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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.

"The Underachiever" depicts a first session in which a therapist wonders if a patient's need to bury his feelings has affected his ability to realize his potential.

Tall and thin with a wiry red beard, Daron Wilson sits across from me looking lost and forlorn. “I’ve never done this before. Never thought I would.”

“How can I be of help to you?” I ask.

“I don’t know. I know you can’t make my wife come back to me.” He sighs, shaking his head. “I love her so much. Her and the kids. But she says she wants more, more for the kids, more for her, more for our family. I don’t know how to give that to her.”

“More in what way?”

“Easy answer would be financially, but I know that’s not what she means. Wants me home more? Yeah, that’s true. But that’s not it either. We were high school sweethearts, madly in love almost from the moment we met. I was valedictorian of my class. She wanted to be a psychologist. Like you. Me, I didn’t know what I wanted. We got pregnant, got married right after high school. She was determined to go to college and she did for a while. I became a long distance trucker. Good way to make money to support a family. And then we had two kids and she dropped out of college and I kept driving. Truthfully, I kind of like it. Feeling of freedom on the road. I drove for other people until I had enough money to get my own truck. Big financial commitment, but now I’m my own boss. It’s okay.” He shrugs. “But Chelsea wants more. And I get it. Our kids are nine and seven. Do we really want them to see that driving a truck is all there is to life?”  

“You sound so sad and lost.”

“Yeah, that’s about right. I don’t know what to do. It’s not like I can snap my fingers and suddenly have a college degree and be working as some hot shit IT guy.”

“You said you were valedictorian of your class. Was that important to you? Were you proud of yourself?”

He shrugs. “Yeah, I guess.”

“Were your parents proud of you?”

He scoffs. “My parents? My parents could have cared less. My father was too drunk to come to my graduation. My mother came, looking uncomfortable every minute. They raised five kids. I was the last. They didn’t have much left over for me.”

“That’s very sad.”

“I guess. After a while you just stop caring.”

“So what motivated you to put forth the effort to become valedictorian of your class?”

“I don’t know.”

“Had you met Chelsea by then?”

“Yeah. We met when we were Juniors.” Pause. “I might have wanted to do it for her.”  

“What have your siblings done with their lives?”

“Liz – the only girl - is a wife and mother. My brothers? One’s an alcoholic; one has serious mental problems, can’t hold down a job. Joe – he’s the oldest - has done okay. He worked for GM when you could still make a decent living that way. I guess they all have their problems.”

“So if you had gone to college when you graduated from high school, that would have been a radical departure from the rest of your family?”

“That’s for sure.”

“And did you have feelings about being that different from your family? Even being valedictorian?”

“I don’t know.”

“How did you feel when you studied? How did you feel when you got good grades?”

“It’s too long ago to remember.”

“Daron, I think over the years you worked pretty hard – unknowingly of course – at trying not to know your feelings, your feelings of sadness and anger and disappointment and hurt. You turned yourself off so that now it’s very hard for you to know what you feel either now or in the past. I guess when you met Chelsea you were able to open yourself up to loving her which may have also opened you up to strive and succeed and do well. I’m not saying you don’t do well as a trucker - you obviously do - but it sounds as though a part of you died in the process.”

Daron’s eyes fill with tears. “That’s what Chelsea says. She says I feel dead.” Pause. “I wonder if that’s one of the reasons I like to drive. Always something new. Sort of escaping from myself.”

“That’s a great insight Daron. I guess the question is whether you’re ready to stop escaping and to look at all the painful feelings you have buried inside you.”

“First thing I thought? How long will it take? Can I do it before Chelsea leaves me?”

“I don’t know the answer to that, Daron. You’ve sat on your feelings for a long time. It won’t be a quick or painless fix.”

“But it’s a shot. I don’t have anything else.”

This blog, The Move, focuses on how a patient's prospective move re-stimulates old issues which result in her returning to therapy to continue the process of mourning and working through.

“Thank you for seeing me again on such short notice,” Joslyn begins hurriedly. Then she pauses and looks at me. “It’s good to see you again after so long. You haven’t changed at all. It must be 10 years.”

“It’s good to see you too, Joselyn. I’m pleased to be able to catch up on your life.”

"Yeah, well lots has happened since I've seen you - I have two sons, I'm a pretty successful elder care attorney - but the funny thing is I'm kind of coming back for the same reason I did before, except in reverse." Then I was miserable about having to leave Wisconsin to move to Boca Raton and now I’m miserable about having to leave Boca to move to Boston. Both times for my husband’s jobs! But I understand. I do. Then he was lucky to get a job teaching history at Florida Atlantic University, but he’s been languishing here and Harvard has offered him a tenure track position. It’s a great opportunity for him.” Pause. “But then there’s me. What about my practice? I’m doing so well here. And somehow I think there’s more of a demand for elder law here than there will be in Boston. And the cold! Brrr. I left the cold when I left Madison. I don’t want to go back to it!”

“So you’re feeling …?”

“Angry. And scared.” Pause. “And sad too. I have a life here. My kids have a life here. There’s a lot to lose.”

“You’re angry at…?”

“My husband. I don’t know why we always have to do what he wants to do. I mean, I shouldn’t say it that way. It’s not like we didn’t talk about it. As I said, I do understand. It’s such a great opportunity for him.”

Listening to Joslyn brings me back to the time I moved from Ann Arbor to Boca Raton 25 years ago, to all the pains of leaving – my friends, my practice and the house I so cherished. I try to shake my feelings and return to Joslyn who continues.

“I try to remind myself that the move to Boca turned out well. So why can’t I assume the same will be true of moving to Boston?”

“Are your parents still alive Joselyn?”

She sighs. “My father died three years ago. He had pancreatic cancer.”

“I’m sorry. And he was the good parent.”

“Yeah. My mother and I have continued to struggle. She needs me more now, so she’s been a little warmer. We were even talking about her moving down here. Obviously that isn’t going to happen.”

“And you feel how about that not happening?”

“Good question.” Pause. “Part of me is relieved, but part is … I don’t know. I guess I’m sad about it.”

“And what exactly are you sad about?”

“I don’t know. I guess it’s like maybe the move would give us another chance. Like maybe it could be different this time. Maybe since she needs me more she’ll be warmer.”

“I notice, Joslyn, that you’re talking a lot about warm and cold. Wisconsin and Boston are cold. Florida is warm. Maybe your mother will be warmer when she’s in Florida. If I remember correctly a lot of your conflict about leaving Wisconsin was leaving your parents, your father because of his ‘warmth’ and your mother because you were afraid if you moved away you’d never, ever get the chance to somehow fix her and finally get the mother you wanted.”

“That’s right! Hmm. So you’re saying maybe that’s still true, maybe I don’t want to give up what will be my last chance to get the mother I want.”

“Yes. It’s like moving from the ‘warmth’ will mean you’ll have to give up forever the hope of getting the mother you never had. It’s again having to give up hope.”

Joslyn eyes fill with tears. “I thought I had already done that.”

“You certainly moved away from that hope when we worked together, but when confronted with lots of new losses, those feelings can resurface. And I’m not saying that all the feelings you’re having are about your mother. Obviously you’re facing real, present day losses – your practice, your friends, lots of things. But I suspect that the relationship with your mother is heightening all these other feelings.”

“I think I’d like to come back and see you for a while. Is that all right?”

“Of course. I imagine you want to say good-bye to me as well.”

“Oh!” Joslyn exclaims. “I hadn’t thought of that. You were my good mother. And yes, I’ll have to say good-bye to you too. That makes me very sad.”

In this week's blog, Forbidden, a therapist treads carefully in examining a patient's taboo sexual dream.

“I didn’t want to come today,” Marlene begins. “I don’t want to talk about what I know I have to talk about since it’s all I keep thinking about. I feel so ashamed.”

I’ve been seeing Marlene in therapy for a little over a year. She was concerned about being a good mother to her then six month old son, Dereck. She felt her own mother had never wanted children and that she remained cold and aloof until she died of cancer when Marlene was 12. Not surprisingly, Dereck’s vulnerability rekindled many of her own feelings of longing and loss, but nothing springs to my mind as something Marlene might do that would create this level of shame.

“I had this dream,” she begins hesitantly. “Dereck was cuddling in my lap.” Pause. “He was as cute as always,” she says, a brief smile flickering across her lips. She lowers her head. “He was naked. I was stroking his hair. He looked up at me and smiled. He reached up and grabbed my breast like he used to when he was nursing. Then he started stroking my breast. I could feel myself getting aroused.” Pause. “But… but this was the worst part. I stared stroking him back. First just his arms and shoulders. But then… but then I started stroking his penis and his penis started growing really big, almost like he was a grown man. What’s wrong with me?! That’s so disgusting!”

“I appreciate your being able to tell me the dream, Marlene. I realize how difficult it was for you. But you do need to remember it was a dream. You didn’t actually do anything to your son.”

“But it’s so perverted. How could I even think such a thing?”

“I would like us to try and understand the dream. Can you talk about it even though it’s difficult?”

“I guess.”

“You say you keep thinking about the dream, what do you think about?”

“It plays over and over in my mind. I’ve asked myself if I’ve ever done anything inappropriate to my son. Like when I’m changing his diaper. I don’t think I have. I mean I have to touch his penis to wash him, but that seems pretty normal. I thought it was cute, this little miniature penis. Is that all right?” she asks, panic rising in her voice. “Is it okay to think it’s cute?”

“Of course it is,” I say reassuringly. “Let me ask you, the tremendous feeling of shame you’re having, is the feeling familiar to you?”

“I don’t know.” Pause. “I was ashamed about how I thought my mother looked the last months of her life. The nurses would bathe her or change her in front of me, in front of any of us. She looked disgusting. I’d kind of look sideways at my Dad and he’d always have this gentle, loving look on his face and I’d wonder how he could not be disgusted too. They weren’t sleeping together at that point. She was in a hospital bed. But still…” Pause. “But that doesn’t seem to have anything to do with my dream.”

I wait.

“You’re not thinking my father abused me, are you?” she asks, wide eyed.

“No. I wasn’t thinking that. What made you ask?”

“I don’t know. Like my having this disgusting dream about my son and now I’m talking about my Dad. I don’t know. It doesn’t make sense.”

“Sounds like you felt bad for your Dad.”

“I did.”

“Were you and your Dad close during the time your mother was dying?”

“Close? I wouldn’t say that. The only person he was ever close to was my mother. He really didn’t care for anyone else. I mean he must have cared a little about us… and about my stepmother, but my mother was really the only person he loved.”

“Did you ever try to comfort your Dad when he was sad?”

“I think I remember stroking his arm sometime, like maybe even at the cemetery when we buried my mother. I don’t think he even noticed.” Pause. “I was talking to my Dad the other night. They’re going to come visit. It was our usual non-conversation, conversation.”

“When was your dream in relation to your conversation with your Dad?”

“I think it was the same night. Maybe the night after. No, it was the same night.” Pause. “Do you think there’s a connection?”

I proceed cautiously. “Well, your son is certainly a lot warmer and more responsive to you than your father. You stroke Dereck and he gets an erection. You stroke your father and he doesn’t even notice.”

“But I didn’t want my father to get an erection!”

“You wanted your father to care about you, you wanted a relationship like the one you and Dereck have.”

“But it’s not sexual! My dream was so sexual.”

“Longing for closeness can take many forms – wanting to be cared about, wanting to be loved, wanting to be sexual. Especially in the unconscious those get all mixed up.”

“I don’t know. I still feel like a pervert.”

“I know this has been hard for you. It would be helpful if we could continue talking about your longings and it would be especially helpful if you could be less judgmental about yourself.”

In this week's blog, And Then There Were None, a therapist tries to contain a patient's overwhelming feelings of pain and loss after the violent deaths of both her sons.

Mary Collins, a 49 year old woman who looks at least 10 tens older, sits across from me, tears streaming down her face, unable to speak. Although I have never seen or spoken to this woman before – her husband made the appointment - I feel the intensity of her pain and find myself similarly at a loss for words. Finally I decide on the most basic of human responses.

“I’m so, so sorry for your loss. I can only imagine the depth of your suffering.”

Mrs. Collins shakes her head again and again, her straight brown hair falling forward over her face. “I can’t …,” she says, continuing to shake her head.

I wait.

“I can’t stand it. I can’t!” she says more loudly. “I can’t stand the pain. I have nothing left, nothing to live for.” Pause. “I know you’re going to say it will get better. My husband says that all the time. But this? How can this get better?”

“Can you tell me about your son, Mrs. Collins?”

“Mary,” she says, still shaking her head.

“Mary, can you tell me about your son?”

“Billy. He was a good boy. A little wild as a kid, but what boy isn’t? He always wanted to be a policeman. I don’t know why.” A blank, distracted look comes across her face. She repeats, “I don’t know why. I don’t know why. I don’t know why.”

“You don’t know why he shot himself?” I ask.

Wailing she beats her fists into her thighs. “Why? Why? Why?”

Without thinking I get up from my chair, kneel in front of her and take hold of her hands. “Hurting yourself won’t bring your son back,” I say softly.

She stops hitting herself and sobs.

After a few moments I return to my chair.

She hides her head in her hands and continues sobbing.

“He didn’t want a divorce. Til death do us part. That’s what he wanted. That’s what he saw in our family. But she, she didn’t want to be married to a policeman, although she knew that’s what he was when she married him.” Pause. “And maybe it was more the boys for Billy, two little boys. Tore Billy to pieces.”  

She pauses. I think about what she said and wonder what her words will trigger for her. I watch the awareness go across her face.

“No! Not both of them! God couldn’t be so cruel. How could he take both my boys? Blown to bits by one of those IEDs. Who cares about that godforsaken place? Why do we keep sending these children to Afghanistan? It’s all so senseless, senseless.”

“I imagine Billy was pretty broken up by his brother’s death.”

“Sure was. And angry. Like me, angry. Ron was his baby brother. Billy kept saying he should have gone first. And now they’re both gone. And I have nothing.”

“Can you say who you’re angry at Mary?”

“Everyone.”

“Can you be more specific?”

“God. The government. The universe. Sue. I’m definitely mad at Sue. That’s Billy’s wife.”

I suspect she’s also angry with Billy for killing himself, but know it’s way too early to broach that topic. “Are you going to maintain contact with Sue? I imagine you’ll need to in order to see your grandchildren.”

She shrugs. “Who knows what she’ll do.”

“You saw each other at the funeral?”

She nods. “But I didn’t know what was going on that day. I don’t think she brought the boys, although I think I saw them later at the house.” Knitting her brow, she pauses. “I don’t know. What difference does it make anyway? Nothing matters anymore.”

“Do your grandsons matter?”

“I guess.” Pause. “Yes, they matter. They carry part of Billy.” Pause. “They’re the only grandchildren I’ll ever have.”

I can see Mary’s despair and rage begin to build, her hands in fists.

“Remember,” I say quickly, “Hurting yourself won’t bring your sons back.”

“But it’s easier. The physical is easier, easier than thinking, easier than remembering.”

“I do understand, Mary. But I don’t want you to hurt yourself. And I’m sure your husband doesn’t want you to hurt yourself either. I know the pain often feels intolerable, but you can survive it. As awful as it is, you can survive it.”

Mary sobs.

“And we can talk about your pain, Mary, your pain and your anger. I know that won’t bring your sons back either, but talking does help. And maybe us talking together will make it easier to bear the pain.”

This week's blog is entitled "Tradition." It illustrates the conflict a man brings into therapy between his parent's culture - most particularly his mother's - and his own desires, only to discover that his loved one is more like his mother than he realized.

Art sits dejectedly in my office, his elbows on his thighs, his head, shaking side to side, cradled by his hands. “I told you it would never work. She’s unrelenting. Tradition is everything to her. But it’s ridiculous! I’ve been in this country most of my life. How can she expect me to accept an arranged marriage? Go back to India and marry the girl her sister finds for me? It’s crazy.”

“I’m so sorry, Art. I can only imagine how difficult this must be for you.”

Lifting his head, he says, “And that’s another thing. She said she absolutely forbid me to have anyone call me anything but my given name, Arjun. She repeated it, yelling, ‘Arjun, Arjun, Arjun. That’s your name and I don’t expect to hear you called anything else.’ Of course I’m not about to do that. My friends haven’t called me Arjun since the first or second grade. And they made fun of me even then. She has no idea what it’s like, how difficult it is for a kid to fit into this culture. And particularly today. Even my brown skin can bring those looks – are you one of those?; are you illegal?; are you stealing our jobs?” He covers his face with one hand. “But there’s no point discussing all that.” Pause. “What am I going to do?” he asks beseechingly?

“I was just going to ask you the same thing.”

“I don’t know. I love Jessica. I want to marry her. We like the same things – hiking, kayaking, watching old movies. We think the same way, have the same values, love kids. My mother just doesn’t get it. We don’t have to be from the same culture, although we basically are. I’m probably more American than Indian.”

“Is that true? I mean you have grown up here most of your life, educated here, working here, but is it true that your Indian culture means so little to you?”

“Right now I just wish I could disown the whole culture.”

“But that’s your anger speaking, right?”

“I don’t know,” he says dismissively.

“I remember how joyfully you’ve described the Hindu weddings you’ve attended, how you know all about your gods, how you say you sometimes pray to one god or another.”

“But that’s just habit. It’s all a bunch of superstition. I don’t believe any of that stuff.”

I realize I’m pushing too hard to have Art take ownership of the Indian part of himself and wonder if that’s because he’s projecting those feelings onto me rather than feeling them himself. I need to step back.

“What are your thoughts?”

“I know I’m not going let my mother bully me. And I also know she won’t retreat. She said Jessica – no, actually she said ‘that girl’ – would never be welcome in her house, that she would never see our children. That hurts. And I know she’ll stick to it. There’s not going to be any Hollywood ending like in The Big Sick.”

Silence.

“I wish my father would say something.”

Is he also wishing I’d say something? I wonder.

“I know my father agrees with me. Or at least he’d accept my decision. But he always bows to her.” Pause. “And that’s another thing she said, ‘Your father and I had an arranged marriage. It turned out well for us.’ I had to bite my tongue there. It turned out well for her. She got to move to the US, be a doctor’s wife and stay enclosed in the Indian community. I don’t think that’s what my father would have wanted, but he’d never say.”

“So you’re angry at your mother for being too dominant and at your father for being too passive.”

“Exactly!”

Silence.

“I was thinking about Jessica and my relationship. Wondering who’s the more dominant one.” Pause. “I guess I’d say she is.” Pause. “I wonder how I feel about that.”

“Good question.”

“Not so good actually.”

“So are you implying that you were raised by a dominant woman and that perhaps now you’re attracted to a similarly dominant women?”

“Oh no! I came in here thinking I had one problem – how to deal with my mother – and now I have two problems – how to deal with my mother and Jessica.”

“Perhaps it’s not so much how you deal with either of them, but how you deal with yourself, the person you want to be, the person you are now given the family and the culture you were raised in. Is there a place between complying and rebelling? Are you unwittingly driven to repeat patterns from your past that you may not consciously want to repeat?”

“Stop! Too much. It’s giving me a headache.”

“There is a lot , but I was just trying to say that we humans are very complex beings and that it’s helpful for us to try and understand ourselves as best as possible.”

In this week's blog a woman's identification with her mother results in her inability to love her young daughter, thereby increasing her own self-hatred. She seeks therapy hoping to have more "normal" feelings restored.

Staring down, Cristina pulls at the fingers of her hands. She has been unable to say anything since entering my office.

As Cristina’s silence continues and her tears fall silently from her eyes, her pain becomes palpable. “I can see how much pain you’re in, Cristina. Can you tell me what’s wrong?”

She shakes her head. But then she practically whispers, “Me. I’m wrong. I’m all wrong.”

Although I have no idea what Cristina’s referring to, I feel the heaviness of her burden.

“I’m sorry you’re in so much pain, Cristina. Can you tell me what’s causing your pain?”

“There’s something wrong with me,” she replies, barely audible.

“Can you say what makes you feel there’s something wrong with you?”

Tears pour down her cheeks. She makes no attempt to wipe them away.  

“I can’t love her,” she says looking up at me beseechingly. “What normal mother can’t love her child?” She pulls harder at her fingers. “They said it was post-partum depression. And maybe it was. But no one has post-partum depression for two years. And, besides, I didn’t feel that way with my son. Peter was my precious baby. I couldn’t stop holding him and cooing at him. I loved him instantly. And I still do. But with her, it’s different. It was different from the start. And it hasn’t gotten any better.”

“So your daughter is two and your son is …?”

“Five.”

“And her name is …?” I ask, aware that she spoke her son’s name, but not her daughter’s.

“Caroline. I want to love her. I do. But it’s not there.” Pause. “Can you help me? Can you cure me? Can you make me normal again?”

“I can certainly help, but it isn’t like you have a disease, Cristina. I understand that you want to love Caroline, but perhaps first we have to understand why your feelings about Caroline are different from your feelings about Peter. And if you could try to understand what you feel rather than beating yourself up for your feelings, that would be really helpful.”

Cristina shakes her head empathically. “It’s not normal. I’m not normal.”

“Is anyone telling you you’re not normal?”

“Oh, yeah. My mother. She’s told me I’m not normal my whole life.”

“Because?”

“Because I’m not like her. My mother is one of these brash, strong, outdoorsy types who won’t take anything from anybody. And me, well today’s not a great example of how I usually look, but I’m usually pretty well put together. People tell me I’m pretty. I care about clothes and my nails, kind of a girlie girl. My mother couldn’t stand that about me.” Pause. “The truth is she wanted another boy, boy number four, but she got me instead. Unfortunately for both of us.”

“Do you think there’s a connection between how your mother felt about you and you feel about Cristina?” I ask.

Cristina looks at me blankly. “In what way?”

“Well, your mother didn’t like you because you were a girl and it sounds like you’re saying it’s much easier for you to love Peter, your boy, than Caroline, your girl.”

“You’d think I’d love Caroline all the more because I know how awful it feels not to be loved.”

“Well, rationally that may be true, but we humans don’t always act on the basis of rationality. There’s our unconscious to consider. There’s, for example, identifying with the parent who hurt us and then despite our best intentions behaving like them. I’m not saying that’s what’s going on for you, but it does sound as though your feelings about your daughter are similar to your mother’s feelings about you.”

“But I don’t know if Caroline is going to turn out to be a girlie girl.” Pause. “But she is tiny. And she seems so vulnerable.” Crying, Cristina adds, “My mother hated vulnerable. I think that’s what she hated more than anything. She hated when I cried. She hated that I cried. Said I wasn’t normal to cry so much. I guess I’m proving her right.”

“No, you’re not proving her right. You’re proving that you’re human. There’s nothing wrong with crying. And there’s nothing wrong with feeling vulnerable. We all feel vulnerable. And children feel most vulnerable of all.”

“You know, that is one of the things that bothers me about Caroline. She seems so fragile. And for some reason rather than being drawn to that fragility and wanting to protect her, I want her to get it together and be strong.” Pause. “You’re right! I sound like my mother. That’s awful. I never wanted to be like my mother. Now I have something else to hate myself for.”

“You’ve brought in a lot of material today, Cristina, and we’ll have plenty of time to work on it, but the more you could wonder why you do or feel what you do, rather than judging yourself, the easier it would be.”