, giving him a chance to reflect.

He continues. “I just got this picture we’ve talked about many times, when my mother beat me in front of my friends because I didn’t take the garbage out the minute she asked. It’s like I don’t know how to reconcile the two. How could she treat me like that if you and my wife care about me?”

“I think what you’re saying, Ben, is that if you’re deserving of love and caring today, you were deserving of it then, but your mother couldn’t give it to you. And if you realize that was her shortcoming, not yours, you have to give up hope that you could ever have gotten her love, regardless of what you did.”

Ben rubs tears from his eyes. “I think that’s right. But I am grateful for the love I have today.”

“I’m really glad to hear that,” I say as the hour ends.

      

In Search of a Self

“I can’t believe it,” Janice says throwing her hands in the air. “Why does she feel she has the right to tell me what I should wear to my child’s graduation? I’m 42 years old. Shouldn’t I know what’s appropriate to wear and what isn’t?”

Janice is talking about her mother’s intrusiveness, a situation that has only worsened since her family moved to Florida a little over a year ago.

“Well,” I ask, “what does give her the impression that it’s all right for her to tell you what to do?”

“She’s always done it. That’s how she was when we were kids – especially with me as the only girl – and that’s how she is now. ”

“What did you say to her when she was telling you what to wear?”

“I said, ‘Ma, I’m a big girl now, remember?’”

“So you don’t confront her; you kind of make light of it.”

“I don’t scream at her if that’s what you mean.”

“No, I wasn’t talking about screaming at her. I was talking about having a genuine conversation about how you’re a grown woman who doesn’t need her mother to tell her what to wear and how it doesn’t feel good to have her invading every aspect of your life.”

Janice pauses and then asks, seemingly puzzled, “What’s the alternative?” 

Similarly confused, I say, “I’m sorry, I don’t know what you mean.”

“Well, when you just said it doesn’t feel good having her invade every aspect of my life, it suddenly felt scary to me, like if she wasn’t invading every aspect of my life would I feel, I don’t know, would I feel lost, abandoned?”

“That’s a very insightful question,” I say, thinking back on my own relationship with my intrusive mother. Early in my life I experienced her hovering as protective and safe, but I grew to chafe against it and needed to set my own boundaries. Perhaps Janice isn’t there yet. “So you’re saying that as much as you protest about your mother’s intrusiveness, perhaps there’s a part of you that still longs for it.” 

Janice looks at me, looks over at the clock, looks back at me and says, almost mournfully, “Ten minutes left.” 

So Janice longs for me as well, I think. I remain silent giving her the chance to pursue her own thoughts.  

“It’s so easy to me to feel lost, empty. Even when I’m with my kids, even when the house is bursting with noise, I often feel alone. I feel alone right now. You’re not saying anything and the session is almost over and I feel scared. And when I feel scared like this at home I call my mother. I sometimes fantasize calling you, but I wouldn’t do that – unless there was really some kind of emergency.”

I wonder how it is possible that I haven’t seen this side of Janice before today, how I accepted her protests against her mother’s intrusiveness at face value and didn’t see the scared little girl underneath. Was it because of my own experience with my mother? Perhaps. But I have an alternative thought. With her mother, Janice is the obedient child who accepts – and perhaps even welcomes - her mother’s intrusion into her life. With me, she is still the obedient child, but she knows – consciously or unconsciously - that I want her to be separate and independent, so she’s being as I want her to be. But as long as she’s being how I want her to be, she’s still not being her own separate person.

“I was just thinking, Janice, that you’re always trying to be the person the mothers in your life want you to be, whether that mother is your biological mother or me or perhaps other people as well. I think in the process of trying to please us all so you don’t have to feel scared and alone, you’ve kind of lost who you really are.”

“That feels really scary. Truthfully I’m not sure I’ve ever known who I am. I was my mother’s child and my husband’s wife and my children’s mother, and my brother’s sister, and your patient. I think all those people are different. I don’t think I have one me.”

“I can understand how that feels really scary, Janice. So I guess we know what we need to do. We need to find out who Janice really is.”

Return

Emma is uncharacteristically late for her first session after my vacation. Usually a psychologically aware woman, she has now spent 20 minutes talking about the plans for her daughter’s high school graduation party, chatting about the guest list and the menu.

I interrupt her. “How did you feel coming today?” I ask.

“Oh,” she says. “Well, I didn’t want to come. I did very well in your absence. In fact, I was thinking that this should be our last session.”

I groan inwardly. I have seen Emma for four years and there is no question she has come a long way – more able to stand up for herself, more self-confident, less intimidated by her husband. But she is a patient who has been in therapy with several therapists over the years, a patient who knows that her more long-standing issues of desire for and fear of intimacy remain stubbornly unchanged. In fact, she is enacting that issue at this moment – feeling abandoned during my vacation she has closed off the needy part of herself and now seeks to reject me just as she felt rejected.

And, it’s worked. I do feel rejected. I feel hurt that she should want to leave me, hurt that she could discard me so easily after the relationship we’ve built up over time. And whose feelings are these?  Always a complicated question. Yes, I do believe that she is rejecting me just as she felt rejected by me and, earlier in her life, by a too-busy, self-involved mother. But I have my feelings too. I do go on vacation. I do have my own life. But my patients matter to me. I care about them. Besides, I don’t like good-byes. 

“So why do you think you would decide this today?” I ask.

“I told you. I did very well in your absence.”

“I’m sure you did. You’ve never been someone who can’t function without me. But you know yourself well enough to question what affect my vacation would have had on this sudden decision.”

“I knew you’d bring that up,” she says, sighing theatrically.

I remain silent.

“What?” she says.

I gesture with my hand for her to continue.

“Why is it that everything I do gets to be analyzed while nothing you do gets put on the table?”

Surprised by her question, I ask, “What don’t I put on the table?”

“Like how do you just get to go on vacation, entirely arbitrarily? You get to decide when you go, for how long, and regardless of what’s happening in my life or any of your patients’. You’ve always telling me I cut myself off from my feelings, well it seems you’d have to cut yourself from your feelings as well.”

Alternate responses flit through my mind. I could pursue her anger which is quite apparent and might well be fruitful. But I worry she would experience that as evasive and defensive. Or I could respond directly to the issue she raised.

“You make a good point, Emma,” I say thoughtfully. “I am the one who arbitrarily decides when I go on vacation and I do put my patients’ lives aside during that time – I put your life aside, just as you often experienced your mother doing. But it doesn’t mean I stop caring about you and it certainly doesn’t mean I feel closed off to you when I return. Quite the contrary, I’m eager to hear about you and what’s been going on in your life and in your mind. And just as you feel hurt and discarded when I go on vacation, I feel hurt and discarded when you announce that you’re unilaterally going to end our four year relationship in one session.”

“You do?” Emma asks incredulously.

“I’m sorry that surprise you so much, Emma. It’s so hard for you to take in my caring. I suspect you’re afraid that if you acknowledge you’re loveable, you’d have to give up hope that your mother would ever love you as you needed and wanted to be loved.”       

Emma’s eyes fill with tears. “This might sound silly, but right that moment when you said that, I felt my heart melt, like something opened in me; something opened, but something made me very sad too.”

“So maybe right at that moment you did feel my caring, but also felt the sadness of your mother’s inability to cherish you as the loveable child you were and are.”

Lost and Perhaps Found

I’ve been working with Marvin, a 72 year old depressed widower for nine months. His sessions – like his life - are boring and repetitive. He refuses to discuss the past – says he’s too old for that – and complains bitterly about the emptiness in his life. “Nothing’s better,” he says today. “I still sit alone in my apartment staring at the beautiful weather and wondering why I can’t get myself out there, even to take a walk. There’s no place to go. I’m just lost. When Esther was around, even if we did fight all the time, at least there was someone there. Now there’s nothing.”

I ask myself, not for the first time, why I don’t feel more empathy for this man. After all, I too am a widow. I know the pain of loss, the feeling of aloneness. It’s his passivity that I find difficult. I want to shake him, tell him to find some hobby, some activity, a friend, a girl-friend. But I do none of that, knowing full well that he would find reason to rebuff any suggestion I might make. Today, I take a different track.

“How do you feel about coming here?” I ask.

“I come,” he says, averting his eyes.

Although his answer is the typical passive, uninvolved response, I sense a certain discomfort and wonder if more is going on than he’s saying.

“But how do you feel about coming?” I ask again, more persistently.

“What do you mean?” he says, even more flustered.

“How does it feel for you to come here?” I repeat. “To see me?”

“I…I don’t know,” he says, squirming in the chair.

I remain silent.

“Maybe I shouldn’t come. Is that what you’re telling me?” he says petulantly.

“I didn’t hear myself say that.” 

He sighs. “Everyone gets tired of me. Even my children tell me if I don’t stop complaining they won’t call any more. Not that they call that much.” He pauses. “You think I complain too much, don’t you?” 

“Well,” I say, trying to be diplomatic, “I understand you’re feeling miserable and unhappy and wanting to talk about your feelings. But you don’t really talk about your feelings. Instead you present as a forlorn, helpless person stuck in your misery. Yes, Esther died and you’re alone and you can’t bring her back. But you can try, ever so slowly to make a life for yourself.”

“I love you,” he blurts out.

I’m stunned. And speechless. I flash on the story a well-known psychoanalyst, Dr. Glen Gabbard, told about himself when he was first starting out in the field. When a female patient told him she loved him, he responded first by saying, “No you don’t” and then by trying to convince her that what she felt was not “real” love, but transference from earlier loved figures in her life. I knew what not to do. What to do was more difficult.

“I’m flattered…” I say.

He interrupts, more animated than I’ve ever seen him. “You mean you love me too?” he asks hopefully.

Oh dear, I think. “I’m flattered that you think that much of me,” I continue. “And I’m really glad you’re able to feel so alive.”

“You don’t love me,” he says, immediately deflated.

“I care about you, but I don’t love you as you want and need to be loved.”

“Nobody ever loved me,” he says. “What a fool to think someone like you could love me.”

“I don’t think you’re a fool at all. I’m glad you’re able to engage in life sufficiently to feel love for me. Now we have to help you find someone who can love you back.”

He shakes his head. “That’s impossible. No one ever loved me, no one ever will.”

“I would really like to understand why you feel so unlovable.”

“Why don’t you love me?” he asks challengingly. 

“I’m impressed,” I say truthfully. “You can be assertive when you want to be. But by looking to me for love, which I suspect you know wouldn’t be appropriate, I’d guess that you tend to look for love from people who can’t love you back, probably like the people who couldn’t love you in the past.”

Marvin slumps further down in the chair.

“You know,” I say, “now that I know you can have that spark, I’m going to be more insistent that you engage with me in therapy. We need to talk about the past. We need to talk about how you feel right this minute. We need to reintroduce you to life or perhaps introduce you to life for the first time.”

“You think that’s possible?” he asks.

“I detected a bit a hope in that question. I say we go with that hope.”

Gifts

This is the beginning of Marjorie’s fourth month of therapy. She’s a reserved 45 year old woman who finds little meaning in her life as the third wife of a rich, older man who was born into money. Her days are spent attending luncheons, galas, and fundraisers. 

She hands me a check for last month’s payment, then reaches into her Gucci purse and pulls out a small oblong package wrapped in stripped red and gold paper, tied with a gold bow. I groan inwardly.

“Marjorie …” I begin.

“I know, I know,” she interrupts. “I’m not supposed to give you gifts. I’m supposed to talk about why I want to give you gifts. But I know why I want to give you gifts. I don’t want to just give you your check. I want to give you more. You’re finally someone I can talk to, someone I can really talk to as opposed to all the ridiculous chatter I do every day.”

Marjorie and I have been discussing the issue of gifts since her second session. That day, when I went to greet her in the waiting room, she had placed a flowering plant in the middle of the coffee table, carefully rearranging the magazines to either side. I was taken aback and suggested we go to my office and discuss the plant.

“I just thought the waiting room needed a plant. I felt more alive after our first session than I had for years and thought a living plant was the perfect thank you.”

“That’s a lovely sentiment, Marjorie. And saying just that without actually bringing the plant would have been more than gift enough. That’s what we do here, we talk about our feelings, we don’t act on them.” 

Many thoughts and feelings went through my mind: What if I can’t keep the plant alive? I remembered years ago when I practiced in Ann Arbor a patient saw the plant in my office as one or the other of us and how that plant fared took on huge significance. I also felt intruded upon. Was that a feeling born from the present interaction with Marjorie or was the feeling tainted by my childhood feelings about my parent’s intrusiveness? What if I didn’t want a plant in my waiting room? 

For the moment, Marjorie and I agreed to disagree. 

Following a particularly difficult session when Marjorie told me her life-long secret, namely that she had been molested by her uncle as a child, she brought me a crystal blue paperweight. “I know I’m not supposed to give gifts, but there was no other way I could thank you for allowing me to unburden myself from my lifetime of shame, for your accepting me, when I was sure no one ever could.”

That time I felt more compassion for Marjorie, experiencing her gift as an expression of her feeling that she herself wasn’t enough, that she had to offer more than herself to express her gratitude. “I appreciate your kindness, Marjorie, but I want you to realize that you, yourself are enough. I don’t need a gift. Your presence, your trust in me, your thank you is gift enough.”

“But I don’t feel that,” Marjorie said.

“I understand that,” I said. “We’ll work on it. But no more gifts.”

So this time, when Marjorie extends the red and gold package towards me, I feel my anger rise. Shaking my head, I say, “I’m not taking the gift this time, Marjorie. My understanding was that we were going to work on you and your words being enough.”

Marjorie looks stricken. “You’re not going accept my gift?”

“I’m not rejecting you, Marjorie. I’m rejecting your insistence on devaluing yourself.” I hear my choice of the word ‘insistence’ and realize that I’m not being completely honest, I’m not dealing with my feeling of Marjorie thrusting her gifts on me. And then I understand.

“Marjorie, I’m going to say something that might be hard for you to hear, but I do think it’s important. I know you give me gifts because you don’t think enough of yourself. But I think there’s something else as well. Your uncle. He presented himself as if he was giving you a gift, giving you something pleasurable.”

Marjorie gasps, covers her mouth with her hands, “You think I’m molesting you?” she says in horror.

“What I think is that you’re helping me to feel how you felt as a little girl. Your uncle was literally intruding on you, abusing you, but he was also giving you pleasure and that’s always what’s most difficult for childhood sexual abuse victims.”

“I feel so dirty,” Marjorie says. “I never wanted it to feel good.”

“I know,” I say, compassionately, “but it’s hard not to crave the attention and your body can’t help but react.”

Barely audible, she adds, “And, each time, he brought me a gift.”      

Why Can’t I Leave?

“I’m such a mess,” Janette says. “And a coward. I hate myself. He does it again and again and I do nothing. I couldn’t believe it when I asked him last week where our tax returns were and he said he asked our accountant for an extension. My stomach dropped through the floor. He tried playing innocent, like he just didn’t have the time to get all the paperwork together and our tax guy was swamped anyway, etc., etc. But I knew better. I was so mad I started hitting him with my fists. He kept trying to worm out of it, but he knew I knew.

“So then he got all apologetic. Sorry! As if that could fix everything! I’m so mad. He goes to his Gamblers Anonymous meetings, he has a sponsor – supposedly anyway – but he keeps betting on those damn games and losing more and more of our money. It’s our money I remind him, but I’m just talking to myself. I know, he’s an addict, but that’s not an explanation. Besides, it doesn’t matter anymore why he does what he does, the problem is that I stay.”

I remain silent. Janette and I have been here many times and she indeed knows the problem.

She sighs. “I know, I’m reliving my childhood, my father an alcoholic, my mother a gambler. You would have thought I’d know better, but here I am, stuck in it all over again. I do hate myself. I’m furious at Joe, but I despise myself for my inability to get out. I know, I should feel more compassion for myself – that’s what you always say – but how can I feel compassionate when I’m so stupid.”

I feel Janette’s frustration, as well as my own, not so much at her inability to leave her husband, but at her unmerciless attacks on herself. “I doubt it’s that you’re stupid, Janette, but rather that you can’t give up hope. When you started this session you said you couldn’t believe it when you realized Joe had been gambling again. I think you couldn’t believe it because you keep hoping Joe will change, just as you hoped that your mother would change and your father would change.”

“Well,” Janette, asks defiantly, “Isn’t that proof that I’m stupid. If you keep hitting your head on the same brick wall, hoping that it will stop hurting, you must be stupid.”  

Janette’s response intrigues me. “That’s an interesting response, you didn’t say hoping the wall would break, you said hoping it would stop hurting.”

“So, what’s that supposed to mean?”

“I’m not sure, but can you talk about your anger at me?”

“I’m just mad. Mad at me. Mad at Joe. Mad at you. We’ve been going round and round on this for a long time, and I’m still here.”

I wonder whether the “here” means with me or with Joe, but I ask, “How does it feel to feel mad at me?”

“Pointless. Just as it feels with Joe. You’re not going to change.”

“How would you like me to change?”

“Tell me how to get out of this damn marriage.”

The response that goes through my head – hire an attorney, file for divorce and don’t go back – shows me I’m more annoyed than I realize. “And if I can’t tell you how to get out of your damn marriage, what do you feel?”

“Angry.”

“I believe that you’re angry, but I wonder if you also feel scared and powerless?”

“I’m scared that he’s going to go through all our money. But I’m not powerless. All I have to do is be brave enough to leave.”   

“What about when you were a child, Janette, when your father was drinking and your mother had gambled away your school lunch money?”

Her eyes fill with tears. “Why’d you have to bring that up?” She pauses. “Yeah, I was powerless then and I hated it. But if I started “sniveling” – that’s what my father called it – he’d just start screaming at me for being such a baby.”

“So that’s what you’re doing, Janette, you’re screaming at yourself just like your father screamed at you. And you keep hoping, not only that Joe and your parents will change, but that you can endure their repeated disappointments without feeling any pain. It’s an impossible task. But if you can acknowledge your own powerlessness and mourn both the husband and the parents you never had, you’ll be more able to make the break.”

“Doesn’t sound easy.”

“No, it’s not. Definitely not easy.”