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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.” 

In this blog, Boredom, a therapist seeks to understand her patient's consistent lateness and her underlying boredom.

I look at the clock. Camilla is now 15 minutes late for her session. I’m not surprised. She’s been consistently late for every session since we started working together several weeks ago. She always apologizes, always has some reason – the car wouldn’t start, she got a last minute phone call, the traffic was bad. 

Finally I see the red light that signals a patient is in my waiting room. 

“I’m sorry,” she says, breathless. “I told myself I’d be on time today. But my Mom called and was telling me I needed to call my Grandmother. I know I should. I love my Grandmother, but I don’t like talking to her on the phone. It’s boring. She asks the same questions – how’s my job, have I met any nice boys, am I going out with my friends. Boring!”

“What makes it boring?” I ask and then immediately regret my question. I want to talk to her about her lateness. Or at least ask her what she means by boring. 

“I told you,” she replies, crossing and uncrossing her legs, combing her fingers through her long brown hair. “She always asks the same questions. My job is fine, I haven’t met anyone and, yes, I go out with my friends.”

We sit in silence for a few seconds until she says, “What? You think I should call my Grandmother?”

I shrug my shoulder. “I think that’s up to you.”

She sighs. “I wish my mother felt like that.”

Silence.

“What?” she asks again. “Aren’t you going to ask me anything?”

“What do you feel in the silence?” I ask.

“What?”

“What do you feel in the silence?”

“Like we’re wasting time, not getting anywhere.”

“That’s what you’re thinking, what are you feeling?”

“I don’t know.” Pause. “Bored I guess.”

“Sounds like it’s easy for you to feel bored.”

“Yeah, I guess,” she says fidgeting in the chair. “I don’t like sitting still. I don’t like quiet. I need to have stuff going on. That’s why I like my job at Saks, even though my parents say they didn’t pay for me to go to college for me to work at Saks. But there are people around and all those great clothes. Even if we have no customers I can walk around picking out clothes, holding them against me, deciding if I see something I really, really want. Although that’s frustrating because I can’t afford most of that stuff anyway, even with the employee discount. Not until my parents give me an allowance again. They say they’re paying for my apartment and until I get a real job that’s all I get.” Pause. “But I’ve told you all this already. What else should we talk about?” she asks, glancing at the clock.

“Do you have any thoughts about why you looked at the clock just then?”

“I don’t know. I guess because I’m bored and because time is just crawling by.”

Ah ha, I think. “Camilla, do you think it’s possible that you’re consistently late here because 45 minutes feels like a long time to sit and talk to me?”

She looks startled. Then smiles. “Yeah! 45 minutes is a long time! I never sit for 45 minutes. It’s why I always nix going to the movies. Who can sit for two hours watching a dumb movie?”

“So you come late so you don’t have to sit so long?”

“Yeah. But it’s not like I decide to come late. It just happens.”

“I understand. But it may ‘just happen’ because you unconsciously don’t want be here for the full session.”

“I suppose.”

“Is there any other reason you might want not to come here?”

“I don’t know. What are you getting at?”

“Well, I was wondering if coming here is kind of like calling your Grandmother. You feel you should do it. You know your parents want you to do it. But maybe it’s not really something you want to do.”

“Maybe,” she says shrugging.

“You’re 25 years old, Camilla. You don’t have to be here if you don’t want to.”

“I know,” she says looking down. “But I have to do some of the things my parents ask.”

“I think it would be important for you and for us to know what it is that you want to do.”  

“I don’t know what I want to do! That’s why I’m here.”

“Does that mean you’re not only being an obedient child by coming here, but that you do want help figuring yourself out?”

“I guess.”

“That doesn’t sound too certain.”

“Can we make the sessions 30 minutes?”

“No. My schedule is based on 45 minute sessions. And, besides, if you decide you want to come, I think it would be good for us to work on what makes it so difficult for you to be still, on what you feel underneath what you call boredom. And perhaps we could look at your lateness – or being on time – as a message about how you’re feeling about me and the therapy. That’s if you decide to continue. And that’s something you will have to decide.”

In this week's blog, "Father's Day" a patient's ambivalence about his parents takes center stage, increasing his anxiety about separation and loss.

“I have to decide today,” says 44 year old Brian, a patient who started seeing me last month because of overwhelming anxiety. Passing his hand through his brown, wavy hair he continues. “I’ve delayed and delayed, but if I’m driving to Pensacola tomorrow in time for Father’s Day, I have to make a decision today. No more procrastinating.” Pause. “It’s no secret that I don’t want to go. Even my mother who’s calling me every day to bug me about coming knows I dread the idea. And my wife is staying out of the whole thing. Which is kind of her. All I’d need is for her to be pulling me in the other direction and saying I need to stay for our boys.”

“I notice you’ve mentioned your mother, your wife and your boys, but not your father.”

Brian chuckles. “You’ve got that right. I realize it’s supposed to be his day, but if it were only for him I know I wouldn’t go. I mean, he was awful my whole life, but ever since he banished my brother because he’s gay and then Trump was elected, it’s impossible to have five minutes of a civil conversation. My father has always been a tyrant. He has an opinion about everything and for some reason he thinks he’s an expert on everything too. Which is ridiculous, since he barely finished high school and clearly isn’t very bright.”

I think of my father, definitely smart, politically like-minded, but most definitely a tyrant. “So why would you go?” I ask.

“My mother.” Pause. “And she’s right, they’re not getting any younger. But she’s pulled out every guilt inducing maneuver she can think of. ‘What if Dad dies and you never see him again?’ ‘Why does his relationship with Paul have to affect you?’ ‘Can you imagine how embarrassing it would be for him if not one of his children is present?’ ‘You can bring Janet and the boys; we’d love to have them; the whole family together’ As if I would subject my boys to whatever explosion is bound to happen.”

“And how do you feel about your mother pressuring you?”

“I don’t know. It’s what mothers do.”

My mind wanders to the many difficult years I had with my father, coupled with my mother’s constant inability to ever see my point of view. Regardless of the circumstances I was always the one who had to make things right.

“But that doesn’t tell us how you feel about your mother pressuring you,” I say.

Brian sighs. “It’s the same old, same old. My mother’s whole life revolves around my father. She has nothing else in her life. Except for us of course. But she’s followed my father’s lead as far as my brother. I wonder how she feels about being totally disconnected from Paul.” Pause. “It’s sad.”

“Sad for her? For Paul?”

“I was thinking sad for her. But it must be sad for Paul too.” Pause. “You know, I’m getting more anxious as we talk about this.” Pause. “And feeling like I should go.”

Silence.

“I, I need you to say something. My anxiety is going through the roof,” Brian says, clenching his hands and fidgeting in the chair.

“So the silence made you more anxious, just like thinking about the disconnect between Paul and your mother.”

“Yeah, I guess so, but I’m not sure how they’re related.”

“Nothing comes to mind?” I ask.

Brian shakes his head, looking puzzled.

Although I would prefer to wait to see what might emerge from Brian, his escalating anxiety pressures me to speak. “I wonder if one of the things that makes you anxious is the fear of being disconnected, not connected to your mother or to me.”

“I’m not sure I understand.”

“Well, you were talking about how your mother has no relationship with Paul. I think that scared you. You wouldn’t want to have no relationship with your mother, so I suspect when that thought went through your mind – consciously or unconsciously – you felt you’d better go for Father’s Day.”

“Wow! You think that’s what my anxiety is all about, being disconnected from my mother?”

“Your anxiety could be the result of many things, but the fear of separation could certainly be one of them.”

“And with you too?”

“Well, you were already feeling scared of being separated from your mother and when I wasn’t speaking I think you experienced that feeling of separation with me as well.”

“I’ll have to think about that. But meantime, what should I do about Father’s Day?”

“I can’t decide that for you Brian. There’s not a right or wrong decision, just your decision.”

“That scares me too.”  

“Because?”

“What if I make a mistake?”

“What if you do?”

“I think I’m going to go. It feels like the safest choice.”

“You need to do whatever you need to do. There was a lot that came up in this session today, too much for us to deal with it all. So I’m sure whatever you decide will be fine and we’ll have other times to work on your anxiety and your relationship with both your parents and with me.”

In this blog, "I'm Finished" a therapist deals with her patient's anger and feelings of exclusion.

“I don’t know why I have to keep talking about this,” Paulette says angrily. “I’m going to be 50 years old. I’m finished. I want out of my marriage! There’s nothing more to talk about.”

Keeping my voice calm, I say, “I certainly wasn’t suggesting you stay in your marriage, but I know every time you’ve left Derek before you’ve gone back, so I thought it would be helpful for us to look at what feels different this time.”

Paulette runs her hand through her hair and sighs. “The kids are gone, either in college or out on their own. They’re launched. I don’t have to worry about them any more.”

Treading carefully I say, “I wasn’t aware that you went back the last several times because of the kids.”

Paulette glares at me. She says nothing.

“Right this moment do you feel you want to leave me too?” I ask.

“That’s exactly what I was thinking. Maybe I should. Maybe I should leave you too. Maybe this has gone on way too long. And now you’re telling me I should stay married even though I’m so unhappy.”

I know that is not what I said, but arguing with Paulette is not helpful, especially when she’s incensed. “So you’d leave me and you’d leave Derek. What specifically would you do?”

“Are you daring me? You think I couldn’t do it. You think I couldn’t walk out of here right now, go home and pack up and leave?”

“I think you’re angry, Paulette. I think when you’re angry it’s a poor time for you – or anyone – to decide anything.”

“Are you trying to aggravate me? Because you’re doing a pretty damn good job of doing so.”

“No, Paulette, I’m not trying to aggravate you. As we’ve talked about, once you’re angry anything and everything can make you angrier.”

“You’re talking to me in that goddamn condescending voice, like I’m a child.”

“I’m sorry. You’re right. I am. But in some ways you feel like a child right now, Paulette. You know when you get angry the feeling just gets bigger and bigger until it wipes everything else away. So much so that you can forgot what you’re even angry about.”

“Did you just apologize to me?” Paulette asks, surprised.

“Yes. I have apologized before. Especially when I’ve let these interactions between us escalate to the point of us both just being angry.”

Paulette takes a deep breath. “That’s true. I remember,” she says, more calm now. She pauses. “Why can’t Derek do that?”

My thought - because he’s not your therapist - goes unsaid. Instead I say, “I imagine because he gets caught up in his own feelings.”

Silence.

“Can you say what you’re thinking?” I ask.

“I was thinking about what set off this whole argument over the weekend and that what I’m afraid of is exactly that, his getting caught up in his own feelings.”   

I wait.

She sighs. “He made plans to go see our youngest daughter at college. Didn’t invite me, didn’t ask me, didn’t tell me,” she says, her voice rising. “Why would he do that?” Paulette demands. “He’d know what my reaction would be.”

“So you see him as provoking you?”

“Well yeah!” she says sarcastically. “But you know that’s not the worst part. He wants to be alone with her. He doesn’t want me around messing it up. I know, she’s a big girl now – sort of – and she’s not going to let him do anything inappropriate. But what if he tries? What if his feelings get the better of him? He’s always wanted her. He always preferred her over me.”

“Paulette,” I say gently. “Your father started molesting you when you were 10. You’ve asked your daughters multiple times, cautioned them multiple times to not let anyone touch them inappropriately, to tell you if anyone ever made them feel even vaguely uncomfortable. Neither of them has ever said a word to you about their father.”

“But what if she likes it?”

Oh, oh, I think. Lots of issues there and we’re near the end of the hour. The thorniest question of whether she’s talking about herself will have to wait for our next session. For now I’ll take the easier path. “Well,” I say, “she may enjoy her father’s attention, the special relationship she feels they have.”

“They’re always excluding me. I feel I’m in competition with my own daughter! That’s sick.”

“Lots of issues came up here, Paulette. Why don’t we table them for the moment and talk about them at our next session.”

In this blog, The Dream, a patient struggles with his terror in the aftermath of a dream, while his therapist must deal with her patient's resulting paranoia and her own uneasiness.

“I had a dream last night,” Justin begins, squirming nervously in his chair. “I can’t remember any of it, but I feel haunted by it. I know that doesn’t make much sense, but it’s like I woke up scared, like something terrible is going to happen, like something or someone is going to get me. I kind of want to keep looking over my shoulder. Even here, I wonder if there’s someone else in the room, although I know that’s ridiculous.”

Justin, a 45 year old accountant, has been my patient for several years and, as far as I can remember, has never before spoken about a dream.

“Well,” I respond, “the dream obviously affected you, so maybe you can talk about your feelings and what those feelings bring to mind.”

“You’re charging your phone,” he says.

“Yes,” I say, surprised. It’s not unusual for me to charge my cell phone while patients are in the office.

“How do I know you’re not recording me?”

Justin can sometimes be a bit paranoid, but his question is beyond anything I would expect. “I guess you are feeling frightened, Justin. Your world suddenly feels very unsafe so even innocuous things can feel threatening."

"You didn’t answer my question.”

I’m taken aback, perhaps even a little frightened myself. Hmm, I imagine Justin is unconsciously inducing his feelings in me. “No, I’m not recording you. You’ve seen me charge my phone before, so I’m assuming that your concern is being triggered by your fear.”

Justin stares at me. My fear builds.

“Would you like me to unplug my phone?” I ask.

“I’d like you to turn it off,” he replies woodenly.

“Okay,” I say as I lean to my left, pick up my phone and turn it off.

The silence that ensues is deafening.

Finally, Justin drops his head in his hands, shakes his head and mumbles, “I’m sorry, I don’t know what’s wrong with me.

I breathe a sigh of relief. “So let’s see if we can figure out what’s going on, perhaps what triggered the dream, what might have led you to feel so frightened.”

“It’s such a terrible time of year. Tax time you know. Some days I’m working 5AM to 10PM at night. And everyone wants a piece of me. My ex-wife’s mad because I haven’t taken the kids. My older son says he needs money for college. My clients are driving me crazy. Everyone wants their taxes last week. I keep telling them it’s no big deal if we have to file an extension. But, no, that’s not good enough.”

“When you say everyone wants a piece of you, what comes to mind?”

“That’s it!” he says excitedly. “That’s what was happening in the dream. Everyone was pulling at my skin, like they were trying to rip me apart. I know there was more after that but …” He stops. “I think there was like a monster there. Maybe like a monster waiting to eat the pieces of me that they threw to it.”

I grimace internally. “That does sound terrifying.”

Silence.

After a few moments I ask, “What’s going on in your head?”

“I don’t know. I sort of feel I used to have that nightmare as a kid. A lot.”

“Any thoughts about it?”

Silence.

“I’m sorry,” he says after a few moments. “I suddenly felt frozen. Like I couldn’t move. And… I know this is ridiculous, but you seem menacing again.”     

“What is it that you’re afraid I’ll do?”

“I know this is crazy, but what jumped into my head was, eat me.”

“Like in the dream.”

He nods.

“Any thoughts?” I ask, although I have a pretty good idea of the answer.

He nods again. “Yeah, my mother. I used to say she loved me to death. But I guess I meant that literally. She wanted all of me. She didn’t want me to have anyone else in my life. She didn’t do that to my sisters, just me. They hated me, thought as the boy I got all of my mother. But I didn’t want all of her! And I sure didn’t want her to have all of me! Yuck! I feel beyond creeped out. I mean, I know we’ve talked about all this before, but having that dream made it so much more real.”

“The dream actually brought you back to the feelings you had as a child, the terror of being eaten, of being swallowed up.”

“Stop! I can’t deal with any more today.”

“Of course. Whatever feels comfortable for you.”

Justin looks at me with tears in his eyes. “I wish my mother could have been concerned about my comfort. And I’m sorry I thought you were recording me.”

“Nothing to apologize for. Totally understandable given what you were feeling.”