Ending

“So,” Philip begins, “There’s something I’ve been thinking about and after all these years I certainly know I’m supposed to talk about everything I’m thinking about. So, here goes,” he says, inhaling deeply. “We have two weeks, six sessions left and for our last session I’d like to take you out to dinner.”

Many thoughts and feelings flit through my mind. I’m surprised. Philip is a 55 year old obsessive man who despite years of therapy is still fairly rule-bound. Taking me out to dinner would definitely be bending those rules. So should I consider his request an indication of progress? Perhaps, perhaps not. Either way, I know I’m not going accept. To do so would be stepping way outside the bounds of our relationship. I have gone to lunch or dinner with patients who have been out of treatment for long time, but then I know that the treatment is definitely over and it’s more like catching up with an old friend. Last sessions and, in fact, the entire process of termination is fraught with many intense and conflicting feelings. A restaurant is definitely not the place to deal with them.

“What makes you ask? Why do you want to take me to dinner for our last session?”

He looks instantly deflated. “You’re not going to do it.”

I smile inwardly. My apparently neutral question wasn’t so neutral after all.  “No, Philip, I’m not going to accept. I’ll explain why, but first I’d be interested in knowing why you want to.”

“Is it because I’m a man? I mean I know we dealt with some of my, uhmm, feelings about you along the way, but this has nothing to do with that. I just want to say thank you for all you’ve done for me.”

“And when you say ‘thank you for all you’ve done for me,’ you’ve given me more than enough, a gift. You’ve been able to put your feelings into words. And your warm feelings at that. That’s a major accomplishment for you.”

“You didn’t answer my question.”

“I’m sorry. No, it’s not because you’re a man. Did I hear a hint of anger in there?”

“No one likes to be rejected.”

“Whoa. Let’s go back a minute. You say that you want to take me out to dinner to thank me for what I’ve done for you. What do you imagine you might be feelings that last day? Or the last week? Or what are you feeling today about ending?”

“Hard to separate out what I’m feeling about ending and what I’m feeling about your turning me down.”

“Okay. Just say what you feel right now.”

“Hmm. I feel disappointed. And hurt. And a little angry. And confused. I don’t understand why.”

“So let’s say we were at a restaurant right now. Would you like to be dealing with all those feelings at the restaurant?”

“I wouldn’t be having these feelings if we were at a restaurant.”

“Ah ha! So perhaps you’ve just told us another reason why you might want to take me to dinner for our last session. Maybe it’s so you won’t feel all the feelings you might be having during that session.”

“Oh.”

“Last sessions can be pretty emotional. I know there’s some excitement about leaving, a feeling of accomplishment. Some people describe it as feeling like graduation. But even graduation has sadness mixed with it, ending a chapter in your life, ending your relationship with me. We’re known each other a long time. It’s always sad to say good-bye. Sad for me too. I’m happy for you and your progress, but your leaving is a loss for me as well as for you.”

Philip stares at me. “You’re so dear to me,” he says softly. “You will always have a special place in my heart. You’ll be with me always and I’ll miss you more than I can say.”

“That’s so beautiful, Philip. Thank you. That means so much to me. I think about how you couldn’t even identify what you were feeling when we first started working together, let alone express it. And to be able to express such deep, caring feelings warms me all over.”  

He smiles. “I was just going to say, ‘So how about dinner?’ and then I realized I was just running from all the feelings in the room. I guess we’ll be meeting here for the remainder of our sessions. Five more to go. Makes me sad.”

You Didn’t Do Anything Wrong

“The most awful thing happened to me last week,” Francis begins. “I was walking out of Macy’s and a security guard stopped me. He asked me to open my purse. I looked at him like he was crazy and asked why. I even wondered if he was a security guard or if he was just wearing the uniform and wanted to steal my wallet or something. He kept insisting. I asked him if he thought I stole something which mortified me and he just kept asking me to open my purse. I finally did and he looked through everything. I felt like a thief. And then he said, ‘Thank you, ma’am, I guess there was a mistake.’ I was shaking. I ran out of the mall. When I got into my car I burst into tears. It was awful. And now I can’t stop thinking about it. I replay it over and over in my head.” 

Francis is a conventional woman nearing fifty who came into therapy when the last of her children left for college, wondering what was next for her in life. “It sounds awful. Can you say a bit more about what you felt?” I ask.

“Humiliated. I couldn’t believe this was happening to me. How could anyone think I’m a thief? And I felt scared. Like I said I wondered if the security guard was an imposter and if he’d rob me. I know how crazy that sounds, but it didn’t seem any crazier than me stealing something.” 

Francis was the “good girl” who evolved into the “good wife and mother.” It is hard to imagine her doing anything rebellious, let alone illegal. “Did you feel angry as being unjustly accused?”

“I guess I did. You know I don’t do anger very well.”

“And since the incident, what is it that you feel when you replay it in your head?”

“The same thing, humiliated and scared. I don’t feel the anger all that much.”

“Does the incident remind you of anything in your past?”

“No! I never stole anything in my life, if that’s what you mean.”

“No. That wasn’t what I meant. What made you think I was suggesting that?”

“I don’t know,” she says, starting to cry. “I just feel so awful. I feel like a criminal. I feel dirty. I know it’s crazy. It was a mistake. I need to let it go.”

“So you understand that what you’re feeling is an overreaction, but we need to figure out what’s causing that overreaction. I’d say it was something from your past, something that made you feel guilty or ashamed or both. That doesn’t mean you did anything wrong. You could feel you did something wrong even if you didn’t.”

“When you just said I didn’t do anything wrong, I felt this tremendous relief, like a burden was taken from me. But I have no idea why. What do I feel so guilty about? What did I do that was so bad? I was always the good kid.”

Various of my childhood and adolescent transgressions flit through my mind: blaming a friend’s sister for my mischief, wearing make-up when I wasn’t allowed to, lying about having a boyfriend. I don’t carry guilt for any of these infractions, but I’m sure far more serious “sins” exist in the cauldron of both my and my patient’s unconscious. “It doesn’t have to be anything you did, Francis. It could be something you wished for or dreamt about. It could be a fleeting thought, like ‘I wish you were dead.’”

“I killed my younger sister’s turtle,” Francis blurts out. “It was an accident. The turtle got out of its little house and I accidentally crushed it with my rocking chair. My sister was really mad. She said I was a murderer. My mother was mad too. I kept saying it was an accident, but they didn’t believe me.”

“Another example of being blamed when you didn’t do anything wrong.”

Francis hesitates then quietly says, “I didn’t like that turtle. It smelled bad. And I don’t like things that crawl around like that. But it was an accident. I didn’t deliberately kill it.”

I wonder if the turtle is a stand-in for Francis’ childhood feelings about her sister – something that smells bad and crawls around – but I decide to leave that interpretation for another day. “But it sounds like you still felt guilty, both because you might have wished the turtle dead and because your sister and mother were so angry.”

“But I didn’t do anything wrong,” she has almost plaintively.

“No, you didn’t do anything wrong,” I say. I suspect this “good girl” has many forbidden thoughts and feelings, but that too is for another day.     

What If You Died?

Tall and thin, with long, straight brown hair, Alicia fidgets in the chair. “I have a new obsession,” she says hesitantly. “I keep worrying about your dying. I feel funny talking about it, but who else can I talk to about something like that?”

I’ve been seeing Alicia for almost five years now. She began when she was 20, when she was so paralyzed by anxiety and by magical, obsessional thoughts that she had to drop out of college. She’s much better now. She’s gone back to school and should graduate in a little over a year.  

She continues. “I know we’ve talked about my being afraid of my parents dying in some horrible accident when they left to go out when I was little. And you said that was because part of me wished they were dead because I was mad that they were leaving me. But I don’t feel mad at you. At least I don’t think I do. Do you think I’m mad at you?”

“I think only you know how you feel, Alicia.”

She pouts. “You could help me.”

There is a childlike quality to Alicia. She looks to me to protect her, to save her, to give her the magical answer. I feel the pull to oblige, but think it best that Alicia find her own strength, her own voice, her own answers. Her mother was overly protective and although both parents pushed Alicia to succeed, there was the contrary message that she stay close to the protection of home.

“I will help you, but I can’t tell you how you feel.”

“All right. All right. Be that way.” She crosses her arms over her chest and glares at me.

I remain silent, but present in the room with her.

“Well now I feel angry. A little. No, not really. I know you can’t tell me what I feel. The problem is that I don’t know what I feel myself.” She pauses. “Scared. I feel scared. I feel scared if I think about your dying. And it’s not like I imagine your dying in some gruesome accident. I just think what if you got sick and died? I mean I know you’re not old. But you’re not young either. Would I even know if you were sick? And how would I know if you died? I wouldn’t want to read it online somewhere.” 

“Do you have any thoughts about what triggered your fears of my dying?” When I look in the mirror I certainly know I’m not getting younger, but I suspect Alicia’s fears have more to do with what’s going on for her internally than with my actual age. 

“I just thought of something. My father’s been talking to me about graduate school. I keep telling him I’m not ready, that I still haven’t finished undergrad, that I have to take one step at a time. I can’t think about graduate school. It scares me. It was after that I started worrying about your dying.”

“So talking about graduate school means growing up, leaving home and that brings up fears about loss, including the loss of me.”

“You didn’t have to put it that bluntly. Now I’m terrified.”

“I’m sorry. I didn’t mean to increase your anxiety, but we do need to know what the issue is before we can work on it.”

“I could never leave you! I’m not even sure I could leave my parents. Oh my God, what happens when they die?” 

“Alicia, let’s put the question of death to the side for a moment. What feels so scary about leaving home?”

“I can’t. I don’t think I could make it.”

“It feels as though you’d die?”

“It kind of does. But when you put it that way, I don’t know, that doesn’t really make sense.”

“So the idea of leaving home feels terrifying, feels like you couldn’t survive. But when you think about it rationally it’s not so clear what you’re afraid of.”

“Yeah. That’s right. That actually makes me feel a little better.”

“You know, Alicia, although leaving home does involve loss, it also involves gains: growth, independence, freedom. It’s about adding to your life, not just taking from it.”

“Yeah. I can see that.”

“On the other hand, I don’t want us to ignore your underlying feelings, including your fear of my dying. I do hear that you feel terrified and we need to talk about those feelings again and again until you’re more sure of your adult competence and your ability to cope.”  

Until Death Do Us Part

Bob Samuels looks as though he would once have been a handsome man. Now his disheveled white hair, creased brown pants and too small plaid shirt, along with his sad eyes and almost shuffling gait, gives him the appearance of a man who has grown old before his time.

“I read your book,” he begins. “I thought maybe you could help me. You know about loss. But I worry that you don’t know about regret. You don’t mention it much.”

I immediately flash on some of the regrets I have regarding my husband’s treatment of prostate cancer and heart disease: Should we have chosen surgery rather than radiation? Why did no doctor ever tell us about the possible false negatives from chemical stress tests? Yes, I have regrets, but they don’t plague me. I accept that no one is infallible; no one can anticipate or control everything. I say nothing and wait for Mr. Samuels to continue.

“My wife died of ovarian cancer five years ago. She was diagnosed five years before that. In the beginning she put up a valiant fight, although I always wanted her to pursue more alternative treatments in addition to the chemo. I don’t mean anything way out there. Stuff like nutrition. I thought she should become a vegan, try juicing, stuff like that. But she couldn’t deal with it. And then in the end, when the cancer came back again and then again, she called it quits. Said she had enough. She stopped all treatment and just died. I wanted us to go to Europe and try some of the experimental treatments that aren’t available in the States. But she said she couldn’t, said she was done.”

I think about my husband’s words when he too decided to stop treatment: “It’s enough already.” He had fought for years to stay alive. But he reached his limit. Although I was grief stricken, I understood his decision.

“Sounds like you’re angry at your wife for giving up,” I say to Bob.

He startles. “No, no,” he says. “I could never be angry at her. I’m angry at myself for not being able to convince her, for not being able to make a good enough argument. I’m inadequate. I couldn’t make her see.”

“You couldn’t make her see what?” 

“That there was a chance. That there were still things we could do.”

I believe that Bob is angry at his wife for letting go. I also believe that he can’t let himself feel that anger, that he blames himself rather than her. And he can’t tolerate the helplessness we must all deal with in the face of death. But these interpretations are all too premature.

“It sounds as though you miss your wife tremendously,” I say instead.

He sobs. Reaching for the tissues he tries to control of himself. “I’m sorry,” he says, his voice breaking.

“There’s nothing to apologize for,” I reply.

“It’s five years. I shouldn’t be like this anymore. But I keep tormenting myself. What if I’d done X? What if I’d say Y? What if I was enough of a husband for her that she wanted to stay?”  

“You think if she loved you enough she would have fought harder?” I ask, wondering if his wife’s decision to stop treatment felt like a narcissistic injury to him.

He cocks his head and puts a finger to his lips, pondering my question. “I think I always loved my wife more than she loved me. I mean, she did love me, but I adored her. She was the only woman who really ever mattered to me. So do I think if she loved me more she would have continued to fight? Maybe I do. I don’t like to hear myself say that. It sounds so selfish, so much about me.”

“You know Bob, in the end, none of us can defeat death, no matter how much we might love or how much we might want to stay.”

“I know.”

“I wonder if you do. I mean I’m sure you know intellectually that we all die, but I wonder if on a gut level you feel that if only we do enough, if only we try harder, somehow we’ll be able to continue on.”

“I don’t know.”

“Bob, my sense is that we jumped right into this very painful, difficult topic because you’ve obviously been struggling with these feelings for quite some time. But I wonder if we could go back a bit so I can get some sense of you, of your life, of who you are.”

He takes a deep breath. “Where would you like me to start?”

“Wherever you’d like.”    

Money Matters Again

I am aware of feeling annoyed as I go to the waiting room to greet Philip. It’s been five weeks since I’ve seen him. Each of the last four weeks he cancelled three or more days prior to our session – well within the time required by my 48 hour cancellation policy to avoid being charged – with various excuses, mostly related to business. Philip is a successful import/exporter. It’s not unusual for him to travel, but we’ve usually been able to reschedule during the week or arrange to talk by phone, even when he’s out of the country.

“It’s been a while,” he says greeting me with a broad smile that enhances his already handsome face. “I’ve been incredibly busy. Business has really picked up. Not that I’m complaining. I know lots of people are hurting, so I’m more than grateful. Other than that, not much is happening. Things are going okay with Serena, although she hasn’t been too pleased with all my traveling. I have been able to keep up with my kids, although I can find myself squeezed between time with Serena and time with the kids.” 

“And us?” I ask.

“Us?”

“We haven’t seen much of each other the past several weeks either and now you seem to be saying that there’s not much to talk about.”

“Truthfully, I haven’t had much time to think about myself. I just keep on truckin’.”

“Does that strike you as strange? You’re someone who usually spends a lot of time reflecting about yourself, trying to understand why you do what you do and now you’re being kind of flip and indifferent.”

“Maybe I’m just tired of spending all this time ruminating on myself. Maybe it’s time to just start living.”

“Philip, what’s going on?”

“What do you mean?”

“First you disappear for over a month …”

“I didn’t disappear,” he interrupts. “I called every time to say why I couldn’t come. Gave you enough advance notice too.”

I find myself confused, annoyed and stymied. When Philip kept cancelling, I thought about our last several sessions trying to understand what might have triggered his desire to keep away and hadn’t come up with anything. Now he’s being disinterested, dismissive and even hostile and I have no idea why. Was he feeling too close and needing to get away? And what was that comment about giving me advance notice? Philip is a wealthy man. Money never seemed to be an issue between us.

“Was it important that you gave me advance warning?” I ask.

“Yeah. Wouldn’t want you to be charging me for a session when I’m not here, especially since you just raised your fee.”

I try to keep my surprise from registering on my face. I raised Philip’s fee by $25, an amount I thought would be insignificant to him.

“Philip, what did it mean to you that I raised my fee?”

“Nothing. You’re entitled. This is your job. You deserve to make a living. And $25, it’s no big deal.”

“Seems like it is a big deal, Philip.”

“Don’t be silly. I can give $25 to the valet when I leave my car at the airport.”

“Except I’m not the valet,” I say quietly.

“I didn’t mean to insult you,” he says quickly.

“Philip, let’s stop a moment. I feel like we’ve been sparring all hour and I think I do understand what’s going on. I understand that the actual $25 an hour increase is inconsequential to you. But I think what it did is remind you that we have a professional relationship, that in addition to our human relationship, in addition to the caring interaction that goes on between us, you do pay me for my time. It reminded you, as you said, that this is my job. And I think that made you feel uncared about.”

“I never thought of that. At least not consciously. But now that you put it into words, I think you’re right.” He pauses. “Know what I just thought about? I thought about the time when I was a kid and my father and I had baseball tickets. I’d been looking forward to it for weeks. And then sometime before the game a delivery guy arrived with an electric guitar I’d been wanting and a note that said, ‘Sorry, kid, can’t make it. Enjoy. Love, Dad.’ I never did play that guitar. I realize it’s not the same thing …”

“But it felt that money, material things were taking the place of time and caring and that’s how it felt with me too.”

“I guess. I’m sorry. I know that’s not fair.”

“Nothing to apologize for. I’m glad our relationship matters to you. It matters to me too. And I’m glad we were able to figure out what was going on.”

Self-Discovery

“I could hardly wait to come today,” Laura says smiling brightly, as she settles into the chair across from me. “Although last time I felt really sad after the session. I always saw myself as having this normal, average family. You know, nice home in the suburbs, Dad commutes to work, Mom substitute teaches, everyone loves everyone else. And I guess that’s still true. But it’s more complicated. Everyone loves everyone else as much as they can, but that may not always be enough for the kids.”

“For the kids?” I ask.

“I guess I mean for me. It’s hard. It’s hard to give up the illusion that everything was just as it should have been. My mother just doesn’t have it, whatever that it is, that maternal instinct, that ability to tune into me. She always preferred being alone with her books and her crafts.” She pauses. “And I didn’t expect to be here. I come into therapy for the first time in my life at 34 to decide whether or not I want to have a child. I never thought I did. And I never questioned why I didn’t, I just didn’t. But with my biological clock getting ready to hit the alarm button and all my friends having babies, I don’t know, I just started to wonder.”

“Do you have feelings about coming into therapy to answer what you thought was a simple question and having me open up Pandora’s box?”

Her eyes twinkle in delight. “That’s why I love coming here. You’re so honest, so straightforward. You always want to know. You want to know me, want to know what I’m thinking, what I’m feeling. It’s incredibly refreshing.”
I smile back at her, thinking that she’s the one who’s incredibly refreshing. “I do want to know you, Laura. It’s a privilege to watch your journey of discovery, to watch you find yourself, discover new things about yourself, confront your pain, as well as your joy.”

She begins to cry.

I remain silent.

“I’m sorry… I know. I know. I should never apologize for my tears. It’s just that you’re so different from my mother. And your being so different makes it terribly clear what she couldn’t give me. And it’s sad. No matter what I do I’m not going to make her into you.” She pauses, then adds quietly, “And I can’t make you my mother.”

I smile inwardly. It’s such a pleasure to work with Laura. Despite her having no psychological background, despite her never being in therapy before, she intuitively grasps profound psychological and unconscious processes. Besides, she’s a warm, caring, thoughtful, loving person. We connect well together and I’m confident that I can help her more fully appreciate the fine human being she is.  

I say, “So I wonder if what you’re saying, Laura, is that as warm and positive as it feels to be in this room with me, it also mirrors the deprivation and loss you felt in your childhood. Your mother couldn’t be the mother you needed and deserved as a child and although I come closer to the mother you want, I’m not your mother – and I certainly wasn’t the mother of your childhood – which leaves you feeling sad and bereft.

“So what good are you?” Laura asks, attempting to smile through her tears.

“You’re smiling, but I bet you feel angry, angry at me, angry at your mother.”   

“That doesn’t seem fair.”  

“Feelings don’t have to be fair, Laura, they just are.”

She looks at me quizzically. “Putting my sarcasm aside, what good is it for me to feel sad and bereft all over again? And how does that help me decide about having a child?”

“Well, feeling sad and bereft with me enables you to replicate in the present the feelings you had as a child, right at this moment between us. It brings those feelings from the past into the present and allows you to feel sad and angry, sad and angry, and sad and angry and eventually to put them away with a different level of adult acceptance. It allows a mourning for that which never was and never can be.”

“And the child part?”

“I think you already know that having or not having a child is tied to your feelings about how you were mothered and how you feel about mothering another little being. I don’t think we understand it all yet, but I suspect as it becomes clearer to you, you’ll know whether or not you want to have a child.”

She sighs. “I bet if you had been my mother I would have had three kids by now.”

“That’s a really interesting statement, Laura. I think we should look at that more closely next time.”

Moving Forward

Crystal greets me with a big smile as I open my waiting room door. A slender, 35 year old woman, dressed in casual black clothes, her hair pulled up in a bun, she looks like the yoga instructor she is.

“It’s been quite a week,” she begins. “We’re going into the New Year and, hopefully, I’m going into my new life.” She laughs. “Maybe that’s a bit dramatic. But I feel I’ve suddenly shed my old self. I was totally miserable when I left here last week. I couldn’t stop crying. I even canceled my classes. I know you’ve been saying it for years, but I never really got it, not really. But last week I really felt for me as that little girl, that little girl whose parents were so wrapped up in each other they didn’t even know I existed. It always felt so unfair. It was unfair. It’s not that they were struggling to make ends meet. It’s not that they couldn’t pay attention, they just couldn’t be bothered. And I kept hoping, hoping that I could make them be different. As a kid. As an adult. But I couldn’t. And I got angrier and angrier. And the angrier I got, the more I messed up my life. I was valedictorian of my high school class and I never even graduated from college. How sad is that? I guess I figured if they didn’t care, why should I?”

I’m pleased. This is one of those moments therapists wait a long time to experience. “Wow, Crystal. I’m impressed. It certainly sounds like something coalesced for you in a very different way last week.” 

“It’s what you said about mourning – not that you haven’t said that a million times before too. And you brought up that movie again, “Inside/Out.” So I watched it again. Especially that scene about the elephant. I sobbed my way through it and then I realized that letting go of the elephant as an imaginary friend was a metaphor for letting go of childhood, letting go of the past and that even though it’s very sad, there’s really no other choice if you want to move forward in your life. I can be mad at my parents forever. I can long for their love and attention, but it’s just never going happen. So I have to stop being a baby, let go and move on.”

“I was feeling so pleased for you, Crystal, but that last sentence raised a red flag for me. When you say ‘I have to stop being a baby,’ you’re now rejecting the hurt, vulnerable child in you just as your parents did.”

“Hmm,” she says thoughtfully. “What should I have said?”

“It’s not a question of what you should have said, but rather what you do feel for that child part of yourself.”

“I guess I don’t like her a lot. At least not this week. I want her gone.” She pauses. “You know, I don’t think I get how I could like that part of me and still move forward. I decided after my epiphany this week that I’m going to go back to college and then on to graduate school, although I don’t know if that would be in business or film or dance. I know, I’m covering the spectrum there.”

Although I wonder if Crystal is pushing herself into activity to get away from her internal sadness, I say, “That’s great, but you raise a very important issue when you say you’re not sure how to be kind to the sad, vulnerable part of yourself while going on with your life.” 
  
“I don’t.”

“Well, you sometimes talk about your neighbor’s little girl. Suppose one day you saw her crying because a friend of hers hurt her feelings or because someone pushed her and she fell. What would you do?”

“I guess I’d hold her and reassure her until she stopped crying and felt comfortable to go back to playing.”

I smile. “Well?” I say. 

Crystal smiles back at me. “I guess you’re saying I should treat myself like I’d treat her.” Pause. “You know, that’s not so easy. It’s like either I have to push myself forward and forget about the sadness or get stuck wallowing in it.” Another pause. “Well, I guess you don’t get rid of me yet. We still have work to do.”

I’m startled as I realize the meaning behind Crystal’s statement. “Crystal, allowing yourself to move forward, to do the things you want to do in your life, doesn’t mean you have to stop seeing me. There isn’t this strict demarcation between childhood and adulthood where adults don’t need love and caring and connection. You can go out into the world and see me for as long as you want or need.”

Crystal’s eyes fill with tears. “You’re amazing. I’m afraid I’ll never want to leave you.”

“That might be a fear of yours,” I say. “And we’ll deal with it.”