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"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.”

In this week's blog, "Panic," the present rekindles the past when a man's wife asks him for a divorce. Overwhelmed by panic just as he was as a child when his mother emotionally abandoned him after the death of his father, he looks to his therapist for a magical solution.

“I couldn’t wait to get here,” Ray says, almost breathless. “Pamela asked me for a divorce. She said we’ve been working on our relationship for years and it just doesn’t get any better. She wants out. She wants a chance to find greater happiness with someone else.”

“I’m sorry, Ray,” I say empathically.

“I…I’m a mess. I don’t think I’ve slept two hours since she told me. I never thought she’d leave me. I don’t know what to do. I can’t think straight. I’m like beyond panicked.”

“What’s fueling your panic?”

“What? What do you mean?”

“I can certainly understand you’re feeling sad and scared and maybe even angry, but what’s underneath your panic?”

“I’ll be alone. She’ll leave and take the kids and I’ll be alone. Oh my God, I can hardly say that. I can’t breathe.”

“I’m here. You’re not alone now. Take a few deep breaths and then let’s try to look at what feels so terrifying to you about being alone.”

Ray looks at me incredulously. He buries his head in his hands and tries to slow his breathing. He bursts into tears.

I sit silently while Ray cries, hoping he has broken through some of the anxiety to feel his sadness underneath.

“Why? Why? Why did she do this?”

Ray’s shock about his wife’s decision is rather surprising to me since they have indeed been working on their relationship for years. Ray told me she had repeatedly said she was unhappy in the relationship, feeling him unable to give to her emotionally or sexually.   

“What did prompt her decision?” I ask.

“I don’t know. Maybe because we didn’t have sex?” he says questioningly.

“You’ve told me that has been one of Pamela’s consistent complaints. That you withhold from her.”

“Do you break up a 15 year relationship because of sex?”

Ray’s consistent disbelief feels incredibly naïve to me. I even wonder if it’s disingenuous. Then I have another thought.

“You feel very much like a scared, hurt child to me,” I say gently.

Crying again, Ray mumbles, “That’s exactly how I feel.”

“So perhaps that’s why you’re panicked. When a child is left he feels panicked because he can’t survive without his mother - or some caretaker.”

“So you think Pamela’s leaving me feels like my mother leaving me?”

I nod.

“But my mother never left me.”

“That’s not exactly true Ray. You’ve told me how she reacted after your father died.”

“Yeah, that’s true. Before I was seven – when my father died – we had a very close relationship. In fact, she was all over me. Sometimes I just wanted to get away from her. It was too much. But after he died, I don’t know, it was like she died too. She got so depressed and didn’t want me anywhere around. In fact she shipped me off to her sister’s for a while. It was awful. My cousins hated me. I’m sure they didn’t want another kid in the family. I had to change schools and that was awful. The whole thing was awful.” Pause. “And when I went back home, my mother still rejected me.” Pause. “And then she started dating. That was worse. All those men. And then my step-father. The whole thing was a nightmare.” Pause. “You know what just went through my mind? I wanted my Mommy back.”

Crying, Ray adds, “And that’s how I feel right now. I want my Mommy. Except it’s Pamela.”   

I remain silent, thinking this is not the time to explore the meaning behind Ray’s similar feelings about his mother and Pamela.

“I guess that helps explain my panic,” he continues. “But it doesn’t take it away,” he adds, looking at me beseechingly. “Can’t you take it away?”

“So perhaps now I’m the Mommy who you want to take away all your fears and sadness.”

“Can you?”

“That’s clearly your wish, but I’m afraid I have no magic wand.”

“No?”

“No, but we can look at your desire for that magic wand, for the all-powerful, all-perfect mother who can take away all your fears, all your sadness so that you feel nothing but perpetual bliss.”

“Sounds wonderful.”

“But I wonder if it would feel wonderful or, as you said before about your early mother, whether it would feel too much and you’d want to get away.”

“I don’t know. Right now it sounds wonderful.”

“When faced with abandonment you yearn for closeness, but when there’s closeness it can feel like too much and you yearn to get away.”

“I don’t know. I can’t deal with all that now.”

“I understand. We’ll have plenty of time.”

In this week's blog, I'm Afraid, the past and present converge, inhibiting a young woman's desire to protest against gun violence in America.

This blog was rather fun to write. More fun, I'm sure, than it would have been to treat this patient.

"Disgruntled" presents a frustrated therapist trying valiantly to treat a demanding, embittered patient.

“I had this unbelievably horrible day yesterday,” 76 year old Joan Green begins. With dyed red hair and raised eyebrows penciled to match, she challenges everyone around her and looks perpetually amazed by their response. She is my patient only because a psychologist colleague of mine begged that I see her. She had moved to Boca Raton, Florida a year ago after her daughter who lives in Phoenix could no longer tolerate her and feared her mother would destroy her marriage. Her son, my colleague, was not faring much better and told his mother that he would no longer have anything to do with her unless she went into therapy.

She continues. “I spent my whole afternoon in the pain doctor’s office and didn’t even get everything done. The pain is terrible. Everything hurts me – my back, my hips, my neck, even my feet. I can’t take it anymore.”

“Did anything go well yesterday?” I ask, perpetually trying to find something positive in Mrs. Green’s constant tales of woe. I doubt I’m the best therapist for this patient. Constant complaining is not my forte, especially when someone is so resistant to looking at her part in the interaction.

“I liked the doctor.”

My eyebrows shoot up in surprise. “Well that’s important. And positive.”

“Well, he was nice, but I don’t see why he couldn’t give me an injection yesterday and not make me come back.”

“Did he tell you why?”

“He needed me to get an MRI first. And he couldn’t do it in his office – I guess he doesn’t have the equipment. That wasn’t good either. And he said I had to call for an appointment. I don’t know why they couldn’t call for me. I don’t carry my phone with me. It’s way too heavy. I didn’t want to have to go all the way home and then go out for an MRI another day. I’m in pain! Obviously or I wouldn’t be in his office. I told them – I was in the waiting room by then, arguing with the office staff - I’d be willing to sit wherever and wait until they could take me.”

“Mrs. Green, does it seem to you that you have lots of expectations of other people, expectations that might be impossible to fulfill?”

“What! What expectations?”

“Well, what are your thoughts about that?”

“Why should I have any thoughts about that? You’re the one who brought it up. You should be the one telling me.”

Annoyed at this constantly demanding patient, I try to step back. “I wonder if you feel so un-given to, so lacking in nurturing that you have a profound need to be taken care of, whether that’s me answering your question rather than your thinking about it yourself or wanting a doctor to have every possible piece of machinery  available in his office, or needing others to make phone calls for you.”

“That’s just stupid psychobabble. Probably because you can’t answer your own dumb question.”

Feeling angry, I’m silent, trying to figure out what I want to say next.”

“What? Cat got your tongue?

“I wonder what you get out of being so difficult and demanding. I know that it can’t possibly get you what you want. Your daughter didn’t want you in the same city as her. Your son won’t deal with you unless you’re in therapy. But therapy is about looking at yourself. And if you’re not willing to look at yourself instead of blaming everyone else for their insufficiencies, we’re not going to get very far.”

“And that would be my fault?! How about your looking at you?”

“I’m happy to look at how I may be contributing to the difficulty we’re having, but that means you’ll need to look at how you might be contributing to the difficulty too.”

“Okay. So tell me. Both sides.”

“I’m going to answer that question, Mrs. Green, but I want to point out that you’ve again issued a demand and as a result of that demand I don’t really want to answer the question. I am going to answer the question, but I suspect that most people who aren’t therapists wouldn’t. They’d see you as an entitled, demanding, angry, embittered woman. And, from my perspective, that’s all true. But I do think there’s a reason you’re that way and I’m willing to work on us trying to figure out what that reason is which might help you to make some changes.”

“And what’s your part?”

“I think it may be particularly difficult for me to have people make demands on me without my wanting to resist their demands and that might make our work together more difficult.”

“So should I find someone else?”

“That’s certainly your choice. I’d be happy to give you some referrals if that’s what you decide.”

“You’re probably all alike. I’ll stick with you for a while and see what happens.”

“Okay. Fair enough.”

"The New Year - Part II" is another of my attempts at a follow-up session. Here the therapist struggles to remain non-judgmental as her patient tries to become someone she's not in order to avoid the pain of a breakup. 

As I open the door, I am surprised to see a smiling Heather waiting for me. Quite a change from just three days ago, I think.

Once comfortably seated in the chair across from me, she says, “Not the person you expected to see today, right? Rob and I got back together.”

“How did that happen?” I ask, while silently thinking, oh no.

“He called. Said he made a mistake and wanted us to be together. Turned out that Brad was actually living with another man and Rob decided he couldn’t deal with the free-wheeling gay lifestyle.”   

I struggle with whether to remain silent or share my concern. While deliberating, Heather says, “You don’t approve.”

“It’s not a question of approval, Heather. I just wonder why you were so quick to take him back. He told you he wasn’t in love with you and you certainly know that you can’t choose who you’re attracted to.”

“We had great sex after the breakup. I remembered what you and I talked about and tried to be more aggressive. It was terrific. We didn’t tie each other up, but I tried to do more to him, like … umm …. doing oral sex and … I’m not sure I can say this …”

Silence.

“Like putting my finger up his ass. I thought I’d be grossed out, but it was okay.”

“So you’re saying that you tried to be what you consider more masculine.”

“I guess.”

“It’s like what you said last time, you thought if you could be more of a man you’d be good enough.”

“Why are you trying to take this away from me?” Heather asks plaintively. “I was so miserable; I felt so shitty. And you can see how much better I feel.”

“I know that breakups are horribly painful, but it seems to me that you’ve put yourself in the position to be hurt all over again. If Rob is gay, he’s going to find another man he’s attracted to and …”

“No, he told me he wouldn’t.”

“Okay,” I say, asking myself why I am pushing Heather so hard. Why am I trying to protect her, rather than looking at the underlying dynamics that have led Heather to return to this relationship? Am I re-enacting something in her family dynamics? Something in my own?  

Backing off I say, “What do you feel would be helpful for you today?”

“Oh!” she says, obviously surprised. “I don’t know.” Pause. “You just stopped. You didn’t keep badgering me. My mother never did that. She didn’t talk to me much, but when she did she was always trying to convince me to do what she thought I should, even if it made no sense.”

“So what do you want to do?”

“I want to stay with Rob, see what happens, and try to be more assertive.”

I think of all the rejoinders to her comment, but decide that confronting her directly will only feel like her old arguments with her mother. “And what would you like me to do?” I ask.

“Hmm. I’d like you to help me be more assertive.”

“So perhaps you’re being assertive right now, by telling me what you want me to do.”

“I guess, but it’s easy with women. Like I pretty much did what I wanted regardless of what my mother said. But with my father, there was no way. I toed his line.”

“So we’re talking about the power your father had and how being male was prized in your family.”

“Oh yeah.”

“And last week you talked about not feeling good enough to keep a man because you weren’t male enough.”    

“Yeah, weird as that is.” Pause. “So I guess I’m saying that I’m going to try to be more male.” Pause. “I guess that’s okay.” Pause. “What do you think?”

“It depends how much you’re twisting yourself into someone you’re not, vs. how it flows naturally.”

“It doesn’t flow naturally.”

Silence.

“So are you saying there’s no hope?”

“Depends what you’re hoping for. If you feel you to need to be a man, there’s certainly no hope for that. If you’re talking about keeping Rob, I’m dubious – although I could be wrong – because I think it’s about him, not you. But there’s certainly hope that you can give up feeling your womanness is inadequate and feel that you’re more than enough for a man.”

“Right now I just want to make it work with Rob.”

“I hear you. And I’ll be with you in any way I can.”