Blogs

In today's blog, "Unrelenting Grief," a patient mourns the profound loss of his safe space, while his therapist reflects upon her own similar loss.

“I just can’t get over this,” Scott says his head buried in his hands, a tall, dark-haired man who looks like he’s in his mid-thirties. “He was 98 years old. Did I expect him to live forever? I loved him so much. And he was always, always there for me. When he and my Grandma decided they couldn’t handle the Kansas farm anymore they moved right next door to us. Actually giving up the farm was pretty hard for me too. I guess I’ve always been a softie. My Dad made fun of me, called me a wuss, a ‘girl,’ too sensitive for my own good. He was always trying to toughen me up. But I loved that farm. It was my safe space. I spent summers there, got to be rid of my Dad and just be loved by my Gram and Gramps. I’m sorry, I’m just rambling all over the place”

a therapist reflects on and uses her angry feelings towards her patient to work more effectively with that patient and to help her patient understand her use of anger as a defense.

Not Again

As Cynthia sits scowling from the chair diagonally across from me, I remember why I was both surprised and less than thrilled to have her call and ask to return to treatment.

After several minutes of us staring at each other I say, “What prompted your wanting to return to therapy with me?”

“The New Year,” she says curtly, as if that provides an adequate explanation.

“And…?” I ask, prodding.

“What the fuck! You know people make resolutions about what they’re going to do to improve their lives. As if January 1 was the magic date.”

“That would imply there were things in your life you wanted to improve.”

“Of course! You know anyone who doesn’t want to improve their life!”

“This all feels very familiar Cynthia. You say you want to improve your life, you asked to come back into therapy with me, yet you’re immediately attacking everything I say.”

“What? You can’t take somebody challenging you?”

“Okay,” I say, hoping I’m hiding my desire to strangle her. “Let’s look at that last comment: You can’t take somebody challenging you. What impelled you to make that particular statement?”

“What? How should I know. It seemed like a good response to your dumb ass comment.”

Silently counting to 10, I reflect on how uncomfortable it is to be angry and to have to contain it. “Okay,” I say. “We already know you’re angry. And we know you have good reason to be angry. But would I be making a wild guess to say that perhaps one of the ways you’d like to make your life better is to be less angry?”

She shrugs.

We again sit in silence, but this silence feels a bit more comfortable, not as raw, not as challenging.

She mumbles something.

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

“It’s not a good way to make friends,” she says, barely over a whisper.

“True. In fact I think that sometimes you use your anger to keep people away.”

“Why would I want to do that?” she asks, the edge back in her voice.

“I wasn’t criticizing you when I said you use your anger to keep people away. I was making a comment that, if correct, might help you to think about when and why you try to keep people away and when you you’d like a person to be closer.”

“I never know,” Cynthia says, again barely above a whisper. “I do want more people in my life. But when they come at me, I don’t know, I just can’t take it.”

“Interesting choice of words, Cynthia – when they come at me – like when your parents came at you to punish you, beat you, hurt you.”

She nods, dropping her head. “Yeah.” Pause. “People aren’t safe.”

“Some people are safe.”

“You can always get them mad.”

“I guess you’re saying YOU can always get them mad by prodding and poking and challenging. Or by running away.”

“Who says I run away?!”

“There’s that edge again, Cynthia. I say you run away. If you didn’t run away you’d have more people in your life. You’d be less lonely.”

“I never said I was lonely!”

“You didn’t imply it?” I ask gently.

She shrugs. Pause. “I guess.” Pause. “I don’t want people getting too close. I could get hurt.”

“I understand that, but I wonder if you’re also saying it feels really scary to want people, to need them. Like it feels really scary to need me, to say you want to be here, that you need to be here.”

“Go fu…” Pause. “I was just going to tell you to go fuck yourself, but then that seemed like exactly what you were saying, that I use my anger to keep people away and maybe it’s because I don’t want to need any of those fucking people who are just going to hurt me again and again.”

“I’m impressed, Cynthia, that you were able to catch that yourself, reflect on it and keep yourself from giving an automatic angry response.”

“Yeah. I guess that was pretty good.”

I smile. “I’m glad you were able to take in a positive comment about yourself and accept it.”

“I guess.”

“Now don’t get too enthusiastic,” I say teasingly.

“I… I’m glad I came back.”

“Thank you, Cynthia,” I say. “I’m really, really glad you came back too.”

Unexpected Fear, a therapist helps her patient to explore the possible underlying reasons for her sudden fear of flying.

“I’m so terribly nervous I can’t stand myself,” Kaleigh begins wringing her hands, jiggling her right foot. “I thought I was going to be so excited about going back to Chicago after my first semester at school. But I’m not! I’m suddenly terrified of flying. I was never afraid of flying before. Maybe it’s because of the Israeli-Palestinian war and I’m afraid of terrorism, like of my plane being shot down. I don’t know.”

“Are you afraid of your plane being shot down?” I ask.

“I don’t know. It sounds ridiculous. But there was 9/11. Of course I wasn’t even born then, but still… It feels like anything can happen.”

“Anything can happen, but it is interesting to wonder why you suddenly developed a fear you never had before. Do you feel especially frightened because you’re Jewish?”

“I asked myself that. I guess someone could bomb the plane because they thought there’d be lots of Jews on it, but it’s not like I think someone’s specifically coming to get me because I’m Jewish.”

“Any other thoughts come to mind?”

“I just had a flash of my older sister. She’s not supposed to be there this holiday… But what if she is? That would be pretty scary.” Pause. “Oh God! It would be so terrible if she’s there. She ruins everything. She ruined my whole childhood! She ruined my family,” Kaleigh says crying. Pause. “I’m pretty sure my father told her not to come. But that doesn’t mean she won’t. And then everything would be ruined! All there would be is screaming and more screaming and tantrums and threats!! I can’t stand it.” Pause. “Do you think that’s why I developed a fear of flying? Like maybe I really don’t want to go home. Like maybe I’m afraid of what’s waiting for me.”

“Have you asked your parents if she’ll be there.”

“No, I haven’t. I feel scared about that too. Scared there will be this big scene about my even asking.”

“Why?”

“My mother will immediately get mad at me for being so afraid of my sister. And she’ll be mad that I might bring up the abuse again. She’s never believed me about the sexual abuse. She knows my sister used to beat the shit out of me, but she always dismissed the sexual abuse as two kids just playing around,” Kaleigh says crying. “I don’t know what’s more painful, the abuse or my mother just dismissing it. No, that’s not true. The sexual abuse was way more painful. I haven’t even told you all of it.”

“Maybe it would be helpful if you did,” I say gently.

“She used to take things, mostly sticks, sometimes a vase or whatever else she found around and put it inside me. A few times she even threatened to use a knife, but she never did.” Pause. “Usually she put it in… in my vagina, but sometimes she’d put it in the other place. That really hurt,” she says crying.

“That’s so awful Kaleigh. I’m so sorry you had to endure that, it sounds like torture. No wonder you’re scared to go home. And I’m so sorry your mother doesn’t believe you. What your sister did is certainly not just ‘playing doctor.’ What about your Dad?”

“I’m so glad you believe me! I was afraid you wouldn’t. Afraid you’d think I was just making it up.”

“Of course I believe you Kaleigh. I can’t imagine why you’d want to make up something like that.”

“I’m so ashamed of it. I even lied to my boyfriend and said I’d had sex with one guy before him. It was better than telling him about what my sister did to me!”

“Shame is a very common in sexual abuse victims, but that doesn’t mean you have anything to be ashamed of. You were the victim. She was bigger and stronger and abused you.”

“I know. But that’s not how I feel.”

“I understand. And we’ll have lots of time to deal with those feelings. I notice you didn’t say anything about your Dad.”

“I’m pretty sure he believes me, but he’s not about to argue with my mother. It was hard enough for him to tell my sister that she wasn’t welcome in their house anymore after she hit him and trashed the entire living room.”

“I am so sorry, Kaleigh. Are you sure you do want to go home? Or maybe there’s someplace you can go where you can feel safe if your sister is there?”

“I can’t imagine announcing that I’m leaving to stay with Brad or even with one of my girlfriends. That would create an uproar in itself.”

“I know we don’t have time to discuss this further today, but we do need to work on you’re not being so afraid of your fear that you’re willing to sacrifice yourself. Obviously you have good reason to be afraid, but you do need to first and foremost take care of yourself.”

a therapist struggles with her countertransference feelings when her patient announces he's taking some time off from therapy.

Jeremy, the prototype of a man who is tall, dark, and handsome, and just beginning to enter middle-age, begins his session by saying, “I won’t be here for the next three weeks. I’ll come back in December.” 

“Are you going out of town?” I ask, surprised. He hadn’t mentioned an upcoming vacation. And I don’t recall him making such an announcement in the two or so years we’ve worked together.

He squirms in his chair. “Umm, no. No, I just figured I could do with a little break.”

“Because?”

He crosses his legs, uncrosses them, then crosses them again. “It’s just beginning to be a bit too much.”

“What’s the ‘it?’”

“This,” he says, gesturing around my office.

“And what’s making it too much?”

“That,” he says brusquely, gesturing toward me with his chin.

“I’m too much.”

More squirming. “Not you exactly, just this, this questioning, probing, always searching for something more, something deeper.”

I try to think what might have occurred in our last few sessions that may have brought about Jeremy’s desire to flee. “Is there something that happened that made you feel I’m too overbearing, too intrusive?”

“I knew you’d say this was about my mother!” Jeremy says angrily.

Although I hadn’t been thinking about his mother, I remain silent, waiting to see what might develop.

“It’s not about my mother. I haven’t spoken to my mother in weeks. I decided to take a break from her too!” He pauses, taking in what he’s just said. “Shit!! I just agreed with you, didn’t I? This could come straight out of a Woody Allen movie!”

I smile. “And like in a Woody Allen movie, I’m going to continue digging. Is it that I’m feeling like your mother or have you experienced me as being more intrusive lately? Or did something happen with your mother?”

“I don’t want to. I don’t want to keep thinking and thinking and trying to figure things out. It’s enough already. I need a break!”

I feel frustrated and annoyed and find myself unable to stop. “Can you at least humor me and help me understand why this has come up right now?” As he is about to respond, I realize that I am indeed duplicating his relationship with his mother and say, “Wait! Let me pull back. First, I realize I am repeating exactly the relationship you have with your mother. I’m coming after you more and more. And the more I come after you the more you resist and the more you resist, the more I come after you. But, and maybe this is the piece you need to own. You’re the one who has put up an unbreakable wall. You’ve said ‘no matter what you say or do, I’m not telling you.’ You may have very good reasons for erecting that wall in the past, but now it feels more like a two-year-old who’s having a tantrum. Which doesn’t excuse my behavior of coming after you. I need to look at that myself and figure out why I couldn’t just pull back and let you tell me in your own time.”

“That’s a lot to take in.” Pause. “I do appreciate your saying that last part, that it’s not all me, that something got kicked up in you as well. It helps break the cycle you were referring to – chased after, run away; run away, get chased after.”

Long pause.

“I think I know what happened,” he continues. “I did have a
conversation with my mother. But before that I broke up with Charlene. I broke up with Charlene for exactly the reason we’re talking about. I told her I was going out with some friends and she asked where we were going. I wouldn’t tell her. We were only going out drinking, although Charlene did think I drank too much. Anyway, I wouldn’t tell her and she came up with more and more preposterous guesses – going to a strip club, hiring prostitutes, etc. It was ridiculous. The more she came at me, the more intransient I became until I finally said, ‘That’s it, we’re done!’ My mother called the next day and began right away bugging me about what had happened with Charlene and when was I going to settle down and give her grandchildren. I hung up on her.”

“So you were tired of all these pushy women, myself included.”

“Exactly!”

“I wonder if you’re so afraid of all these pushy women that you erect barriers to protect yourself or whether you erect those barriers so that women WILL come after you so that you can be ‘justified’ in rejecting them.”

“Why would I do that?”

“We’re almost out of time and you’ll need to tell me whether you’ll be here next week or not, but I think you might want to reject them so you never have to deal with the need for genuine connection that exists within you.”

“Wow! That’s a lot to digest”

“Yes, it is. And if you want to take some time to digest it, that’s fine and if you want to come in next week that’s also fine.”

“Can I think about it and call you?”

“Yes.” 

“I did it!” Charlotte says, gleefully.

“Congratulations,” I say enthusiastically, “And welcome back.”

“I’m not talking about going by myself to Italy.”

“Oh! What did you mean?”

“I did go by myself to Italy. It was hard. And all you’ve heard about Italian men, don’t believe a word of it. No one gave me a second glance. Oh course, why look at a middle-aged woman when you have all these gorgeous young, half-dressed I might add, girls running around. But seriously, don’t you remember what we talked about our last session?”

“I thought I did but… Oh, Charlotte, you really didn’t…”

She smiles broadly nodding at me.

“You pretended you were sick,” I state matter-of-factly.

“Correct! You see, not even you can remember me unless I do something daring, outrageous.”

“Of course I remember you. I didn’t remember that you were considering presenting yourself as someone who was ill, but I remember …”

“It doesn’t matter. I figured out how to get the attention I wanted. The more outrageous I made the story the more attention I got. It’s amazing how solicitous flight attendants can be when you tell them you’re dying of cancer or that you just had a chemo treatment.”

“And is that whose attention you wanted?”

“Anyone is better than no one, but no, that’s not whose attention I wanted. But it was fun trying out different stories and seeing what provoked the most sympathy or what made people the most uncomfortable.”

“What did make people the most uncomfortable?”

“If they thought I was going to throw up all over them. That was a good one, especially on a plane with the person sitting next to me.”

“Sounds like you took a lot of pleasure making people uncomfortable.”

“Yes, I did. Felt like I was getting back at all the people who’ve made me uncomfortable, people who look at me like I’m ugly or don’t look at me at all, as if I don’t exist.

“What do you feel as you tell me all this?”

“First word that came to me? Triumphant!”

“And since you’ve been home?”

“It’s back to the same boring life. Biller in an ophthalmologist’s office. Real exciting. A great place to not be seen.” Pause. “But I am thinking about bringing my little pretense back home. Maybe in grocery stores or gas stations – I can go someplace I don’t usually shop. I’ve even considered taking it to work. Who’s to say I couldn’t start telling my co-workers I haven’t been feeling well, that I’ve gone to the doctor, that I have some kind of cancer, etc., etc.”

“Charlotte, when you first started talking today I felt annoyed with you, annoyed for the people you were duping and angry that you felt you had to stoop to subterfuge to get people to pay attention to you. But as you’ve kept talking, I find myself feeling sadder and sadder. And I suspect you also feel both angry and sad. You’re such a bright, insightful person. You could do so much more with your life.”

“Except that I’m ugly.”

“I know you feel ugly, and this is something you and I constantly disagree about, but you don’t have to be the most beautiful woman in the room to have friends, to have lovers, to have a job that fulfills you.”

“You mean billing doesn’t fulfill me?” she asks sarcastically.

I sigh. “I know your mother didn’t value you. I know you feel your older sisters were prettier and smarter than you. And given all that, it is still possible to have a meaningful life.” Pause. “You’ve always talked about writing. You certainly demonstrated that you can be creative with your storytelling about yourself. Put the stories down on paper instead of acting them out.” Pause. “I’m sorry. I’m preaching. I know I can’t decide your life for you.”

“I’m 55 years old. Don’t you think it’s too late for me? How do I change now?”

“You went to Italy.”

“And my most fun was spinning a death fantasy about myself.”

“What was your fantasy about what the trip would be like before you left?”

Charlotte drops her head. “I thought I’d meet the love of my life. I know, that’s stupid, ridiculous. I feel like an idiot even saying it.”

“It’s not stupid, Charlotte, it’s a wish. But maybe it would have been good if we had talked more about your imaginings about the trip before you went so that you could have anticipated several scenarios, thought of the good things that might have happened, as well as the disappointing things. And I know that although many people like it, traveling alone can be very hard.”

Charlotte starts to cry. “It was very hard.”

This blog looks at one consequence of lying, as a therapist's good guess leads to her patient becoming suspicious of her.

“When I left your office last time I was thinking that I’d go home and confess to my Mom that I really hadn’t wanted to kill myself,” David begins immediately. “But that’s not what happened. My Mom had called my Dad and he was there when I got home. He wasn’t happy. He asked me what kind of shit I was pulling, why I had to scare my Mom, that he knew I was just bullshitting and I better knock it off and he wasn’t paying for any wimpy therapy. My Mom jumped in and said she would pay for it, that if her son even had a fleeting notion of killing himself, she was going to be sure he got help. My father exploded. Told her she was an idiot. That she was making me a Momma’s boy and that he didn’t want anything to do with either of us. Then he stormed out of the house.”

“Wow! I’m sorry David.”

“I was shaking. I did tell her I liked you and that I promised I wouldn’t kill myself. I asked if she’d really pay for therapy, even if Dad refused and screamed and yelled. She said she would, but I was scared all week it wouldn’t happen. But I’m here!” he says with an almost-smile. “My Mom gave my father the cold shoulder all week and my father hardly said a word to me, but something must’ve worked.”

“And how did all that make you feel?”

“Scared, really scared.”

“I certainly can understand that. But I imagine you must have felt really angry with your father. And how did you feel about your Mom sticking up for you?”

“I was surprised.” Pause. “I guess I really scared her last week,” he says with a sly grin.

“So you’re pleased that you scared her, helped get her in your corner.”

“Oh no, I wouldn’t say that. I don’t want to scare my Mom.”

“Maybe part of you doesn’t want to scare your Mom, David, but I wonder if that’s completely true of all of you. You said last week you were angry at your Mom for always going over to your Dad’s side. But this was one time she didn’t. You won. You told her you wanted to kill yourself and that did it! She was staying on your side.”

“Yeah, I guess that’s true.” Pause. “But that makes me feel bad.”

“I think you do feel bad about being angry, David, particularly at your Mom. That’s why I said last time that I thought your lying was a way for you to express your anger. It’s a way of getting back at her for not always being in your corner.”

“Oh! Now I get it.” Pause. “But it’s not like I feel angry and then deliberately decide I’m going to lie to my Mom to get back at her. Usually I lie to make her feel better.”

“But is that really genuinely making her feel better, David? If you got an A+ on a paper and told her you got an A+ on a paper that would be genuinely making her feel better. But if you got a C on a paper and told her you got an A+ that would be putting one over on her, telling her she can’t make you study more or do better than you want to and that you resent the pressure she puts on you.”

“How did you know that? How did you know that I resent the pressure she puts on me?”

I smile. “I didn’t know that, David. I was actually just making it up but I think it’s pretty common for adolescents to resent the pressure their parents put on them.”

“I guess,” he says, sullenly.

“What’s going on David?”

“What?”

“I don’t know, you sounded unsure.”

Silence.

“Oh. Do you think I’m lying to you? You think what? That your mother told me that she put pressure on you to do better in school?”

Silence.

“I guess that’s a problem with lying, David, you end up assuming that everyone lies to you too. I promise you, I will never, ever lie to you, even if telling the truth is difficult or hurtful. Therapy necessitates openness and honesty and that’s hugely important to me.”

“Okay.”

“Sounds like that means ‘okay, I’ll try to believe you.’ Let me also say, David, that if your Mom or Dad ever contacts me I will tell you that they did and will tell you what they said. And I’d tell them I was going to tell you before they spoke to me.”

“Really? That sounds pretty good. So there would be no secrets?”

“No, no secrets. Oh, I should say if you told me you were going to hurt yourself and I believed that was a real possibility, I would contact your Mom.”

“I get that. That’s okay. I’m not going to kill myself.”

“I’m very glad to hear that.”

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.”