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"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.” 

 "Being Vaccinated," as a therapist deals with her patient's aversion to receiving the Covid19 vaccine, the patient-therapist relationship comes to the fore, as does the question of caring and being cared for.

“So I know I’m locked in the house like everyone else and hating it and ready to strangle my husband, but I really need to talk to you about my daughter. She’s driving me crazy,” Paula says, barely stopping for a breath. “She just doesn’t stop. ‘Mom, did you get the vaccine? Have you tried getting the vaccine? Have you signed up through the Department of Health? Did you try your local grocery store? What about Dad?’ She doesn’t stop. You have to tell me what to do.”

Paula, who I’ve only ‘seen’ for a few sessions via the telephone, is a seemingly headstrong, stubborn, opinionated 67 year old woman. “What should you do about…? I ask.

“About her of course! What should I do about my daughter constantly bugging me?”

“What have you done?”

“Nothing.”

“Nothing? But what do you say to your daughter when she asks you about being vaccinated?”

“I just put her off, you know, like saying ‘not yet’ or ‘it’s not in the area yet.’”

“Do you plan to get the vaccine?”

“Not if I can help it!”

“Because…?”

“I’m not into being a guinea pig! Who knows what the government is putting into those vaccines? How do we know they’re safe? They’re so new. Maybe they’re giving it to all us old folks first because they think we’re disposable. Who cares if some old people die! I didn’t trust Trump and I don’t trust Biden any more.”

Although I knew that Paula was distrustful of others, I hadn’t recognized the extent of her suspiciousness. I tread carefully. “So why haven’t you told that to your daughter?”

She scoffs. “My daughter’s a doctor. She’ll laugh at me and tell me I’m crazy.”

Although I find myself agreeing with my patient’s daughter, I stall for time by asking an inane question. “What does your husband think?”

“He doesn’t care. He’ll do whatever I say. We’re both healthy. I mean I know we’re both over 65, but we’re in good health. Why take any chances?”

“And yet you’re comfortable taking your chances with Covid?”

“Maybe.”

“I’m sorry. I’m not sure what you mean.”

“How do we know the whole thing isn’t a hoax? Maybe there is no Covid. Maybe it’s all just a big scam.”

“And what would be the purpose of this scam?”

“I don’t know. Maybe to try out these experimental drugs for some future disease, some other virus that strikes 25, 100 years from now. Who knows.”

I sit with my anxiety for a moment until what I hope is aninspiration strikes me. “You know, Paula, since you’re so reluctant to share your reservations about the Covid vaccines with your daughter, I’m impressed that you feel comfortable telling me about them.”

Silence. The silence continues.

“Paula, are you there?”

“I’m here.”

“Okay. Good.”

Silence.

“I’m supposed to tell the truth here, right?”

“Yes. That’s definitely helpful.”

“Well I know this sounds terrible, but I can tell you because you don’t matter. My daughter matters to me. What she thinks of me matters to me. What you think of me doesn’t matter because you don’t matter to me. I pay you to give me a service. Beyond that you’re irrelevant. Does that sound terrible?”

“Well,” I say cautiously, “it’s definitely honest.” I pause, trying to gather my thoughts and think of an appropriate response. Speaking softly, I say, “I wonder what it means that I don’t matter to you, that you can so easily dismiss me as irrelevant. I wonder who in your life has made you feel you don’t matter. I wonder if you yourself feel you don’t matter. And I wonder if one of the reasons you’re so suspicious about the virus or the vaccines is that it’s hard to believe that anyone could feel you’re important enough to care about.”

“Are you saying I should care about you?” Paula responds, understandably not able to take in what was a long, complicated interpretation.

“Only you can answer that.”

“Well, I don’t know if I can or if I should care about you.”

“I understand. I think perhaps our first questions should be whether you’re able to care about you and whether you’ve felt cared about by important people in your life.”

“You mean like my parents?”

“Yes. As well as others.”

“I told myself I wasn’t going back, that I wasn’t going to dredge all that stuff up.”

“Yet you chose to see me, a psychoanalyst, so perhaps part of you wants to dredge all that stuff up.”

“Nonsense!”

“But we’re meeting again next week, right?”

“I suppose,” Paula responds grudgingly.

“I’m glad to hear that. I’ll talk to you then.”

a patient and therapist as they work to understand how the patient's past led to her blunted response to the storming of the Capitol.

I don’t get it,” Marlene begins, her face appearing tense and puzzled on my screen. “Every time I talk to one of my friends or even exchange an email, they’re talking about how devastated they still feel about the storming of the Capitol. I agree, go along with it, so they don’t think I’m some sort of a weirdo, but I don’t get it. It was a building for God’s sake. Yes, 5 people died and I’m sorry about that, but I see people dying of Covid every day in the hospital, people who are scared and alone and broken. We’ve lost way more than 300,000 people to Covid and people are so distressed about a building! What’s the big deal?”

I’ve had many patients who were very distressed by the events of January 6, others who, not surprisingly to me, didn’t even mention it. But I am surprised by Marlene’s lack of emotional response. As a nurse she has been on the front line of the pandemic, so perhaps, I think to myself, she can’t allow herself to feel any more pain. Still, politics matters to her. She usually has very definite opinions, often accompanied by intense affect.

“It sounds as though you’re uncomfortable with your not experiencing it as a big deal,” I suggest.

“I suppose. I don’t know, it just makes me feel different. Which is certainly not a new feeling for me.” She sighs. “Poor white trash, daring to want to make something different of myself. That got me beaten at home for thinking I was better than them and bullied at school because those kids sure as hell didn’t think I was as good as them. Shitty beginning.”

“And you’ve taken yourself far from those beginnings.”

“Yes. And I haven’t told you, but I’ve been thinking of applying to school to be a Physicians’ Assistant.”

 “That’s wonderful, Marlene. I’m so pleased for you.”

“You don’t think it’s crazy? I’m already over 40. And PA school is very competitive.”

“You know, Marlene, I think you just asked me if I think you’re being too uppity, going too far from ‘home,’” I say.

She chuckles. “I think you’re right.”

“So do you think it’s weird that I don’t feel more about the storming of the Capitol?”

“I don’t think it’s weird, Marlene, but I do think it’s unlike you.”

“So you had strong feelings about it.”

“I did. But I’m wondering right now why you are asking me all these questions rather than telling me more about what you’re thinking, what you’re feeling.”

“I guess I’m feeling weird, which takes me back to my childhood.”

“What specifically in your childhood?”

“All of us living in that three room house. All the screaming. All the violence. My Dad beating the shit out of me if he found me reading a book. All the kids at school circling me, jeering at my clothes.” Marlene’s eyes fill with tears. “Will those images ever go away? I want them to go away.”

“Let me ask you something, what brought those images back so vividly?”

Marlene’s eyes widen. “Oh my God, seeing those people storm the Capitol! That’s what brought those images back. Those were quote, unquote, ‘my people.’ Oh my God,” Marlene says sobbing. “Oh my God! It’s so awful! Of course I couldn’t take it in. It’s way too close, way too close. It makes me sick. I don’t want to be like them, I don’t, I don’t.”

“You’re not like them, Marlene. You’ve grown a long way from there.”

Marlene continues crying, tears streaming down her face as she stares at me on the screen. “I wish I was in your office right now. I wish I could feel your presence, like your presence would erase the awfulness of those images.”

“I wish that too, Marlene. But I do hope you can feel that I’m here for you.”

She nods. Grabbing a tissue, she blows her nose and wipes her eyes.

“So I couldn’t take in the horror of the mob attacking the Capitol because it brought me too close to my childhood experience? So I did what, I shut down, and didn’t allow the horror to penetrate?”

“I’d say that’s exactly what you did, Marlene. At first I thought you’d shut down because of all the months of dealing with the stress of Covid meant you couldn’t take in one more horror. But I’d say, you got way closer to the real reason you shut down, the need to distance yourself from the horrors of your childhood.”

Tag words: Psychotherapy, mental health, defense, patient-therapist relationship, childhood, violence, growth, ambition, numbness, shutting down.

a patient and her therapist seek to understand why this troubled, depressed patient is faring better than usual during Covid and its restrictions.

“I realized the oddest thing this week,” Anne begins, her voice fairly upbeat as she speaks into the telephone. “I’ve been feeling okay.”

“That’s terrific, Anne,” I say excitedly.

“Yeah, I’ve been talking to you for how many years? And this is probably the first time I’ve ever said I feel okay. I can’t figure out why. Nothing has changed. I’m stuck indoors like everyone else. Our Covid numbers are spiking, I’m as terrified as ever of getting the virus and yet I’m okay.”

Anne is correct. I have been speaking with her for a number of years and this is probably the first time she has not described herself as depressed, anxious and isolated. We began working in person when she relocated to Florida to take care of her aging and always demanding mother, a long and arduous process that called upon all the strength Anne could muster and all the support I could give. After her mother died, Anne returned to New York, saying it felt like home, although she had neither friends nor career to return to. She did, however, now have sufficient money to live comfortably whether or not she could find a career path commensurate with her intelligence and education, leaving behind her unsuccessful attempts in retail or restaurants.

“What are your thoughts?” I ask.

“I don’t know. I’ve done the same thing these past several weeks as I’ve done for months, or even years, and I feel strangely content. No despair, no pressure. Of course I haven’t had any pressure for a while, not since my Mom died.”

“Except for the pressure you put on yourself.”

“That’s true.” Pause. “I still feel I should figure out what to do with the rest of my life. I should be looking at various career possibilities, seeing what piques my interest. But I guess I know what the reality is with Covid. New York is decimated. There are thousands and thousands of people unemployed, stores are boarded up. No one is going to hire a 52 year old woman who has probably never held a job for more than a year. I also feel I should go back to my painting. I was pretty good at it. Why don’t I spend my very excessive amount of free time painting again? I should. But I don’t.”

“So you’re still putting pressure on yourself.”

“Yes” Pause. “And I do still hear your voice telling me I should be spending more time with people. But of course everyone is told not to spend time with people these days. But I know you’d still be telling me I should at least reach out to my sort-of friends by phone.”

“You still feel pressure from both yourself and me, but you feel different, calmer, less despairing.”

“Yes.”

“And you don’t feel isolated?”

“Everyone feels isolated.

“Maybe that’s comforting.”

“What’s comforting?”

“That everyone feels isolated.”

“That’s a good point. I don’t have to feel like such a freak.” Pause. “Yeah, that’s right. Usually this time of year would be the worst. Thanksgiving in November, Christmas and New Year’s in December. Everyone running around buying food and presents and looking forward to seeing family and friends. And then there’s me. Sitting at home stuffing myself with junk food and wondering if I should kill myself. But not this year, this year everyone’s in the same boat as me. I know they still have these ridiculous TV commercials with people sitting around a big table together or drinking themselves sick at parties, but now they look exactly like that – ridiculous. No one should be doing that this year. Everyone should be doing exactly what I’m doing, sitting home alone, no one else there. Yes, it’s a tremendous relief. That’s exactly why I feel okay.”

“Where do I fit in?” I ask.

“You’re my one exception. You’re here. But of course you’re not here. You’re thousands of miles away.”

“And that means what for you?”

“Actually makes me feel a little sad. But not too much, because I know even if you were next door we’d be meeting just as we are now, on the telephone. Yes, that makes me feel better immediately. So I guess that’s another thing Covid has done for me – made me feel less like a freak and made our distance feel less significance. No wonder I feel better.”

Anne may feel better, but I’m left feeling sad, both for the sadness she likely feels underneath her “better,” as well as for the isolation she wears as a protective shield, unable to breach the chasm between herself and others. Covid will eventually end and unless we are able to breach that chasm she will return to feeling like a freak, the forever outsider longing to be part of the lives she only imagines.  

Tag words: Psychotherapy, mental health, patient-therapist relationship, projective identification, isolation, sadness, despair, aloneness, Covid19.

"In Mourning," a patient returns to therapy after the death of his mother, struggling with a depression he cannot shake.

“Well, I’m back,” David says morosely. “I thought I could at least make it a couple of years without seeing you, but there’s no way. I can’t stand myself any more. I knew I’d have to see you virtually too, which only makes it worse, but I just can’t get myself out of this depression.”

“Do you know what’s gotten you so depressed?”

“Yeah, my mother died of Covid in April.”

“I’m so sorry, David. Yet another victim of the pandemic.”

“Yup! I mean, I know my mother was 92, and her health wasn’t the best, but she still had all her marbles. And of course, just like in the news, she died alone in the facility.” Pause. “I feel so incredibly depressed. And you must think I’m nuts since I had such a difficult relationship with my mother. You’d think I’d be, I don’t know, relieved, or something.”

“What do you feel?”

“But when you were a little boy, you felt your mother as the only loving presence in your house. And she was a huge protector. She protected you against your father, she protected you against your older brothers.”

“But I’m not a little boy any more.”

“Except that you carry that little boy inside you as an adult, just as we all carry our child selves with us.”

“So you think that’s why I’m depressed?”

“I think you’re in mourning so it’s not surprising you’d be sad, but the depression seems as though it’s more than that.”

“So what it is?”

“You know, David, it’s interesting that you look to me to tell you what your depression is about. That may be another indication of how lost you’re feeling, looking to me for answers that reside in you.”

“That’s true.” Pause. “I want you to tell me what’s wrong and make it go away. I know therapy doesn’t work like that. But it’s like I’m too depressed to even do the work I know I have to do.” Pause. “Please help me.” Pause. “I sound like a sniveling baby!”

“Well right then, you sounded like your Dad berating you, rather than being able to have compassion for yourself.”

“That’s true!”   

“So you’re mad at yourself for feeling depressed.”

“Definitely. I thought we fixed me. That my depression would be gone forever.”

“So, David, do you think you’re also mad at me? Mad that I didn’t fix you.”

Hanging his head, he nods. “Yeah. When my depression came back, I started questioning whether therapy had made any difference at all. When Covid first hit I felt very different. I felt that as was coping with all the stress and insanity and that I was a good support for both my wife and daughters. In the beginning we were all living together. My daughters came back from college, my wife was teaching from home, and I was doing my accounting from home too. It was kind of crazy, but sort of fun too. Felt like we were whole, a big, happy family again.  And I wasn’t allowed to see my mother so that took away my worry about whether too much time had passed and whether I had to go see her. Now my daughters are back at college, although they’re still doing most of their courses virtually, my wife is back teaching and I’m back in my office although I still meet with clients virtually. And obviously my mother is dead so I don’t have to worry about seeing her.”

“Sounds like you are feeling a lot of loss, not only of your mother, but also your big, happy family.”

“So there’s loss everywhere.”

“Definitely.”

“I notice though, that as soon as you acknowledged your anger at me and your lack of compassion towards yourself, you were able to start doing to the work, start looking at what was going on in your life that’s been contributing to your depression.”

“That’s true.” Pause. “I just wanted to ask you if that means I’ll stop being depressed.”

I smile. “I think with the loss of your mother, it’s easy for you to want to put me in the place of the mother who can make everything all right. I’m sure you have lots of feelings about your mother’s death, as well as issues about the inevitable passage of time.”

“Just hearing you say that made me depressed again.”

“I’m sorry. But sounds like that’s an issue we’ll definitely have to address.”