Blogs

Alone Together, when a married patient talks about her feelings of aloneness during the stay-at-home orders, her therapist helps her to see how these feelings are related to her long-standing fear of both knowing and expressing her own needs.

“I’m feeling so horribly sad,” Marion says, her sadness apparent from her voice which I hear remotely on my cell phone. “I feel sad for the country, sad for the world, sad for all the people who are losing their lives every day.”

Pause. “But mostly, I must admit, I feel sad for me. I mean, I’m grateful that everyone I know personally is well, that I haven’t had to deal with a loved one dying without being able to say good-bye… But I feel so alone, which is ridiculous. I know I’m not alone. Arnie is here with me as always. I get to FaceTime with my daughter and grandchildren almost every day – although how they’re all surviving in that apartment I have no idea. And with my son and his husband at least once a week. They’re actually doing very well, working from home and enjoying what they call a second honeymoon.”

Silence.

If I were I in my office with Marion I know I would wait for her to continue before I speak. But remotely I’m concerned that the silence will increase her feeling of aloneness. “And you feel sad because…?” I ask.

She sighs. “Arnie and I have no relationship. None. I mean I know we’ve been together for 30 years. I don’t expect us to be falling over each other like my son and his husband. But something, something…” Pause. “We sleep in the same bed. We get up in the morning, have breakfast, each of us focused on our iPads, barely speaking. Then he goes into the living room to watch endless news shows about the virus. I sometimes take a walk, then head for the bedroom to watch old movies or read or sometimes talk on the phone. I wish we at least had a dog, but of course they don’t allow them in our condo.”

Pause.

“Before at least I got to get out, had a change of scenery. I played cards, had lunch with my girlfriends, went to a movie. When I worked that was entirely different. You know, it’s sometimes hard to believe that Arnie and I were both teachers, that we had interesting lives, interesting things to say to each other. Now there’s nothing. Nothing. Emptiness.”

“And feeling alone with someone feels worse than being alone by yourself.”

“That’s definitely true.”

“You said that you and Arnie sleep in the same bed. Do you ever have sex?”

“I’d be hard pressed to remember the last time we had sex.”

“Do you miss it?”

“Sex has been so perfunctory for so many years it’s hard to say I miss it. I do miss cuddling. I miss the occasional kiss, holding hands, caring about each other. Now there’s literally nothing. The absence feels so bleak. And it’s mirrored in all those pictures of cities without people. Or even here – shuttered tennis courts, golf courses, emptiness.”

“Have you talked with Arnie about your feelings?”

“I’ve tried, maybe not enough, but I’ve tried. I tried sitting next to him on the couch, putting my hand on his knee, asking him something about what’s on the TV. Nothing.”

“But have you told him about your feeling of emptiness, of aloneness?”

“I can’t do that.”

“Why?” I ask.

Pause. “You know what I thought of? I thought of being a child, maybe 10, 11 I’m not sure. It was a rainy, dreary day. Must have been a weekend since I wasn’t in school. I was bored. I went to my mother to see if she wanted to play a game, but she was on the phone and put her finger on her lips and motioned me away. So I went to my father just to be with him. I knew he wouldn’t want to play a game. But he was reading the paper, looked at me annoyed and shooed me away. I learned never to ask, just to wait and see if someone will be there for me.”

“We’ve talked previously, Marion, about your unconsciously choosing a man like your father, but today I’m wondering about something else. What is it that you feel, you, the adult Marion, if you think about telling Arnie what you’re feeling?”

“I can’t.”

“But what is it that you feel?”

“Uncomfortable. Vulnerable. Maybe embarrassed. Like I’m not supposed to have feelings. Maybe like I shouldn’t need anything from anyone.”

“Like you shouldn’t need anything from anyone. I think that’s a very important statement, Marion. I think you’re saying that a long time ago you withdrew from your own needs, that you walled off those needs and locked them in a room somewhere deep inside you. And what you’re left with is a feeling of profound aloneness.”

“That feels right. But what do I do about it?”

“I think we have to start looking for the keys that will help us unlock that door, so we can find the sad, vulnerable child who reached out to her parents that dreary day.”

Today, as I send this blog, I know that we are all in an alternative universe, overwhelmed by fear, locked in our homes, trying to get by the best we can. When I say I hope you are all well that hackneyed phrase takes on a whole other meaning. And I do wish you are well, with special thoughts to the New Yorkers on this list who are particularly under siege.

My blog, "Why," is unsurprisingly about the coronavirus, illustrating a patient's terror and her unrealistic demands of her therapist.

“I can’t stand it!” Marilyn yells into the telephone. “Why did this have to happen? I can’t stand being all by myself. There’s no one here, no one. I’m totally and completely alone.”

“I’m here,” I say quietly.

“No, you’re not! You’re not here. I don’t even know where you are but I know I’m not with you. I have to be near you. I have to imagine being able to touch you, even though we never do! And that’s what I want right now. I want you to touch me! I want you to hold me!”

Like most therapists these days, I am ‘seeing’ my patients remotely from home. Since for most of my career I have used the telephone when patients cannot be in my office, I am more comfortable using this modality than facetime or video conferencing. Most patients have been able to adapt to this new reality.

“Sounds like you’re feeling alone and desperate and wanting me to take care of you.”

“Now there’s a therapist response if I ever heard one! What good are you? You’re just a disembodied voice floating out there somewhere in space. You can’t give me what I need.”

“I understand that you’re feeling alone and uncared for, just as you felt as a child,” I say. “I understand that you want me or someone to save you, just as you did as a child. We’re all scared, Marilyn. We’re all in the same frighteningly unknown scary position.”

“But not everyone’s alone.”

“No, not everyone’s alone,” I agree. I want to add that many people are alone. I want to suggest that she call friends, reach out to family. I want to suggest that she start some of the projects she’s been wanting to do around her house, anything that will help her to feel more adult. But I know Marilyn will not, at this point, be able to hear such suggestions. She feels far too scared, back to being a child with an explosive, alcoholic father and a depressed, absent mother.

“Is there someway I can be helpful to you, Marilyn,” I ask.

“You can tell me when this is going to end! You can tell me why this is happening to me! You can tell me why only bad things have happened to me my entire life! It’s not fair!! I hate it!! I hate it!!”

Although I can feel my patience fraying, I try to retain my image of Marilyn as the frightened and vulnerable child. “I hear you, Marilyn. And I’m sorry you’re in so much pain.” I refrain from saying that this isn’t only happening to her and that she has known good times in her life. I know the futility of such word.

“I know,” she says suddenly. “I know how you can help me. You can tell me your address and I can come by and give you a hug and we can sit in your living room and visit.”

I am taken aback by the outlandishness of her request. At first I begin to respond directly, “You know that’s not something…” Then a thought comes to me and I stop myself. “Marilyn, have you just set yourself up? Have you just asked for something you know I won’t do so that you can continue to feel that I’m just one more of the long list of people who aren’t there for you, who don’t care about you, who can’t save you?”

She bursts into tears. “But you don’t!! You don’t care. Why can’t I come see you? Why can’t I come hug you?”

“Marilyn, can you try to answer those questions yourself,” I ask gently.

She sobs on the other end of the telephone. “You don’t care about me! I’m just a patient to you.”

I again consider responding directly and then decide against it. “What if you allowed in that I do care about you? What if you allowed in that I care about you and still can’t tell you when this will be over or why it’s happening? What if you allow in that I can care about you without being able to save you?”

Marilyn is sobbing uncontrollably on the other end of the line. “That can’t be! That can’t be!” she says between sobs.

I am silent and then say quietly, “It’s very hard to give up the hope of being saved, of being saved in the present and of being saved in the past.”

“I want you to hold me, I want you to hold me.”

I imagine Marilyn hugging herself and rocking back and forth in her chair. “I know, Marilyn,” I say, “I know.”

In this month's blog, Denial, a patient explores her inability to face the painful reality of infidelity.

As soon as I open the door I know that a different Rita is waiting for me today. Instead of her usual bubbly, sometimes false cheery self, I see a woman on the verge of tears who looks up at me beseechingly. 

Seated in my office, Rita begins. “I don’t know what’s wrong with me. I know I’m not stupid and I know I’m a 52 year old woman, so I don’t know why this is hitting me so hard. But I had no idea, absolutely no idea.”

I first thought Rita was referring to her husband Henry’s infidelity, but since it has been several months since she found out about his long-term affair, I assume she is referring to a more recent event. I wait.

“My parents are getting a divorce. They’re in their seventies! I couldn’t believe it.”

“I can understand being shocked about a decision that came out of the blue.”

“But that’s just it. It didn’t come out of the blue! My mother couldn’t believe I hadn’t known. She told me my father was unfaithful to her their entire marriage, that they fought about it constantly.”

Now it’s my turn to be surprised. Rita had always described her parent’s marriage as idyllic. She said that’s what made Henry’s betrayal even more disturbing. She’d never been personally close to anyone who dealt with infidelity.  

“I feel like I’m going crazy. I called my sister – my sister who’s younger than me - and she knew! She said they always fought about it! I asked her why we never talked about it. She said we’d literally put our blankets over our heads and guessed we did that figuratively too, like we didn’t want to think about it.”

“That’s a lot to take in. Maybe we should start with what you find the most disturbing about all these new revelations.”

“I don’t know. All of it. That I had no idea. How did I do that? Did I do that in my marriage too? Was I blind to my husband’s affair? Did he have other affairs I have no idea about? I feel as though I’m going in circles. My head feels like mush.”

“I guess one thing we know is that you have a striking ability to not know, to not see what you don’t want to see.”

“But why? Why can’t I know?”

“I guess it felt too intolerable to know.”

“But I can’t live my life like that! It’s a tremendous handicap. It’s like being divorced from reality.”

“I agree, but I think the question we need to ask ourselves is why you felt the need to deny what was right in front of you. You need to understand, not to beat yourself up.”

She sighs, but remains silent, looking dazed and confused. 

I think about denial as a defense. It works as long as it works, but when it breaks, reality smacks you in the face, hard.

“What do you feel about your Dad’s infidelity now? How do you feel about them divorcing?”

“I don’t know. I haven’t gotten there yet.”

“Okay, so tell me where you have gotten.”

“Trying to remember the past. Trying to remember them arguing, trying to remember putting my head under the covers.”

“What would you have felt if your parents divorced then, when you were a child?”

“That wasn’t possible! It’s couldn’t happen!”

“So let’s assume for a moment it was possible. What would you have felt?”

Rita stares at me wide-eyed, shaking her head, repeating, “It couldn’t happen, it couldn’t happen.”

“Rita, see if you can find your feelings,” I say gently.

She continues to stare at me until she starts sobbing. Then she buries her face in her hands.

“No, no,” she moans. “I’m all alone, left. I won’t make it. I can’t make it.”

I remain silent, respectful of her feelings as the scared, vulnerable child.

“A family, a unit,” she says between her sobs. “We were one or nothing. Lost, adrift, floating, nothing.”   

“Sounds pretty scary. I can certainly understand not wanting to know something that would lead to such catastophe.”

“But it’s not rational,” she says, quickly shaking her head as if trying to wake from a nightmare.

“No, it’s not rational, but that doesn’t mean it’s not how you felt and it’s how you felt that matters.”

Silence.

“I suddenly started thinking of my husband. Do I feel the same way about him? Do I feel there’d be nothing if I left him? Is that why I’m not leaving him?”

“Those are really good questions and I’m sure we’ll return to them next hour and for some time to come,” I reply, while thinking of the power of the unconscious, about Rita choosing a womanizer like her father without even consciously remembering that he was a womanizer.

"Compassion" addresses the difficulty a therapist has moving her patient beyond self-hatred to a place of compassion where she can mourn the mother she always wanted but never had.

“You don’t understand!” Morgan screams at me through clenched teeth, hitting the sides of her head with her fists. “I hate myself! I hate myself! I’m stupid and ugly and awful. Bad! Bad! Bad!”

“Stop it, Morgan,” I say raising my voice. “You know you’re not allowed to hurt yourself in my office. Stop and try to calm down.”

Morgan brings her fists in front of her eyes and bursts into tears. I silently breathe a sigh of relief. She continues to sob.

“I’m here, Morgan,” I say gently.

She nods, still crying. 

“She’s such a bitch,” Morgan manages to say through her tears. “But why am I such a mess? I should know it by now. She’s the golden child. Everything good comes to her. And me? I’m just bad and deserve everything I get.”

“Morgan, is there even a little part of you that knows that’s not true, that knows you were a small, helpless child who deserved to be cherished, not beaten?”

“Nope! You just said it. I was small and helpless, by definition that made me bad.”

“But all children are small and helpless, Morgan.”

“But not all children are illegitimate.”

“That was hardly your doing.”

“Tell that to my mother. I was born, ergo it’s my fault. And then Prince Charming comes into the picture and the golden child is born and I’m even more worthless than before. And now not only does Mom get to beat up on me, but my sister does too. You should have heard her gloating. Gloating! I mean I get it. She’s happy she’s pregnant. I should be happy for her. But gloating. Like it was a contest. I can’t even get a relationship and she and Rob are going to be the ‘happiest people in the world. You’ll know what I mean when it happens to you.’ Gag! I thought I’d throw up. But that’s because I’m bad. Because I can’t love my sister, because I can’t be happy for her.”

“It’s very hard to be happy for someone who smiled sweetly after she got you in trouble and watched you be beaten.”

“But I deserved it! I did pull her hair, or steal her doll, or punch her. I hated her! I still do. And that makes me really, really bad.”

“Does it?”

“Doesn’t it? Aren’t you supposed to love your sister? Aren’t you supposed to turn the other cheek?”

“Your rage at your mother had to go somewhere.”

“See, that’s exactly what I mean. I was a rageful brat. And if I couldn’t rage at my mother, I turned it on my sister. Charming!” 

I sigh. “I always feel as though I’m arguing with you, Morgan, always trying to convince you that you need to have compassion for yourself…”

Morgan interrupts me, snorting her disdain. I continue talking.

“…that you need to have compassion for yourself as the scared, helpless child you were and understanding for yourself as the angry adult who keeps turning that anger on yourself.”

“Compassion doesn’t exist is my vocabulary, let alone in my experience.”

“If you read about a child who was beaten with a belt, who was locked in a closet, who was repeatedly sent to bed without food, wouldn’t you feel compassion for that child?”

“Maybe. But for me, for me I feel only hatred. I was bad. My mother was trying to beat the badness out of me. If my mother was bad she would have beaten my sister too. But it was only me, only me who needed to be beaten.”

“I do understand, Morgan, that you have to hold on to the belief that you were the bad one because as long as you’re the bad one you still have hope you can be different and win your mother’s love. But if she can never love you – perhaps because of the circumstances of your birth, perhaps because you reminded her too much of her – then the hope of her loving you is gone and you’re left in mourning, without the only mother you ever had. And that’s sad, Morgan. Very sad. And you need to find compassion for yourself.”

“There’s that word again. You don’t get it. There’s no word like that for me. It’s as though you were speaking Chinese.”

“I do understand that compassion feels entirely foreign to you. But you need to find your compassion for yourself, perhaps by first taking in my compassion for you. Your life has been terribly painful and unfair and you need to be able to feel sad for you.”

This blog deals with the "Fallout" of a broken relationship. After a patient's girlfriend breaks up with him, he and his therapist deal with his need to continually choose women who give him less than he wants.

“This has been one shit week,” 35 year old Adam says, staring down at his hands. “Chelsea broke up with me. I mean, it was kind of mutual, but really it was her. She said I’d never be happy with her. She’s convinced she doesn’t ever want children. She’s way too into her career – I think she even fantasizes about being President one day – and then her own background was so awful. Drug addicted mother, alcoholic father. If it wasn’t for her grandmother she would never have made it.”

“I’m sorry, Adam. I know you loved her and hoped it would work,” I say.    

“But she was right. I always hoped she’d change her mind about children, that as her biological clock started to run out she’d want a have a child.”

“And did she hope you’d change your mind?”

“Maybe. But I think our relationship was always more important to me than to her. I know it’s supposed to be the other way around with men and women, but it doesn’t seem to work that way for me. Anyway, there’s another part. Since I didn’t see my parents over the holidays they decided to come down this past weekend. I thought that would be good. They’d support me, be a shoulder to cry on. So I waited until we got to their hotel and suggested we have a drink. As soon as I told them, and they could tell I was pretty broken up, my mother’s first response was, ‘Well, I hope you’re able to take an important lesson away from this.’

“I just stared at her. I couldn’t believe it. ‘What’s that supposed to mean?’ I asked. ‘You know,’ she said, ‘such a different background, how could you expect it work out, especially in the long run. I mean I know she was white, but wasn’t she Cuban or something? I’m sure there are many nice Jewish girls you can choose from.’ This is my Democratic, college education mother talking. I really got mad. It’s a good thing we were in a public place or I know I would have started screaming. As it was, I had this deliberate, icy voice, telling her she was the biggest hypocrite I knew and that she must have forgotten that Chelsea who, in fact, had been born in the States, had a Ph.D. in political science. She didn’t give an inch, just kept saying it didn’t matter, that one’s background always made the difference. At that point I just got up and left. I was done.”

“Did you see them again?”

“Yeah, my father called and convinced me to go to dinner with them. It didn’t go well. My mother and I hardly said a word to each other; my father kept asking me inane questions about work, IT stuff he doesn’t understand and clients I can’t talk about. It was ridiculous. And the next day wasn’t better. She just wouldn’t move from her super-prejudiced position.”

“I’m sorry. It must feel as though you lost both Chelsea and your mother.”

“Yeah, and in the end unless I play nice I’ll lose my father too. He always ends up siding with her.”

“So how are you doing now?” I ask.

“Interesting you ask that. I was wondering where you stand. What you would feel if it was your son who was dating someone from a shitty background or another culture?”

As Adam was speaking I had been thinking about my first serious boyfriend who had, in fact, been from a shitty background and a different culture and, much like Adam, I was surprised to see how negatively my extremely liberal parents reacted. But Adam doesn’t need to hear my story.

“So how do you think I’d feel?” I respond.

Adam rolls his eyes. “Are you really going to fall back on that therapist routine?”

“You’re angry. Who’s to say you’d believe whatever I said?”

“Just answer the goddamn question,” Adam says raising his voice.

“I’d like us to look at a few things first. We’ve talked about how you keep trying to win with your mother, trying to get her to love you for who you are as opposed to who she wants you to be. I think that’s why you choose women, like Chelsea, who are less into you than you’re into them. You keep hoping to win them over.”  

“Makes sense.”

“And I think deep down you weren’t at all surprised by your mother’s reaction, just as you weren’t surprised that Chelsea would break up with you. You have to be able to give up hope of winning the unwinnable woman.”

Pause.

I continue, “And even demanding that I answer your question. I could answer it, but perhaps it would be better if I didn’t so we can bring right into this room your feeling of loss and longing.”

“Great! So now I feel as though I’ve lost you too.”

“Do you?”

“A bit. But I also understand what you’re saying. And I’d like to stop picking women who I’m always chasing after.”

Losses," focuses on the experience of absence many feel, particularly during the holidays. It also highlights the importance of the relationship between therapist and patient.

“I couldn’t wait to get here today,” Carol says, practically breathless. “I had the most awful dream. It’s not as though anything so awful happened in the dream, but it felt awful.”

I have been seeing Carol in intensive treatment for many years. She entered therapy her mid-40s, terrified of being depressed and non-functional like her mother. She felt overly anxious and unsure of herself and although by all external appearances she had a successful life, inside she felt like a scared little girl.

“In the dream,” she says, “I was back in the apartment I grew up in as a child, which of course was awful in itself. I was sitting at the same shabby kitchen table I sat at as a child. We were having dinner. It was just me and my parents. I don’t know where my sister was. Maybe she had a fight with my father and stormed out. My mother was her usual depressed self, beaten down, defeated. My father was stuffing his mouth, but I had the feeling he was fuming. Of course he was always fuming, so that’s no surprise. I felt terrified. I don’t know if I was waiting for my father to explode. I don’t know, but I hated it! I hated that I was dreaming of that place again.” 

“What comes to mind about the dream?” I ask.

“I don’t know. It seemed to come out of nowhere. You know I’ve been feeling really sad since Thanksgiving. I would have thought I’d be dreaming about that, all the losses. You remember, sitting around my daughter’s table and thinking of all the people who weren’t there.”

I did indeed remember. Thanksgiving brought up similar feelings for me, an awareness of all the absences, all the people who had died. 

She continues. “My husband dead of pancreatic cancer, my son killed in Iraq, so many of my friends. I’m only 50, how can there be so many people in my life already dead. I mean I love my daughter and she made a beautiful Thanksgiving, but the losses, the losses overwhelm everything.” 

She pauses, dabbing tears from her eyes. “So what am I doing dreaming about my childhood apartment? That’s one thing I don’t mind having lost. I guess I felt sad when my mother died, but in many ways I thought she welcomed death. Now at least she could be at peace. And my father, I know it’s terrible, but truthfully his death was a relief.”

“So why do you think you’re dreaming of your childhood apartment at this time?” I ask, a thought forming in my mind. I also used to dream of having to leave my idyllic home and adult life and return to the apartment of my childhood. For me those dreams were about my fear of loss, of losing what I so cherished in my present, adult life. For Carol many of the losses have already happened. 

“I wish I knew.”

“Is there a connection between the losses you felt so acutely at Thanksgiving and the dream of returning to your parent’s apartment?” 

“What I just thought is, maybe there’ll be no one left, maybe everyone will die, maybe there’ll be no place to go. If there’s no one left, maybe the only place I can go is to go back to them! I mean I know that doesn’t make logical sense because they’re dead too, but maybe that’s how it feels. If everyone leaves me, I’m back to being an abandoned child, a helpless, dependent child who has to go back to my parents.” She starts sobbing. “No,” she whispers. “No, that won’t happen. I have you. And as long as I have you, I don’t ever have to worry about going back there. You’ll remind me I’m not that helpless, dependent child. And if I do slip into that helpless place, you’ll be here to help me back up.”

I hesitate. We’re near the end of the hour. This has been a difficult session for Carol. But… “Carol, I wonder if you realize how much you’ve been your own therapist this hour, how much of me you’ve taken in over the years…”

“You’re not leaving are you?” she interrupts, panicked. “You’re not retiring? You’re not dying?” Her fear is palpable.

“I have no plans to go anywhere. But as you well know, we never know what life has in store for us. I do know I won’t live forever. And I also know that you’ve taken in so much of me. Did you recognize, even just in this session, how much you were able to do your own therapeutic work?”

“But…” she begins.

“We’re not ending, Carol. I’m not going anywhere. And it is also important that you recognize your own strengths. They don’t reside in me. They live in you.” 

Removed, a patient's difficulty in connecting to others is unsurprisingly replicated in the therapeutic relationship.

“I’m thinking of breaking up with the girl I’ve been dating,” Andrew begins. 

If I’m not mistaken, this is the third woman he’s broken up with in the several months I’ve been seeing him. Tall, with curly brown hair, 35 year old Andrew could be described as a handsome man, except that he feels too flat, too disengaged.  

“I know,” he continues, “I just said I thought she might be the one. I don’t know, we just don’t seem to click. I mean, we’re okay sexually, it’s not that. Maybe she’s too eager, too needy. I need her to back off. But that’s pretty crazy,” he says, half laughing at himself. “You’d think with my parents being so disconnected, I’d be dying to have a woman who’s really into me.”

“Can you say what she does that makes you feel she’s too needy and what goes on inside you?”

“I don’t know. Well, like she’s constantly texting me.” Pause. “But that’s not really true. She might text me in the morning and then once maybe after she’s done teaching for the day.”

“But it feels like a lot.”

“Yeah, that’s right. It feels like she’s always there.” 

“And when you’re actually with her?”

“I know this sounds bad, but I kind of want us to do whatever we’re going to do – go out to eat, go to the movies, whatever – go back to my place, have sex, and then have her leave. That’s enough for me.”

“While you’re with her, do you feel connected to her? You know, I just realized we’re both talking about ‘her,’ not using her name.”

“Her name’s Paula. And no, I don’t feel connected to her.” Pause. “I’m not sure I feel connected to anyone.”

“No one?”

“I don’t think so. I mean, I get along with people, I know what to say, how to act. But I wouldn’t say I feel connected. I tell my parents I love them. I hug my sister and my nieces. But it’s more that I know I’m supposed to do those things.” 

“Do you feel connected to me?”

“To you?” he asks, surprised.

I nod.

“No. We have a professional relationship. I pay you to listen to me and then I leave. I can’t imagine feeling connected to you.”

Kind of like what he wants from Paula, I think. What I say is, “Can you imagine feeling connected to anyone?”

“I guess my wife when I have one. And my kids, whenever that happens.”

“And not feeling connected, how does that make you feel?”

“I don’t know. Normal, I guess. Normal for me anyway. It’s how I’ve always felt.” 

“Do you ever feel lonely?”

“Lonely? I don’t know. I like being alone. I’ve always felt alone.”

“You know, Andrew, as I listen to you, I feel sad for you. You seem so alone, so cut off, so removed, both from others, as well as from your own feelings.”

He shrugs.

“And you did come into therapy. I think you said you wanted to figure out why you weren’t able to stay in a relationship with a woman. Sounds like we need to figure out why you can’t be in a relationship with anyone.”

“I guess.”

“Andrew, do you remember what you felt when you were little and your parents left you with one of your nannies and went away on business for months at a time.”

“That’s just how it was.”

“But how did you feel? How did you feel as that little boy?”

“I don’t remember.”

“Can you imagine doing that with your child some day?”

“Oh no! No, I couldn’t imagine ever doing that.”

“You seem to have more feelings about imagining leaving a child you still don’t have, leaving that imaginary child alone, than you’ve had about anything else we’ve talked about today.”

“I guess that’s true. But what does that mean?”

“That you’re that imaginary child; that buried deep inside you are lots of feelings about being left, sad feelings and scared feelings and angry feelings.”

“You think so?”

“Yes, I do.”

“So why don’t I feel them?”

“I imagine you locked those feelings away a long time ago and that opening that door feels overwhelmingly scary.”   

“And how’s that related to my not staying in relationships?”

“I think that when you start to get close to someone or if someone starts to get close to you, the possibility of needing or relying on that person brings you way too close to the scared, vulnerable, needy feelings you had as a child and you immediately close off and run away.”

“I guess that makes sense, but what do I do about it?”

“We start by carefully looking at your feelings as you go about relating to people in your life, including me, and seeing if we can find when you start to get scared and start pulling away.”

“Sounds like a long process.”

“I’m not planning on going anywhere.”

Left, strikes a theme familiar to us all. A therapist goes on vacation for a week and returns to an angry, defensive patient. 

LeAnn has been sitting across from me for at least five minutes, staring down at her hands, occasionally raising her cobalt blue eyes to scowl at me. I have made several attempts to ask her what’s going on, but have been met with silence or another scowl.  

“Are you angry with me because I was gone for a week?” I ask.

“I almost didn’t come today,” she responds.

“I guess you’re angry with me.”

Silence.

I continue, “I understand that separations are hard for you, LeAnn, that you have lots of feelings about being left. You’re frightened that I won’t come back, just like your mother didn’t come back.”

LeAnn’s eyes fill with tears. Fiercely, she brushes them away. “I’m such a baby! I’m 28 years old, not five. Besides she didn’t mean to leave, she died! Why can’t I get that through my head!? And you’re not my mother. It shouldn’t be a trauma for me to have you leave for a week.”  

“You notice, LeAnn, that first you were angry at me and now you’re angry with yourself. I wonder why you have to be angry with someone.”

“What’s the alternative? It has to be someone’s fault. You left me and that’s your fault and it bothers me and that’s my fault. If it didn’t bother me, you could go on as many vacations as you’d like and I wouldn’t care one way or the other.”

“Except that’s asking yourself to be like a robot, to have no feelings about anything, to make your past disappear and not affect you in the present.”

“Yeah! That would be a great idea. Not having the past affect me. Wait a minute, you mean I’m doing all this therapy and I’m still going to fall apart every time anyone I care about goes away for a few days? That would be pretty pointless.” 

“Well, let’s look at that. What did you feel when I left for a week?”

“Mad. Like how dare you leave me when you know I need you, when you know how hard it is for me.”

“Okay. Did you feel anything besides mad?”

“Why don’t you just tell me what you’re after?”

“I guess you’re still mad.”

She sighs deeply, rolling her eyes.

Despite LeAnn’s provocativeness, I don’t feel angry with her. Her scared, powerless child-self is so glaringly apparent. “I think anger is easy for you. It’s the feelings underneath that are more difficult – sadness, fear, vulnerability.”

“Those all sound charming.”

“As I said, anger is your easy go to. But think about yourself as that little child. Your parents go on vacation, leave you with an aunt you don’t particularly like. Your father comes home alone. He tries to explain to you that your Mom had an accident, that she fell from the balcony of their hotel room, that the railing gave way. That would be a lot for an adult to take in let alone a five year-old child. And then your father himself becomes unavailable, never really coming back from his grief. You’re all alone. How could you not feel overwhelmed by fear and sadness?”

“And this will help me how?”

“As long as you defend against your feelings of sadness and fear with your anger, you can never really complete the mourning process. The five year-old child in you needs to feel all your feelings so that you can move beyond them, so that you can truly know that although you may feel sad and scared as an adult, you won’t feel it with the same desperation as that five year-old. You won’t feel as though you can’t survive. You won’t feel that your very life is threatened when I or your boyfriend or whomever leaves. You can never predict what will happen, you may not have someone to blame, but you’ll know that you can indeed survive whatever happens.”        

“That sounds like a pretty story, but how do I know it will work like that? What if I let myself feel all those feelings and all that happens is that I’m stuck there, stuck as that five year-old forever? That scares the shit out of me. As it is, I’m a mess when you leave for a week. I don’t want to be a sniveling baby forever.”

“I understand that it’s scary, LeAnn, but not feeling all the feelings involved in mourning is much more likely to keep you stuck than daring to let yourself dive into the muck and come out a stronger person in the end.”

“I hear you. I just don’t know if I believe you.”

“Fair enough. We’ll keep working and see what develops.”

a patient's early guilt feelings spill over into her present, including the treatment.

Opening my waiting room door I’m surprised to see the usual bubbly Marlene sitting downcast, twisting a tissue in her hands. She rises slowly, manages a weak smile and walks into my office. “I feel awful,” she says. treatment.

“I can tell. What’s wrong?”

“It’s Scooter.”

It takes me a second, but I realize she’s talking about the family’s dog, a relatively young schnauzer if I remember correctly. 

“My son will never forgive me. He keeps telling me he hates me, that Scooter was a member of our family, that it’s all my fault. And he’s right! I don’t know how I could be so stupid,” she says, bursting into tears.

I find myself holding my breath, wondering what happened to Scooter, hoping he’s not dead.    

Marlene continues, “I opened the garage door. Scooter ran out. He was hit by a car. He’s not dead, but the vet doesn’t know if he’ll make it. His leg’s broken. Depends on how much internal bleeding there is.”

Tears well in my eyes, as images flash in my head. Poor rescued Siggy who I’d nursed back to health on a graduate student’s stipend, running out the front door, killed by a car; Brenna, our black Lab, poisoned, hovering between life and death but fortunately making it; and Hadley, so connected in my mind to my late husband, needing to be put down when auto-immune disease ravaged her seven year old body.

“I’m so sorry, Marlene. I know how hard this must be for you. And for your son. I really hope Scooter’s all right.”

“Me too,” she says smiling wanly. “Didn’t take any time for my ex – almost ex – to start screaming at me. Even threatened to bring it up in mediation. Said he wasn’t sure he could trust me with Davey. How could he know I might not let Davey out the door? Talk about pouring salt on the wound.” Pause. “Davey’s so mad at me. He doesn’t remember a life without Scooter. And now without his Dad…,” she says crying. “I can’t believe I was so stupid.”

“You keep saying that. I don’t think it has anything to do with being stupid.”

Marlene looks up at me, frowning. “What are you implying?”

Taken aback I say, “That you’re not stupid.”  

“So are you saying I did it on purpose?”

Puzzled, I look at Marlene and say, “Absolutely not! I was saying it was an accident.”

“I thought you people didn’t believe in accidents.”

“’You people?’”

“You know, shrinks.”

“Tell me what’s going on Marlene. I understand that you’re sad and distressed about Scooter. I understand you feel guilty. But it sounds like you’re attributing thoughts to me that I’m in no way thinking. What is it that you’re thinking, fearing, worrying about?”

She sighs. “When I was a kid we had a parakeet. Actually it was my younger sister’s. I wanted a dog. My mother said no way. So we got a bird. I never liked it much. The bird got out of the cage and ended up flying out the window. My sister cried for days. My mother said it was my fault, that I let the bird out.”

“And you’re worrying I’ll think you let Scooter out the garage door?”

“I didn’t!”

“It never occurred to me that you did.”

“It didn’t?”

“No, it didn’t.” Somewhat hesitantly I add, “But I don’t know about that bird. How did the bird get out of the cage?”

Marlene lowers her eyes. “I let it out,” she says quietly. “But I didn’t mean for it to fly away. I just wanted it to do something besides sit in that dumb cage all day!”

“Sounds like a perfectly understandable thing a child might do.”

“It does?”

I nod. “Also sounds like you’ve been carrying that guilt around with you for a long time.”

“But I didn’t want to get rid of Scooter! I know he can be demanding sometimes and that he does take up time, but he’s a member of the family. I didn’t want him gone.”

“I believe you Marlene. We all want beings we love gone sometimes, including human beings. It doesn’t mean we stop loving them or that we really want them gone forever.”

Marlene is sobbing. “Thank you. I really needed to hear that.” Pause. “Cause truthfully I got scared when my ex said he wasn’t sure he could trust me with Davey. I started wondering if I was purposefully negligent.” Pause. “If I was evil. That I’d harm Scooter or even Davey just like I hurt that bird.”

“You’ve been carrying around a lot of guilt for a very long time. Seems like it’s something we need to look at.”

A patient's competitiveness is directly on display in the treatment room.

Gina smiles at me, sashaying into my office from the waiting room in her short, tight, floral dress.

“Like my new dress?” she asks, settling into the chair, trying unsuccessfully to both cross her legs and cover them. “My friends tell me 45 is too old to wear a dress like this. But I don’t care. I’ve got it, I’m flaunting it. They’re just jealous. What do you think?”

I silently agree with her friends and wonder if she wants me to be another jealous woman. I say, “You get to wear whatever you want to wear.”

“It makes me feel alive. Of course, I’ve been feeling pretty alive these days anyway. Nothing like an affair to spice up one’s life. New man, new compliments, new sex. I love it when I get on top of him and all the lights are on and he looks at me while stroking and pinching my nipples. We can go for hours.”

Gina and I have talked a lot about her affair. I remain silent.

She pauses and then continues, “You know how I like to read all these mysteries – some old, some new – Agatha Christie, John Grisham, Patricia Cornwell, Scott Turow…?”

I nod, unclear where Gina is headed.

“Well, ever since I’ve read that Presumed Innocent book about the wife trying to get back at her husband by framing him for his girlfriend’s murder by using his semen, I’ve been fantasizing about how to kill you know whose wife and set my husband up to take the fall.”

My anxiety spikes. “Actually I don’t know who,” I blurt out, “since you continue to refuse to tell me who he is.”

She laughs. “It’s just an expression. We’ve been over this a million times. She’s in your field. I’m afraid you’d know her, or even him. End of topic.”

“It can’t be ‘end of topic’ if you’re considering killing her!” 

“You’re being so silly today,” she says dismissing me with a wave of her hand. “I didn’t say I was going to kill her – I couldn’t do that – I’m just fantasizing about it.”

I think about what she just said. It’s true. She was talking about fantasy, not action. I’ve listened to many patients over the years talk about their murderous and/or suicidal fantasies without assuming they were going to act on them. What’s different here, I ask myself.

Gina is speaking, “..it wouldn’t even be hard. My husband and I even have a better sex life these days. I guess I’m so turned on all the time, I’ve been more sexy with him too. See, he’s enjoying my affair too. But I can’t figure out how I’d get him to use a condom. So far my fantasy hasn’t helped me with that one.”

And do you find your murderous fantasies a turn-on?”

She taps her lips with her left index finger, considering my question. “I guess. But the turn on is having the power to figure something like this out – not dummy Gina after all. It’s exciting.” Pause. “Don’t you think it’s exciting?”

Suddenly I’m convinced that everything that’s happened in this room today is about Gina and my relationship. 

“Gina, I wonder if we can step back for a minute. It feels to me that you’re trying to one up me..”

“What are you talking about?”

“Well, I think you’ve tried to make me jealous, tried to titillate me with your sexual stories, dangled withheld information in front of me, and terrified me with talk of murder.”

“You have one warped mind if you think I’m trying to turn you on!”

Interesting comment, I think to myself. “I didn’t say that you were trying to turn me on. I think you’re trying – and I’m not saying it’s conscious – that you’re trying to make me feel less than you, trying to win over me, just as you tried to win over your mother to be closer to your father.”

“I’ve told you, I did win! My father called me ‘the beauty.’ It’s me he wanted to twirl around in my new clothes. It’s me he took to breakfast on Sunday morning, just me, not my mother, not by brothers.”

I think, but reject saying, ‘but who went into the bedroom at night?’ a remark that feels both premature and hostile. “Let’s go back to us for the moment,” I say instead. “You started the session talking about your friends being jealous of you. Seemed as though you wanted me to be jealous too, like you’re flaunting your beauty, your sexuality.”

Gina looks at me coyly. She drops her head for a second and then looks at me defiantly, “I don’t want to be mean, but you’re not a worthy opponent. You’re too old.”

“Wow!” I say. “You’re correct. I’m considerably older than you. But the way you just said that, sounded like you were intent on delivering a death blow. I guess I’m another murder victim.”