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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.”

"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.”