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  • 11/18/2020 6:27 PM | Anonymous

    "In Mourning," a patient returns to therapy after the death of his mother, struggling with a depression he cannot shake.

    “Well, I’m back,” David says morosely. “I thought I could at least make it a couple of years without seeing you, but there’s no way. I can’t stand myself any more. I knew I’d have to see you virtually too, which only makes it worse, but I just can’t get myself out of this depression.”

    “Do you know what’s gotten you so depressed?”

    “Yeah, my mother died of Covid in April.”

    “I’m so sorry, David. Yet another victim of the pandemic.”

    “Yup! I mean, I know my mother was 92, and her health wasn’t the best, but she still had all her marbles. And of course, just like in the news, she died alone in the facility.” Pause. “I feel so incredibly depressed. And you must think I’m nuts since I had such a difficult relationship with my mother. You’d think I’d be, I don’t know, relieved, or something.”

    “What do you feel?”

    “Lost.” Pause. “That sounds crazy when I say it. My mother was so suffocating. I was always trying to get away from her. And now I feel lost without her?”

    “But when you were a little boy, you felt your mother as the only loving presence in your house. And she was a huge protector. She protected you against your father, she protected you against your older brothers.”

    “But I’m not a little boy any more.”

    “Except that you carry that little boy inside you as an adult, just as we all carry our child selves with us.”

    “So you think that’s why I’m depressed?”

    “I think you’re in mourning so it’s not surprising you’d be sad, but the depression seems as though it’s more than that.”

    “So what it is?”

    “You know, David, it’s interesting that you look to me to tell you what your depression is about. That may be another indication of how lost you’re feeling, looking to me for answers that reside in you.”

    “That’s true.” Pause. “I want you to tell me what’s wrong and make it go away. I know therapy doesn’t work like that. But it’s like I’m too depressed to even do the work I know I have to do.” Pause. “Please help me.” Pause. “I sound like a sniveling baby!”

    “Well right then, you sounded like your Dad berating you, rather than being able to have compassion for yourself.”

    “That’s true!”   

    “So you’re mad at yourself for feeling depressed.”

    “Definitely. I thought we fixed me. That my depression would be gone forever.”

    “So, David, do you think you’re also mad at me? Mad that I didn’t fix you.”

    Hanging his head, he nods. “Yeah. When my depression came back, I started questioning whether therapy had made any difference at all. When Covid first hit I felt very different. I felt that as was coping with all the stress and insanity and that I was a good support for both my wife and daughters. In the beginning we were all living together. My daughters came back from college, my wife was teaching from home, and I was doing my accounting from home too. It was kind of crazy, but sort of fun too. Felt like we were whole, a big, happy family again.  And I wasn’t allowed to see my mother so that took away my worry about whether too much time had passed and whether I had to go see her. Now my daughters are back at college, although they’re still doing most of their courses virtually, my wife is back teaching and I’m back in my office although I still meet with clients virtually. And obviously my mother is dead so I don’t have to worry about seeing her.”

    “Sounds like you are feeling a lot of loss, not only of your mother, but also your big, happy family.”

    “Yeah, that’s true. Like there’s this void.” Pause. “And I turned 60. That didn’t feel good at all. Made me feel old. The time I have left in my life is getting shorter and shorter.” Pause, “I guess my mother’s death added to that feeling.”

    “So there’s loss everywhere.”

    “Definitely.”

    “I notice though, that as soon as you acknowledged your anger at me and your lack of compassion towards yourself, you were able to start doing to the work, start looking at what was going on in your life that’s been contributing to your depression.”

    “That’s true.” Pause. “I just wanted to ask you if that means I’ll stop being depressed.”

    I smile. “I think with the loss of your mother, it’s easy for you to want to put me in the place of the mother who can make everything all right. I’m sure you have lots of feelings about your mother’s death, as well as issues about the inevitable passage of time.”

    “Just hearing you say that made me depressed again.”

    “I’m sorry. But sounds like that’s an issue we’ll definitely have to address.”  

  • 10/13/2020 7:20 PM | Anonymous

    Today's blog, "In A Quandary," focuses on a patient who returns to treatment to deal with the stresses imposed by Covid19, stresses that necessarily tap into past conflicts and issues.

    “It’s kind of weird starting therapy on FaceTime,” my new patient, Leah, begins. “But I’m a therapist myself, getting used to working virtually, so I figured it was time to get myself back into treatment. I certainly could use the help.”

    “And how can I help you?”

    “I guess the big push for me to start treatment again is my father, but of course like everyone else in the world, I have problems and problems and more problems.” She sighs. “I’m 45. I’m married, my husband, Ed, is an IT guy working from home. I have two kids, girls, 12 and 14, who are in school virtually. So there we all are at home, each in a separate room, learning, seeing patients and solving computer problems. Sometimes it works, sometimes it doesn’t. It’s a problem if one of my girls doesn’t understand something she’s being taught and thinks she can just interrupt me in a middle of a session. I’ve tried to explain she can’t just do that, but if she goes to Ed, well, he just doesn’t have the patience, so she’ll end up interrupting me anyway. I’ve tried locking my door, but Elisa – she’s my youngest – gets really scared if I do that, so that doesn’t work either.”

    “Sounds like you’re being pulled in every direction.”


    “That’s for sure. And then there’s my father. My Mom died three years ago and at first I thought my Dad would be okay but now I can see he’s starting on the road to dementia – actually getting worse faster than I would have expected - and I’m worried about him being alone. Sometimes he calls again and again to ask the same question. He told me he’s burned a couple of pots forgetting he had the fire on. He’ll sometimes forget which apartment is his. And, of course, like many people during Covid, he’s lonely and, because he’s who he is, he’s angry. So I’m trying to decide if I should move him into the house with us.”

    “Wow! Sounds like you have a tremendous amount on your plate.”

    “Yeah. And the added problem is that I don’t like my Dad. I mean I love him – I guess – but I don’t like him. He’s angry, opinionated, narcissistic, dogmatic and intrusive. And that was all my life, not just since my Mom died or since the dementia.”

    “So what was it like for you growing up?”

    “Well, I’m a therapist, that should give you a big hint,” she says with a small smile. “It was hard. I was the oldest of three girls. My Mom was this really sweet person who didn’t have a backbone. She accepted anything and everything my father did, worshipped him really, and left us to fend for ourselves. Which usually meant I was the one arguing with him. My middle sister was the good girl, kind of like my mother, and my youngest sister just sort of floated through life, which is kind of what she’s still doing. I think she just ended marriage number three and career number … I don’t know. Too many to remember.”

    “So what do you think it would be like with your father in the house?”

    “Awful. I know it would. My youngest daughter is scared of him, always has been; and my oldest, at 14, she’d probably be arguing with him just like I used to. But I don’t know how they’d do with his dementia.”

    “You haven’t said much about your husband.”

    “I know,” Leah says sighing. “It’s hard. I mean I love Ed and I know he loves me, but even after all my previous therapy, I still think I married my father. No, that’s not really fair. Ed isn’t an angry bully like my father. But he is self-centered and not inclined to go out of his way to be patient or helpful, like I was saying before about his not helping my youngest with her schoolwork.”

    “I notice you keep referring to your children as ‘yours’ rather than ‘ours.’

    “That’s true. They’re very much my responsibility. I mean he loves them and he’s great about playing with them as long as it’s something he enjoys. But he’s definitely the fun parent and I’m the one who keeps after them to do their homework, pick of their rooms and so forth.”   

    “So you always end up in the role of the responsible one. Any idea why?”

    “First response, I was the oldest. Second, it’s the only way I’m sure things will get done.” Pause. “Maybe it’s the only way I feel safe.”

    “There’s certainly a lot there for us to explore there.”

    “I want to ask you before we stop if I should take my father in, but I know you can’t answer that.”

    “Maybe we first need to look at why you only feel safe when you carry all the weight of responsibility.”

  • 09/17/2020 7:43 PM | Anonymous

    The convergence of 9/11 and Covid-19 and illustrates how a therapist tries to help her patient understand how the terrors of his childhood contribute to his fear in the present.

    “Is it all right that we’re meeting on FaceTime today?” Jason asks.


    “Of course,” I reply.

    “You didn’t mind that I called and asked if we could?”

    “No. But why are you sounding so tentative, scared.”

    Jason drops his eyes. “It was 19 years ago today,” he says softly. “I was 25 years old. Seems impossible I was ever that young. But it also seems impossible that 19 years have passed. All I accomplished was that I got out of New York. But I’m as terrified today as I was then. At least then it felt as though there was an escape – get out of New York and your chances are way better. Now, now it doesn’t matter where you are, you’re doomed, subject to the whim of a virus. I’m tired, tired of feeling frightened.”

    “I believe you, Jason. You were terrified during the 9/11 attacks and you’re terrified again. And, of course, we can’t forget that you were terrified your entire childhood.”

    “I know you keep saying that and it’s true, but this is real! There

    is this deadly disease out there that can strike anyone at anytime and there are a bunch of idiots who don’t think they should be wearing masks. Who wouldn’t be frightened?”

    “Do you feel your childhood terrors weren’t real? An explosive, alcoholic mother who would beat you with a strap. I’d say that’s pretty real.”

    “But that was then. That’s not what I’m living through now.”

    “You may not be living through that now, but you are living with it. Those memories, those experiences are always with you.”

    “I suppose.”

    “Jason, why do you think you were so tentative about asking me to meet on FaceTime, why you had to check to see if it had been okay to call?”

    “But you said it was all right,” he responds, tremulously.

    “What are you feeling right now?” I ask softly.

    “I just want to be sure it was okay to call, okay to ask for something different,” he replies, staring at me intently.

    “Are you frightened of me right now?”

    “I… I don’t know.” Pause. “Can you just tell me I didn’t do anything wrong?”

    “Of course you didn’t do anything wrong. What you’re showing both of us is how easy it is for you to become frightened. You’ve put your mother’s face on me and are afraid I’ll be just as scary and irrational as her.”

    Silence.

    “I was thinking of that time I was, I don’t know, maybe 12, and my sister had a bunch of her friends over. My mother got mad at me for something, I don’t remember what.  She started to throw out my comic book collection. I was really into comic books. She took one bunch of comic books after another and took them to the dumpster. I was hanging unto her leg and crying and begging her to stop. Right in front of those girls. Then she took the belt and started beating me. She was like a crazy woman. I begged and cried and screamed. I was so humiliated.”

    “Oh Jason, that’s such a sad story. I’d just want to hug that little boy and tell him it will be all right. I wish you could hug that little boy and feel for the terrorized child in you.” Pause. “Your mother is like the 9/11 attacks and the virus rolled into one.”

    “So you’re saying that’s why I feel so frightened.”

    “Yes, just like you became instantly frightened of me when you thought I might just possibly be angry that you’d asked for a change in how we meet.”

    “I get that in terms of you, but the virus is real, it’s scary. Shouldn’t everyone be frightened?”

    "Certainly everyone should be concerned with their safety and the safety of others. But beyond that, and I’m not talking about the politics surrounding the virus, beyond that, how people feel about the virus depends a lot on what they bring with them from their childhoods. If children grew up in a basically safe and loving environment they’re more likely to feel things will work out okay, that they won’t be harmed. That doesn’t mean they won’t be harmed, but they don’t feel terrified every minute of every day. On the other hand, if a child grew up in an environment where one or the other parent was anxious all the time about some unknown danger, that person is likely to be a more anxious and frightened adult. And growing up as you did, where anything really bad could happen at any moment, well that’s going to lead to where you are today, scared and waiting for catastrophe to strike.”

    “But what do I do about all that? I can’t redo my childhood.”

    “What we have to do is allow you to feel all the terror you felt as a child and then get to a point where you can take in that you’re no longer a child, that you no longer have to be afraid of your mother, not the real one nor the one that walks around in your head.”

    Tag words: psychotherapy, mental health, patient-therapist relationship, transference, Covid, fear, terror, childhood.


  • 09/04/2020 4:17 PM | Anonymous

    “I know I keep saying the same thing over and over,” David says, his despair and anxiety apparent even over the telephone, as all our therapy sessions are conducted these days. “I feel scared all the time. I’m sure Covid is going to get me. I’m sure I’m going to die. Yet it helps me to tell you. I mean I know you can’t keep the virus from killing me, but telling you makes me feel at least a little better.”

    “Do you know why telling me helps?”

    “You’re the only person I can tell. My wife doesn’t want to hear it any more. She says I’m a 48 year old man who rarely leaves the house, so how likely am I to get Covid. She’s just fed up with me. And I try not to talk about it in front of the kids. I don’t want to scare them. But I’m so glad they’re not going back to in-person school. I don’t know if I could have tolerated having them go into a classroom every day and then came back home.”

    “So is it that you feel less alone when you talk with me?”

    “Definitely.” Pause. “I’ve always been afraid of dying. Even when I was a kid. If I saw a dead bird, I’d cry and cry and not be able to sleep for days. I was sure that would be me. And when my cousin enlisted in the army, I was in shock. I couldn’t imagine how anyone would volunteer to be killed. But this, this is the worst it’s ever been. There’s this disease that’s killing hundreds of thousands of people. It makes complete sense that I’ll be one of them.”

    “It makes complete sense because…?”

    “Because I know I’m going to die.”

    “And what does knowing you’re going to die mean to you?”

    “What!?”

    “What does knowing you’re going to die mean to you?” I repeat. “We are, after all, all going to die.”

    “You say that so calmly.” Pause. “Of course I know we’re all going to die, but that terrifies me. And it removes all meaning from life. Why bother being in a marriage, having kids, being successful? In the end it all goes away.” Pause. “I know we always go back to my father’s heart attack when I was seven, but even then I was amazed that he was able to come back from that and throw himself back into the business as if he hadn’t been on death’s door.”

    “But that wasn’t your mother’s reaction.”

    “Oh no, not at all. She hovered around him like he was about to die at any second.”

    “Just like she hovered around you when you were sick,” I add.

    “That’s for sure. She was an anxious mess. All I had to do is run a slight fever and you’d think I was dying.” Pause. “I know we’ve talked about this before. You think that my mother’s over-reaction to my being sick is why I always think I’m going to die.”

    “Well, maybe it’s not quite that simple. How did you feel about your mother’s reaction to your being sick?”

    “I don’t know. I guess I kind of liked it. Made me feel like she really loved me.” Pause. “Especially after my father’s heart attack, she paid way less attention to me, so it was nice having her focus on me again. And actually it drove my father crazy. He’d say that she was babying me, that all I had was a cold or a sore throat or whatever and that I’d be fine. I remember, he’d say, ‘Stop treating him like a baby.’”

    “So when your wife doesn’t want you to talk about your fears, what do you feel?”

    “Ignored, I guess.”

    “Unloved?” I ask.

    “I suppose. But I’m not really sure how much my wife loves me. Ever since we’ve had kids, she’s way more focused on them than on me.”

    “So you felt you lost your mother to your father and now you feel you’re losing your wife to your kids.”

    “Yeah! That’s right.”

    “And what about me?”

    “You?”

    “Um hmm. You said I’m the only person you can talk with about your fears.”

    “Certainly the only person who will listen.”

    “And that makes you feel how?”

    “I guess it makes me feel like you care.”

     “So maybe you learned early on that the only way to feel loved was to be sick.”

    “But I could be sick without dying.”

    Silence.

    “I just thought of something,” David says. “Maybe dying is my punishment, my punishment for being such a baby and wanting Mommy’s attention.”

    “That’s a great insight, David. We’ll talk about that more next time.”


  • 08/20/2020 7:24 PM | Anonymous

    A patient's early loss makes working remotely painful, creating a yearning for in-person contact with her therapist.

    “I’m sitting in your parking lot,” Laurie says barely whispering into the telephone.

    I consider asking her why, but I know the answer. Instead I say, “I’m sorry.”

    “Not even your car is here. I thought maybe I’d at least see your car.”

    “You know I’m working from home, Laurie.”

     “I know. But I thought maybe I’d get lucky.” Pause. “How long is this going to go on?” she asks, plaintively.  

    “I don’t know. No one knows the answer to that.”

    “But you could see me. We’re not under lockdown. I can eat in restaurants. I can have my hair done.”

    “That’s all true, Laurie, but it doesn’t feel safe to me for us to be behind a closed door in a small space without a mask.”

    “I know. I know. We’ve been through this a hundred times before. But I have to see you! I have to! I have to know you’re really here!”

    “We did try FaceTime.”

    “That’s worse. That’s like you’re here and not here. I don’t know. That totally spooked me. Then you really aren’t real. It’s almost like you’re a figment of my imagination. Like I willed you onto my phone. Flat. Way too flat.”

    “Flat or dead?”

    “I know you keep going back to that.” Pause. “Maybe. I don’t know. I went off to school, came home and my mother was dead. I’m sure that did a number on me. Oh yes, and by the way, she killed herself.”

    “You’re talking about that horrible time almost like it happened to someone else.”

    “I don’t want to feel that now! I’m too sad, way too sad, why would I want to start feeling about my mother offing herself?”

    “Maybe because you are feeling it. Maybe because every time you pour over the statistics about how many people have died and how old they were and where they lived, you’re actually mourning your mother again and again.”

    “Don’t I ever get to have mourned enough?”

    “I think there are always times that losses in the present trigger past losses, especially when that loss was so primal.”

    “How about if I met you in the parking lot for a session? At least that way I could see you.”

    “And what? We’d both sit in our cars and …” I stop myself. Giving Laurie the practical reasons why her suggestion won’t work is not what’s needed here. “You know, Laurie, it strikes me that you’re trying to undo your mother’s death. It’s as though if you figure out a way to see me, to erase the missing, to erase the absence, then that will magically make everything all right including bringing your mother back to life.”

    Silence.

    “What do you feel if you accept that we’re not going to see each other for some indefinite period of time?” I ask.

    “Angry!! Angry, angry, angry! Because it’s only an indefinite period of time because you’re making it an indefinite period of time. It’s you, you, you!! You’re doing this.”   

    “Just like your mother killed herself.”

    “Right! Who the fuck has the right to kill themselves and leave behind a six year old child? It’s not right! It’s not fair,” Laurie says sobbing.

    “No, Laurie, it’s definitely not fair,” I say softly.

    “Okay, so I’m mourning now, are you happy?”

    “I’m definitely not happy you’re in pain, but you know I always think it’s best for you to feel whatever it is you’re feeling.”

    “I want to see you! I want to see you! That’s what I’m feeling.”

    “I’m sure that’s true. And I’m sure that’s what you were feeling as a child as well.”

    “Fuck you! Leave me alone.”

    Silence.

    The silence continues.

    I hear Laurie crying.

    “I’m here Laurie,” I say quietly.

    “You sure?” she whispers.

    “I’m positive.”

    “I used to make believe that I was talking to my mother on the phone, like she’d taken a trip somewhere and was missing me and couldn’t wait to get home to see me. Isn’t that pathetic?”

    “No, Laurie, that’s not pathetic at all. It’s totally understandable and very, very sad. Don’t you feel for the little girl who was you who wanted her Mommy to come home?”

    “I guess. Sometimes.” Pause. “And sometimes I just want her to stop being such a baby. I guess like I should stop being a baby when it comes to wanting to see you.”

    “You’re not being a baby. You’re yearning for what your mother took away from you and what you feel I’m taking away from you too.”

    “But you’re really here, right? I’m not just imagining you and I will get to see you again sometime?”

    “Yes. I’m here. And we will see each other again.”

  • 07/01/2020 8:21 PM | Anonymous

    The problem many therapists face as the pandemic continues to rage and patients seek relief from their anxiety, depression and isolation.


    Hello,” I say to an attractive, dark-haired woman who appears before me on FaceTime. “I’m glad to meet you.” And so begins my first experience beginning therapy remotely.

    I practice in Florida, one of the states that is seeing a sharp uptick in Covid-19. Although I have toyed with the idea of returning to in-office sessions, I continue to find myself reluctant to do so. During the initial phase of the pandemic, I turned away new referrals, uncomfortable starting treatment with anyone I could not meet at least once in person. But as my time away from the office continues, I decide I need to go beyond my comfort zone.

    “Hi,” Jennifer replies. “This already feels weird. I’ve been in a lot of therapy, but obviously in person. I kept thinking I’d wait until I could go to your office, but who knows when that will be, and I’m having a really hard time.”

    “It feels strange to me too,” I say, “But why don’t you tell me how I can help you.”

    I watch her take a deep breath. “I’m 49, I’m alone, I’m terrified of the virus and I just found out that my ex-husband has lung cancer. And that he hasn’t told our daughter yet. I’m so anxious I can’t stand myself.”

    “That is a lot.”

    “I’ve always been afraid of being alone and now I’m alone all the time. I mean, I talk to my daughter, but she’s in New York and she’s had a really hard time so I don’t want to lay all my stuff on her. And I worry about how she’ll respond to the news about Greg, that’s my ex.”

    “Lots of people have been struggling with their aloneness during the pandemic, can you talk about what it’s like for you.”

    “I’ve always hated being alone, ever since I was a little girl. I was the kid who was afraid of monsters under the bed, always had to have a light on, and would run into my parent’s room in the middle of the night. That’s why it took me so long to leave Greg, even though I knew about his affairs for years. And when he moved out I put way too much pressure on my daughter to be my companion, just as my Mom did to me. I mean, my parents stayed married, but they had a lousy relationship and I was my mother’s confidant. My Mom’s still alive. She remarried after my father died and she’s much happier now. We’re close, but not like it was when I was a kid.”

    “Are you saying you miss your childhood relationship with your Mom or that you’re relieved?”

    “I don’t know. Maybe both. When I’m happy, I’m relieved. But now that I’m so anxious, I guess I want my Mommy. I know that sounds silly.”

    “Not at all. I totally understand.”

    “I did tell my Mom about Greg, but she didn’t get it at all, thought I’d be happy that something really bad happened to him.”

    “And is a part of you happy?”

    “Oh no! I mean he certainly wasn’t a good husband but I could never be glad he got cancer.”

    “So you’d feel guilty if you felt glad?”

    “Definitely. I was brought up to be the good girl and the good girl I remain.”

    “Can I ask you how this is feeling to you right now?”

    “I guess it still feels weird. And I’m still anxious. I’m used to having my anxiety get better when I’m in

    a therapist’s office. But I guess I’m not in your office. It’s like you’re here and not here. It’s similar to how I feel talking to my New York friends on the phone. They don’t feel really present to me so I’ve pretty much let most of those relationships kind of peter out.”

    “Oh oh,” I say. “Does that mean you’re likely to do the same thing with us?”

    She shrugs. “I don’t know.”

    “Maybe you yearn for relationships that duplicate the early connection you felt with your mother, perhaps that’s the connection that reduces your anxiety, makes you feel safe, and that without that kind of connection you feel afraid.”

    “I guess that’s true. But I thought I wanted to get away from my mother.”

    “I suspect that a part of you does want to get away, but the scared little girl part of you still yearns for what you experience as safe.”

    “I suppose.”

    “I feel as though you’re less engaged with me right now.”

    “Yeah. It’s not you. I just don’t know if this is going to work.”

    “I suppose the question is whether you’re willing to give it a chance. We’ve actually talked about quite a bit today: anxiety, guilt, your need to be a good girl and, I suspect, although we haven’t talked about it, your difficulty allowing yourself to feel angry.”

    Jennifer brightens. “That’s right! I feel really bad when I get angry.” Pause. “But right this minute I feel a little less anxious.”

    “Maybe it helped that I figured something out about you, and that made you feel more connected, less alone.”

    “Could be.”

    “I can’t guarantee I’ll do that every session, but if you’re willing to give this a try, maybe our work together could be helpful, despite not being in person.”


  • 06/13/2020 2:21 PM | Anonymous

    In this month's blog, teletherapy diminishes the feeling of connection between patient and therapist restimulating old losses and increasing the dread of new ones.

    Chelsea, a relatively new social worker, is talking about her work at the local hospital. “It’s scary being there right now, even though there isn’t all that much to do since our census is so low. Still, having to deal with families who are deciding where to place their elderly relatives is hard, even harder than usual. Who would want to put someone in a nursing home right now? But some families just can’t take them home – small kids, home schooling. It’s a challenge. And it’s worse since I have to do it all by phone or video conferencing.”

    “Interesting, Chelsea, since that’s how we have to work too.” I have been seeing Chelsea for several years now, beginning when she was in college, through her Master’s program in Social Work and now as a beginning professional. We have a strong, caring bond. But switching to teletherapy has been difficult for us. Something is definitely missing. I even suggested we switch to FaceBook, hoping that might recapture our connection. But it’s still not the same.

    She sighs. “Yeah. But the problem I have with the families isn’t the same as the one I’m having with you. I don’t know the families, so not seeing them in person makes it harder for me to have a sense of who they are as people. I mean if someone is sobbing about the thought of putting their mother in a nursing home, I certainly get how they feel. But if they’re more neutral, is it because they don’t care or because they’re just trying to hold it together. I can’t tell.”

    “But that’s not true for us?”

    “Not at all. I most definitely know who you are.” She smiles. “You’re my savior. I don’t know where I’d
    be if it wasn’t for you. I mean I know I have a mother transference to you. How could I not, with my mother dead by the time I was nine and no one else really caring about me? But this not in person stuff just isn’t working for me. I even considered asking you if we could take a break from our sessions until we could meet in person again.”

    “Really? I’m surprised.”

    “Yeah, I know. But I chickened out. It would feel like too much of a loss.”

    It would feel like a loss to me too, but I keep that feeling to myself.

    “Maybe it would be helpful, Chelsea, if we really tried to figure out what the difference is for us, because I agree with you, something is different, something is missing.”

    “I just don’t know,” she says shrugging. “I have wondered whether it’s somehow related to my mother’s death, but I’m not sure exactly how. Sort of like how she faded away from cancer and whether us not being in person makes me feel as though you’re fading away too.”

    “That’s a really good thought.”

    “But you know, just saying that made me really anxious. Like, my God, are you fading away? Are you leaving me? Are you dying? That’s so terrifying to me I can hardly stand to think of it. I mean, here we are in the middle of a pandemic and you have to be in the age group that’s most at risk. But I never thought of that. I never thought I might actually lose you!” Chelsea says bursting into tears.

    “I understand that would be really scary. And sad. And of course I can’t tell you I won’t get Covid, although I’m trying my best not to.”

    Still crying, Chelsea looks up at me, stricken, shaking her head. “So many thoughts just went through my head. I think I’ve been mad at you. I think I’ve been mad that you weren’t seeing me in person, like you were rejecting me. But that’s not true at all. You weren’t rejecting me, you were taking care of me, trying to stay here for me. I mean not just me, for yourself and for your other patients too. But I think I’ve been mad and scared and sad and I didn’t know about any of it! What’s wrong with me!?”

    “Nothing’s wrong with you, Chelsea,” I say smiling. “This is a scary, unknowing time for us all, including not always knowing what’s going on inside of us. And death is all around us. It’s hard not to worry about loss, or to defend against acknowledging it.”

    “I feel so incredibly sad. I truly don’t know how I’d deal with losing you.”

    “I understand. And I hope you won’t have to deal with it for a very long time.”

    “You know what, though? I feel closer to you right now.”

    “I agree. Defending against fears of loss meant we lost each other in the present. And that’s even worse than losing each other in the future.”

  • 05/12/2020 8:29 PM | Anonymous

    Alone Together, when a married patient talks about her feelings of aloneness during the stay-at-home orders, her therapist helps her to see how these feelings are related to her long-standing fear of both knowing and expressing her own needs.

    “I’m feeling so horribly sad,” Marion says, her sadness apparent from her voice which I hear remotely on my cell phone. “I feel sad for the country, sad for the world, sad for all the people who are losing their lives every day.”

    Pause. “But mostly, I must admit, I feel sad for me. I mean, I’m grateful that everyone I know personally is well, that I haven’t had to deal with a loved one dying without being able to say good-bye… But I feel so alone, which is ridiculous. I know I’m not alone. Arnie is here with me as always. I get to FaceTime with my daughter and grandchildren almost every day – although how they’re all surviving in that apartment I have no idea. And with my son and his husband at least once a week. They’re actually doing very well, working from home and enjoying what they call a second honeymoon.”

    Silence.

    If I were I in my office with Marion I know I would wait for her to continue before I speak. But remotely I’m concerned that the silence will increase her feeling of aloneness. “And you feel sad because…?” I ask.

    She sighs. “Arnie and I have no relationship. None. I mean I know we’ve been together for 30 years. I don’t expect us to be falling over each other like my son and his husband. But something, something…” Pause. “We sleep in the same bed. We get up in the morning, have breakfast, each of us focused on our iPads, barely speaking. Then he goes into the living room to watch endless news shows about the virus. I sometimes take a walk, then head for the bedroom to watch old movies or read or sometimes talk on the phone. I wish we at least had a dog, but of course they don’t allow them in our condo.”

    Pause.

    “Before at least I got to get out, had a change of scenery. I played cards, had lunch with my girlfriends, went to a movie. When I worked that was entirely different. You know, it’s sometimes hard to believe that Arnie and I were both teachers, that we had interesting lives, interesting things to say to each other. Now there’s nothing. Nothing. Emptiness.”

    “And feeling alone with someone feels worse than being alone by yourself.”

    “That’s definitely true.”

    “You said that you and Arnie sleep in the same bed. Do you ever have sex?”

    “I’d be hard pressed to remember the last time we had sex.”

    “Do you miss it?”

    “Sex has been so perfunctory for so many years it’s hard to say I miss it. I do miss cuddling. I miss the occasional kiss, holding hands, caring about each other. Now there’s literally nothing. The absence feels so bleak. And it’s mirrored in all those pictures of cities without people. Or even here – shuttered tennis courts, golf courses, emptiness.”

    “Have you talked with Arnie about your feelings?”

    “I’ve tried, maybe not enough, but I’ve tried. I tried sitting next to him on the couch, putting my hand on his knee, asking him something about what’s on the TV. Nothing.”

    “But have you told him about your feeling of emptiness, of aloneness?”

    “I can’t do that.”

    “Why?” I ask.

    Pause. “You know what I thought of? I thought of being a child, maybe 10, 11 I’m not sure. It was a rainy, dreary day. Must have been a weekend since I wasn’t in school. I was bored. I went to my mother to see if she wanted to play a game, but she was on the phone and put her finger on her lips and motioned me away. So I went to my father just to be with him. I knew he wouldn’t want to play a game. But he was reading the paper, looked at me annoyed and shooed me away. I learned never to ask, just to wait and see if someone will be there for me.”

    “We’ve talked previously, Marion, about your unconsciously choosing a man like your father, but today I’m wondering about something else. What is it that you feel, you, the adult Marion, if you think about telling Arnie what you’re feeling?”

    “I can’t.”

    “But what is it that you feel?”

    “Uncomfortable. Vulnerable. Maybe embarrassed. Like I’m not supposed to have feelings. Maybe like I shouldn’t need anything from anyone.”

    “Like you shouldn’t need anything from anyone. I think that’s a very important statement, Marion. I think you’re saying that a long time ago you withdrew from your own needs, that you walled off those needs and locked them in a room somewhere deep inside you. And what you’re left with is a feeling of profound aloneness.”

    “That feels right. But what do I do about it?”

    “I think we have to start looking for the keys that will help us unlock that door, so we can find the sad, vulnerable child who reached out to her parents that dreary day.”

  • 04/06/2020 8:37 PM | Anonymous

    Today, as I send this blog, I know that we are all in an alternative universe, overwhelmed by fear, locked in our homes, trying to get by the best we can. When I say I hope you are all well that hackneyed phrase takes on a whole other meaning. And I do wish you are well, with special thoughts to the New Yorkers on this list who are particularly under siege.

    My blog, "Why," is unsurprisingly about the coronavirus, illustrating a patient's terror and her unrealistic demands of her therapist.

    “I can’t stand it!” Marilyn yells into the telephone. “Why did this have to happen? I can’t stand being all by myself. There’s no one here, no one. I’m totally and completely alone.”

    “I’m here,” I say quietly.

    “No, you’re not! You’re not here. I don’t even know where you are but I know I’m not with you. I have to be near you. I have to imagine being able to touch you, even though we never do! And that’s what I want right now. I want you to touch me! I want you to hold me!”

    Like most therapists these days, I am ‘seeing’ my patients remotely from home. Since for most of my career I have used the telephone when patients cannot be in my office, I am more comfortable using this modality than facetime or video conferencing. Most patients have been able to adapt to this new reality.

    “Sounds like you’re feeling alone and desperate and wanting me to take care of you.”

    “Now there’s a therapist response if I ever heard one! What good are you? You’re just a disembodied voice floating out there somewhere in space. You can’t give me what I need.”

    “I understand that you’re feeling alone and uncared for, just as you felt as a child,” I say. “I understand that you want me or someone to save you, just as you did as a child. We’re all scared, Marilyn. We’re all in the same frighteningly unknown scary position.”

    “But not everyone’s alone.”

    “No, not everyone’s alone,” I agree. I want to add that many people are alone. I want to suggest that she call friends, reach out to family. I want to suggest that she start some of the projects she’s been wanting to do around her house, anything that will help her to feel more adult. But I know Marilyn will not, at this point, be able to hear such suggestions. She feels far too scared, back to being a child with an explosive, alcoholic father and a depressed, absent mother.

    “Is there someway I can be helpful to you, Marilyn,” I ask.

    “You can tell me when this is going to end! You can tell me why this is happening to me! You can tell me why only bad things have happened to me my entire life! It’s not fair!! I hate it!! I hate it!!”

    Although I can feel my patience fraying, I try to retain my image of Marilyn as the frightened and vulnerable child. “I hear you, Marilyn. And I’m sorry you’re in so much pain.” I refrain from saying that this isn’t only happening to her and that she has known good times in her life. I know the futility of such word.

    “I know,” she says suddenly. “I know how you can help me. You can tell me your address and I can come by and give you a hug and we can sit in your living room and visit.”

    I am taken aback by the outlandishness of her request. At first I begin to respond directly, “You know that’s not something…” Then a thought comes to me and I stop myself. “Marilyn, have you just set yourself up? Have you just asked for something you know I won’t do so that you can continue to feel that I’m just one more of the long list of people who aren’t there for you, who don’t care about you, who can’t save you?”

    She bursts into tears. “But you don’t!! You don’t care. Why can’t I come see you? Why can’t I come hug you?”

    “Marilyn, can you try to answer those questions yourself,” I ask gently.

    She sobs on the other end of the telephone. “You don’t care about me! I’m just a patient to you.”

    I again consider responding directly and then decide against it. “What if you allowed in that I do care about you? What if you allowed in that I care about you and still can’t tell you when this will be over or why it’s happening? What if you allow in that I can care about you without being able to save you?”

    Marilyn is sobbing uncontrollably on the other end of the line. “That can’t be! That can’t be!” she says between sobs.

    I am silent and then say quietly, “It’s very hard to give up the hope of being saved, of being saved in the present and of being saved in the past.”

    “I want you to hold me, I want you to hold me.”

    I imagine Marilyn hugging herself and rocking back and forth in her chair. “I know, Marilyn,” I say, “I know.”

  • 03/10/2020 7:53 PM | Anonymous

    In this month's blog, Denial, a patient explores her inability to face the painful reality of infidelity.


    As soon as I open the door I know that a different Rita is waiting for me today. Instead of her usual bubbly, sometimes false cheery self, I see a woman on the verge of tears who looks up at me beseechingly. 

    Seated in my office, Rita begins. “I don’t know what’s wrong with me. I know I’m not stupid and I know I’m a 52 year old woman, so I don’t know why this is hitting me so hard. But I had no idea, absolutely no idea.”

    I first thought Rita was referring to her husband Henry’s infidelity, but since it has been several months since she found out about his long-term affair, I assume she is referring to a more recent event. I wait.

    “My parents are getting a divorce. They’re in their seventies! I couldn’t believe it.”

    “I can understand being shocked about a decision that came out of the blue.”

    “But that’s just it. It didn’t come out of the blue! My mother couldn’t believe I hadn’t known. She told me my father was unfaithful to her their entire marriage, that they fought about it constantly.”

    Now it’s my turn to be surprised. Rita had always described her parent’s marriage as idyllic. She said that’s what made Henry’s betrayal even more disturbing. She’d never been personally close to anyone who dealt with infidelity.  

    “I feel like I’m going crazy. I called my sister – my sister who’s younger than me - and she knew! She said they always fought about it! I asked her why we never talked about it. She said we’d literally put our blankets over our heads and guessed we did that figuratively too, like we didn’t want to think about it.”

    “That’s a lot to take in. Maybe we should start with what you find the most disturbing about all these new revelations.”

    “I don’t know. All of it. That I had no idea. How did I do that? Did I do that in my marriage too? Was I blind to my husband’s affair? Did he have other affairs I have no idea about? I feel as though I’m going in circles. My head feels like mush.”

    “I guess one thing we know is that you have a striking ability to not know, to not see what you don’t want to see.”

    “But why? Why can’t I know?”

    “I guess it felt too intolerable to know.”

    “But I can’t live my life like that! It’s a tremendous handicap. It’s like being divorced from reality.”

    “I agree, but I think the question we need to ask ourselves is why you felt the need to deny what was right in front of you. You need to understand, not to beat yourself up.”

    She sighs, but remains silent, looking dazed and confused. 

    I think about denial as a defense. It works as long as it works, but when it breaks, reality smacks you in the face, hard.

    “What do you feel about your Dad’s infidelity now? How do you feel about them divorcing?”

    “I don’t know. I haven’t gotten there yet.”

    “Okay, so tell me where you have gotten.”

    “Trying to remember the past. Trying to remember them arguing, trying to remember putting my head under the covers.”

    “What would you have felt if your parents divorced then, when you were a child?”

    “That wasn’t possible! It’s couldn’t happen!”

    “So let’s assume for a moment it was possible. What would you have felt?”

    Rita stares at me wide-eyed, shaking her head, repeating, “It couldn’t happen, it couldn’t happen.”

    “Rita, see if you can find your feelings,” I say gently.

    She continues to stare at me until she starts sobbing. Then she buries her face in her hands.

    “No, no,” she moans. “I’m all alone, left. I won’t make it. I can’t make it.”

    I remain silent, respectful of her feelings as the scared, vulnerable child.

    “A family, a unit,” she says between her sobs. “We were one or nothing. Lost, adrift, floating, nothing.”   

    “Sounds pretty scary. I can certainly understand not wanting to know something that would lead to such catastophe.”

    “But it’s not rational,” she says, quickly shaking her head as if trying to wake from a nightmare.

    “No, it’s not rational, but that doesn’t mean it’s not how you felt and it’s how you felt that matters.”

    Silence.

    “I suddenly started thinking of my husband. Do I feel the same way about him? Do I feel there’d be nothing if I left him? Is that why I’m not leaving him?”

    “Those are really good questions and I’m sure we’ll return to them next hour and for some time to come,” I reply, while thinking of the power of the unconscious, about Rita choosing a womanizer like her father without even consciously remembering that he was a womanizer.

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