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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.

"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.”