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.”    

Frustration

Jennifer Holland sighs deeply as she settles into the chair. “Well, another holiday season is upon us and I’m alone.”

“I thought both your sons were coming with their families,” I say too quickly and concretely.

She sighs again. “It’s not the same.”

“You mean your husband Dave isn’t here?”

Her eyes fill with tears as she nods. “It’s been five years since he passed. Five years of being alone.” 

“I understand that no one can replace Dave, but that doesn’t mean you’re alone.” 

“It’s not the same,” she repeats.

I’m back in a familiar place with Jennifer. I do understand her feelings. As a widow myself, I know all too well that the holidays bring one’s sense of loss and loneliness to the foreground. But Jennifer’s inability to appreciate what she does have, to take in anything positive from anyone – including me – leaves me feeling angry and frustrated.

“I know it’s not the same, but I wonder how your sons would feel if they heard you discounting their love and caring.”     

“They can’t understand. I know they lost their father, but they have their own families, their own lives.”

Feeling my anger rise, I wonder if I am feeling not only my own anger, but Jennifer’s as well. “Are you angry that your sons have their own lives, that they’re not here with you?”

“I’d prefer they were here. But boys don’t stay with their mothers. I have friends who are widows whose daughters live nearby. I get jealous whenever they bring up spending time with them. But me, I’m alone.”

“You just said you have friends,” I say, immediately aware that I am fruitlessly attempting to change Jennifer’s mind. 

“Yes. But they’re just friends.”

I try to get beyond my frustration and my wish for Jennifer to be different and say, “Do you hear yourself reject anything positive you might receive from anyone: friends, your sons, me?”

“But it doesn’t feel positive.”

Stymied again.

“What would be positive?” I ask.

“Having Dave back,” she says, crying.

From most patients, I would experience such a statement with great empathy. With Jennifer, I feel only anger. “I’m sure that’s true,” I say, trying to conceal my anger, “But you can’t have Dave back.”

“I hate when you say that!”

“Do you hate me?”

“No, I could never hate you. You’re trying to help me.”

“Are you saying you feel that you’re not allowed to hate me because I’m trying to help you?”

She nods.

“But you might hate me even if you feel you shouldn’t.”

“You’re confusing me. Besides, I don’t know why we’re talking about this. I want to know how to be less alone.”

I’m ready to scream. I try to step back and understand what’s going on between us. What I feel is that Jennifer is determined to spit me out. Well, I think, maybe that’s a starting place.

“Jennifer,” I say, “I know that your life has been unbearably sad and painful since Dave’s death, but my experience of the immediate right here and now, of this session right at this moment, is that you reject anything I offer that might help you to feel less alone, like you’re spitting me out.”

“But you haven’t said anything to make me feel less alone.”

“If you’re saying I haven’t said anything that’s going to bring Dave back, that’s true. If you’re saying you’re unwilling to take in anything that might make you feel better unless it’s bringing Dave back, I’d say you’re holding out for the impossible. And if you are saying you’re going to reject anything that isn’t going to bring Dave back, I’d say that’s what we need to work on.” Am I being too harsh, I wonder? Is my frustration turning into hostility?

“I don’t know what you want from me,” Jennifer says plaintively. 

Yes, I’m being too aggressive but Jennifer’s passivity and sense of entitlement is difficult for me to handle. I try to soften my tone. “Can you say what you’d like from me, Jennifer? Or what you think you might be able to do to help yourself to feel better.”

“I don’t know,” she laments. “I thought you were supposed to tell me that.”

“It’s so, so hard for you, Jennifer, to take in positives, to feel good about your sons coming, to feel pleased to have friends.”

“It’s not enough.”

“I understand they’re not Dave. But maybe you won’t be able to begin to take in the positives in your life until you’re able to accept that regardless of how much you might want it, Dave can’t come back.”

“I hate when you say that.”

“I know. It’s a reality you don’t want to accept.”

Invisible

Invisible

Mrs. Jackson sits across from me looking all of her 80 years. Speaking slowly and softly, I strain to hear her. “I know it’s ridiculous. My parents have been dead for years. I’ve had my own family, my own life and yet I can’t get past what they did to me. Or what they didn’t do, would probably be more accurate. I was invisible to them. They couldn’t have cared less about me. There were days I went hungry because they couldn’t be bothered to feed me. But my brother, he always got fed. The crown prince.”

“You sound angry,” I say.

“Oh yes,” she replies in barely a whisper, “I’m angry. But what I am supposed to do about it?”

“Do you always speak that softly when you’re angry?”

She smiles. “My husband always tells me I go around whispering.”

“Any idea why you speak so quietly?” I ask, thinking it’s both a way to keep herself invisible, as well as a way to force others to pay close attention to her.

She shrugs. After a pause she says, “I know it’s not unusual for parents to prefer the boy, I sometimes felt that with my own children, but it wasn’t only that. My mother would walk by me like I wasn’t in the room. She didn’t help me understand how to dress appropriately, how to make friends, couldn’t care less if I got myself to school. I did go to school. I couldn’t pay attention very well, but at least that was a time I didn’t have to deal with my mother’s rejection.”

Although I’m aware that Mrs. Jackson has ignored my question, possibly repeating the experience of being ignored herself, I opt for empathy at the moment rather than confrontation. “I’m sure being constantly ignored was extremely painful, but do you have any thoughts about why you decided to come into therapy at this particular moment.”

“I’ve been in and out of therapy my whole life. It never works. I try, but it never works.”

“What do you mean it never works?”

“I can’t let go, I can’t forget about how they treated me, despite what the therapists say.”

“And what do the therapists say?”

“They say I should forget about it. And I agree. But I can’t.”

“I don’t think the problem is that you can’t forget how they treated you, but rather that you can’t move beyond the feelings you had as a child. The pain of their rejection feels as though it happened yesterday as opposed to 70 plus years ago.”

“You’re absolutely right. I can’t get beyond the feelings.”

“Can you imagine what it would be like not to have those feelings?” I ask.

Mrs. Jackson mumbles a response.

“I’m sorry” I say, “I didn’t hear you.”

“Free,” she whispers, looking down at the floor.

“You sound so tentative. I wonder if it feels scary to imagine yourself as free.”

“Why would it be scary?”

“Well, for one thing, it’s very foreign to you. Being free means putting yourself out there, speaking up, feeling you’re valuable and worthwhile. You’ve spent your life making yourself as invisible as you were to your parents.”

“That’s true. But I’m 80 years old. I’m 80 years old and I still feel like a child.”

“It’s really hard to change a lifetime of how you feel about yourself, how you are in the world. Perhaps you hope that if you make yourself invisible enough, your parents will finally love you.”

“But my parents have been dead for years.”

“Yes, but we all walk around with parents in our heads and those parents never die. We still try to get those parents to love us, to notice us, to approve of us. To get beyond the hurt and angry feelings you carry inside you, you have to mourn those parents in your head. You have to come to a place where you know and feel that you can never, ever get the love and attention and caring you needed and deserved as a child, regardless of how invisible you make yourself.”

There’s another inaudible reply.

“I’m sorry, I didn’t hear you,” I say. “I don’t have the greatest hearing, but I suspect it’s not only my hearing that’s the problem.”

“I said I’d try.”

“Do you want to try for you or are you trying to please me?”

She chuckles. “Perhaps a little of both.”

“It will be important for us to pay attention to who you’re trying to please – me, the parents in your head, or yourself. Hopefully you can get to a place where you’re doing what you want to be doing for you.”