A patient lashes out as a result of feeling 'less than' allowing his therapist to demonstrate how the past impacts the present.

“I hope you had a better New Year than me,” Jeff says with a bitter edge as he settles into the chair across from me.

“I thought you were really looking forward to spending New Year’s with Eileen.”

“Yeah, me too. She broke up with me.”

“Oh, I’m sorry. You thought this relationship had real potential.”

“Them’s the breaks. I don’t seem to be able to find anyone since my divorce. Sometimes I wonder if I should have stayed with my ex, but I know we were both totally miserable.”

Forty-two year old Jeff is a good looking man with blonde curly hair, a dimple in his chin and intense blue eyes. He has, however, had little success in establishing a new relationship.

“Did Eileen say why she broke up with you?”

“Something about my being too sarcastic or too needy or some stuff like that.”

Silence.

“I guess you want to know what I think about what she said to me.”

“Jeff, your tone is pretty biting today. Are you angry with me?”

“I guess.”

Silence.

“I’ve been reading your blogs. And I was wondering why you never write about me. What makes the patients you write about more interesting than me?”

“Before I address that question directly, I’d like to look at the feelings that were brought up for you.”

“Makes me feel like I’m not as good as your other patients, not as important, not as interesting.”

“Sounds pretty much how you felt in relation to your two older brothers.”

“That’s for sure,” he says, smirking. “I was the pretty one, but not a girl. And my brothers had the smarts and the artistic talent which was way more important than looks in my family.”

“So you feel less than.”

“Yup! Guess you could say that.”

“And the fact that you’ve built a thriving accounting firm doesn’t undue the messages of ‘less than’ that you took in as a child.”

“Right again!” Pause. “I’m just a numbers man, not an intellectual, not an artist.”

“And the worse you feel about yourself, the angrier you are at the other – me, Eileen, whoever – for, in your eyes, not being valued.”

“So you’re saying Eileen was right about me. That’s great, real support, and from my therapist no less!”

“I don’t know if Eileen was right about you or not. What I do know is that when you feel diminished, less than, you’re so hurt by those feelings that you lash out and that doesn’t serve you well.”

“So why haven’t you written about me?”

Although Jeff’s demandingness makes me want to withhold from him, I feel it is more important to respond to his question and then deal with his reaction to what I have to say. “I don’t know, Jeff, how many of my blogs you read, but every so often I explain that the ‘patients’ in my blogs are fictionalized. I’m real – as real as I can imagine myself to be in a made up situation with a fictionalized patient. Otherwise I’d be concerned about patient confidentiality.”

“You’re kidding me?! Now I feel like a real ass. Competing with imaginary people! You must have been laughing your head off at me.”

“Not at all. This has been a very important session. We could see right in front of us how hurt you feel when you feel devalued and how quick you are to attack the person you experience as diminishing you. It clearly comes from how you felt as a child, but we need to work on helping you not to automatically assume that you are being devalued and, even if you are, not to bring to the current situation all the rage you felt as a child.”

“You know, I don’t even remember being enraged as a child.”

“Well, you might not have been allowed to show it.”

“That’s for sure. No one did anger in my family. We talked about issues like ‘civilized’ people. Anger was off the table.”

“So you’re probably sitting on years and years of anger.”

“You mean like when my mother would make me draw and draw and draw, despite the fact that I had no talent and that she would sit there criticizing everything I produced?”

“Yes, like that. I’m sure that made you plenty angry.”

“Holy shit! You know what I just realized. If the patients in your blogs are fictionalized, that means you’re one of those creative people. Does that make me feel less than? Yes, it does. But for whatever reason, right now that actually makes me feel more sad than angry. I guess I feel sad for the kid whose talents weren’t recognized and only found lacking for what he wasn’t.”

“That’s great, Jeff. I’m really glad you’re able to feel compassion for yourself as that child. That awareness will serve you well.”