“I have something I need to talk about, but I’m not sure I can,” begins Victoria, squirming in her seat. She is a smart, insightful, vivacious thirty-two year old woman who has been in therapy with me for a little under a year.
Her words put me on immediate alert, concerned about what secret she might reveal. I remain silent as thoughts race through my mind: Was she raped? Is she an incest victim? Did she shoplift?
She stares at me, takes a deep breath and says, “OK. I was at a dinner party on Saturday night. There were a couple of therapists there and your name came up. I was surprised. That’s the first time it’s happened. I didn’t know if I should immediately say that I was your patient, but I didn’t. I wasn’t sure I wanted my date to know I was in therapy and I guess I was afraid they might stop talking and I was kind of curious as to what they might say about you. But it was sort of scary too. Like what if they said something bad? I mean they didn’t, not at all. They started talking about the great blog you write. And that you wrote a book too.” Victoria stops and stares at me again.
Feeling as though I’m being scrutinized, I keep my face neutral as I wait for her to continue.
“So the next day I went on line and googled you and looked at your website. I don’t know if I should have done that.”
“Because…? I ask.
“Because I don’t know if I’m supposed to. Because I don’t know if you’ll be mad at me. And I guess I’m not sure I want to know stuff about you.”
“Lots of reasons,” I say softly. “So what are your thoughts?”
“Have you noticed how I always stare at you? I’m always trying to figure out what you’re thinking, trying to read your body language, trying to know if you’re approving of me.”
“So you’re afraid I’ll disapprove of something you say or do and that I’ll withdraw my caring, just like your mother did.”
“Exactly. I was always trying to read her. She could be so cold. And when she got angry with me for anything – a look, an expression, never mind misbehaving – she was entirely gone, absent. It was awful.”
“And you bring that fear of rejection into this room and our relationship.”
“Definitely. And to other relationships too.”
“That’s why it’s so difficult for you to hold onto a sense of yourself. You too easily become a chameleon, trying to figure out what other people want of you and fulfilling their expectations rather than your own.”
“So are you mad at me?”
“What do you think?”
“You don’t seem to be. But I still have the feeling it was bad of me to look, as though your life is off limits to me.”
“Was that true with your mother too?”
“Definitely! She was always telling me I should mind my own business, even if I asked her where she was going when she went out. And when she was pregnant with my younger sister I thought she’d kill me when I asked how the baby got there and what happened to her fat stomach.”
I laugh. “Sounds like a smart question to me. But I guess curiosity was forbidden, and sexual curiosity even more forbidden.”
Absolutely. I knew nothing about sex except what I learned from my friends, and you know how accurate all that stuff is.”
“Before we run out of time, I want to make sure we look at what you said about not being sure you wanted to know about me.”
“Yeah. I mean, I do want to know, but I’m not sure it would be good for me. Like what if I read your book and find out all these things about you. Then I could really be on my guard. Now I don’t know all that much about you, and I’m constantly looking at you trying to figure out what you think. But if I did know more, I might take all sorts of stuff off the table or really watch what I said or didn’t say.”
“Good insight. So I guess you’ll need to figure out what you do or don’t want to do.”
“Which means you’re not going to tell me what you think.”
“I think whatever decision you make, we’ll be able to deal with the feelings that come up as a result.”
I have been seeing John for a little over a month. He is a reluctant patient: removed, distanced, openly skeptical that therapy can be of help. “I’ve tried it before. I can’t see how talking makes a difference. So what if I understand myself? It doesn’t mean that will make me different.”
John, now 60, grew up on a Midwestern farm with an alcoholic father and a depressed mother, neither of whom had the time nor inclination to pay attention to their son. John always knew he wanted out; always knew he wanted more. And he succeeded, at least financially. He started out acquiring small, undervalued properties and parlayed it into a now huge real estate fortune. Personally, however, John has been far less successful. He’s been married and divorced three times, has no relationship with any of his children, and spends most of his time alone, working or following the stock market. My sense of John is that he is protecting himself from knowing the extent of his own childhood neediness, erecting a fortress around him that neither he nor anyone else can penetrate.
At the end of today’s session John takes out his checkbook and says, “Let me pay you for last month.” He stops, looks at me and asks, “If I pay you in cash, will you reduce your fee?”
I’m startled. The session is over. No time to ask what this question means to him; what he’d think of me if I said, yes; what he’d think of me if I said, no. “I’m not comfortable with that,” I reply. He nods, writes out a check, hands it to me and leaves.
I am bothered and discomforted. Although I have other patients to see, John intrudes into my thoughts for much of my day. Why did he ask me that question? Is it just that he sees himself as a shrewd businessman, bargaining over his fee as he would a piece of property? Does he feel that everything and everyone is for sale? Was he testing me? And then a strange thought occurs to me, was this a set-up? Was he hired by someone to entrap me, to see if I’d be willing to take cash and not declare the income? What a crazy thought, I tell myself; a paranoid thought that’s completely out of character for me.
At the end of my day, I’m finally free to explore the possible meanings of both my patient’s question and, more importantly, my own thoughts. It’s clear that my patient has profoundly affected me. He has intruded himself into my mind in a way that has resulted in my thinking inordinately about him, as well as thinking in an unusually suspicious manner.
So what might have happened here? My assessment of John is that he is consciously aware of his own distrust, but totally unaware of his own neediness. In therapy, the boundary between patient and therapist can be fluid, such that the patient can unconsciously prompt the therapist to experience feelings the patient himself may not be aware of. Today’s interaction with John left me feeling suspicious, like John himself, as well as preoccupied with him, raising the possibility that John may have unconsciously communicated to me his need to have me both think about him and feel as he does.
But I’m not an empty shell that a patient can just put feelings into. What was my contribution to this interaction? Although I am not aware of being consciously tempted by John’s proposal, I also know that I too have an unconscious and, by definition, the unconscious is unconscious. Perhaps an unknown part of me was tempted, felt guilty and then needed to punish myself by imagining that I would be caught and punished for my transgression.
In our next session, although I doubt John will gain much awareness from the discussion, I raise the issue of why he asked if I’d lower my fee for cash and how he felt about my declining.
He shrugs. “It never hurt to try. Thought it could be a good deal for both of us.”
“But is this about a deal, John, or is about a relationship?”
“I pay you, don’t I?”
“Yes, you pay me. And we’re still two people relating to each other, sometimes about really important and painful feelings and experiences.”
He shrugs again. “No big deal.”
Last week’s experience comes into my mind: John denying his need, while “taking over” my mind. “That’s where I’d disagree, John. I’d say you are a big deal, so that anything that pertains to you and anything that happens in this room is of utmost importance.”
John stares at me quizzically. I’d guess he’s not sure he believes me. I’d guess we have a long, long way to go.
Thea, a woman in her mid-thirties, with porcelain skin, curly red hair and deep blue eyes, glares at me from across the room, her brows knitted, her arms folded tightly across her chest. We have been sitting in silence since she entered my office and threw herself into the chair. Only a few minutes have elapsed, but the time hangs heavily in the room.
Concerned that we fall into a power struggle of who speaks first, I decide to break the silence. “You’re obviously having lots of feelings, Thea. Can you talk about what’s going on for you?”
“Why should I?” she retorts.
“Well, that is usually what we do here. You tell me what you’re thinking and feeling and we try to better understand you.”
“Don’t be a smart ass! You know goddamn well what I mean.”
Thea is correct. I do know what she means. She is a therapist herself and someone I have seen in treatment for several years. “OK,” I say. “So this is our first session back since I returned from vacation and you’re clearly angry with me. But that doesn’t help me understand if this break in our schedule was particularly difficult for you and if so, why.”
“I ran into Cathy in the grocery store. She knows that I see you – and obviously knew you were away - but why she found it necessary to tell me that you were presenting a paper I have no idea.”
Cathy is a colleague who did in fact know that I presented a paper during part of my time away, although I too have no idea why she needed to give Thea that information. However, she did, and it is now our job to understand the feelings churning inside Thea. Although I’m always eager to treat other therapists, they do present their own unique set of difficulties, particularly in a small therapeutic community where you don’t always know who knows whom.
“So what did it mean to you that I presented a paper?” I ask.
“You could have told me!” Thea replies, her voice still sharp and raised. “It was embarrassing that Cathy knew more about you than I did.”
I keep my face impassive, although I’m immediately puzzled. Certainly Thea knows that Cathy would know more about me than Thea herself. I say nothing, hoping that Thea will continue her self-exploration.
“What?” she says. “You’re not going to say anything?”
This whole session feels like a land mine. If I stay silent, Thea might well experience me as withholding and provocative, much as I am experiencing her. If I confront her on what seems an extremely unlikely reason for her anger, she could experience me as both challenging and negating. If I guess at what I think might be going on here, I am doing her work for her.
Perhaps the most productive course is to follow Thea’s direction. “I thought you might say more about what was embarrassing about Cathy knowing I was giving a paper while you didn’t.”
“Isn’t it obvious?”
“Thea, I know that you’re angry with me and I’m not trying to be dense here, but you’ll need to say more before I can understand what it meant for you not to know I was presenting a paper. You also didn’t know where I was going in my absence, if Cathy told you that would you have been equally angry?”
“She did tell me. And, no, I didn’t care about that. Oh!” Thea’s pale skin turns scarlet.
I think of how difficult Thea has made this session. I think about her being many years my junior in terms of professional experience. I think about her highly successful older sister, Emily. I have a sense of what’s going on here, but realize how important it is for me not to be the wise, all-knowing therapist.
“Now I really am embarrassed,” Thea says, dropping her eyes, her anger fading. “I’m mad that you got to give a paper and I didn’t, just like with Emily, who got to read her reports in school and get into the best universities and snare the best academic job in the country. I’m sorry. I was behaving like a brat.”
“You have nothing to apologize for. You had feelings. You brought them here and you figured them out. I’d say you did just what you needed to do.”
“But it’s not right if I put my feelings about Emily onto you. And I’m sure I put them on other people too.”
“Perhaps what you’re saying is that we still need to work on your feelings about Emily, as well as feeling competent and capable and good about yourself.”
“I can’t understand it,” says Beverly, an attractive 48 year old attorney, passing her hand through her short, curly black hair. “I’ve been with Joanne for over 20 years and now that there’s the possibility that we might be able to get married, I’m getting cold feet. We love each other, we get along. I just don’t understand myself. I haven’t said a word to Joanne. She’s floating on air. I don’t want to burst her bubble.
“She’s such a good person,” she continues, warmly. “I never want to hurt her, although I know I have. There were those years that I had lots of affairs. Looking for more exciting sex. But I’m really committed to Joanne now. You and I worked on it and I haven’t seen another woman for a long time. I promised Joanne I wouldn’t and I’d never go back on my word. We have a decent sex life. It’s not what it was 20 years ago, but what couple who’s been together for 20 years does?”
Beverly and I have worked together for several years. She was initially a difficult patient, challenging, argumentative, defensive. But she’s now far more thoughtful and open.
“Does it seem to you that if you get married you’ll be more tied down, less able to turn to other women if you chose?” I ask.
“That doesn’t seem right. I promised Joanne and my word means more to me than a piece of paper.”
We sit thoughtfully in silence. I think about the wonderful gay wedding I attended last year, the glorious celebration of love and possibility. I think about my lesbian friend who died suddenly many years ago and whose partner could not speak of her loss in the school system where she worked. I’d like Beverly to be able to get married, but that’s my desire, not necessarily hers.
“I was thinking about my parents.” She laughs. “I do that a lot here. My sisters and I have already begun planning their 50th anniversary party. It makes me nauseous. What’s to celebrate in 50 years of misery! I still don’t understand why they’re together. My father’s this horrible, authoritarian person who bosses around my meek, mousy mother who is constantly depressed and bemoaning her life. I know, I know, they must get something out of it to have stayed together. I think they enjoy torturing each other. Besides, no one else would have either of them.” She sighs. “Am I afraid my marriage would end up like theirs?”
“That’s a good question, are you?”
“Not consciously. One of the good things about being gay was that I knew my relationship could never look like theirs, at least not literally.”
“So how about figuratively?” I ask, hoping to help get beyond the conscious.
“When my sister got married, my mother decided to tell her about her own wedding night. I mean she knew my sister wasn’t a virgin, so I don’t know why she had to tell her all that stuff. She said how painful sex was and how my father didn’t care about her, just his own pleasure. So what else is new? He takes what he wants and she cries about it. Ugh! It’s such an awful relationship.”
I think about my own parents who shared some similarities with Beverly’s. My father was explosive and tyrannical; my mother was compliant, but definitely a competent, capable person, who saw both the world and my father through rose-colored glasses. They loved each other and, although I would have disagreed, they both would have said they had an excellent marriage. Unlike Beverly, I had a mother I could identify with, without getting stuck in a passive, depressed position. For Beverly to propel herself into the world, she needed to identify with her father, an identification that has carried some negative consequences for her.
“I was thinking, Beverly, that you said at the beginning of the session how you never wanted to hurt Joanne but that you did with sexual relationships with other women. And now you’re talking about how your father took his pleasure sexually and was unconcerned about your mother. Do you think you’re concerned that marriage will give you more of a license to hurt Joanne, sexually or some other way?”
“Hmm. I know that makes no sense logically, but I don’t know. I’ve certainly learned about the power of the unconscious. So if I get married, I’ll be more like my father – married – and therefore more likely to act like him. I’ll have to give that more thought.”
“Not to negate your possible fear of being more like your father, I’d say that your thoughtful, non-defensive interaction with me today indicates how far you’ve moved from being the authoritarian your father is.”
“Thank you. That means a lot to me.”
“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.”
