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"I Can't Stand It!" starts with a patient's anger and despair about covid19 and ends with a surprise for the therapist.

“I can’t stand this anymore!” Karen shrieks. On my video screen I watch a usually attractive 35 year old woman grimace and pull at her hair. “When, when is it going to end?”

“I don’t know the answer to that, Karen. It’s a pandemic and the virus will do what it’s going to do.”

“But we can’t plan anything. We don’t know from one moment to the next what’s going to be happening. How many times have we gone back and forth from being in the office and back on video? I can’t stand it! I feel as though I’m going crazy.”

“The uncertainty is difficult for everyone, Karen. And I do understand that going back on video after a few weeks in the office is very disconcerting.”

“And then there’s your vacation! How could you leave in the middle of all this?! What if you got sick? What if you died? Would I even know? Would anyone tell me?”

“I understand your feeling angry with me for abandoning you.”

“But answer my question. Would anyone tell me if you died or would I just be wondering forever?”

“Yes, a colleague would contact you if I died. But I wonder if your worrying about my dying came from your feeling so unsafe without me. My absence has always been understandably frightening to you and certainly with Covid raising everyone’s anxiety, it’s easy to see how you’d fear losing me forever.”

“You mean like when I was a kid and my mother went away leaving me with my insane father?” Pause. “Yes, that was terrifying. It was always terrifying, even when she was there, but when she was gone that was really, really terrifying. I never knew what to expect. Truthfully, my mother was useless at preventing my father’s explosions, but it still felt a bit safer when she was there. He was so unpredictable. You just never knew what would set him off: a book left on the kitchen table, the dog barking, my clattering a dish. It was so scary. And I could never understand why she had to go away. What was so much more important than me?!”

“The pandemic replicates your childhood experience in so many ways: you never know what’s going to happen next and, just like your mother, even when I’m here I’m pretty ‘useless’ to change the reality of the pandemic, just like she couldn’t prevent your father’s explosions.”

“But why did you have to go away? She went away for business, although as a kid I never knew what that meant. She went away to see her parents, but I didn’t understand why she couldn’t take me with her. I guess my Dad would say we couldn’t afford it, but I didn’t understand that either.”

“I don’t think, Karen, anything your Mom told you about why she went away would have felt like a good enough reason to you and I’m sure that’s true of me as well. You’d always feel you weren’t important enough, that you were being left for something more important than you.”

“You’re not going to tell me, are you? You’re not going to tell me why you went away.”

“I don’t think the reason I went away would make any difference to you. As I said, it wouldn’t make you feel any less left or abandoned.”

“But it might make me feel like I mattered enough for you to tell me.”

“Did you have any thoughts, ideas of why I went away?”

“Well that’s an obvious therapist trick! I won’t play!”

“What I think is happening now is that you’re finding something to fight with me about, as opposed to us dealing with your anger about my leaving, and perhaps also the fear and sadness you felt underneath.”

“Why won’t you tell me?!”

“Because no matter what I say, I will have left you for someone or something else and it’s those feelings we need to deal with, not the specifics of where I went or why. Your mother told you why she went away and it never made a difference to you.”

“Tell me.”

I struggle to decide how to respond. I’m beginning to feel angry, which I know is also what Karen feels. I don’t think an endless power struggle between us will be helpful. And I also don’t think my telling her will change her feelings. I finally say, “I went to attend a friend’s special birthday.”

“You told me! I won!”

I’m startled.

“Yay!! You didn’t expect me to react like that. This was great. I feel powerful! And way less scared.”

“That’s true, Karen, that’s not how I expected you to react. You feel as though you won and therefore you’re no longer the scared child, but rather the powerful adult.”

“Yes.” Pause. “And you’re right, I still feel you put someone else above me. But it doesn’t hurt nearly as much.”

“There’s a lot to process here. We’ll have to continue next session.”

The Outsider, a young man who felt different and defective in his family, experiences and appreciates his therapist's validation and encouragement.

“I told my Mom I wasn’t coming come for Christmas,” Doug says, adopting a calm, matter-of-fact tone. “It didn’t go over well. She kept telling me I couldn’t split the family over politics, that family was more important. And I kept telling her nothing was more important than what’s happening to our country and, besides, as she might have noticed at Thanksgiving, our family was already split. Then she told me she didn’t know how I got so brainwashed, that I was brought up in a good, solid Republican family and how did I end up being so liberal. Unlike my brother’s reaction, she didn’t call me crazy or a Communist, so at least she hasn’t painted me as evil incarnate.”

“So how do you feel, Doug? How do you feel not going home for Christmas? How do you feel being the odd person out in your family?”

“Hmm. I didn’t think I was feeling much about it, but when you just asked, I don’t know, I guess it made me feel sad, like maybe even lonely. I mean my girlfriend and most of my friends think like I do, but still, my family is my family. I wouldn’t want to lose them. That’s really why I came to see you to begin with, feeling separate, apart, isolated even when I’m with a bunch of people.”

“Yes, you said you didn’t know why you should feel so alienated, when so many people obviously cared about you.”

“Yeah.” Pause. “But maybe I never felt really cared about in my own family.” Pause. “I mean, I was always different. My family is really into sports, group games, tossing around a football. That’s never been me. I was always the stereotypical shy kid who had my head in a book or, which I loved most of all, drawing, painting, looking to see how I could capture the essence of the world on a piece of paper.”

“No wonder you’re an artist,” I say, smiling.

“Well, I’m trying. But meanwhile I’m sort of making a living giving art lessons.” Pause. “My father keeps trying to talk me into being a financial planner like him, going into his firm, but that’s absolutely the last thing I want to do. I can’t imagine staring at numbers all day and trying to make more and more money. There’s so much more beauty in life.” Pause. “But that’s the problem, I’m different, always have been.”

“I guess my question is, why is being different a problem? Are you saying that in your family being different was automatically seen as bad?”

“Defective. I think that’s the word. There was something wrong with me. There was something wrong that I’d want to try to draw a perfect rose, to get the color absolutely right, rather than screaming at a football game. My Dad used to call me a sissy. I think he worried I’d turn out gay. That would have been a nightmare, gay in my family! When I was younger, I worried about it a bit too, but once I hit adolescence there was no question I was into girls. It was a relief actually. And I never had problems with girls. Girls liked me. Probably because I was sensitive and cared about them. And all that helped. But it still didn’t take away the feeling of being different.”

“Feeling different and feeling defective aren’t the same.”

“That’s true. I guess sometimes I feel one and sometimes the other. But the defective feeling doesn’t go away.”

“What about your mother? How did she see you?”

“Hmm. This might sound strange, but I guess kind of neutrally. I mean I know my mother loves me, and she never saw me as negatively as my Dad, but I don’t know. I think I was just sort of there for her and she knew she had to take care of me and she did what she had to do.” Pause. “This is a little embarrassing, but you know earlier when you smiled at me and said, ‘no wonder you’re an artist,’?”

I nod.

“Well, that’s not a response I ever would have gotten from my Mom. It’s like you were pleased with me, validating me. I never felt that in my family.”

“That’s really sad, Doug,” I say, feeling both his sadness and my own. “Thank you for telling me.”

Tears fill his eyes. “There you go again, giving me something I would never have received in my family.”

I smile. “It sounds as though you’re going to be able to take in my validating words and, as you do, I suspect you’ll come to feel less defective and less lonely.”

In today's blog, "Emptiness," a therapist helps her patient explore her feelings of despair about her husband's terminal illness and his decision to stop all treatment.

“I can’t understand it,” Valerie says sobbing. “Why would he want to leave me? We said it was forever. He’s breaking his promise! It’s not fair!! This should have been the best time of our lives. Approaching retirement, soon able to travel wherever we wanted. And now I’m just going to be alone.”

“Valerie, is Dave really choosing to leave you?” I ask gently.

“Of course he is. The doctor said there were several other chemo options he could try.”

I am more than familiar with the pain of losing a life partner, so I know to tread carefully in this most difficult of life experiences. “Can you understand Dave’s decision to stop further treatment?”

“No. Definitely not.”

“Do you have a living will, Valerie?”

“Yes, of course. I wouldn’t want to be kept alive if I was in a vegetative state, or if my mind was totally gone. But that’s not where Dave’s at.”

“Where is Dave at? What’s his quality of life? How does he spend his days?”

“He’s in bed a lot. He’s always tired. He sleeps. I know it’s partly from the lung cancer and partly the pain medication. But we still have conversations. We still sleep in the same bed. Sometimes we watch TV together. He coughs all the time, sometimes says he can’t catch his breath. Tells me he has a lot of empathy for Covid patients but he also says…” Valerie breaks off, puts her head in her hands and sobs.

When she composes herself she continues, “He says at least they have vaccines for Covid now and new medications and that at least Covid patients have the chance to get better and live normal lives. He no longer has hope. But I have hope. He could try some of these other drugs, these other regimens.”

“It sounds as though Dave is very tired, Valerie.”

She sobs again. “You think I should let him go?”

“Sounds like he’s saying he’s had enough.”

She sobs. “I’m so scared. I’m going to miss him so much. I’m not saying our marriage
was perfect, no marriage is perfect I know that. But we’ve been together for over 30 years. I don’t know what it’s like to live alone. I’ve never lived alone. I lived with my parents then roommates and then Dave. I just see myself locked in that house rotting away.”

“Rotting away? That’s a very graphic image. What makes you think you’ll rot away?”

“I don’t know. I guess like old food in the refrigerator that is left and forgotten about and just rots away. Like no one would know whether I’m alive or dead.”

“I don’t in any way doubt that you’re describing your feelings, but it’s surprising to me that you picture yourself so desolately. Before your husband’s illness you seemed to have a very active social life, to be involved with lots of people, in lots of different ways.”

“All meaningless. And besides, it was my husband who was the social one. Left on my own I just rot.” Pause “There’s that word again, rot.”

“Do you feel as though you’re rotten, Valerie? Rotten as in bad?”

“No, I don’t think I’m bad.” Pause. “I just think I’m not much of anything. Kind of a blob. My husband brought life into our home. Left to my own devices I’m afraid I’ll be swallowed by the emptiness.”

“I know depression can put a pall over everything, but this sounds like something more, like you’re literally afraid of disappearing into the void.”

“That’s it exactly. No Dave, no me, just an empty blob.”

Feeling more and more of Valerie’s despair, I ask, “And you felt that way as a child as well and as a young adult, like in college?”

“Well, there were my parents to tell me what I was supposed to do and then, as I said, I had roommates and sort of followed along with the crowd.”

“It sounds, Valerie, as though you’ve spent your life following along with whomever you’ve been with. And now, with Dave’s decision to stop treatment, you’re confronted with the terrifying feeling of not knowing who you are apart from him, and perhaps of never knowing who you were.”

“I’m terrified. I think you’re absolutely right and that makes me need Dave even more. Do you think I can persuade him to continue treatment until you and I can work this out? Until you can fix me?”

“Right this minute you may feel that you need Dave more, but nothing has actually changed. We definitely do need to work on your feeling more your own sense of self, but whether Dave will stay around until we accomplish that I can’t say.”

“I’m not sure I can survive. I want to survive but I’m not sure I can.”

“You just said something very important. You said you want to survive. That’s you, Valerie, knowing what you want.”

Self = Bad, describes a challenging se4ssion for a therapist whose patient is determined to see herself as bad.

“So I’ve been thinking about where we ended last time,” Paula says, starting right in from our previous session. “You said we’d need to figure out why I can’t forgive myself for not being more attentive to my mother when she was dying. I’ve thought about it and I don’t see why I SHOULD forgive myself. I know I was a teen-ager, but I was old enough to know better. I did know better. I was being cruel and nasty and just plain BAD.”

“So what made you bad?”

“I suppose I was just born that way – selfish, self-centered, only caring about myself. And that’s how I was being when my mother was dying, paying attention to me not her.”

Convinced of the futility of arguing with Paula’s view of herself, I pursue an alternative approach. “How does it feel for you to see yourself as selfish and self-centered?”

“It feels …” Pause. “It feels accurate and true and I guess kind of shitty….” Pause. “And familiar.”

“Familiar?”

“Yeah, like I’ve always seen myself like that.” Pause. “And I guess my parents, especially my mother, always told me I was selfish, like ‘why can’t Monica go with you to the movies?’ My mother was always trying to get me to take my sister along with me and my friends.” Pause. “I hated Monica. I hated her from the moment she was born. Everyone fussing over the baby. I didn’t see anything so special about her. She just lay there and stared. And then when she turned out to be autistic, well that just made everything worse. All the attention went to poor Monica, understanding Monica, making allowances for Monica. But you see, you see how selfish I am, wanting all the attention, wanting Monica and all her problems to just disappear.”

Here again I feel the pull to reassure Paula, to tell her she was just a child who of course had angry, rejecting feelings towards her younger, challenging sister. Yet I know that Paula will only dispute what I say. “Paula, if I were to try and reassure you, to tell you all children have negative feelings towards their siblings, you’d tell me that your feelings were worse, stronger, more heartless, right?”

“Yes. Because it’s true. And you’re only trying to make me feel better. But I don’t deserve to feel better.”

“Why don’t you deserve to feel better?”

“Because I’m bad, very bad.”

“It sounds as though being bad is almost like a core sense of who you are. Being Paula equals being bad.”

“Yes. I’m bad because I hated my sister and didn’t want to be there for my mother.”

“I wonder if you had fantasies about killing your sister.”

She nods. “See, I told you I was bad, worse than bad, evil.”

“It’s not unusual for children – or adults for that matter – to have fantasies of killing a sibling, or a parent, or boss or whomever. But I suspect my saying that isn’t going to make you feel any less bad.”

“I’m bad. I’ve always been bad. My grandma used to tell me that I was like that girl in an old movie, “The Bad Seed,” I think she called it.”

“Why did your grandma think you were bad?”

“She never liked me. She thought I was mean to both my mother and sister. And she doted on Monica. The sun rose and set on Monica.” Pause. “I think grandma might have been on the spectrum too, but of course no one talked about that.”

“Paula, do you have a sense of who you’d be if you weren’t ‘bad?’”

“But I am bad.”

“I understand that’s your view of yourself. But I’m asking if you can imagine you as someone who isn’t bad.”

“No, that’s impossible.”

“So that’s one of the big problems we have here. Being ‘bad’ is such a core sense of yourself that to imagine anything else is destabilizing. It’s like you said, being ‘bad’ feels familiar.”

“It’s familiar because it’s accurate.”

“Do you want me to dispute that with you right now?”

“What do you mean?”

“Well, it feels as though you’re almost asking me to say ‘no, that’s not so.’ But If I disagree with you, does that give you the hope that you might in fact not be bad or does it just help you shore up your argument when you counter me?”

“I’ve never thought of that.” Pause. “I wouldn’t want you to think I’m as bad as I think I am.” Pause. “So I guess maybe I am hoping that I could eventually see myself as you see me. It makes me sad when I say that.”

“I understand that. If you see yourself through my eyes, it means giving up seeing yourself through the eyes of your parents and your grandma, which means leaving them behind and bringing up feelings of loss and sadness.”

"An Apology" presents a session in which a patient and her therapist seek to understand the patient's depression after her previous session, as well as her reaction to her therapist's apology.

“I’ve been depressed since our session this past Monday,” Paula begins. “I’m not exactly sure why.” Pause. “I guess it’s because we were talking about my mother’s death – for a change – and that always makes me depressed. It’s been almost 20 years for God’s sake, I don’t see why I can’t let it go.”

“I know you get depressed when we talk about your mother’s death, Paula, but I thought about our last session too. I feel as though I was pushing you too hard and I want to apologize for that.”

“That’s what you get to do. If you didn’t push me, I’d be even more stuck than I am already.”

“I don’t know. You were talking about your guilt about your mother’s death and although it’s true that from my perspective you have nothing to feel guilty about, what matters is your perspective. I don’t think I gave you enough of a chance to talk about your feelings, including your guilt feelings.”

“My mother died of cancer. I get that I was a teen-ager, more preoccupied with my own life. But I could have gone to the hospital more. I could have spent more time with her. I could have just sat holding her hand.” Pause. “Besides, why would I get depressed if you were pushing me to not feel guilty? You’d think I’d appreciate it.”

“Well, what is one of the big problems you had with your mother even before she got sick?”

“She was always in my face, always on top of me, telling me what to do, telling me what I should think, what I should feel … Oh! I get it! You think you were being like my mother, intrusive like my mother”

“Yes.”

“Hmm. I guess that’s a good point.” Pause. “But I still don’t know why that would get me depressed.”

“Well, what did you feel when I was pushing you to not feel guilty”

“I don’t know if I felt it then or whether I’m feeling it now that we’re talking about it, but right now I guess I do feel, hey, isn’t this where I get to talk about my feelings? How come you’re not letting me feel what I feel?  I thought that’s what I get to do here!” Paula pauses. On my video screen I watch as she drops her head, her straight brown hair falling forward over her face. “I’m sorry,” she mumbles, “I didn’t mean to get annoyed.”

“Paula, what just happened? You seemed to go from a person expressing her feelings and her right to be heard, to what seemed to be a scared, apologetic little girl?”

“I felt guilty for being ang… annoyed at you.”

“So you can’t even say you’re angry at me.”

“I’m afraid to be angry at you.”

“Because?”

“I don’t know,” she says in a barely audible voice.

Silence.

“Your anger feels dangerous?” I ask.

She nods. “I was angry at my Mom and look what happened to her. It’s much better to keep it tucked safely away.”

“Except it’s never ‘safely away.’ It’s turned inward on yourself so that you end up feeling depressed.”

“So you’re saying I was depressed after last session because I was angry at you and turned it on myself, not because my mother died? That makes me sound even more selfish and self-centered!”

I feel the urge to argue against Paula’s interpretation of her depressed feelings and wonder if her way of being self-deprecating, tends to elicit a reassuring, albeit intrusive, response from me. Do I feel a similar pull with other patients? Does Paula unconsciously set up this dynamic?” I’ll have to think about all that, but right now I need to respond to Paula.

“I think you can be depressed for more than one reason, but it sounds as though you’re saying you should feel depressed about your mother’s death.”

“Yes, of course I should feel depressed about my mother’s death. She’s dead!”

“You can certainly feel sad about your mother’s death, but I don’t know that carrying depression around as a heavy weight that burdens all aspects of your life is at all helpful.”

Paula sighs. “I guess after almost 20 years I should be able to cut myself some slack.”

I nod, smiling.

“But why is that so difficult for me?”

“I guess because you still feel the need to punish yourself.”

“I think you’re right.” Pause. “But what can I do about that?”

“I guess we’ll need to talk more about why you can’t forgive yourself for what you see as your adolescent ‘sins.’”

Today's blog, "Good-bye Again," deals with the spike in Covid cases necessitating a return to virtual treatment yet again, leaving both patient and therapist to deal with a myriad of feelings.

Although it is not my norm, today I begin Laurie’s session. “I need to tell you, Laurie, that starting next week I’m going back to working from home.”

“What?!” she shrieks. “You’ve got to be shitting me! We just came back to your office! You know how much I need to see you. You can’t do this to me. You can’t, you can’t,” she says sobbing, her face buried in her hands.

“I knew this would be very difficult for you, Laurie, but you know how Covid cases are tearing through Florida. I can’t risk your health, mine or anyone else’s.”

“I hate you! I hate you!! You’re like a big tease. ‘Here I am and now I’m gone!’ I can never rely on you. I can’t rely on you any more than I could rely on anyone else.”

Although I know it’s very unlikely to help Laurie to feel better, I feel compelled to say, “Remember when you felt just seeing me once would be reassuring to you, would convince you that I was indeed alive and not a figure of your imaginings.”

Laurie looks at me scornfully. “You’re joking, right? What does it matter what I was feeling then? This is now and I feel like crap and it’s your fault.” Pause. “What if we wore masks?”

“You know the answer to that, Laurie. I wouldn’t be able to hear you and it’s impossible to do therapy if I can’t hear you. We can do therapy without seeing each other, but it’s impossible to do therapy without hearing each other.”

“So there’s no compromise?”

“I don’t know if it’s a compromise, but you now know that we will see each other at some point, we will be back in the office as soon as it’s safe.”

“As soon as YOU say it’s safe!”

“Yes, that’s true. It is my call. And that is part of what I do, Laurie, keep us both as safe as possible.”

“You’re talking about my mother, right?”

“Yes. She didn’t keep you as the six-year-old child safe when she killed herself and she certainly wasn’t keeping herself safe.”

“But I don’t see how that helps me now!”

“Well, I may be mistaken, but it seems to be that you are feeling a little calmer right this minute.”

“I’m feeling depressed. I’m feeling I have to deal with yet another loss, the loss of you. Makes me very sad.”

“Do you feel depressed or sad?”

“You always ask me that. I can never tell the difference.”

“Depression is more a feeling of numbness, of nothingness. And it’s often a result of anger turned inward, like turning your anger at me in on yourself. Sadness is more acute, more intense and is often about mourning.”

“I’m feeling both. I don’t want to be angry at you. It scares me. What if I’m angry at you and then you get Covid? I’d feel horrible, guilty. I wouldn’t want that to be the last thing you remembered of me. But I also feel this huge loss. I know, you’ll say I’m still mourning my mother, and maybe I am. But it’s also about you. I need you so much and it is so good to see you in person and it just feels like this huge emptiness, again.”

“I do understand, Laurie. It’s a loss for me too. It’s been wonderful seeing you in person, actually having you as a real, live person in my office. But it’s not forever, unlike with your mother.”

“I wish you wouldn’t keep bringing her up.”

“Because…?”

“Well, what first jumped in my head, is that it feels like you’re trying to pass the buck, trying to get me to talk about her rather than you.”

“That’s a really good point, Laurie. Maybe you’re right. Maybe I also was trying to move away from the sadness between us.”

“Really! Wow, I’m surprised. I’m surprised that you’d feel that and, truthfully, surprised that you’d admit it.”

I smile. “Therapy is a place I get to be truthful too, it’s a place I get to reflect on myself just as you do.”

Tears fall down Laurie’s cheeks. “You see, that’s why I love you so much, that’s why I miss you, you’re such an amazing special person. There’s no one in the whole world like you.”

“Remember how much you hated me at the beginning of the session? I’m neither a horrible, evil person nor a saintly one. I’m both. And it’s important that you try and hold onto both parts of me.”

“But now I have to say good-bye again and that makes me really, really sad.”

“Yes, it is sad, but we’ll talk to each other next week and we’ll both be very much real and alive.”

Today's blog is entitled "Too Close." In it a therapist helps her patient explore her reluctance to get close to others, including her resistance to returning to in-person treatment.

“I went out with Charles again last night,” Ashley begins. “You know the guy I met on Match who I’ve been out with a few times.”

“I remember,” I say, nodding at the computer screen. “You kind of liked him.”

“I guess, but he was a little too much last night.”

“Meaning?”

“I don’t know. Like he started telling me all about his childhood, which was pretty terrible. He was physically abused by his mother, like really bad. And he wanted to know all about me. I’m not sure I was ready for that.”

“What made you uncomfortable?”

“What if we don’t work out? Why should I tell him all about me? Does he really need to know that my mother died of cancer when I was four and that my father wanted nothing to do with me?”

“I’d say there would be no reason for him not to know.”

“I never understand why you feel I should be blabbing my whole life to anyone and everyone.”

“Well, if you’re not presenting who you are to people it’s kind of impossible to get close to them and it takes a lot of energy to be play acting through a large part of your life.”

“Aren’t you play acting? Isn’t being a therapist all play acting?”

“In what way?”

“You could be in terrible pain right now, physical or emotional, and you wouldn’t tell me about it, right?”

“That’s true. We do all have roles that we inhabit in our lives and…”

“See, I told you! So I’m no different than you or anyone else!”

“We all have roles that we inhabit. Being a therapist is one

role, just as being an attorney is another. And, no, in our professional roles we’re not telling everyone everything about us. You’re not going to be in front of a judge and say, “Your Honor I can’t try this case today because I had to put my dog down yesterday and I’m a total basket case. But yesterday, when you put your dog down – obviously I’m just using that as an example – would you have been able to call a friend and say I need to talk?”

“I don’t have a dog,” Ashley says matter-of-factly. “I don’t want a dog.” Pause. “Actually, dogs are kind of like that guy last night. They want too much. They’re always there, always begging. I guess you’ll say that’s my need to keep my distance.”

“Yes, I would. And there’s the question of why that distance feels so necessary for you.”

“It just popped in my head that we’re back in your office next week. I don’t like that idea either. This is much more convenient. I don’t have to drive to and from your office. I don’t have to waste time sitting in your waiting room. I just turn on my computer screen and here you are.”

“So I assume by bringing that up right now, you’re making the connection that returning to my office feels closer – literally and figuratively - than virtual therapy.”

“Right. And I’d prefer continuing just as we are.”

“So do you have any thoughts about what makes closeness so uncomfortable?”

“It’s messy. People are just so needy. They want so much. Just like a dog.”

“Are you needy, Ashley? Do you want so much?”

“Me? No way! I can take care of myself.”

“I think you learnt that early on. If there’s no one really there for you, you learn that you have to take care of yourself.”

“Right!”

“But there’s a problem with that, Ashley. When you were four years old you couldn’t take care of yourself. You were a helpless, dependent little girl who just lost the most important person in your life. That little girl is still inside you. She still wants and needs and longs for someone to care for her…”

“Ugh! That’s disgusting. I hope that’s not true. And if it is true I want her gone, poof! Like she never existed.”

“I wonder, Ashley, if that’s exactly the reason you didn’t like the man you saw last night and the reason you don’t want to return to in office visits and the reason you don’t want a dog, all of that brings you closer to that dependent, childhood part of yourself.”

“So what should I do about it?”

“Well, first we’ll resume in office visits and we’ll talk about how that feels for you. And when you’re with someone and feel the need to get away, maybe you can try to pay attention to what you’re really trying to get away from. I suspect it might be the needy part of yourself.”

“What if I just avoided people?”

“Well, what do you feel when you avoid people? What did you feel when we were locked down in the pandemic?”

“Lonely. Like something was missing.”

“I guess that’s your answer.”

Endless Despair, a therapist attempts to help her patient understand how her tie to her critical mother fuels her recurring feelings of sadness and depression.

 “I don’t understand,” Amber wails over the phone. “I was doing fine. I had a good day. I took my dog for a long walk. And then with one phone call I’m a wreck. I can’t stop crying. I feel as though I want to beat my head against the wall,” she says sobbing.

“Can you tell me what happened during the phone call?”

“Nothing! I mean nothing that would lead me to feel awful. I don’t understand. Why doesn’t it stop? Why do I always, always feel so awful?”

Having seen Amber for several years, I realize nothing I say at this point is likely to be of help. Still, I reply, “You don’t always feel awful. You were just telling me you were having a really good day.”

“But it always comes back! Why does it always come back?”

“Part of the problem for you is that when you feel awful, the feeling takes you over completely and you can’t remember that you felt really good yesterday or the day before.”

“But why does it always come back?”

“What’s the ‘it’ that always comes back?”

“The bad feelings. They always come back.”

“You know, that’s a really good question. Why do your bad feelings always come back? Like today, you said you didn’t think the phone call should have triggered your bad feelings, but it did. And perhaps I should ask what specifically you mean by bad feelings.”

“Sad feelings. Depression. Feeling everything’s pointless.”

“Okay. So why do your sad, depressed feelings always come back?”

“I don’t know!”

“Well, what did happen on the phone call?”

“My boss told me I did a really good job on the marketing project. She had a few minor corrections, but basically complimented me on a job well done.”

“And you felt how about that?”

“While I was on the phone with her I felt good, pleased. But then, I don’t know. It just washed over me and I felt like shit.”

“What washed over you?”

“Despair. Like what does it matter anyway. It’s just a stupid marketing job, for some stupid liquor company that’s just going to turn people into alcoholics.”

“Whose voice is that, Amber?”

“It’s mine.”

“Yes, but isn’t it also someone else’s voice? You’ve certainly told me that your mother was always critical of you, always telling you what a failure you were, how you couldn’t do anything right.”

She sighs. “Yup. That’s my mother.”

“So when you were talking to your boss you could take in your her voice, you could take in the compliment. But when you got off the phone, your mother’s voice returned with a vengeance.”

“I guess so.” Pause. “But why?”

“What are your thoughts?”

“I certainly heard her voice a lot longer. It’s louder, telling me how stupid I was and that I’d never amount to anything. And she still does. Why did I go into marketing? Why couldn’t at least have been a teacher? Why aren’t I married? Why am I such a bad daughter, etc., etc.”

“Yes, her voice is louder. And I also wonder if you’re invested in staying attached to your mother’s negative voice.”

“Why?”

“If you move away from your mother’s voice, maybe it’s like moving away from her, leaving her behind. And she is, after all, the only mother you ever had.”

Amber starts sobbing. “I can’t leave her. I can’t. I’d feel way too guilty.”

“Plus, if you take in more positive voices and leave your mother behind, you’d also have to mourn never having the mother you wanted or deserved, not as a child and not as an adult.”

Amber continues sobbing. “I can’t! I can’t! You can’t make me! Oh my God, I’m being swallowed up by those bad feelings again!”

“No, Amber, I can’t make you. I neither could nor would force you to do anything. But I think you can see how terrifying the thought is for you, the thought of moving away from your mother, of mourning who she isn’t and wasn’t.”

More sobbing. “But maybe she’s right. Maybe I am bad and stupid and incompetent, maybe that’s why she couldn’t be nice to me.”

Softly I say, “I understand that it feels safer to take the badness inside you, to take it away from your mother, so that as long as it’s inside you you can hold onto the hope that if only you were different she would treat you differently, would love you more.”

“Wouldn’t she?”

“Only you can answer that, Amber, but from what you’ve said, it sounds as though your mother was rejecting of you from the moment you were born, for her own reasons, stemming from her own problems, but extraordinarily destructive and painful for you.”

“I can’t. I just can’t.”

“I understand. You can only do what you can do. And we’ll keep working, working at a pace that you can tolerate, that isn’t unbearable to you.”

"A Dream," a patient and therapist work together to understand and detoxify the patient's dream.

“I’m so glad I’m talking with you today,” Rose stays, starting immediately. “I had this awful dream last night and it’s haunting me. The specifics are kind of vague at this point, but the feeling it left me with is very clear - horror. And it was like a horror movie or something out of a scary sci-fi movie, neither of which I ever watch. So it was like this force, not sure what the force was – people, aliens, I don’t know. I don’t know that I ever saw any particular thing or person, I guess that’s why I call it a force - that was going around and doing something to people so that they looked like their whole body had been burned and like instantly turned to ash and dissolved. Ugh! It makes me shudder just to think about it. And I guess I was going around trying to avoid this thing, but also to warn people, people I knew and cared about, that they were in danger. I think I had a better idea when I first woke up who some of those people were, but now I’d just be making it up. I keep shaking my head wanting that image of people dissolving into ash to go away.” She takes a breath. “So what do you think?”

“I can certainly understand how disturbing a dream it was,” I say, impressed with how Rose has managed to convey her horror so well over the telephone. “What are your thoughts?”

“I don’t know. I was watching this TV show that had a cancer patient in it last night and it struck me how he seemed to be being eaten up from the inside out.”

Silence.

“I just keep feeling the horror.”

“Where does that feeling take you?”

“The horror? I guess the horror of the pandemic, of how many people have died. Oh! I guess that could be the force, the unseen virus, killing all these millions of people.” Pause. “But I wonder why I’d have the dream now. Things do seem to be getting better, at least for us. I’m vaccinated, most of the people I love and care about are vaccinated. Why now?”

“You said you thought there were specific people you were trying to save. Even if you have to make it up, who do you think some or one of those people were?”

“My mother comes to mind. She’s been dead for over 10 years now. She had a long life, almost 100 and she was pretty good until the last few years. She was ready to go. That made it easier for me, although it was still hard losing her. Painful, but not horrifying.”

Silence.

“What are you thinking about?”

“First I was thinking about this article I read about how deaths to overdose have skyrocketed during the past year. That feels like another force taking over people, especially young people. But then I ended up

someplace entirely different. I was thinking of the horror of growing up in my house, of my parents screaming and screaming at each other, of us cowering in the corner waiting for my father to start beating up on my mother or turning on one of us. He was definitely a force to be reckoned with, although he was a specific person, a tangible force, not a sci-fi character.”

“Maybe that made him even more scary. You couldn’t just turn off the TV.”

“That would explain why I was trying to save my mother. I was always trying to save my mother and feeling awful that I couldn’t.” Pause. “But still, I don’t know why I’d be dreaming about this now. This is an old story. Why now?”

Silence.

“Any thoughts about people being turned to ash and dissolving?”

“Cremation. Lots of cremations during the pandemic.” Pause. “The Holocaust. That was certainly a force of evil. Hitler, the gas chambers. But it doesn’t seem to be about that either. It felt more contemporary, like right now.”

“All right. Right now, what’s horrifying you, scaring you, threatening you?”

“Aging. I turn 65 next month. I know that’s not old these days, but I worry about aging, about who will take care of me if I’m ill or incapacitated in some way. And I suppose death itself feels frightening, the unknown, the aloneness. Death is a pretty scary, menacing figure. You think that’s what the dream’s about?”

“It’s certainly possible. And it’s also possible that it’s about all the things you’ve talked about today.”

“I suppose.”

“What are you feeling now?”

“Definitely not as horrified. Talking about it made it less scary. I feel more removed from it, like it’s something to look at and to figure out.”

"From Father to Son," a therapist helps her patient see how his relationship with his father affects his feelings about his own son.

\

“My son’s home on Spring break,” Craig says, looking forlorn.

I wait.

“I know I should be happy, glad to see him. He’s a good kid, getting great grades in college, actually thinking about becoming a psychologist,” he says with a wry smile.

“But you’re not happy.”

He shakes his head. “And I hate myself for it!” Pause. “You know, I told you my father was an ass, always criticizing me, always telling me all the things I’d done wrong. He was the perfect one, I was the incompetent fool. Made me the anxious, insecure mess you see now.” Pause. “It’s not that I’m like that with my son Daniel. I’d kill myself if I was like that. I swore to myself I’d never be like that with my kids and I haven’t been. It’s more what I feel inside. And I’m so ashamed, how could I be such an awful person? It’s not like that with Britany, my daughter. We have a great relationship, so easy to spend time with, so easy to talk to.”

“So what is it that you feel about your son?” I ask.

“Jealous. Jesus, I hate that about me, what an awful thing to feel about your own son.”

“Beating yourself up for your feelings isn’t helpful to you. Or to your son for that matter. It would be better if we could understand your feelings. What do you feel jealous about?”

“It’s so embarrassing, but I’m jealous about everything. I’m jealous of his relationship with my wife. I’m jealous about his ease in the world. I’m jealous he has all these friends. I’m jealous that he already has a sense of purpose. I’m jealous, I’m jealous and I’m sick of myself.”

“It sounds like you’re saying you’re jealous of Daniel because he’s had a much easier time in himself and in the world than you had.”

“And what kind of father is that?! Fathers are supposed to want more for their children, want their kids to do better than them. And me, I’m a despicable jealous fool!”

“You certainly still carry your father’s critical voice with you inside your head, condemning yourself for who you are and what you feel.”

“But I should condemn myself. How else could I feel?”

“Well, you might feel compassion for yourself and, again, try to understand where your feelings come from.”

“It’s not only how I feel, it’s how I act! It’s not that I’m critical of Daniel but I’m – I’m not sure what to say – I’m distant, reserved and I worry how he interprets my coolness.”

“Do you think your father felt jealous of you?”

“What?! No. I told you, he thought I was an incompetent jerk.”

“But maybe he needed you to be a, quote, ‘incompetent jerk.’ Maybe he needed you to be less than him so he kept you down by being critical and demeaning. I don’t mean he knew all that consciously, but unconsciously he might have experienced you as a dangerous competitor.”

“I don’t know what to say to that. It’s like turning my world on its

head.” Pause. “And what would that mean in relation to Daniel?”

“Well first, as I said, you carry your father’s critical voice with you in your head. That critical voice certainly gets turned against you, but it sounds like you’ve also been afraid you’d turn it against Daniel and rather than do that, you’ve withdrawn from him.”

“Wow, that makes sense. I’m not sure what I do with it, but it makes sense.” Pause. “What about Barb, my wife?”

“What are your thoughts?”

“Barb always doted on Daniel. Britany was our first born, but I thought Barb always favored Daniel. I don’t know why, maybe because he was a boy and she lost her father shortly before Daniel was born. I guess I was jealous then, jealous of their bond and I worried that she was indulging the boy. Wow! I do sound like my father when I say that. My father was always telling my mother she was spoiling me, but unlike Barb my mother would immediately stop however she was being to me and side with my father.”

“So you lost your mother to your father. Are you saying you feel as though you lose Barb to your son?”

“I don’t know. Maybe. Especially since we’ve gotten older, you know, as the passion dims.” Pause. “I feel as though my heads spinning.”

“We have dealt with a lot today. Some of it might make sense intellectually, some not, but there are certainly a lot of feelings to work through on an emotional level. For sure, your relationship with your father has affected your being a father and that’s pretty much true for everyone.”

“So I’m not a freak?”

“That’s you father’s voice again, Craig. And, no, you’re definitely not a freak.”