Blogs

In "Guilt" a therapist meets with a young woman who desperately strives to please her parents, blaming herself for falling short and giving them problems.

“I feel so awful, I can’t believe that I had to disappoint my parents. I can’t believe I couldn’t handle college, that I had to come home. My parents have always been there for me, always wanted the best for and all I do is screw up.”

This is my first session with Tiffany, a slender, attractive young woman with blue eyes and long blonde hair. Her mother, sounding concerned, had called to make the appointment, saying that Tiffany was having difficulty at Duke and needed to come home.

“I hate myself!” Tiffany continues.

“Wow! That’s pretty strong. Can you say why you hate yourself?”

“All I’ve done is give my parents problems my whole life, even before I was born. My mother had to be in bed for two months before she had me! She’s a physician – so’s my father – she can’t just take two months off. But she had to because of me.”

“That hardly sounds like your fault, Tiffany. I assume it was some medical condition your mother had.”

“She never had that problem with my brother. My brother never gives them problems. He’s graduating from Yale and going on to medical school. Of course!”

Clearly hearing her sense of competition and failure in relationship to her brother, I decide, for the moment, to focus more on her current situation. “Can you tell me what was going on for you at college?”     

“All those science courses! I can’t handle them. I’m just not smart enough. I started crying at every little thing. And I think I pretty much stopped eating. And then I couldn’t even get myself out of bed to go to class. Especially Chemistry class.  I don’t understand it. It makes me feel stupider than I already feel.”

“Are there classes that you enjoy, that you do well in?”

“Oh yes,” she says, brightening. “I love anthropology and I’m…hmm…I’m a pretty good writer.”

“So you take science courses because…?”

“What do you mean? I have to take science courses to get into medical school.”

“And do you want to go to medical school?”

“I’ve always known I’d go to medical school.”

“That’s not the same thing as wanting to go.”

“Yes, I want to go to medical school. I put my parents through a lot when I was a kid. I got rheumatic fever and ended up in the hospital for quite a while. I could tell how scared they were.”

“You must have been pretty scared too.”

“I was, particularly when I was alone. But the doctors and nurses were great. And I kind of enjoyed watching all the machines and monitors. That’s the kind of doctor I want to be, a pediatrician, to help kids like me.”

“And do your parents want you to be a doctor?”

“Definitely. It’s like a given.”

“So what if it wasn’t a given? What if you could decide to do anything you wanted to do?”

“I’d go on archeological digs and write about them or even write made-up stuff about the digs, like mysteries. But that’s not at all practical. No way to make a living.”  

“Have you ever wondered, Tiffany, why you feel so guilty in relation to your parents?”

“I told you why, I’ve always given them problems.  Besides rheumatic fever I was a sickly kid. And I broke my arm doing gymnastics. They always had to worry about me.”

“It seems that a lot of the things you feel guilty about you had absolutely no control over, like your mother needing bed rest or your having rheumatic fever or breaking your arm.”

“I was fooling around on the bar, that’s how I broke my arm.”

“You sound determined to have things be your fault. Do you think, Tiffany, if you felt things weren’t your fault, you’d end up feeling powerless and scared?”

“I don’t know. I’m not sure I know what you mean.”

Too soon for that interpretation I tell myself. I decide to pursue a different path. “Do you ever feel angry at all the pressure you’re under?”

“Angry? I don’t think so. I feel mad at myself for not being able to keep up and, like I said, worrying my parents.”

“So, now that you’re home, do you think you’re going to be able to relax and take it easy for the rest of the semester?”

“Oh no. My parents are going to get me a chemistry tutor so I can go back to school more prepared.”

At this point I find myself feeling angry at Tiffany’s parents and wonder if I’m feeling Tiffany’s unacknowledged  anger. That could explain the tremendous guilt she feels – guilt for the anger she doesn’t even know she has. But those interpretations are also premature.  

“Our time is almost up for today. But I hope I’ll be able to get to know you more and I hope you’ll tell me more about your wishes and your dreams, even if they aren’t always practical.”

“I wish you could make me smarter.”

“I don’t know if I can do that, but perhaps I can help you to be more accepting of yourself.”

"Being Checked Out" illustrates a therapist's attempt to engage an untrusting, young African-American man in the treatment process.

This is a first time I am seeing Maurice, a tall, thin, 22 year old African-American man. He looks uneasily around the room, settles himself in the chair across from me, still holding his phone and keys in his hands.

“How can I help you?” I ask.

“Dr. Hudson said I should come. He’s my English professor at the University. Says I have more potential than I show.”

“And do you agree with him?”

“About my potential, yeah, I do.” Pause. “But if you can help me, I don’t know.”

“Because…?”

“I don’t mean to be disrespectful, but you’re white. And you’re a lady.”

“You’re right. I am both white and a lady. And that makes you feel I couldn’t help you, couldn’t understand you?”

He nods.

“Well, we’d only know that as we got to know each other and, hopefully, learned to trust and respect each other.”

Silence.

Maurice sighs, shakes his head. “I don’t know. I don’t know if I can just do that, just start talking and hope that I can trust you.”

“Do you trust Dr. Hudson, since he’s the person who referred you to me?”

“I trust him as a teacher. I’m not telling him all kinds of shit about myself.”

“That’s true.”

Silence.

“You’re not trying to talk me into trusting you,” he says.

“I think that’s pretty hard to do. But I was about to ask what you thought might help you trust me enough to tell me about yourself.”

“I know shrinks don’t usually do this, but what if I ask the questions, ask you about yourself?”

“Well, I guess that would depend what the questions were. If you asked me to tell you about every person I ever dated and what our sex life was like, I’d probably want to know how that was relevant to your concerns about trusting me.”  

He laughs. “No, I wasn’t going to ask you that.” Pause. “Although now that you mention it, I did think of something kind of like that. Did you ever date a black man?”

I hesitate. “The answer happens to be yes, but I don’t think if the answer was no, that would mean you couldn’t trust me.”

“No. But, it’s a piece of information.” Pause. “Did you ever have a black friend?”

“Yes.”

“Did you ever live in the ghetto?”

“No.”

“Have you ever been inside a prison?”

“Yes.”

He looks surprised. “How come?”

“I worked as a group therapist in a men’s prison when I was in graduate school. I did my doctoral dissertation in that prison. I also worked in a forensic center and at a women’s prison.”  

Maurice nods his head. He places his phone and keys on the small table next to him.

I take those gestures as a sign I can take on my more traditional therapeutic role. “So I assume you or someone close to you has been in prison.”

“Yeah. Like all my brothers. I did a little time in juvie, but no hard time.”

“And you feel how about having been the only one of your brothers to avoid prison?”

“Bad. Lucky. Glad. Guilty. Like shit. Fortunate.”

“Lots of mixed feelings.”

“Yeah.”

“So can you tell me more about you?”

Silence.

“I can, but I wouldn’t want you to think that means I totally trust you.”

“Maurice, trust takes a long time to build. There’s no question, no hundred questions that you could ask me that would assure you that you can trust me. And besides, trust is a complicated word. What does trust mean to you?”

“First thing I thought, ‘That you’re not going to stab me in the back.’ And I guess I mean that both literally and figuratively.”

“I get it that young black men have to first be concerned for their lives. And after that, I guess you’re saying that you’re afraid I’ll somehow lure you in and then turn on you, betray you.”

Maurice nods. “I want to write. I think I have something to say. But I’m ignorant. I don’t know enough. I need to get my degree. So many of my people – both my family and black people in general – have sacrificed so much so that I can have this opportunity. I don’t want to let them down. I can’t let them down. But I can’t get out of my own way,” Maurice says with clenched teeth.

“Any idea why that is?”

Silence.

“I wish you were black. And I wish you were a man.”

“Well, I’m not,” I say shaking my head. “And it’s not like I have any black, male colleagues I can refer you to. So I guess you’ll have to decide if I’m good enough.”

“I like you, Doc. I guess that’s as good a place as any to start.”

Exploring a therapist's attempt to understand her patient's sudden pronouncement that she's going to have an affair.

Judith is a tall, attractive 44 year old woman who carries herself as if she knows she will be noticed, clearly distinguished from those around her. Although she’s presently a stay at home Mom, today she is dressed as the lawyer she is, a perfectly fitting gray suit and black high heels.

“I’ve decided to have an affair,” she says matter-of-factly.

I’m startled. In the six or so months I’ve seen Judith, she talked about being dissatisfied in her marriage, but hadn’t mentioned the presence of another man.

“With whom?” I ask.

“I don’t know yet.”

Silence.

“I know,” she continues, “that’s a rather unusual way to go about it, but since my husband hardly gives me the time of day – I can’t even remember the last time we had sex or even had a real conversation  - I decided I might as well get my needs met elsewhere. I’m not going to leave him. The kids need their father and I need some male attention so, an affair’s the answer.”

During the course of my career I have seen many men and women who have been unfaithful to their partners with one or many other people.  I’ve always been comfortable talking with them about both their feelings and the meaning of these multiple relationships. But Judith’s cavalier manner, her impulsive decision, and her pronouncement to me without any apparent willingness to discuss her decision, is both off-putting and confusing.

“When did you make this decision? And how do you feel about it?”

“It feels like a good decision. Solves lots of problems. I guess I decided a couple of days ago. Hence my outfit today. I figure any time I’m out and about I need to be looking my best.”

“Did anything happen in the last couple of days? Anything happen since we last met?”

“No,” she replies flatly. “Nothing happened. Same old, same old, I guess that’s what happened.”    

“Do you plan to talk to your husband about your decision?”

“What!? Are you crazy? He’d divorce me in a minute.”

I knew she wouldn’t tell her husband. Why did I ask that question? Was I trying to make her feel guilty? Surprisingly, what Judith is contemplating does feel ‘wrong’ to me, it feels ‘wrong’ for a person in a committed relationship to decide in a calculated and apparently logical way to become involved with an unknown other person. I feel very differently if the person has an affair and wants to talk about it, understand it, and deal with the meaning it has for them. Hmm, I think. Her pronouncement felt as though she was throwing down a gauntlet. Perhaps that means her decision is about me, about our relationship. What was it we talked about in last week? Of course! She told me she read my book, the book in which I discuss both the intensely loving relationship I had with my late husband, as well as my strong emotional involvement with many of my patients.

“Judith, how did you feel about my book? I know we talked a little about it last week, but you seemed to skirt really looking at your feelings.”

“Now where are you going? I told you I thought you wrote very well and that the book was engaging.”

“But how did you feel about it? How did you feel about my relationship with my husband? About my relationship with my patients.”

She shrugs. “I guess I felt you were lucky. Here you had this shitty relationship with your father, but you found this adoring man to marry. I didn’t have that shitty a relationship with my father – not that he paid much attention to me, too focused on my mother – and I married a man who still doesn’t pay any attention to me.”

“So, perhaps you felt angry with me, that, in your words, I got lucky, while you got stuck.”

“Yeah, that’s about right.”

“So I came out ahead just as your mother came out ahead and that makes you doubly angry.”

“I hadn’t thought of that, but I guess that’s true.”

“So your ‘decision’ to have an affair is really based on your anger at both me and your mother for getting more than you, for leaving you feeling cheated.”

“You really don’t want me to have an affair, do you?”

“I think you’re saying I’m trying to keep you away from happiness, from your father.”

“That’s a bit too deep for me. I think you think having an affair is wrong.”

“I don’t necessarily think that having an affair is wrong. I think affairs have many meanings.  For you those meanings are clearly related to feelings about both your parents, that you bring into the present and into this room.”

“So you think I shouldn’t have an affair?”

“I think we should talk about it a lot more before you act.”

“I can’t promise that.”

“I understand. You don’t have to promise anything. You get to do what you do and we get to deal with it.”

“Okay. As long as that’s clear, I’ll see you next week.”   

A patient lashes out as a result of feeling 'less than' allowing his therapist to demonstrate how the past impacts the present.

“I hope you had a better New Year than me,” Jeff says with a bitter edge as he settles into the chair across from me.

“I thought you were really looking forward to spending New Year’s with Eileen.”

“Yeah, me too. She broke up with me.”

“Oh, I’m sorry. You thought this relationship had real potential.”

“Them’s the breaks. I don’t seem to be able to find anyone since my divorce. Sometimes I wonder if I should have stayed with my ex, but I know we were both totally miserable.”

Forty-two year old Jeff is a good looking man with blonde curly hair, a dimple in his chin and intense blue eyes. He has, however, had little success in establishing a new relationship.

“Did Eileen say why she broke up with you?”

“Something about my being too sarcastic or too needy or some stuff like that.”

Silence.

“I guess you want to know what I think about what she said to me.”

“Jeff, your tone is pretty biting today. Are you angry with me?”

“I guess.”

Silence.

“I’ve been reading your blogs. And I was wondering why you never write about me. What makes the patients you write about more interesting than me?”

“Before I address that question directly, I’d like to look at the feelings that were brought up for you.”

“Makes me feel like I’m not as good as your other patients, not as important, not as interesting.”

“Sounds pretty much how you felt in relation to your two older brothers.”

“That’s for sure,” he says, smirking. “I was the pretty one, but not a girl. And my brothers had the smarts and the artistic talent which was way more important than looks in my family.”

“So you feel less than.”

“Yup! Guess you could say that.”

“And the fact that you’ve built a thriving accounting firm doesn’t undue the messages of ‘less than’ that you took in as a child.”

“Right again!” Pause. “I’m just a numbers man, not an intellectual, not an artist.”

“And the worse you feel about yourself, the angrier you are at the other – me, Eileen, whoever – for, in your eyes, not being valued.”

“So you’re saying Eileen was right about me. That’s great, real support, and from my therapist no less!”

“I don’t know if Eileen was right about you or not. What I do know is that when you feel diminished, less than, you’re so hurt by those feelings that you lash out and that doesn’t serve you well.”

“So why haven’t you written about me?”

Although Jeff’s demandingness makes me want to withhold from him, I feel it is more important to respond to his question and then deal with his reaction to what I have to say. “I don’t know, Jeff, how many of my blogs you read, but every so often I explain that the ‘patients’ in my blogs are fictionalized. I’m real – as real as I can imagine myself to be in a made up situation with a fictionalized patient. Otherwise I’d be concerned about patient confidentiality.”

“You’re kidding me?! Now I feel like a real ass. Competing with imaginary people! You must have been laughing your head off at me.”

“Not at all. This has been a very important session. We could see right in front of us how hurt you feel when you feel devalued and how quick you are to attack the person you experience as diminishing you. It clearly comes from how you felt as a child, but we need to work on helping you not to automatically assume that you are being devalued and, even if you are, not to bring to the current situation all the rage you felt as a child.”

“You know, I don’t even remember being enraged as a child.”

“Well, you might not have been allowed to show it.”

“That’s for sure. No one did anger in my family. We talked about issues like ‘civilized’ people. Anger was off the table.”

“So you’re probably sitting on years and years of anger.”

“You mean like when my mother would make me draw and draw and draw, despite the fact that I had no talent and that she would sit there criticizing everything I produced?”

“Yes, like that. I’m sure that made you plenty angry.”

“Holy shit! You know what I just realized. If the patients in your blogs are fictionalized, that means you’re one of those creative people. Does that make me feel less than? Yes, it does. But for whatever reason, right now that actually makes me feel more sad than angry. I guess I feel sad for the kid whose talents weren’t recognized and only found lacking for what he wasn’t.”

“That’s great, Jeff. I’m really glad you’re able to feel compassion for yourself as that child. That awareness will serve you well.”

In this blog a patient continues to struggle with his terror about his therapist dying, as the therapist seeks to understand the origin of that terror.

“I can’t stop thinking about it,” Trevor begins. “Two therapists in this office died. Who’s to say you won’t be next? I’m having nightmares about your dying almost every night. What did they die of?”

Trevor’s speech is rapid, staccato, his anxiety palpable.

“I’m sorry you’re so distressed, Trevor, but I can’t see how knowing the details of other therapists’ deaths would help to calm you. What we need to do is deal with your fear of losing me.”

“More like terror.”

“Well let’s talk about that terror.”

“In my dreams I see you here in this office and as I’m talking to you, you start fading away, vanishing right in front of my eyes. And then you’re just gone and I’m here in an empty office. Sometimes I start screaming. Sometimes I wake myself up screaming.”

Listening to Trevor’s dream is difficult – his distress, the description of my death, plus the whole idea of fading away which actually taps into my own childhood nightmares. But I’m the therapist here and my patient needs me to act as one.

“Any idea, Trevor, why you’re dreaming this particular way of losing me, my fading away?”

“What difference does it make? Any way you’re gone.”

I’m surprised by what I hear as an angry tone to Trevor’s response. I remain silent.

“I really feel I should cut down on my sessions. I need to become less dependent on you. I need to prepare myself for your… for your leaving.”

“And how do you feel when you think about that?”

He pauses. “Not so good.”

“If you cut down on your sessions, would that be like your gradually fading away from me?”

“Oh! I never thought of that!” Pause. “But maybe that’s not a bad idea.”

“As in you’d leave me before I left you?”

“Yeah. Yeah. Something like that.”

“Would that feel like you’re getting back at me?”

“I don’t know. Feels more self-protective.”

“Trevor, it strikes me that a lot of how you’ve been in the world is self-protective, removing yourself from people, remaining distanced.”

“I suppose.”

“And we’ve always thought about that self-protection as stemming from your feeling the need to protect yourself from your father, and even more so when you realized you were gay.”

He nods.

I’m silent.

“What are you getting at?” he asks.

“Well, I was wondering two things, first how your mother fits into all this and second whether there isn’t some anger, some retaliation in your withdrawal.”

“Wow! I need to think about that.” Pause. “You know, Myra, my oldest sister, used to say that as my mother had more kids – 4 after me - she faded away more and more.” Pause. “I think that’s true. Early on Myra and I probably had the best of my mother, but then she kind of vanished.” Pause. “Just like you in my dreams.” Pause. “You think that’s why I’m so terrified of losing you, it’s like losing my mother all over again?”     

“I think it’s very possibly at least one of the reasons. And it’s certainly interesting that Myra talked about your mother vanishing and your nightmares are about my vanishing.”

“But that doesn’t change the terror.”

“Well, if we’re able to help you re-experience your childhood terrors and come to know – and feel – that you’re not the helpless, dependent child you once were, I suspect you’d have much less terror about losing me. And there’s still the question about your anger and retaliation.”

“But what if I don’t feel the anger? What makes you sure I’m angry?”

“I can never be sure, but when you talk about wanting to leave me before I leave you, it sounds like retaliation, it sounds like you want to punish me and that feels like retaliation.”

“Like you think I was angry at my mother?”

“Yes.”

“Myra was certainly angry at my mother. She had no doubt about it. Practically ruined her life. She was so busy rebelling she became a drug addict! But she came around.”

“So you’re saying that anger is dangerous.”

“You bet! Just try being angry around my father!”

“And what about your mother? How did she react to anger?”

“I can’t believe I’m saying this, but she faded away even more.”

“So being angry with your father is physically dangerous and being angry with your mother leads to abandonment. No wonder you don’t feel your anger.”

“This has been a heavy session. Feels like a lot going on.”

“I agree.”

He sighs. “So I guess I shouldn’t cut back on sessions.”

I smile. “Sounds like a wise choice.”

This week's blog deals with a therapist's need to first understand her patient's desire to withdraw and then address his underlying fears. 

Trevor sits quietly in the chair across from me. After a few moments he says, “It was an okay week. Nothing special happened.”

I wait. There is silence. I’m puzzled. I have seen 26 year old Trevor for many years. I might even say I helped him grow up. When he first came to me he described himself as shy. During those years long silences were commonplace. But as he moved away from his fear and self-loathing he’s been far more engaged with me and, to a lesser extent, with the world outside my office. He acknowledged his gayness and was able to come out to his family and some of his friends. He’s still never been in a love relationship, a problem that we’ve been working on. But today his silence confuses me.

“Is something going on, Trevor?” I ask. “You seem particularly quiet, uncomfortable.”

He shakes his head and looks away from me.

I wait. I think about our last session. Did something happen that distressed him? We’d been talking about Thanksgiving with his family, but that had seemed to go fairly well despite his father’s usual blustering. Was there some tension between us? Nothing that comes to me. Don’t be impatient, I tell myself, just sit with him.

After a while he says, “I’ve been thinking maybe I should cut back to once a week. I’m doing pretty well and, like today, I don’t have much to say.”

I’m stunned. In all the years, Trevor has never asked to come less frequently and, in fact, has often asked for additional sessions. Something must have happened between us.

“Trevor, you need to tell me what’s going on. Did I say something last session that distressed you?”

“Why does something have to be wrong? Why can’t I just want to cut back?”

“Because you know as well as I do that there’s always a reason – usually more than one – for everything we do.”     

He sighs. “Why did that psychiatrist retire?”

“What psychiatrist?”

“The one next door.”

The light dawns. He asked me last time what had happened to my neighbor. When I told him he retired, he obviously became fearful that I might follow a similar path. “He retired because he wanted to travel, have more time to himself, pursue other interests. And, no, I have no plans to retire, ever. I love what I do and as long as my mind is still with me I plan to stay right where I am.”

“And why is the sign on your door different? What happened to the other therapists? The ones who’d worked here? Did they retire too?”

Now we’re in more difficult territory. I’ve been surprised by how few patients have asked me about the change of signage on the front door. “No, Trevor, they died.”

His already pale skin blanches further.

“Okay,” I say in a calm voice. “I understand that you’re frightened of losing me. First you were afraid I might retire and now you’re afraid that I’ll die. And of course I can’t make guarantees about my dying, but it’s certainly my hope to stick around for a long time.”

“I have to cut back to once a week. I have to become less dependent on you. Right now if something happened to you I don’t think I’d survive.”

“Trevor, the idea is that our work together will help you to be able to be more and more engaged with people other than me, but we can’t accomplish that by your cutting the frequency of your sessions. You’ve been doing very well lately, going out to lunch with people, meeting friends for dinner and a movie …”

“But that’s because of you!” he says. “I wouldn’t be able to do that without you.”

“Then we’ll have to understand why you feel you can’t do those things without me and help you to feel more comfortable being in the world.”

“Did they know they were going to die?”

Loathe to provide too many details, I say, “Yes, they both knew they were ill.”  

“So they could tell their patients?”

“Yes, their patients knew they were ill.”

Trevor starts to cry. “I couldn’t stand it! I couldn’t stand it if you died! I couldn’t watch you die.”

“I understand, Trevor, but I’m not ill and I’m not planning to die any time soon. Obviously none of us know when we’re going to die and it’s always sad to lose someone we love, but what we need to do is focus on helping you to be fully in the world, to embrace life and enjoy it.”

“Can we talk about this again next week?”

“Of course. I’ll see you Monday.”

This week's blog illustrates a therapist's frustration with a patient who is both unaware of her own anger and unable to see how she provokes anger in others.

“You sound less than excited about the invitation.”“My neighbor invited me for Thanksgiving,” Marnie says without enthusiasm.

“Yeah.”

I remain silent.

“It’s her family.” Pause. “It’s not my family. I won’t know anyone. Except her husband and I don’t like him much.” Pause. “I don’t see why my sister couldn’t have invited me. Or my daughter.”

“I thought your sister was going on a cruise.”

“She is. But she didn’t have to. And I know, I told my daughter I didn’t want to travel all the way to Seattle, but she could have insisted.”

I find Marnie maddening. Nothing is ever good enough for her. I try, yet again, to provide some insight into her behavior.  

“You notice, Marnie, that you’ve again set up a situation where you can’t be satisfied. Your neighbor invites you to her house, but you’re unhappy because it’s not your family. You expect your sister to not go on her cruise because she should be here to invite you for Thanksgiving…”

“What’s so wrong about that?” she asks, interrupting me.

Responses flit through my mind from ‘you’ve got to be kidding’ to ‘would you have canceled your cruise for the sister you rarely speak well of?’ Instead I take a breath and pause. “Marnie, I know that you grew up in a hostile, unloving home. I know that your parents were too involved in their own battles to care about their young daughter who had the misfortune to be born just when they were considering divorce. I know you didn’t get enough love, enough nurturing, enough care. But by finding fault with everyone, by demanding that everyone always think of you first, you’re insuring that you will never feel as though anyone cares about you.”

Marnie’s head droops. Tears fall silently from her eyes. I can anticipate what’s coming next and, unfortunately, Marnie doesn’t disappoint me. “So you’ve turned against me too,” she says, whining.

I want to scream. I suspect my anger is not only mine, but also a projection of the anger Marnie keeps buried inside herself. “Marnie, can you tell me what you’d like from me right now?”

“I’d like you to understand how much pain I’m in and support me.”

“And your pain is about never feeling loved?”

She nods.

“And you feel angry about never being loved?”

“I guess.” Pause. “You know anger wasn’t allowed in my house. Not as a child. I don’t like to feel angry.”

“But it would make sense for you to feel angry about never being loved, right?”

“I guess,” Marcie responds reluctantly.

“So you weren’t allowed to feel anger as a child and you’re not comfortable feeling angry now.”

She nods.

“Would you consider the possibility that you bring all that stored up anger into the present and behave in ways that both expresses your anger and probably leads people to be angry with you?”

“I don’t understand. Why would anyone be angry with me?”

I consider whether I should answer that question in the here and now about Marnie and my relationship, and decide a bit more distance might be preferable. “Well, let’s consider the invitation from your neighbor. If in accepting the invitation…”

She interrupts me. “I didn’t accept, I told her I’d let her know.”

In my mind, I think, ‘well that certainly illustrates my point.’ I continue, “I wonder if your not immediately accepting the invitation is an expression of your anger. It’s like saying the invitation isn’t good enough.  It’s possible your neighbor might have felt hurt or insulted about your not accepting and might be less likely to invite you in the future which would lead you to again feeling rejected.”

“But I’m not sure I do want to go to someone else’s family.”

“I wonder if you realize, Marnie, that you do the same thing to others as was done to you – you’re not good enough so I won’t love you.”

“So do I have to accept whatever anyone offers me?”

“Good question.” I pause. “I guess I’d say it would be important for you to consider why you’re rejecting an offer. Like, would you really prefer to be alone for Thanksgiving? Do you want to be alone so that your sister feels bad for you? So that your daughter feels bad for you?”

“What’s wrong with wanting them to feel bad for me?”

“”Because you’re cutting off your nose to spite your face. And because you don’t realize that wanting them to feel bad for you is an expression of your anger.”

“I don’t understand that at all.”

“And you’re angry with me right now, correct?”

Pause. “I don’t think so. I’m just confused.”

‘Foiled again,’ I think. “Well, it’s time for us to stop, but we’ll continue next week."

In this week's blog, Choose Me, a therapist struggles to understand and cope with a patient who insists on being loved while behaving in very unlovable ways.

“I don’t understand!” Marcy shrieks at me, continuing the stalemate we have been have been in for weeks. “Why won’t you just tell me I’m your most favorite patient? You know that I am. You know that you care about me more than anyone else, that you love me, so why don’t you just say it!”

Thoughts race through my mind as my patience runs thin: ‘You’re upping the ante. Now you want to be the person I care most about in my life, the person I love above all others. You’re certainly not being very loveable right now.’ I remain silent.

“Why don’t you say something?” Marcy yells.

I sigh. “Truthfully, I don’t know what to say. We’ve been arguing about this for weeks. We know that your mother abandoned you to the care of her sister. We know that your aunt clearly favored her own daughter over you, that you felt like a second class citizen, like Cinderella, as you say. And all these things are horribly sad and painful for a child, but there’s no way I or anyone else can make up for that. If I told you you were my favorite patient, that wouldn’t take away your pain about your mother or your aunt.”

“Then what good are you?”

“I’m here to help you mourn the past, to be sad and angry, sad and angry, sad and angry about what you didn’t get as a child and then to be able to accept what was and to move on, able to take in the good from others in the present.”

“Is that a script you read? You say the same stupid shit all the time,” Marcy responds, crossing her arms in front of her chest, chin raised, staring at me defiantly.

I’m pissed. I remain silent while I try to collect myself.

“What?” March says.

“You know, Marcy…” I begin before she interrupts me.

“Oh,” she says sarcastically, “here comes the lecture.”

I ignore the interruption. “It’s interesting to me how much your behavior is counterproductive.”

“What’s that supposed to mean?”

“You say you want to be my favorite patient, but you behave in a way that would make you anything but my favorite patient.”

“Oh! So now I’m supposed to be Miss Goody Two-Shoes. I thought you always told me – for years and years in fact – that I was supposed to say everything I was thinking, not censor anything.”

“I’m not suggesting that you censor what you say. I’m suggesting that what you say has consequences.”

“So now you’re threatening me?”

‘Stay calm’ I tell myself, knowing Marcy wants to provoke me. “The more you angrily demand that someone care about you, the less likely that person – me in this instance – is going to respond the way you want. So the question becomes why do you behave in a way that is least likely to get you what you want?”

“Don’t change the topic,” Marcy demands.

“I’m not…” I stop myself. “That last comment, for example. You know I’m not changing the topic. You’re just being provocative and trying to not consider what I’m saying.”

“OK, smarty pants, why don’t you tell me why I behave this way. I know you have some nice little theory floating around in your head.”

“Let me ask something else first. What would happen if I did tell you you were my favorite patient?”

“I’d ask if that meant you loved me.”

“And what would you feel if I told you I loved you?”

“I’d need you to prove it. Like, would you see me for free?”

“So you’re saying you’d add more and more demands until you got to a place where you could again feel unloved and unchosen.”

“Why would I do that?”

“Good question. Why would you?”

“I don’t know.”

“I suspect you unconsciously want to be rejected so that you can stay connected to your rejecting mother and aunt who walk around in your head. If you take in the good, the caring in the present, then – here’s my script again - you have to mourn what you didn’t get in the past. You have to give up the hope of getting the love you needed and deserved as a child from the people in your life who were supposed to care for you but never came through.”

“That sounds way too hard.”

“I wonder if it’s any harder than repeatedly demanding love from people in the present in such a way that you insure you’ll never get it.”

This piece is a continuation of my last blog, "Untold," in which a patient was finally able to tell his therapist about his sexual abuse by his priest as a child. In this blog, the patient struggles with his feelings of disgust, shame and guilt as a result of the abuse he has carried with him into adulthood.

“Thank you for seeing me for an extra session this week,” Peter begins. 

“No problem.”

“I haven’t been able to think of anything else but what you said, that by not talking about my priest abusing me I’ve done exactly the opposite of what I intended, I’ve let him continue to control my life.” Pause. “That makes me sick. But I can’t stop thinking about it.”

“And feeling …?”

“Sick. Angry! Scared. I keep remembering what he did to me. I try to figure out how many times it happened. I wonder why I never told my parents, anyone.” Pause. “I guess I know the answer to the last one, I didn’t think anyone would believe me.”

“Do you feel sad for you as the abused child?”

“I hate when you put it like that! That’s not all I am!”

“That’s true. It would have been better for me to say, do you feel sad for the child in you who was abused?”

Peter’s eyes well with tears. “You’re amazing. You listen and understand and take responsibility for even a little mistake.”

“Unlike the priest who took responsibility for nothing.”

“Unlike the priest. Unlike my parents who could never understand.”

Silence.

“Would it be helpful if you told me what actually happened between you and the priest or do you feel you’re not ready?”

Silence.

“He’d touch me. Usually until I climaxed. And then he’d make me touch him. Sometimes – I don’t know how often – he’d tell me to kneel – Catholics are good at that – and then he’d… he’d, you know, he’d make me use my mouth. I hated that. It was disgusting.”

“Thank you for telling me Peter. I know how hard it was for you. How do you feel now having told me?”

“Relieved. I knew I’d have to tell you. It feels like a relief to have it over.”

Silence.

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

“I was actually wondering what you’re thinking. I was afraid you’d think I was disgusting.”

“You’re not in any way disgusting, Peter.”

“I was afraid my wife would think that too. I wonder if she thinks about it when we make love. I wonder if a part of her recoils from me.”

I wonder to myself if Peter thinks about the abuse when they make love, but decide it’s too soon to ask that question. “Does she seem to recoil from you?”

He shakes his head. “No, not at all.” Pause. “But, but it’s hard for me to have … to have oral sex. Either to give it or receive it. I know it’s because of the abuse. Sometimes I force myself because I know she likes it, but it seems kind of disgusting to me.” Pause. “Actually, when she does it to me it feels good at the time, but then, then afterwards I don’t feel good at all.”

“You feel guilty?”

“Definitely.”

“And you felt guilty with the priest as well?”

“Yes. Guilty and ashamed. I was afraid someone would find out and think I was disgusting. Afterwards I’d come out from the church… If it was sunny I’d wonder how that was possible. It seemed so dark where I’d just been. I couldn’t understand how the sun could be shining. I didn’t want it to be sunny. I wanted to hide.”

“Peter, very often the hardest thing childhood sexual victims struggle with is the pleasure that they themselves felt. Like how could I have been abused if part of me enjoyed it?”

“That’s exactly right! How can it be abuse if I, if I climaxed?”

“Because your genitals were being stimulated and your body responded just as it’s supposed to. You were also a frightened, lonely child and some esteemed authority figure was paying attention to you, making you feel special and bringing you pleasure.”

“No, that’s not completely right. I didn’t feel special at all. I felt I was being singled out because I was disgusting and he knew I was disgusting. Don’t forget he was my confessor.”

“And what had you done that made you feel disgusting?”

“I touched myself.”

“You masturbated just like every child. I’m sure the priest made you feel guilty and ashamed of doing what was entirely normal, but the horrible irony is that he was the one who was doing what was horrible, illegal, destructive. That’s enraging. I feel enraged for you.”

“I feel as though I’ve been in a trance this session. Like I want to shake myself and come back to reality.”

“I think what you’re saying, Peter, is that you’ve been back being your child self. I’m sure that will be helpful to you - and to us - because it’s that part of you that was damaged and needs to heal.”

Untold, which describes the experience of both patient and therapist when after almost three years of treatment, the patient reveals what he has kept secret.