Blogs

In this blog, a patient stays stuck in misery, hoping to find someone - perhaps

 her therapist - to take care of her, rather than owning her adult capabilities.

Beth smiles wanly at me as I open the waiting room door. I anticipate a long, dreary session.

In this session the patient, Jacquelyn, runs from the anger she felt in the previously, but is able to return to those feelings with her therapist's self-awareness, insight and support.

This weeks blog focuses on a patient's particular response to a TV show which further reveals the patient's conflict around aggression, enabling her therapist to bring the conflict more clearly and directly into the consulting room. 

Thirty year old Jacquelyn looks unusually pensive as she settles herself into the chair across from me.

“A weird thing happened this week. Kind of disturbing ,” she begins. “You know how I tell you that I always watch those gruesome  shows like Criminal Minds or CSI, but that I have to cover my eyes during the particularly gory scenes?” she says grimacing.

I nod.

“Well, one of those gory scenes came on, and instead of covering my eyes I felt sort of compelled to watch it. And I – this is kind of embarrassing. I, umm, I actually felt kind of excited and found myself rooting for the serial killer. I wanted to watch him kill that, that, umm, that woman.”

“What did you first think of, Jacquelyn, before you said ‘woman?’”

Jacquelyn lowers her head. “First I thought to say ‘bitch,’ then ‘sniveling baby,’ or ‘coward’ or ‘idiot.’ But they sounded too negative, so I settled on woman.” Pause. “You know, you’re always telling me that I have lots of anger, but that I keep it buried inside me.” Pause. “I didn’t feel angry, not even when I was wanting him to kill her.” Pause. “That doesn’t make sense when I say it out loud.”

Jacquelyn’s last comment is encouraging. Although I’m sure she’s at least of average intelligence, she tends to be quite concrete, has difficulty with self-reflection, and is often unable to take in what seems to me the most obvious of connections.

“Was it that you wanted this particular man to kill the woman or did you want this particular woman dead?” I ask.

“Do you think I’m terrible for thinking about this?”

“Not at all. You weren’t killing anyone, you were watching a TV show.”

“I guess,” she replies dubiously.

Silence.

“You want me to answer your question.”

“Yes.”

“I wanted this woman dead.”

“And can you say more about that? Why did you want her dead? Who did she remind you of?”  

“I don’t know.”

“Well, how about thinking about it now.”

Silence. Jacquelyn squirms in her chair.

“Can’t she just be a woman?”

“If you think about a woman, what woman comes to mind?”

“She wasn’t like my mother.”

“Does that mean your mother was the first woman you thought of?”

She nods, looking down.

“And what’s the similarity between your mother and this woman in the TV show?”

Still not looking at me she says, “They were both housewives.” Pause. “They had children.” Pause. “Umm. Umm. They couldn’t stand up to their husbands.”

Thinking to myself, ‘now we’re getting somewhere,’ I ask, “How did the woman in the TV show not stand up to her husband?”

She looks up. I suspected that it would be easier for her to talk about the TV character than her mother.

“There’s this scene at the breakfast table where her husband is screaming his head off at both her and the kids. You know he’d be cursing in real life but of course they can’t show that on TV. He goes off on the little girl when she spills a glass of milk, calling her an idiot and worthless. The little girl starts to cry and the woman tells her husband to calm down and that does it, now he’s really off the wall, screaming at the woman and even looking as if he might hit her. She cowers and turns back to washing the dishes while the father starts screaming at the girl to stop crying and when she doesn’t he slaps her across the face. The woman doesn’t do anything.”

“Does that sound familiar, Jacquelyn?”

Tears roll down her face. “I didn’t want to kill my mother. Oh my God, I hope not. I hope I didn’t wish her gone, because then I would have been left with him.” Pause. “We were both such cowards,” she says now sobbing.

“What do you mean?” I ask.

“Both of us. Neither of us could stand up to him.”

“Jacquelyn, you were a little girl. How were you going to stand up to him?”

She shakes her head and continues sobbing. “Cowards. We were cowards. We should have done something.”

“You’re angry at both yourself and your mother for not being able to fight back.”

“We were cowards.”

“You can’t accept your own vulnerability, Jacquelyn.”

“No! I can’t!”

“So you wanted to kill the woman in the TV show because of her ‘weakness,’ because of her vulnerability.

“I didn’t want to kill her, I wanted her dead.”

I think Jacquelyn has had enough for today and decide to back off.

“You’ve done a lot of good work today,” I say. “I wonder how you’re feeling.”

“Scared.”

“Scared of?”

“I’m not sure. Being slapped across the face like the girl in the TV show. That’s silly. I feel bad, like I did something wrong and I’m going to be punished.”

“I understand, Jacquelyn. You’ve gotten closer to your anger than you’ve ever been and I think that’s frightening you.”

“You think so?”

“Yes, I do.”

“Okay. I’ll try to think about that.”

This week's blog, Chaos, looks at a therapist working to calm a traumatized patient who is turning his aggression on himself.

“Welcome back,” I say to Ed, smiling. He attempts a smile in return, walks into my office, sits down in the chair across from me, and sighs. A smart, sensitive, psychologically minded twenty year old college student, Ed has had difficulties for much of his life – anxiety, compulsivity, facial tics, self-flagellation - but seemed markedly improved before returning to his home in New York City for the summer.

Shaking his head from side to side, he says, “It was too soon. I shouldn’t have gone home. And I shouldn’t have participated in that anti-Trump demonstration. Too much, way too much.” I watch Ed’s eye begin to twitch. He raises his right hand, then catches himself, makes a fist and puts his hand down. “As you can see, it’s back,” he says contemptuously.

“I’m sorry, Ed. I really am. Did you really feel so angry with you that you wanted to hit yourself?”

“Yes. I wanted to beat the shit out of myself,” he says clenching his jaw. “I’m sorry. I know you’ve worked so hard to help me stop that.”

“You don’t have to apologize, Ed. I’m just sorry you’re in so much pain.”

“I’m weak. I’m a sniveling baby. I can’t do anything to help myself.”

“That certainly sounds like the voice of your father.”

“Yeah, so what else is new? I thought I could take him on. I thought I was ready. How stupid of me. And joining that demonstration was terrible.” Ed’s eyes widen. I can feel the fear seeping from him. He fidgets, crossing his legs from side to side. “There were so many people, angry people. And they should be angry. We have an insane bully in the White House. North Korea, Venezuela, racists, Nazis! It’s insane. It scares me. But all the anger scares me too. It reverberates in my head. I can’t turn it off. I feel like I’m crazy too.” Ed digs his nails into both fists. He looks down at those fists as though they’re an alien part of him. He starts to beat his thighs.

I want to go and hold his hands to subdue him, to reassure him, to prevent him from hurting himself. Instead, I softly say, “Ed, Ed please look at me. I’m here. We’ll get through this. You’re with me now. You’re not in that demonstration, you’re not with your parents.”

Ed looks at me, first as though he doesn’t see me and then with dawning recognition. Tears roll down his face. He buries his head in his hands. “I don’t want to be crazy. I don’t want to be crazy,” he mumbles through his hands.

“You’re not crazy, Ed. You’ve been traumatized, actually re-traumatized, and it will take us a while to work it through. Can you talk about some of the things that happened with your parents or does that feel like too much for today?”

He lifts his head and smiles at me. “Well, that never happened. No one was ever sensitive to my feelings. It’s amazing what a difference just a little understanding and caring makes. How many times have I said I wish you were my mother?”

“Except there’s usually a second part to that statement.”

“Yeah, I’m afraid that not even you could stand up to my father and I wouldn’t want to find that out. And then you say you couldn’t promise me that you’d be able to stand up to my father but you certainly hope you’d try.”

“I also say that your father’s rage is not the only rage you’re afraid of, that you’re afraid of your own rage as well.”

In this weeks blog, "The Consultation," a patient presents herself as an angry, contemptuous woman, hiding the sad, damaged child underneath.

Rebecca Whitman rises from the waiting room chair extending her hand to greet me. She is dressed in a pale lavender suit and matching high heeled shoes which are surprisingly flattering with her flowing dyed red hair. I wonder at her age. Mid-forties? Hard to know how much plastic surgery she’s had.

“This is a consultation, right?” she begins immediately . “I’ve had lots of them. You get to decide if you want to work with me and – never to be forgotten - I get to decide if I want to work with you. So what do you want to know?”

Feeling as though she has just thrown out her opening salvo, I say, “That’s quite a beginning.”

She sighs. “I believe in getting to the point. Why waste time. It is my money after all.”

“Do you want to be here, Ms. Whitman?” I ask, noticing that I have automatically called her by her last name.

“Why do you ask?”

“Well, we’ve never met before and yet it feels to me that you’re already angry with me. That doesn’t make much sense unless you’re angry at being here.”

“I’m always angry. I’m angry at being here. I’m angry that I have to pay you to listen to me. I’m angry that I’ve seen I don’t know how many therapists. I’m angry they’ve either thrown me out or been completely incompetent or both. I’m angry that even though I’m one of the best real estate agents in the area, I eventually get shown the door. No biggie, I’m good enough I always find another agency. I’m angry that I’ve had three failed marriages and heaven knows how many other relationships that failed. Any questions?”

I feel torn. A part of me wants to join all the others who have gone before me and stop this consultation immediately.  But another part, perhaps the grandiose part, wants to give it a shot. I do know if I’m going to try, I want to do something other than taking her anger on directly. 

“What would you be feeling if you weren’t feeling all that anger?” I ask.

She laughs. “I’ve heard that one many times before. You think a simple question is going to have me dissolve into tears. You’re going to have to do better than that.”

So much for not taking her anger on directly. “Do you like being angry? Do you like losing jobs and relationships and therapists? And why are you here? What do you want to accomplish?”

“Better,” she says.

I feel myself getting angry at her constant evaluation of me. I keep silent.  

The silence persists.

“I guess you want me to answer your questions.” Pause. “Ok, Ok, I’ll answer the questions. Sometimes I like being angry and sometimes I don’t. And, no, of course I don’t like losing job or relationships.” Pause. “I’m not sure why I’m here. I guess I’m hoping someone doesn’t throw me out.”

Her last statement sounds so sad that I find myself fighting back tears. 

“Someone I can have respect for, that is,” she adds with her typical bravado. 

My sadness shuts down immediately. Rebecca Whitman has told me a lot about her defensive need for anger.

“If I ask you who was the most significant person in your life who threw you out, who would you say?”

She shrugs, “My mother.”

“Ok, Rebecca, so I do think you’re afraid if you let down your anger you’d be left with lots and lots of tears, tears of loss, abandonment, worthlessness and, of course, rage.”

“Think you’re smart, huh?”

“Rebecca this isn’t a contest. I’m not here to beat you in a competition. I’m on your side. And I know you can’t simply put away your defensive angry. It’s been a part of you for a long time. But hopefully if you come to trust me, you can let it down little by little and together we can deal with the pain underneath.”

“Ok smarty-pants, guess why my mother threw me out.”

“There’s no way I could guess that, but I’d appreciate your telling me.”

“Because I told her my step-father – step-father number three, by the way – was doing it to me.”

“Oh, Rebecca, I’m so sorry.”

“Yeah? Yeah? What the fuck good is your pity going to do for me? I was eleven years old. Eleven years old for God’s sake!”

“That’s more than reason enough to be angry. But you must also feel sorry for you as that eleven year old child.” 

“I don’t believe in a pity party!”

“Compassion for a child is not a pity party.”

“So are you going to work with me?”

“Yes, Rebecca, I’m going to work with you. I’m not going to throw you out.”

“Ok,” Rebecca says as she sprints towards the door.

A therapist is confronted with a new patient who she suspects is fabricating her story. The therapist wants to know if she is indeed lying and, if so, why.

Maxine sits comfortably in my chair, runs her hand through her curly brown hair and begins. “I came to therapy because I keep having fantasies about killing my daughter.”

Oh oh, I think, remaining silent and neutral. Maxine seems a bit taken aback by my silence. What she doesn’t know is that I am immediately on guard, unsure if I am about to hear a story that is truly every therapist’s nightmare, or one that is completely fabricated. A colleague told me she saw a new patient who told her a similar story and then admitted it was only a test for the therapist.

“I don’t know why I’m having these fantasies,” Maxine continues. “I love my daughter. We’ve always been close.”   

Not wanting to accuse a truly troubled person of lying, I decide to go along and see what develops. Of course, a woman who goes from therapist to therapist fabricating a story, must be pretty troubled as well. “What’s your guess?” I ask. “Why do you think you have been having these fantasies? How long have you been having them?”

Maxine sits comfortably in my chair, runs her hand through her curly brown hair and begins. “I came to therapy because I keep having fantasies about killing my daughter.”

Oh oh, I think, remaining silent and neutral. Maxine seems a bit taken aback by my silence. What she doesn’t know is that I am immediately on guard, unsure if I am about to hear a story that is truly every therapist’s nightmare, or one that is completely fabricated. A colleague told me she saw a new patient who told her a similar story and then admitted it was only a test for the therapist.

“I don’t know why I’m having these fantasies,” Maxine continues. “I love my daughter. We’ve always been close.”   

Not wanting to accuse a truly troubled person of lying, I decide to go along and see what develops. Of course, a woman who goes from therapist to therapist fabricating a story, must be pretty troubled as well. “What’s your guess?” I ask. “Why do you think you have been having these fantasies? How long have you been having them?”

“It was right after Barbara’s – that’s my daughter – right after her thirteenth birthday, about six months ago. I don’t know why I’m having the fantasies. If I knew I wouldn’t have come here. What do you think?”

I think this is a sham, but I’m still reluctant to confront Maxine.

“It’s pretty hard for me to have any idea since I know next to nothing about you.”

Maxine sighs, seeming exasperated.

I’m rather annoyed myself, but try to return to my more neutral tone. “Can you tell me about you?  What’s your present life like? Married? Other children? Working? And what was it like for you growing up?”

“I’m a stay at home Mom. My husband is an entrepreneur. He travels a lot. I was thinking I should probably go back to work. With Barbara growing up there’s not that much for me to do.”

“What are your feelings about Barbara growing up.”

“Mixed. I’d like my little girl back and I’m looking forward to seeing where my life takes me.”

“Where do you want it to take you?”

“I’m not sure yet. I think that’s one of the reasons I feel so dissatisfied with myself.”

I find myself liking Maxine more, yet feel entirely confused about what’s going on in the session or what’s real and what isn’t. I decide to take the plunge.

“Maxine, what of what you’ve told me today is true and what isn’t?”

“You figured it out! You’re the first one. Oh good, now you can be my therapist.”

“I had a rather big clue. One of my colleagues told me she’d seen a patient who told her a pretty similar story and that it was supposed to be a test for the therapist.”

“Oh! What a disappointment. Now I can’t tell if you’re really smart or not.”

“Maxine, you must by now know from therapists’ reactions that it’s quite insulting and infuriating to be tested by a series of lies. But I’d like to know the underlying reason you found it necessary to go through this charade.”

“I didn’t think I could trust someone who wasn’t smart enough to figure me out.”

“Well, I’d guess that you definitely feel you can’t trust people and I’d also guess that you see yourself as very troubled and in need of someone who can not only understand you but handle you as well.”

“You are smart. You can be my therapist.”

“But this is a two way contract. There’s the question of whether I feel I’m up to being your therapist.”

“Please, please, I’ll be good.”

“You sound like a scared little girl when you say that.”

Maxine starts to cry.

“Maxine, I know this is unusual for a first session, but this has been an unusual first session anyway. I want you to tell me what the secret is.”

“No, no, I can’t. Not yet.”

“I’m sorry. That’s my condition for us starting therapy. And if you tell me another lie you’ll only be hurting yourself. There’s something you’re terribly afraid of or guilty about, something you need to start dealing with even though you want to keep it hidden.”

“I killed my sister.”

“Is that another lie?”

“No, no, it isn’t. I wish it were. I didn’t do it deliberately.” Maxine’s next words are flat, expressionless. She stares straight ahead. “A group of us were playing soft ball. I was at bat. I swung. I lost control of the bat. It hit my sister in the head. She died. My parents sent me away.”

“I’m so sorry, Maxine. What a horrible accident. How traumatic. And then to be sent away on top of it. I’m really, really sorry.”

“So you’ll be my therapist?”

“Yes,” I say, although I realize that it will take me some time to totally trust what Maxine tells me.  Hmm, I think, Maxine has led me to feel the distrust she feels in the world.  

“It was right after Barbara’s – that’s my daughter – right after her thirteenth birthday, about six months ago. I don’t know why I’m having the fantasies. If I knew I wouldn’t have come here. What do you think?”

I think this is a sham, but I’m still reluctant to confront Maxine.

“It’s pretty hard for me to have any idea since I know next to nothing about you.”

Maxine sighs, seeming exasperated.

I’m rather annoyed myself, but try to return to my more neutral tone. “Can you tell me about you?  What’s your present life like? Married? Other children? Working? And what was it like for you growing up?”

“I’m a stay at home Mom. My husband is an entrepreneur. He travels a lot. I was thinking I should probably go back to work. With Barbara growing up there’s not that much for me to do.”

“What are your feelings about Barbara growing up.”

“Mixed. I’d like my little girl back and I’m looking forward to seeing where my life takes me.”

“Where do you want it to take you?”

“I’m not sure yet. I think that’s one of the reasons I feel so dissatisfied with myself.”

I find myself liking Maxine more, yet feel entirely confused about what’s going on in the session or what’s real and what isn’t. I decide to take the plunge.

“Maxine, what of what you’ve told me today is true and what isn’t?”

“You figured it out! You’re the first one. Oh good, now you can be my therapist.”

“I had a rather big clue. One of my colleagues told me she’d seen a patient who told her a pretty similar story and that it was supposed to be a test for the therapist.”

“Oh! What a disappointment. Now I can’t tell if you’re really smart or not.”

“Maxine, you must by now know from therapists’ reactions that it’s quite insulting and infuriating to be tested by a series of lies. But I’d like to know the underlying reason you found it necessary to go through this charade.”

“I didn’t think I could trust someone who wasn’t smart enough to figure me out.”

“Well, I’d guess that you definitely feel you can’t trust people and I’d also guess that you see yourself as very troubled and in need of someone who can not only understand you but handle you as well.”

“You are smart. You can be my therapist.”

“But this is a two way contract. There’s the question of whether I feel I’m up to being your therapist.”

“Please, please, I’ll be good.”

“You sound like a scared little girl when you say that.”

Maxine starts to cry.

“Maxine, I know this is unusual for a first session, but this has been an unusual first session anyway. I want you to tell me what the secret is.”

“No, no, I can’t. Not yet.”

“I’m sorry. That’s my condition for us starting therapy. And if you tell me another lie you’ll only be hurting yourself. There’s something you’re terribly afraid of or guilty about, something you need to start dealing with even though you want to keep it hidden.”

“I killed my sister.”

“Is that another lie?”

“No, no, it isn’t. I wish it were. I didn’t do it deliberately.” Maxine’s next words are flat, expressionless. She stares straight ahead. “A group of us were playing soft ball. I was at bat. I swung. I lost control of the bat. It hit my sister in the head. She died. My parents sent me away.”

“I’m so sorry, Maxine. What a horrible accident. How traumatic. And then to be sent away on top of it. I’m really, really sorry.”

“So you’ll be my therapist?”

“Yes,” I say, although I realize that it will take me some time to totally trust what Maxine tells me.  Hmm, I think, Maxine has led me to feel the distrust she feels in the world.  

This week's blog deals with the difficult issue of love in the consulting room and how it can be dealt with appropriately with the patient's best interest in mind, or inappropriately creating long lasting damage.

“I love you,” Melanie says, looking downward.

Twenty-five year old Melanie has been my patient for two years, a lovely young woman struggling with anxiety and depression.  One of six children raised on a farm by parents who saw their offspring as laborers, rather than cherished beings, Melanie has come to rely on me as one of the few people who is consistently in her corner. Professing her love for me doesn’t take me by surprise.

“Thank you, Melanie,” I say, “that’s a lovely gift.”

“No,” she replies. “It’s much more complicated.”

I wait, unsure what she means.

“I said that to my last therapist,” she says hesitantly. “You know, I’ve talked to you about Dr. Hopkins. I saw him for a couple of years before you.”

I nod.

“But I never told you what happened, why I left.” She pauses. “We had an affair.”

I’m shocked. Not that I’ve never heard of therapists inappropriately crossing sexual boundaries, but I’m surprised Melanie never told me something of such significance.

“I’m so sorry, Melanie. How come you never told me before?”

“I was too ashamed.”

The victim blaming herself. Not unusual I think to myself. “Do you realize that Dr. Hopkins abused you?”

“No. It wasn’t like that,” she protests. “I told you, I loved him. And he loved me back. That was the most wonderful surprise of my life. Someone I so looked up to and admired actually loved me!”

“Melanie, how did your therapy with Dr. Hopkins end?”

“Well, for a while we saw each on the outside and I continued to have my regular therapy sessions. Dr. Hopkins was very clear that we couldn’t do anything sexual in the office, that we had to remain professional during our sessions.”

I am beyond furious at this so-called therapist, but hope that I am successful at concealing my feelings.

“But then Dr. Hopkins told me he didn’t think I needed therapy anymore. So I quit and just saw him on the outside.”

Still seething, I wonder if Dr. Hopkins thought his prowess as a lover had “cured” Melanie or whether he just found it too difficult to keeps his hands off her during their sessions.

“But then one day,” she continues, “he said that we couldn’t see each other anymore. He told me his wife was sick and that he felt too guilty being with me. I was devastated. I mean, I knew he was married. I knew it wasn’t like we’d be together forever and ever. But I loved him so much. And I thought he loved me. So how could he just walk away?”

“When you say you thought he loved you, are you now questioning that?”

Melanie starts to cry. “I was a fool. I know I was a fool. Did I really think a smart, educated man more than twice my age would be in love with me? He wanted my body. But I just wanted so much for him to love me, that I deluded myself into thinking he did. That’s what I’m ashamed of, being such a fool.”

“There’s an awful lot to deal with here, Melanie, and I’m sure we’ll return to this many times, but I want to come back to us before the session ends. So what did it mean to you to tell me you loved me? And what response did you hope for – or fear?”

“I’m not sure. I know I don’t want to sleep with you, but I do want you to love me. I guess I want to crawl into your lap and have you stroke my hair and tell me you love me, just as you’d tell your own daughter. Is that wrong?”

“No, Melanie, what you wish for can never be wrong. But acting on that wish is different. You wanted Dr. Hopkins to love you, which really meant you wanted him to care about you, to cherish you and to act in your best interest, not his. He did abuse you, Melanie. He took advantage of your need, of your vulnerability and crossed what should have been an unbreakable boundary. As for us, the wish to crawl into my lap and be my daughter is a more than understandable wish for someone who was so neglected as a child. But if I were to act on that wish I would not be acting in your best interest, because I would be giving you the false hope that you can go back to being a child and get from me what you couldn’t get from either of your parents.”

“That makes me sad.”

“I’m sure it does. Mourning what you never got and never can get, is always sad.”

It’s been a year since my wife died,” Andrew    Solomon begins. “She died of breast cancer. It    was a long process. Hard. She fought for as long    as she could, but she had an aggressive cancer.    She couldn’t beat it. Now, now I have the rest of    my life. I’m 65. I guess people consider that young  these days,” he adds with a slight smile. “I’m still working, thank goodness. It’s a great distraction. I’m an accountant. I have my own business so can pretty much make my own hours, except during tax season. But I cut down on my clients during my wife’s illness, so I do have more time on my hands.”

Mr. Solomon is a good looking man with wavy white hair, intense brown eyes and a slight dimple in his chin. I wonder what has brought him into therapy at this point, but wait to see where his thoughts take us.

He continues. “My friends tell me it’s time for me to start dating. That I’m young, secure financially, decent looking and that I’ll have women, younger women, flocking all over me. Maybe. But I don’t know. I don’t know that I feel ready.”

“How do you feel about your wife’s death?” I ask.

“Sad. Like there’s this big hole in my life. Don’t get me wrong, Bella – that’s her name, that was her name, hard for me to talk about her in the past tense – Bella and I didn’t have a perfect marriage. We had our fights. And I wasn’t always the ideal husband, especially when our kids were young. I had a couple of affairs. Never felt right about that. We got lots closer after our kids left. And actually we got even closer when she got sick. I guess I realized how much I was going to lose…” He trails off fighting back tears.  

“Sounds like you’re still understandably very sad.”

“But shouldn’t I be better after a year?”

“What do you mean by better?”

“Better, less sad, not so teary, ready to move on. Finished with grieving.”

“Grieving the loss of a loved one is not something we ever finish.”

Mr. Solomon looks startled. “No that can’t be. I can’t stay at this level of pain forever.”

“It’s not that grief doesn’t diminish that, as you said, the level of pain remains as intense, but we certainly don’t stop loving or missing the person we’ve lost.”

“But does that mean I shouldn’t start dating? Maybe I should start dating, maybe that would help with the pain.”

“That’s certainly not a decision anyone but you can make. Some people start dating soon after their partner has died, others wait years, and still others never date at all. There’s not one right answer for everyone.”

“I had a friend who got involved with the woman who eventually became his second wife, a month after his wife died. I thought that was awful. I lost respect for him.”

I flash on what Mr. Solomon said about having affairs earlier in his marriage and wonder if guilt plays into his question about whether or not to start dating. “How would you feel about yourself if you decided to start dating?”

“Bella told me it would be all right with her. I thought that was an amazing gift she gave me, especially since she knew about the affairs, or at least one of them.”

“Sounds like you still feel guilty about your affairs.”

“Yes, yes I do. I know it’s silly. It’s so many years ago. But especially when Bella got sick, I kept thinking how horrible I had been to her. How could I have even looked at another woman when I had Bella this amazingly strong, brave, good, beautiful woman?”

“You know, Mr. Solomon…”

“Please, call me Andrew.”

“You know, Andrew, I wonder if your guilt about those affairs very much affects you in the present, both in terms of how you feel about Bella’s death and also about whether you feel comfortable dating.”

“Why should that be?”

“Well, our pasts always affect the present and we haven’t even talked about your past before Bella – your childhood, your young adulthood. I suspect that guilt may have played a role in your life then as well. And we haven’t talked about why you think you had those affairs. Were you angry with Bella? Were you angry with her attention to your children?”

“Wow! I guess there is a lot there. I thought I was going to come in today, solve the problem of whether or not I should start dating and that would be that.”

I smile. “Therapy is way more complicated than that. It opens lots of questions before you’re able to answer even one.”

 

 

 

An adopted patient again struggles with her feelings about her therapist not being her mother.

“I’ve decided to really start looking for my biological mother,” Liz says at the beginning of our session.

I have seen 27 year old Liz for a tumultuous five years, and although she has brought up trying to find her biological mother on previous occasions, today she does sound more determined.

“Did something happen that reawakened your desire to find your biological mother?” I ask.

She shrugs. “I’ve talked about it before. I just think it’s time. I know you don’t think it’s a good idea, but I want to know who she is.”

“It’s not that I think it’s a bad idea, I just want you to be prepared if the reunion with your biological mother doesn’t prove as idyllic as you hope.” I think of all the adopted people I have known – both patients and friends – who have found their biological mother only to be horribly disappointed yet again, people who have been outright rejected, others whose mother wanted to take over their lives, still others who wanted to be financially supported. Finding the perfect fantasized mother is rarely the outcome.

“What choice do I have?” she asks.

There’s a familiar edge to Liz’ voice, an underlying anger, an underlying demand. I look at her quizzically and remain silent.

“Don’t play dumb,” she says. I now definitely know that something is going on between us. “I have no mother. My so-called mother doesn’t give a shit about me. She was just thrilled when I finally moved out of the house so she could start redecorating and have my father all to herself. And then there’s you. You’re just never going to be more than my therapist. If I even move slightly towards wanting more from you, you run for the hills.”

This is a familiar refrain, one that has played out repeatedly over the time we have worked together. From the beginning, Liz wanted me to be her mother. She had fantasies of moving in with me, fantasies of traveling with me, fantasies of curling up next to me on a couch and watching a movie. Sometimes she presented these as poignant longings, at other times she lashed out at me in rage, furious at my refusal to satisfy her desire. I cared deeply about Liz, understood her longing and was able to hang in there with her during even the most difficult times. I think back on our last session and suddenly realize what has led Liz to experience me as pulling back and wanting to search for a more perfect mother.

“You were angry that I didn’t want you to take my picture,” I say.

“I don’t see what the big deal was. It was only a stupid picture! Everybody takes pictures these days, pictures of dogs, pictures of signs, pictures of themselves. So what was the big deal with taking your picture?”

“You tell me, Liz. What was the big deal about taking my picture? Obviously you have a lot of feelings about my asking you not to take my picture.”

“Yeah and you gave me some mumbo, jumbo about my needing to take you in and have a picture of you in my mind without needing to have an actual picture. So? I can do that. I have you in my mind. We worked on that for a long time and now I can do it.”

“That’s great, Liz. So the question remains, then why did you want an actual picture?”

Liz looks angry and then seems to deflate in front of my eyes. She sighs deeply and looks down at her hands. “I guess because people always have pictures of their family,” she says quietly.

“I know it’s very hard for you, Liz,” I say with compassion, “But the reality is that I will never be your mother. That doesn’t mean I don’t care about you, it doesn’t mean that I won’t be here for you, it doesn’t mean you’re not important to me, but it does mean that however much you may want it, I will never be your mother.”

“I hate when you say that,” Liz says, more sadly, than angrily.

“I know,” I reply.

“Can we still talk about my looking for my biological mother?”

“Of course. But as much as possible, you need to try and separate your wish to find your biological mother from your wish that I was your mother. And, as I’ve said, you also need to be prepared to be disappointed in your biological mother as well.”

“I hate when you say that, too.”

“I know.”