Blogs

In today's blog, "Please Help Me," I explore the difficulties that can arise when patient and therapist have different ideas of what kind of help is possible.

 “My name is Lisa Henry. I’m forty. And I’m desperate. If you can’t help me I don’t know what I’ll do,” says this clearly anxious woman whose appearance reminds me of the stereotypical 50s housewife, page boy hair style, pink dress gathered at the waist, flaring outward. “Can you help me?”

“I think you’ll first need to tell me what you need help with.”

“My son.”

Silence.

“He… he just told me that he’s … that he’s gay,” she says taking a deep breath. “There, I said it!” 

“I gather that’s a problem for you?”

She looks startled. “Of course it’s a problem. How could it not be!”

“Is it a problem for your son?”

“He says it isn’t, but that’s impossible. He was a normal boy. He played baseball. He was always popular.” Pause. “And he grew up in our family.”

“And what was it like growing up in your family?”

“We’re a Christian family. My husband is always praying and reading the Bible. And of course we pray as a family before every meal. We eat together. There are seven of us. My son – the one I’m talking about – he’s my eldest. My husband will never, ever accept this. I’m afraid he’d disown my son, but that’s not going to be necessary because you’re going to help me, right?”

“Mrs. Henry, exactly what do you want me to help you with?”

“Telling me how to convince my son he’s not gay.”

“I’m sorry, but there’s no way I can do that. I can’t convince anyone that he isn’t gay and I can’t help anyone to change in any way who isn’t in my office and who doesn’t want to change.”

“That’s the first thing we need to do. We need to convince him he does want to change, that he isn’t gay and if he needs to see you that’s fine.”

“I’m sorry, Mrs. Henry. I can’t do that. I can help you try to come to terms with your son being gay…”

“No way,” she interrupts. “You have no idea what you’re saying! I could never accept such a thing. And even if I could … could … I don’t know, … pretend it’s not happening, my husband would never, ever be able to even look at my son again.”

I realize I have been so taken aback by this woman’s request, that I have been debating with her, rather than dealing with her underlying feelings. “That’s really sad, Mrs. Henry. You must be feeling very sad and scared that there’s going to be this tremendous breach in your family and that you might even lose your son.”

“No, no, no. That’s not going to happen. It can’t happen again. It can’t,” she says, starting to cry.

“I’m sorry, what do you mean it can’t happen again?”

“That’s what happened to me.”

I look at her, totally bewildered.

“I lost my family,” she says in a whisper. “My family were orthodox Jews. When I married outside the religion my family sat shiva for me. I haven’t seen any of them since.”

“I’m so sorry. That must be terribly painful.”

She nods, as tears fall down her face. “But I thought I put it behind me. I made my own family. And I was always going to have that family, the family I have now. You see, that’s why you have to help me, you have to help me not lose another family.”

“I understand why you feel so desperate, but there are some things I can help you with and some things I can’t help you with. I can help you to grieve the family you lost, your family of origin. I can perhaps help you to accept your son’s gayness. And I might even be able to help you find a way to talk with your husband about your son…”

She shakes her head vigorously.

“I understand that seems impossible to you now and it may be impossible, but I can help you to maintain a relationship with your son regardless of how your husband feels…”

“No, that’s not possible either. He would never allow it.”

“Do you love your husband, Mrs. Henry?”

“Yes, of course, what kind of question is that?”

“Does he love you?”

She hesitates for a moment but says, “Yes, yes of course.”

“So your relationship is important to both of you. Perhaps that means you could talk, negotiate…”

“No. My husband makes all the decisions.”

“And did your father make all the decisions?”

“Yes, yes he did. How did you know that?” 

“Different religion, but similar way of being in the world.”

“Yes, that’s true.”

“Mrs. Henry, our time is almost up for today and I don’t know if you want to continue working with me or not. I can’t help your son be not gay. I can help you deal with the very painful situation you’re in now, which also brings up a very painful loss in the past. But you’ll have to decide if that’s the kind of work you want to do before you decide whether or not to work with me.”

“I don’t know.” Pause. “Can I think about it?” 

“Of course. Just call and let me know what you decide. And know that regardless I wish you the best.”

I wish you and those you love a Happy New Year filled with health, peace, love and fulfillment.

In today's blog, "Another Year," in an initial sessions a therapist must navigate not only her patient's ambivalence about treatment, but his conflict about closeness and distancing as well.

“I’m here because of my wife,” Kevin begins. He’s a good-looking man who I judge to be in his early 50s, wavy brown hair beginning to be streaked with just a hint of gray. “She gave me a really nice Christmas present – a trip to St. Barts, just the two of us. Our kids decided they wanted to spend the holidays with their boyfriends’ families, so we were on our own, two lovebirds.” Pause. “But turns out she had an agenda.” He sighs. “It was all a plot to get me into therapy. Said it was a new year, time to press the reset key. She says I’m uptight and angry all the time. And of course as soon as she said that I got angry which only proved her point.”

“So do you see yourself as angry and uptight?”

“I can get angry, but I always think I have a good reason.”

“Like when your wife said you were uptight and angry all the time?”

“Yeah,” he says, with an edge to his voice. “Like you’re telling me that’s not a good reason to get angry! She blind-sided me. Here I think we’re going on this romantic trip and actually she just wants to get me into therapy. It’s not right!”

I feel as though Kevin is daring me to prove his anger isn’t legitimate and I struggle to not engage with him on that level. “So what do you feel right now, right at this moment?”

“That’s a typical therapist question, at least from what I see on TV, not from personal knowledge.”

Silence.

“Oh yeah, that’s another therapist trick, silence.”

I again struggle to not pick up the gauntlet he’s thrown down. “I’m wondering why you decided to come into therapy, to do as your wife asked.”

“I just told her I’d try it out.”

“So is this a trial session?”

“I suppose.”

“Do you feel invested in not having it work? Because it feels like we’re almost in a fencing match. Or maybe there’s a part of you that really wants to be here.”

He sighs. “Actually my sister saw you. She said you were really good, that you helped her a lot.”

“Wait, I saw your sister?”

“Yes, Alison Bentley. Different last name. Quite a long time ago. You helped her deal with the sudden death of her husband.”

“If I’d known you were related to someone I’d seen, I would have referred you to someone else.”

“Why? Allison’s fine with it. She doesn’t even live here anymore, moved to Texas with her new husband. She’s good.”

“I’m glad to hear Allison is good. But it strikes me as really interesting that first you come in today and are unsure whether you want to be here and then you tell me I saw your sister and now I’m unsure of whether we can work together.”

“But why? You have a head start on me. You know the backstory, my insane family of origin, which should make our work quicker.”

“I’m just taking a stab here, but is it your experience that if someone moves closer to you, you pull away and if they move away, you move closer? Sort of like the fencing match I mentioned.”

“Definitely! You are good! How’d you come up with that?”

“Well, first you’re angry at being here and only doing it for your wife, but when I express reservations, you suddenly want to be here. Seems like you want to create distance, unless the other person – in this instance, me – pulls back.”

“I get it.”

“But I don’t know where that leaves us. I’m truly not sure I’d be the best therapist for you even though, yes, I know some about your family of origin. But I know about it from your sister’s perspective, not from yours. That’s not always helpful. Your subjective experience has to be different than her subjective experience.”

“That sounds like psychobabble.”

“Are you getting angry right now?”

“A little.”

“So this time I’m backing away and you’re still getting angry. Is it that you’re not getting what at least a part of you wants, namely me?”

“Yeah. I hate not to get what I want. Makes me mad and frustrated and all around pissed. Just like my father. And it especially makes me mad if the reason I’m being rejected … I mean the reason I’m not getting what I want makes no sense.”

“I don’t know about you, Kevin, but I found this to be a complicated session. I’m not sure what I think would be best for you and I’m not really sure what you want. Our time is almost up, but what if we agree to make another appointment and each think about it during the week and discuss it next session?”

“I guess.”

“You still sound pissed off.”

“I just don’t get what the big deal would be your seeing me after you saw my sister.”

“Well maybe during the week you can think about what you’d like to get out of therapy and we can talk some more about it.”

“Okay,” he says, half-heartedly.

"A White Lie," a therapist struggles to absorb her patient's deception, while trying to understand its meaning and remain in to with the patient.

“It was my birthday this past Saturday,” MaryAnn begins smiling, combing her fingers through her long, silky hair.

“Congratulations,” I respond enthusiastically, “Twenty, right?”

MaryAnn pauses, drops her head, then raises it again to look

directly at me. “Not exactly. I turned 18.”

I stare at her, startled. “But we’ve been working together for two years. You told me you were 18 when we started.”

“Yes, I did. I lied. But that’s the only thing I’ve lied about.”

“But you were a minor when we began working together,” I say, quite distressed. “I would have needed your parents’ permission to see you.”

“Exactly! That’s why I told you I was 18. Could you imagine my parents allowing me to see you and air all their dirty secrets. It’s no big deal, just a little white lie.”

I’m stunned. MaryAnn and I had what I thought was a close, intense bond, with a heated transference/countertransference relationship. I quickly became the mother she wished she had, not the socialite who left her daughter to be raised by a series of nannies while she spent her husband’s money throwing elaborate parties or meeting a series of lovers somewhere in the world. For my part, I usually felt motherly and protective towards her, unless her excessive demands made me pull back in either anger or self-defense. Her “little white lie” feels like a betrayal and I struggle to make sense of it.

“Come on!” MaryAnn says. “You look like I’ve committed some terrible sin! Why is it such a big deal?”

“Well, first you made me complicit in breaking the law – seeing you without parental consent.”

“But you didn’t know!!” she interrupts.

“Second, this is a tremendous breach of trust, of what I assumed was a good faith relationship between us.”

“It is.”

“Is it?”

“Yes, I don’t know why you’re making such a big deal about it. I lied so I could see you. What’s wrong with that?”

“How did you pay me every month?” I ask.

“You know money isn’t an issue. There are huge amounts of cash lying around, or signed checks. Neither of my parents cares how much money I spend. They never check up on me.”

“So you were stealing money to pay me?”

“I wasn’t stealing. I told you. I can spend money on whatever I want. They never ask.”

Through what feels like my foggy mind, some thoughts vaguely occur to me. “You know, MaryAnn, one of your complaints about your parents is that they’ve always had relationships with other people, while continuing on with what feels to you like their sham marriage.”

“That’s not the same thing!”

“You’ve grown up in a household where lying and deceit was second nature. It’s not so hard to imagine you’d also lie to get what you want.”

“I told you, I had no choice!”

“Perhaps your parents would say the same thing. And, besides, if your parents are so indifferent to what you do or don’t do, how do you know they wouldn’t be fine about your being in therapy.”

“I told you, because they don’t want all their secrets out there! Maybe I shouldn’t have told you. Maybe I should have just said yes, I’m 20.”

“So that brings me to another issue, MaryAnn, maybe the most important issue in terms of our relationship.”

She sighs, exasperatedly.

I continue. “A lie keeps distance. Your lie kept distance between us, just as your parents’ lies keeps distance between them and between the three of you. Maybe, unconsciously, it was important that you keep a distance between us, maybe you couldn’t risk being closer to me than to your parents.”

“But that doesn’t make sense. I’ve always wanted more from you, wanted you to take care of me, had fantasies of your being at my wedding one day, meeting my children, all that.”

“That’s what you’ve wanted consciously, but I wonder if unconsciously it would have felt very risky to be closer to me than to your parents, maybe it would have felt like I was replacing them, doing away with them. However not ideal they’ve been as parents, they’re the only parents you’ve ever had or will have.”

“I don’t know, maybe. But what now? What happens between us?”

“What would you like to happen?”

“I’d like you to forgive me and for us to go on as before.”

“Now that I have what feels to me like a psychological understanding of what prompted your lying, I’m no longer so shocked or angry. As far as us going on as before, if that means do I still care about you and want us to continue working together, the answer is certainly yes. But relationships always change, MaryAnn, and this relationship will definitely be impacted by what occurred between us today. For sure I’ll be looking to see if there are other ways you create distance in our relationship.”

“I am sorry. But I’m still not sure I would have done anything differently.”

“I hear you.”

Beyond Afraid," concerns a man who begins therapy because of his overwhelming anxiety about his mother dying, while his therapist sees a man who is terrified of separation. 

I open my waiting room door to a mid-thirtyish man pacing back and forth in front of the couch. “Frank?” I ask.

He startles and turns to face me. “Oh, I’m so sorry. Did I frighten you? I didn’t mean to frighten you. I just can’t sit still. I’m so jittery. I just…”

I note that he’s afraid of having frightened me when he’s clearly the one who’s terrified. “It’s all right,” I interrupt. “Why don’t we go into my office and sit down.”

He sits, but perches at the edge of the chair, as though posed for flight.

“What has you so frightened?” I ask.

“My, my, mother,” he stammers. “I’m afraid she’s going to die. My father died a year ago. He was fine, came home from work, went upstairs and died. Doctors said something about his heart. I couldn’t understand it. My Mom started screaming and screaming. I guess I did too. It still all a blur. But now I’m worried about my Mom. They say she has something in her uterus. I’m afraid she’s going to die. I couldn’t make it if she died. I couldn’t make it,” he says starting to cry.

“What does she have in her uterus? Are her doctors concerned? Is she concerned?”

“She’s a wreck. Her doctors say it’s nothing, just something to watch. I don’t know, fibrosus?”

“Fibroids?” I ask.

“That’s it! Can that kill you?”

“I’m not a medical doctor, but my understanding is that fibroids aren’t usually a problem.”

“Are you sure?”

“Frank, do you think anyone can sufficiently reassure you?”

Still crying, he says, “I’ve always been this way. Everything scares me. Mom’s like that too. Dad was also kind of anxious. Only my sister isn’t. She’s the opposite. She’s in something like the Peace Corps. In India. My parents flipped out when she joined. But she was determined. And now she married an Indian guy so I guess she’s never coming home. I worry about her dying too, but it’s not as bad as with my Mom.”

“Can you tell me a little about your growing up, Frank. What was it like being a kid in your family?”

“It was great. I didn’t worry about anyone dying then.” Pause. “But I was always afraid. Hard not to be. My Mom worried about everything, about us being kidnapped, about us driving. I didn’t drive ‘til I was 20 or something. She’d take us to the doctor for the least little sniffle. Make us stay home from school.” Pause. “That was okay with me. I didn’t like school. I mean it wasn’t school I minded. I just didn’t like being away from home. I always felt scared being away from home. The other kids made fun of me, called me a Momma’s boy. I guess I was. Guess I still am.”

“Have you ever lived away from home?”

“I tried. Went away to college, but didn’t last a semester. I came home, got a degree in accounting. Dad was an accountant. But I’m an assistant accountant. I didn’t want all that responsibility. I didn’t want the work to kill me like it killed Dad. I work mostly from home, especially since Covid, and especially since my Dad died. I want to be around for my Mom. She’s my responsibility now that he’s gone.”

“Have you been in therapy before?”

“I may have gone awhile when I was a little kid. But not really, no, not since I’m grown.”

“How do you feel about being in therapy? And how do you feel being with me?”

“I guess I need it. I’d like to not be so scared all the time.” Pause. “And I like you. You’re nice. Sort of like my Mom, except not as nervous.” Pause. “Can you help me be less scared?”

“I certainly hope so. But I do want to say, Frank, that you may not always think I’m so nice. There are times therapy can be hard and painful. Like one of the things I suspect you and I are going to look at is your relationship with your mother.”

“Why? I have a great relationship with my mother.”

“Except it’s hard for you to have a life apart from her.”

“Are you going to take Mom away from me?” Frank asks, panic seeping into his voice.

“No, Frank. I don’t have the power to do that nor would I want to. But having part of your life be separate from your mother seems like something an adult child might want.”

“I guess.”

“You can always disagree with me, Frank. My saying something doesn’t make it so.”

“That’s not like my mother! She always wants me to think the same way as her.”

“Well, maybe that’s one thing we’ll get to look at together, how you feel about always needing to think like your Mom.”

a therapist helps her pregnant patient deal with her and her husband's fears of her raising a child given her past history.

Katie barely smiles as I greet her in the waiting room. She walks slowly to my office and gingerly lowers herself into the chair. Oh no, I think to myself, did something happen with her pregnancy? Just last week she was radiant, bubbling with joy, thrilled that she’d be giving birth to a little girl.

“What’s wrong, Katie?” I ask.

Silent tears stream down her face.

“Did something happen to the baby?”

She shakes her head, cradling her stomach. “On Monday,” she says hesitantly, “Patrick woke up and right away he seemed different. He didn’t kiss my stomach and listen for the baby as he usually does. He just got up and started getting ready for work. I asked what was wrong, but he said he was just tired. I tried to connect with him, but he just ate breakfast and left. He texted me a couple of times during the day so I thought maybe everything was fine. But when he came home he was still distant, preoccupied. I told him he had to talk to me, that we weren’t having dinner until I knew what was bothering him.

“And then he asked me, he asked me if I was ever afraid I’d hurt our baby. I couldn’t believe it. I felt as though he’d slapped me. I started crying. He said he’d had a dream that I was shaking our baby and screaming at her. He said I must have thought about it, that I couldn’t have not thought about it given my history. I couldn’t stop crying. I just couldn’t stop. Like I can’t stop now.”

“I understand you’re in a tremendous amount of pain,” I say softly, “And this might seem like a ridiculous question, but can you say what you are crying about? Is seems like there’s many things you could be crying about right now and maybe it would be helpful if we tried to understand them.”

“I’m crying about Patrick even questioning that I could possibly, possibly ever hurt our child.”

“I understand that Katie. But you’ve questioned yourself too. We spent many sessions talking about your fears about your past, about whether you’d repeat your history.”

“And you told me not everyone who’s abused becomes an abuser!” Katie says, practically yelling at me.

“That’s absolutely true.”

“So?”

“And did my saying that take away all your fears?”

Katie covers her face with her hands, sobbing and shaking her head. “Why couldn’t he have faith in me? Why does he have to doubt me?”

“So you feel abandoned by Patrick.”

“Yes, yes!! He’s always been my biggest champion. He was always the one who said I could overcome anything, do anything.” Pause. “I would never, ever have agreed to have a child if I thought he didn’t believe in me!”

“I wonder if you’re saying that if Patrick doesn’t believe in you, you can’t believe in you either.”

Katie stops crying and looks at me. “That’s right. That’s absolutely right! That’s why Patrick’s question devastated me. I can’t lose my biggest champion just as I’m about to undertake the scariest step of my life.”

“So you do know it’s scary, scary for you and scary for Patrick. It’s sound like it would help if both of you talked about your fears, not to make accusations, but to provide each other with support and understanding.”

Silence.

“Where did you go, Katie?”

“Ever since Monday I’ve been re-living the horrible things my mother did to me, how she’d slap me around, take a belt to me, drag me around the floor by my hair, make me eat dog food, spit at me. She hated me. I know she wanted me dead.” Katie’s voice gets flatter and flatter as she recounts the abuse.

“Katie, you can feel about all these horrible things your mother did to you. You don’t have to shut down. You can hate her back.”

“I don’t want to hate her back. I just don’t want her to affect my life in any way.”

“It would be good to be indifferent to your mother, but it’s impossible that she not affect your life. She’s your mother. And she was your mother when you were a helpless, vulnerable, dependent child. But your life doesn’t have to be determined by her.”

“So you don’t think I’ll abuse my child?”

“No, I don’t think you’ll abuse your child. You’re a great aunt to your brother’s kids. You love your animals.”

“My brother’s kids are boys. Will that make a difference?”

“It sounds like that’s something you’re concerned about.”

Katie nods. “It crossed my mind when I knew I’d be having a girl. But I also thought, good, I get to do a do-over with my little girl. I just know it will be different.”

“You mean you and Patrick will make it different.”

“Yes, that’s exactly right. And Patrick and I are going to be doing some heavy talking. Thank you so much. Helpful, as always.”

“My pleasure,” I say smiling.

"Unsure," a young woman enters therapy to decide whether or not to marry and quickly discovers that there are many old issues influencing her decision.

“I feel ridiculous going into therapy because I can’t decide whether or not to get married,” Nina, a slender young woman with shiny dark hair and large brown eyes, begins. “I mean I’ve been in therapy before, lots of times. It’s been a lifesaver sometimes, but going into therapy because I can’t decide whether or not to marry Sam seems silly. Either I want to marry Sam or I don’t. I don’t know what makes it so hard to decide.”

“What does make it so hard to decide?”

“I guess because I don’t know if I love him. But is it even necessary that I love him? I’ve loved other guys and they all turned out like shit. I don’t know. I keep going round and around in my head.”

“Nina, I hear that you feel a lot of pressure to decide right now, but it would be helpful if you told me something about you, your background, why you’ve been in therapy before, maybe something about the shit guys.”

Nina sighs. “I knew I’d have to go through the whole thing again. It’s so tedious. Okay, here goes. When I was a kid, my life was pretty normal until I was six. Then my mother was hit by a car. She lived on a ventilator for a year or so until my Dad won the court battle with my Mom’s parents and had her disconnected. My Dad didn’t let me see my grandparents for quite a while, but then I got to see them and that was hard too because they talked such shit about my Dad. That’s when therapy was really helpful. Things got better after that until my Dad started dating and dating and dating. I guess he was trying to drown his sorrow in women, at least that’s what my therapist said. Fast forward, I now have my fourth step-mother except of course I don’t live at home any more so I don’t really care who he’s with. End of story.”

“That’s an overwhelming story, Nina, yet you told it like you were reading from a book, like it happened to someone else.”

“I just can’t feel about it anymore. I don’t want to feel about it anymore. I want it over.”

“But maybe it isn’t over.”

“What do you mean?”

“Well, that’s a tremendous amount of loss and trauma for anyone to go through, let alone a young child. You lost your Mom, your grandparents and your Dad.”

“My Dad’s not dead.”

“No, but it sounds as though once he started dating you felt as though you’d lost him.”

“Yep! But that was just me being jealous. That was another therapist’s opinion.”

“And what’s your opinion?”

“I don’t know. It felt too soon. It felt like he forgot about my Mom. It made me wonder if my grandparents weren’t right about him. It made me sad. I missed him. I missed them all,” Nina says, her voice breaking a bit.

“I’m sorry Nina.”

Her eyes fill with tears which she blinks back. “But what does this have to do with my not being able to decide whether or not to marry Sam?”

“First tell me whether the previous guys you loved were unfaithful to you or otherwise unavailable.”

She snorts. “You mean like married? Yeah, I had my share of those. And my share of womanizers too. So you think I have an Oedipal thing, right? You think I want my father just for me.”

“Is that what you think?”

“Maybe. I just don’t know any more.” Pause. “For sure Sam isn’t anything like my father. He’s kind and generous and faithful. I know he loves me. I just don’t know if I love him.” Pause. “So you’d say I have to give up on my Dad in order to allow a different kind of man into my life.”

I smile. “You’re certainly no stranger to therapy.”

She nods. “Too true.”

“But I wonder if, as you said, it’s only an ‘Oedipal thing.’ You’ve had so many early losses, Nina, losses that had to have a huge affect on your life. I wonder if you’ve walled yourself off from ever allowing yourself to be really close to anyone for fear that the pain of losing them would be too much. If you choose unavailable guys, they maintain the distance. If you choose a guy who is available, maybe that’s just too scary. What if you come to rely on him like you did your Mom or your Dad? What if he leaves or is in an accident? What if he dies? Maybe your six year old self doesn’t feel like she could cope with that.”

“But I’m not six.”

“The unconscious is timeless, Nina. We’re all whatever age we are today as well as six and ten and fifteen. That’s how we’re made.”

“But what do I do?”

“I’d say we have to go back so that you can feel the tremendous pain and loss and fear you felt as a child and help that child mourn and grow so that you can allow yourself to love and to know that however painful it might be you could again survive loss.”

“Sounds charming.” Pause. “When do we start?”

"Being Bad Part II," a therapist helps her patient to understand the feelings behind her compulsion to act-out by damaging cars.

“I’ve been thinking about what we talked about last time,” Brenda says, beginning immediately. “About my being angry. I suppose I could be, but I don’t know what I’d have to be angry about. I have this great life, a family who’d do anything for me, a nice condo, great weather. What else do I need? Well, I guess I’d like to find a man, but I’m not angry about that. It will happen eventually.”

“You mentioned last time that when you felt angry you stopped eating. What was that about?”

“Mostly I was just mad at myself. Mad that I let myself get too fat.”

“You said that when that didn’t work, you’d eat and throw up, what did you mean by that?”

“When my Mom got mad at me for not eating. Or more like when she kept asking if I didn’t like her food, or if I could tell her what she could make me that I’d like,” she says rolling her eyes. “It got annoying so I’d eat and throw up later.”

“You were annoyed at your mother?”

“Yeah. She can get pretty annoying. She thinks my skirt is too short or my hair is too long or I wear too much make-up, whatever.”

“So you can feel angry with her.”

“Yeah, I guess. My Dad’s not like that, pretty much everything I do is okay, but I don’t know, it’s almost like it doesn’t matter what I do, almost like he’s not interested. Yeah, I guess that’s right. I’m the afterthought. My brother’s the boy, my sister’s the smart one and I’m just me. I mean, he does like it that I do well selling houses. That he cares about.”

“So you feel criticized by your mother and ignored by your father except at his business.”

“That pretty much sums it up.”

“Don’t you think that’s something to be angry about?”

“I suppose. But it’s not like I’m being abused or beaten up or neglected.”

“That’s true. But you’re entitled to have whatever feelings you have. You don’t have to be beaten up to feel hurt and angry.”

“No one gets angry in my family. We’re polite and respectful, except when we were little kids of course. But like I’ve never heard my parents fight. They never scream at each other.”

“And do you think they have a good marriage, a close marriage.”

“I wouldn’t say that. They kind of exist in the same house and are pleasant enough to each other, but I wouldn’t say they’re close. I’m not sure anyone in my family is close to anyone else.”

“Sounds lonely. And sad.”

“I guess. I’m not sure I know anything else.”

“It sounds like you know something else when you batter cars.”

“That’s not being close!”

“No, but you were feeling something intensely. I think you said you felt free, that you were showing them you couldn’t be pushed around.”

“Yes, that’s right, but I’m not sure how that’s related to my parents or to closeness.”

“As you said, everyone in your family is proper and respectful. Everyone is good. But there’s an absence of feelings, any feelings, angry feelings, loving feelings. It kind of sounds like you’re living in a doll’s house.”

“Funny you should say that. I’ve had friends tell me my parent’s house reminds them of a doll’s house. I always thought they meant because it was super done by an interior designer, but maybe they meant more than that.” Pause. “So you think it’s good for me to be ramming cars because it gives me a chance to express my feelings?”

“I wouldn’t say that. It does give you a chance to let loose with feelings you’ve kept bottled up, but you’re acting out the feelings against inanimate objects, not really letting yourself know what or who you’re angry at. I suspect you’ve been carrying around lots of feelings for a long time.”

Silence.

“So what should I do about my obsession about ramming cars?”

“Well, when you first have the thought or the impulse, I’d try asking yourself what you’re feeling right then. What made you have that impulse right at that moment?”

“But can I still do it?”

“Perhaps it would be better to ask if you can not do it. If you can not do it, that would be best, but I don’t know if you can stop quite that easily.”

Silence.

“I just had the desire to do it, to do it as soon as I leave your office.”

“And do you know why that is?”

She shakes her head.

“You sure?”

Brenda drops her head. Very quietly she says, “Maybe because I felt you were taking something away from me.”

“Which made you feel…?”

“I guess annoyed.”

“So it felt like I was telling you what to do – or what not to do – and depriving you of something you enjoy. That made you angry and wanting to act out that anger by ramming cars.”

“I guess.”

“I think we made a lot of progress today.”

“But what if I still want to ram cars?”

“No one changes overnight, Brenda.”

"Being Bad," concerns a young woman who seeks therapy to help her stop a seemingly inexplicable destructive behavior.

I open my waiting room door to a slender young woman who looks up at me as though startled. With perfect posture she follows me into my office and sits gingerly on the chair I designate. She stares at me expectantly.

“How can I help you?” I ask, smiling.

“This is all confidential, right?” she asks quietly.

“Yes,” I say, immediately on guard.

“I’ve done something terrible.”

I say nothing, my anxiety increasing.

Silence.

“Do you want to tell me what that terrible thing was or would you prefer to give me some background information first?” I ask, trying to make us both more comfortable.

“Well, I’m Brenda Masters. I’m 29, a real estate broker. I work in my father’s company. I do pretty well,” she adds, smiling for the first time. “I like it. I did graduate from college because my parents wanted me to, but I kind of always wanted to go into the business. My older brother’s in the business too. My older sister is studying to be a doctor. She was always the brain. I own my condo – my Dad bought it for me – although I’d like to own a house one day. I date, but there’s no one special, not for a while.”

Pause.

“My life’s pretty good. That’s what makes this all the more strange.”

“Perhaps you need to tell me what “this” is.”

Taking a deep breath, she says, “About a month ago I parked downtown and went to do some shopping. I’m not sure how long I was gone, but when I got back there was a BMW convertible behind me and some fancy Porsche in front. They penned me in. I couldn’t move. Made me mad. I stood there a while hoping one of them would come back. No such luck. Finally I got into my car and tried to more a few inches up and back, up and back. But it was ridiculous. I couldn’t get anywhere.”

Pause.

“So then I stepped on the gas to see if I could move one of the cars a

little. And then I gave it more gas and before long I was ramming first one car and then the other. Bang! Bang!! Up and back, up and back. Crunch, crunch, crunch. I was obviously damaging my car too, but I didn’t care. I liked the feeling, the power. I liked showing them they couldn’t just push me around!” she says, quite animated at this point. “This time I was the one doing the pushing! And then I was out! I was free! It was a great feeling. I showed them!”

She pauses, seemingly trying to return to her previous calm and controlled state. “I guess I was lucky there weren’t many people around that day, maybe because it was raining. I told my Dad someone messed up my bumper and he had it fixed. No biggie.”

“And does it feel like ‘no biggie?’”

“Well, I guess I felt both thrilled and guilty. I decided not think about it. But I couldn’t. That’s the problem,” she says, lowering her head. “I’ve done it again. More than once. I look for the right place and the right day and I do it again. I know that’s not good. I know it’s wrong. And I know I’ll get in trouble. But it’s become like an obsession. Can you help me?”

“I think so, but first we have to understand why it’s become an obsession, why you feel so stimulated battering someone’s car. Do you have any thoughts?”

“I don’t know. I’ve never seen myself as an angry person. I was always the good girl. My brother used to tease me for being so good, said it made him look bad.”

“Do you know why you were so good?”

“I don’t know. Maybe because my brother was the boy and my sister was the smart one and I had to do something to distinguish myself, so I was good.”

“And what happened when you felt angry?”

“I didn’t get angry.”

“You never felt angry?”

“I never expressed it.”

“So what did you do with your anger?”

She hesitates. “I didn’t eat. And when that wasn’t okay, I ate and threw up.”

“Do you still do that?”

“Sometimes, but not much.”

“What’s going on in your life today when you eat and throw up.”

“I don’t know. I guess I feel fat.”

“Has your throwing up increased or decreased since you’ve been ramming cars?”

“Hmm. I might not have thrown up since that first time. Wow! You think there’s a connection?”

“Could be. You know, Brenda, you immediately struck me as a person very much in control, holding yourself back, reining yourself in. I wonder if both throwing up and ramming cars is a way for you to let go, to release some of the anger you’ve been sitting on your whole life.”

“But what do I have to feel angry about?”

“I guess that’s one of the things we’ll need to figure out.”

Undecided Part II, continues to explore a patient's conflicts around his sexuality identity and illustrates how fear can lead to paranoid thoughts about his therapist.

“It’s not good,” Stan says, shaking his head from side to side. “You have to tell me what to do! I can’t stand it! All I do is think about this day in and day out. Should I stay with Paulette and my family or should I throw it all up in the air and be with Frank?”

Silence.

“Tell me.”

“You know I can’t tell you Stan. No one can make that decision but you.”

He drops his head into his hands. “I can’t. I can’t make the decision.”

“If I told you what to do – which I wouldn’t – what would you hope I’d say?

“That I should follow my heart and be with Frank.”

“So is that what you want?”

“Yes. Yes. It is what I want. But is what I want enough? Is what I want always what matters most? If I want to go murder my boss, should I go murder my boss? No, obviously not. Sometimes you can’t have what you want. Sometimes you shouldn’t hurt other people to get what you want.”

“That’s a very good point. Let me ask you something, why would my telling you to follow your heart and be with Frank, change what you just said about not hurting Paulette and your children?”

“And my parents. And the rest of my family”

“And why would my telling you to be with Frank change how you felt about hurting those people?”

“I guess because you’d be giving me permission. Because you’d be saying being gay isn’t bad, isn’t a perversion.”

“So now you’ve introduced something else. It’s not only about hurting people, it’s about whether you think being gay is bad.”

“Is it?”

“No. But it’s not about what I believe, it’s about what you feel. If you tell me you want to work on the negative feelings you have about homosexuality, I’m happy to do that, but you’ll still have to decide whether or not you want to leave your marriage. And I suppose there’s also the question of whether if you stay in your marriage and feel as though you’re accepting second best, are you making Paulette accept second best as well? Are you depriving her of feeling with someone else the same way you feel with Frank?”

“Oh no! You’ve just made this even more complicated!” Stan stares at me intently. “Wait a minute, are you a lesbian? Do you feel I should be with Frank? That’s it’s better to be homosexual than heterosexual?”

I’m startled. “Now I’m confused,” I say. “I thought you wanted me to tell you to be with Frank which I certainly haven’t done, but now you wonder if I’m a lesbian because I raise the question of whether staying with Paulette is the only way to not hurt her?

“Wow!” Pause. “I guess it wouldn’t have been all right with me if you’d told me to be with Frank. Even giving me a possible reason to leave Paulette, like it would be kinder to leave her to find someone who was really into her, it… I don’t know. I guess it really scared me.” Pause. “I guess it’s that I don’t want to be gay. I don’t want to be rejected by my family. I don’t want all the hassles gay people have to go through. I just want to be normal, to have things be how they were.”

“And is that possible, Stan?”

“That scared me again. And again made me wonder if you really are gay.”

“I think you are very frightened. And when you feel as scared as you feel right now, it’s easy to think that there’s someone outside of you who’s frightening you, and right now that someone is me.”

“So you’re saying I’m being paranoid?”

“I’m saying right now you feel me as dangerous. And that’s okay. We can deal with that. We can explore what makes you so frightened both inside your head and outside in the world.”

“So you could think that homosexuality was okay and not be homosexual yourself?”

“Yes,” I say, concerned about how much less adult Stan feels to me right now. “Stan, you told me that you came from a Christian, conservative background. I assume the message was that homosexuality was bad, a sin?”

“Definitely.”

“And do you think that’s what’s scaring you now, that you’re afraid if you’re gay you’ll go to hell?”

“But maybe if I give up Frank and stay with Paulette I could go back to having a normal life and be redeemed.”

“I guess you’ve added a whole new dimension to your conflict. It’s not only figuring out what you want and not only trying not to hurt anyone, it’s also wrestling with a difficult religious question.”

“And can you help me with that?”

“Well, I can help you explore your thoughts and feelings, but I can’t answer the religious question for you any more than I could answer whether or not to be with Frank.”

“Thanks. I don’t know why, or how, but somehow I think this helped.”

“I’m not sure why either, but perhaps it was parsing out the different pieces of your conflict so that your feelings don’t seem so overwhelming.”

"Undecided," a patient looks to his therapist to help him make what could be a life-changing decision.

“I appreciate your willingness to see me, even virtually,” Stan begins. He’s a nice looking man who seems anxious, unsure, fidgeting with his fingers, moving in his seat.

“How can I help you?” I ask.

“I just hope you can help me. I want to leave my wife. No, no, that’s not exactly true. I don’t want to leave my wife. I love Paulette. But I have to leave her. I love her and I love my two boys, but I just can’t go on like this. I’m sorry, I know I’m not making any sense.”

“You can say whatever you need to say, however you need to say it.”

“I’m in love with someone else. A man! I can’t believe it. I don’t even know how this happened. I’ve never been attracted to a man before. Or, or maybe I have. I don’t know. But all I know is that I love Frank. I never expected to love Frank, I mean I don’t know if I even liked Frank at first, but then, there it was, he kissed me and I don’t know if I ever felt anything so powerful in my life. So that’s it. I love Frank and I love Paulette. But I can’t keep lying to Paulette. I don’t even know how she hasn’t figured it out. I do everything I can to avoid having sex with her. Not that I mind having sex with her, but it feels like I’m being unfaithful to Frank! Which I know is completely crazy”’ Stan takes a breath. “So that’s the story. Do you think I’m awful?”

“No, of course not. I think you’re in a lot of pain. Can you to tell me a little more about yourself?”

“I’m 38. I’ve been married for 12 years. I have two boys, six and ten. I was supposed to be a physical therapist, but I ended up selling solar panels. I like it. Makes me feel I’m helping people. And the environment. That’s how I ended up in Florida. It’s a good place to sell solar panels. My wife and I are actually from a small town in Ohio west of Cleveland, conservative, Christian area. South Florida was an adjustment, but we’ve learned to love it.” Pause. “‘We’ve learned to love it.’ That’s the problem, ‘we’ has always meant me and my wife. I don’t know. I don’t know if I can leave that ‘we,’ break up my family, have to explain all this to my wife. And to my parents. I don’t even want to think about them.”

 “And if you do think about your parents…?”“They’ll never accept it. I don’t think they’d say they didn’t want to see me again, but I know my mother would cry hysterically and my father would preach endlessly about my going to hell.” Pause. “This whole thing is such a mess. What would I tell my kids? Would my wife keep me from seeing them? No, I don’t think she’d do that. You know, the more I talk about this the more I wonder if I should just leave things as they are, keep lying, keep seeing Frank on the side. Maybe this thing with Frank will just burn itself out. Maybe it’s not love, maybe it’s just lust.”

“Can we talk a little about your sexuality? You said Frank was the first man you’d been attracted to and then you didn’t seem sure of that.”

“I played football in high school. And you know, we’d all be in the locker room, showering, trying to see whose was bigger while pretending we weren’t looking. Sometimes there would be a guy and, I don’t know, I guess you could say I might have been attracted to him, but I didn’t think much about it. I dated girls. I had sex with girls. I met my wife in college, we had sex, we dated a while, we got married and here we are.”

“And how was the sex with girls? With your wife?”

“Good. Good. It was good.”

“But not as good as with Frank?”
“Nowhere near. I never had sex like with Frank. I can see with across the room and all I want to do is jump into bed with him. He was my customer, buying solar panels for his house. At first I thought he was stuck-up, arrogant. Seemed like an awfully big house for one person. When I came by he started asking me to have a glass a wine. And that led to lunch. And that led to sex and where I am today.” Pause. “What do you think I should do?”

“I can’t possibly answer that…”

“What would you say if I was your son?” Stan asks, interrupting.

“What makes you ask that?”

 “I don’t know. I guess you’re probably about my parent’s age.”

“It sounds as though your concern about what others think makes it hard for you to sort out what you want for you.”

“That’s definitely true.”

“I know you feel a lot of pressure to try and make a decision right now, but I’d suggest that you give yourself some time and that you give us some time to figure out what you really want.”