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  • 01/09/2018 3:44 PM | Anonymous

    In this week's blog, The New Year, patient and the rapist seek to understand the patient's unconscious need to choose men who, seemingly unknown to her, are gay.


    The New Year

    Heather blows her nose and rubs her very red eyes. 

    “I feel as though all I’ve been doing since the New Year is crying,” she says. “I was sure Rob was it. I even thought he might propose on New Year’s Eve. Instead I just sat there waiting for him. Eventually I got panicked and started calling hospitals. He was always punctual. I don’t know why he couldn’t just call and tell me!”

    “There you sound angry,” I say.

    “I guess. But I can’t hold on to the anger. Mostly I just feel sad. And I think really stupid things like ‘it’s such a waste’ or ‘he was pretty good in bed.’ I know that’s ridiculous, he is who he is and that’s that.” Pause. “Except that I love him,” she exclaims, crying. “And I thought he loved me. When he finally got the nerve to call on New Year’s Day, he gave me that old line, he loves me but isn’t in love with me. Thought he could make it work until he met Brad and they just clicked. I had the sense they practically fell into bed two minutes after they met. And there I had one of those awful thoughts again. I was going to say, isn’t that what gay men do? I don’t want to be thinking that. That’s not who I am. I’m the most tolerant, liberal person around.”

    “Perhaps that’s your anger speaking.”

    “Maybe.” Pause. “This isn’t the first time,” she says softly.

    “Isn’t the first time …?”

    “I was involved with another man who realized he was gay. We weren’t quite as serious as Rob and I, but we’d been going together for a while.” Pause. “I’m not sure why I never told you. It was a pretty big deal to me, especially at the time. And now it’s happened again.”

    “What are your thoughts about not telling me about the first man?”

    “I’ve thought about it. I think I was ashamed. Ashamed that I wasn’t enough of a woman to hold onto a man. Or maybe ashamed of being a woman, that being a woman in and of itself isn’t enough.” Pause. “I think my mother thought that. I wasn’t enough and she wasn’t enough.”

    “Enough for what?”

    She shrugs. “Enough to be successful in the world, enough to be smart and educated and intellectual like my father. Enough to hold my father’s interest. He was never interested in her. He’d rather sit around with his fellow professors and have philosophical discussions. You know, I’ve told you, as a family we kind of weren’t. We all went our own way. My father paid attention to me when he wanted to impart some tidbit of knowledge, otherwise I was just kind of there. As for my Mom, we never talked, not even when we went on vacation. Just the two of us. My father never came.”

    Heather continues. “You know. I wonder if there’s a connection between my not feeling like enough and choosing – unconsciously choosing – gay men. Almost like – this is ridiculous too – they’re less of a man and I’m less of a woman, so maybe I’d be able to hold onto them.”

    “What was it like for you sexually, Heather? Did you feel like less of a woman in bed? Did you feel they were lesser men?”

    “They weren’t lesser men. Rob was a very attentive lover, always wanting to please me. In fact, he embarrassed me. He wanted me to tell him what it felt like, what I felt when he’d do one thing or another. I didn’t like all that focus on my body. It embarrassed me, made me self-conscious. He’d always satisfy me, always. That made me uncomfortable too because he didn’t always … umm … ejaculate.”

    “And the other man?”

    “Now I’m really embarrassed.” Pause. “That was different. That was a lot rougher. Sometimes he’d tie my hands and like take me really hard and fast. It was a turn-on. For both of us. When he told me he was gay I asked him about our sex, about how exciting it seemed for both of us. He said it made him realize how much he wanted done to him what he did to me. That made me feel less than. I couldn’t do what he wanted, not only because I didn’t have a penis, but because I just couldn’t. I couldn’t be that aggressive.”

    Heather pauses and then continues. “So what am I saying, that I’m not enough of a woman because I’m not a man? Wow! That’s wild. That’s messed up.”

    “You’ve described your father as the source of power in the family, the person both you and your mother hoped to ‘interest,’ so it’s not surprising that only maleness feels like enough. How that relates to your choosing gay men isn’t clear – at least to me – and something we’ll have to continue talking about.”

    “Definitely. I’m not interested in repeating this for a third time.”  

  • 11/16/2017 8:00 AM | Anonymous

    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.

    “I’m still miserable,” she says, sitting down, immediately confirming my worst fears. I do understand that Beth has good reason to be miserable. Her husband divorced her after 20 years of marriage, leaving her with two teenagers, three dogs and a six bedroom house. It’s a lot to deal with. And we’ve been dealing with her misery for almost two years.

    “Of course I had another problem this week. The kitchen sink started leaking. I freaked out. I went running around to my neighbors to ask if they knew a plumber. Luckily one of them did.”

    Knowing I am about to make a futile statement, I say, “So that’s something that worked out well.”

    “Not really. It took me days to reach the plumber and then more days before he could come. And in the meantime the kids and I had to eat out which certainly doesn’t help my budget.” She sighs. “It’s all so complicated. I don’t know why life has to be so difficult.”

    I wonder how many times I have said things such as, ‘life can be difficult and you’ve certainly had a difficult time, but life can bring lots of joy as well.’  I remain silent.

    “Well …?” she says.

    My stomach tightens. I feel as though she is commanding me to respond.

    “What is it that you want from me right now?” I ask. I hear my choice of words, the tone of my voice and realize that Beth is making me feel as she feels – burdened, put upon, ineffectual, despairing. Ineffectual. That’s an interesting word to flit through my mind. Perhaps that’s what Beth feels. Now alone, she feels unable to competently contend with life.

    “I need you to reassure me, to tell me that it will all work out okay.”

    “Would you believe me?”

    Beth opens her mouth to speak and then stops. After a pause she says, “Well if you said it, it might reassure me.”   

    This time I don’t hear Beth’s words as a command to speak, but rather a wish that I take care of her. “I understand that you want reassurance, but you often hear that reassurance as empty words.”

    “But I don’t know what to do. I have all these responsibilities. The kids. They’re certainly becoming more than a handful. How am I supposed to handle two teenagers by myself?” She takes a breath. “And what if I get sick? That’s all I’d need. How could I take care of all the things I need to take care of if I got sick? Who would take care of me?”

    “I definitely hear how overwhelmed you feel, Beth. Like there are all these things that happen on a day to day basis and then there are all the things that might happen. How are you going to cope?”

    “Exactly.”

    “But I wonder, Beth, if it would be more helpful to you if you were able to see your own strength, if you were able to realize that you’re far more capable than you think you are.”

    “But I’m not!”

    “Do you really feel as though you’re not a competent, capable adult or are you afraid to let yourself know you’re a competent, capable adult?”

    “They always said I wasn’t.”

    “Who’s they?”

    “My parents, my sisters, my husband. Even my children. They say I’m a wreck, that I can’t do anything right, that I’m always running around in circles. And I am. I’ve been doing that my whole life.”

    “So what would it feel like to be competent?”

    “How do I know? I’ve never felt it.”

    “Would you like to?”

    “Of course!”

    “Beth, can you think about that a bit more? I wonder two things: If feeling competent feels so foreign to you that it would be like you’re becoming another person and that in itself would feel pretty scary. And two, you’re not sure you want to be all grown up before you find someone who’ll take care of you.”

    “My husband said he’d take care of me. But he never did. He just nagged at me for what I didn’t do right. Even my parents. I was the fifth girl. They’d had enough by that time. I was kind of an add-on.”


    “I understand, Beth, that it’s very difficult to give up on wanting the love and caretaking you never had, but there’s no way to get that kind of caretaking as an adult. It doesn’t mean you can’t be loved and cherished, but you can’t go back to being the child and, in the end, it does feel much better to have confidence in your ability to take care of your adult self.”

  • 10/27/2017 2:59 PM | Anonymous

    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.

    “You know, I’ve been thinking,” Jacquelyn begins. “I’ve been thinking I should take a break from therapy for a while.”

    Internally, I scream, ‘What!? I thought you said you were going to think about your anger?’ To Jacquelyn I say, “And why is that?”

    “I don’t know. I’ve been doing this for over a year, seems like it’s time for a vacation.”

    “Does your desire for a vacation seem connected to last week’s session when you realized you were angry at your mother for not protecting you as a child?” I ask.

    “I didn’t say that.”

    “Not exactly, but you did want the woman in the TV show who reminded you of your mother to be killed by the serial killer.”

    “I didn’t say that either.”

    Disappointed that Jacquelyn has moved so far away from her more open, insightful stance of last week, I ask, “What’s your sense of what’s going on between us right now?”

    “Nothing special.”

    Feeling increasingly exasperated, I ask, “Can you say what you think is going on between us even if it’s not anything special.”

    “You’re mad at me. You’re mad at me because I want to stop therapy.”

    “I am annoyed with you, Jacquelyn, because I felt so hopeful last week, hopeful that we’d made a breakthrough, that you experienced your anger at your mother and that although you were scared of the repercussions, you went away wanting to think about it.”

    “It was too scary.”

    “I do understand that, Jacquelyn,” I say, thinking that perhaps she’s put one toe back in the water.

    “But why were you angry at me if you understood?”

    Hmm, I think to myself, I wonder if Jacquelyn wanted me to feel angry so that I could feel what she feels – angry but thwarted in its expression. I decide to keep that thought to myself. “I can understand and still be angry. Anger is a feeling. We can’t control what we feel, although we can control what we say or what we do.”

    “So you don’t feel scared when you feel angry?”

    “No, I don’t feel scared when I feel angry. Except some times.”

    “Like when?”

    Although repeatedly answering a patient’s questions is unusual for me, I feel that in Jacquelyn’s case it is a helpful form of modeling, perhaps making her own anger less frightening. “Well, I guess like in that TV show you talked about last week, I’d probably be scared if I got angry at the serial killer because I’d be afraid if my anger showed he might immediately kill me.”

    “That’s it!” Jacquelyn says staring at me, her eyes wide open. A second later she’s sobbing, pulling at her hair.

    “It’s ok, Jacquelyn,” I say quietly. “There’s no serial killer here and your father is long dead.”

    She continues crying, but seems calmer. Through her tears she haltingly says, “I never even knew I was afraid he’d kill me. Like he could read my mind. Like he’d know I hated him. I was always so scared, so scared, so scared,” she says cradling her body in her arms and rocking in the chair.

    “I’m so sorry, Jacquelyn. I’m so sorry that you had to go through all that. You were only a powerless, dependent little girl. You were so scared.”

    I can see Jacquelyn bristle. She stops crying and lifts her head. I went too far.

    “I’m sorry, Jacquelyn,” I say, “I know it’s very hard for you to be aware of how powerless you were as a child. It makes you feel all the more frightened.  It’s more than you can bear.  

    “Maybe it is time to take a break from therapy.”

    I look at Jacquelyn tenderly. “No, it isn’t,” I say. “I know I went too far. You were back there being that little girl and I so terrified you that you had to come back to your adult self, had to go back into a defensive mode. Will you forgive me?”

    She is again crying. “I don’t think in my entire life anyone asked me to forgive them. I used to dream about that. I used to dream that one day both my mother and father would take me aside and apologize for all the bad things they’d done to me. But of course that was ridiculous. Except it’s kind of like you made my dream come true, even though you didn’t do anything nearly as bad as they did.” Pause. “Yes, I’ll forgive you,” she says crossing both her hands on her lap and staring directly at me.

  • 10/19/2017 5:27 PM | Anonymous

    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.”

  • 09/18/2017 3:45 PM | Anonymous

    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.”

    He nods.

    “I wonder if that’s what happened in the anti-Trump demonstration. You were…”

    Ed interrupts me. “I did think that my father is a lot like Trump. A bombastic bully who’s thin skinned and easily narcissistically wounded.”

    “So you mean you’d be afraid of going up against Trump, just like 

    you’re afraid of going up against your father?”

    “Yes.”

    “That makes a lot of sense.”


    “But you were you going to say something when I interrupted you.”

    “Oh, yes. About your anger. I was wondering if in the demonstration you saw all these people who seemed comfortable with their anger and that that scared you, made you afraid that your anger might get out of hand, especially since, as you just said, Trump reminds you of your father.”

    “You know, I’ve never quite gotten that bit about my anger, but somehow it makes sense in the context of that demonstration. There were all these people yelling their heads off, shouting terrible things about Trump. I wanted to join in, to become a part of the crowd. But instead I drew in and had all this noise going on in my head.” Pause. “Thank you. I feel much better.”

    “My pleasure. See you Thursday.”

    “Thanks again.”

  • 08/21/2017 10:37 PM | Anonymous

    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.

  • 08/11/2017 4:58 PM | Anonymous

    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.  

  • 07/18/2017 3:19 PM | Anonymous

    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.”

  • 06/28/2017 3:14 AM | Anonymous

    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.”

     

     

     

  • 06/27/2017 2:51 PM | Anonymous

    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.”    


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