I walk across the street to the lot where I used to park for my bikini waxes, and I feel both lighter and like I might vomit. A supervisor once likened doing psychotherapy to undergoing physical therapy. It can be difficult and cause pain, and your condition can worsen before it improves, but if you go consistently and work hard when you’re there, you’ll get the kinks out and function so much better.
I check my phone.
A text from Allison:
Remember, he’s trash.
An email from a patient needing to move her session.
A voicemail from my mom wondering if I’m okay.
No message from Boyfriend. I’m still hoping he’ll call. I can’t understand how he could be fine while I’m suffering so much. At least, he seemed fine when we coordinated my returning his belongings this morning. Had he gotten through his sadness months ago, knowing that eventually he was going to end things? If so, how could he have kept talking about our future together? How could he send I love you emails just hours before what was to become our last conversation, at the start of which we made movie plans for the weekend? (Did he go see the movie? I wonder.)
I start to stew again on the drive to the office. By the time I pull into my building’s parking garage, I’m thinking about the fact that not only has Boyfriend wasted two years of my life, but now I’m going to have to deal with the fallout by going to therapy, and I don’t have time for any of this because I’m in my forties now and half my life is over and . . . oh my God, there it is again! Half my life is over. I’ve never said that to myself or anyone else before. Why does it keep popping up?
You’re grieving something bigger, Wendell had said.
But I forget all about this as soon as I step into the elevator at work.
8
Rosie
“Well, it’s official,” John says after slipping off his shoes and sitting cross-legged on the sofa. “I’m surrounded by idiots.”
His phone vibrates. As he reaches for it, I raise my eyebrows. In return, John gives me an exaggerated eye roll.
It’s our fourth session together, and I’ve started to form some initial impressions. I get the sense that, despite all the people surrounding him, John is desperately isolated—and that this is by design. Something in his life has made getting close seem dangerous, so dangerous that he does everything in his power to prevent it. His arsenal is effective: He insults me, goes on long tangents, changes the subject, and interrupts whenever I attempt to speak. But unless I can find a way to get past his defenses, we’ll have no chance of making headway.
One of these defenses is his cell phone.
Last week, after John began texting in session, I brought his attention to my experience of feeling dismissed when he texts. This is called working in the here-and-now. Instead of focusing on a patient’s stories from the outside world, the here-and-now is about what’s occurring in the room. You can bet that whatever a patient does with his therapist, he also does with others, and I wanted John to begin to see the impact he had on people. I knew I ran the risk of pushing too far too soon, but I remembered a detail about his earlier therapy: It had lasted just three sessions, exactly where we were. I didn’t know how long I’d have with him.
I was guessing that John had left his previous therapist for one of two reasons: either she didn’t call him on his bullshit, which makes patients feel unsafe, like children whose parents don’t hold them accountable; or she did call him on his bullshit, but she moved too fast and committed the same mistake I was potentially about to make. I was willing to risk it, though. I wanted John to feel comfortable in therapy but not so comfortable that I wasn’t helping him.
Above all, I didn’t want to fall into the trap that Buddhists call idiot compassion—an apt phrase, given John’s worldview. In idiot compassion, you avoid rocking the boat to spare people’s feelings, even though the boat needs rocking and your compassion ends up being more harmful than your honesty. People do this with teenagers, spouses, addicts, even themselves. Its opposite is wise compassion, which means caring about the person but also giving him or her a loving truth bomb when needed.
“You know, John,” I’d said the week before as he texted away, “I’m curious if you have any reaction to my feeling dismissed when you do this.”
He held up a finger—Hang on—but continued to text. When he finished, he looked up at me. “Sorry, what was I saying?”
I loved that. Not “What were you saying” but “What was I saying.”
“Well—” I began, but his phone pinged, and off he went, responding to another text.
“See, this is what I mean,” he grumbled. “I can’t delegate anything if I want it done right. Just a sec.”
Judging by the pings coming in, he seemed to be having multiple conversations. I wondered if we were reenacting a scene that played out with his wife.
Margo: Pay attention to me.
John: Who, you?
It was profoundly annoying. What to do with my annoyance? I could sit and wait (and become more irritated), or I could do something else.
I stood up, walked over to my desk, searched through a file, picked up my cell phone, walked back to my chair, and started texting.
It’s me, your therapist. I’m over here.
John’s phone pinged. I watched him read my text, surprised.
“Jesus Christ! You’re texting me now?”
I smiled. “I wanted to get your attention.”
“You have my attention,” he said, but he kept on texting.
I don’t feel like I have your attention.
I feel ignored, and a bit insulted.
Ping.
John sighed dramatically, then resumed his texting.
And I don’t think I can help you unless we’re
able to give each other our full attention.
So if you’d like to try to work together, I’m going
to ask that you not use your phone in here.
Ping.
“What? ” John said, looking up at me. “You’re banning my cell phone? Like I’m on an airplane? You can’t do that. It’s my session!”
I shrugged. “I don’t want to waste your time.”
I didn’t tell John that our sessions aren’t, in fact, his alone. Every therapy session belongs to both patient and therapist, to the interaction between them. It was the psychoanalyst Harry Stack Sullivan who, in the early twentieth century, developed a theory of psychiatry based on interpersonal relationships. Breaking away from Freud’s position that mental disorders were intrapsychic in origin (meaning “in one’s mind”), Sullivan believed that our struggles were interactional (meaning “relational”). He went so far as to say, “It’s the mark of a senior clinician that he or she is the same person in their living room that they are in their office.” We can’t teach patients to be relational if we aren’t relational with them.
John’s phone pinged again, but this time it wasn’t me. He looked between me and his phone, deliberating. As his internal battle waged, I waited it out. I was half prepared for him to get up and leave, but I also knew that if he didn’t want to be here, he wouldn’t have come. Whether he understood it or not, he was getting something out of this. I was likely the only person in his life right now who would listen to him.
“Oh, for God’s sake!” he said, tossing his cell onto the chair across the room. “Okay, I’ll put down the goddamned phone.” Then he changed the subject.
I expected his anger, but for a second it looked as if his eyes had moistened. Was that sadness? Or was that a reflection from the sun streaming in the window? I toyed with inquiring, but there was only a minute left in the session, a time usually reserved for putting people back together rather than opening them up. I decided to file it away for a more opportune moment.
Like a miner spotting a glimmer of gold, I suspected that I’d hit on something.
Today, with much restraint, John stops mid-reach, leaving his vibrating phone alone and continues his story about be
ing officially surrounded by idiots.
“Even Rosie’s being idiotic,” he says. I’m surprised to hear him talk this way about his daughter, who’s four. “I tell her not to go near my laptop, and what does she do? She jumps on the bed, which is fine, but it’s not fine to jump on the laptop that’s on the bed. Idiot! And then as soon as I yell, ‘No! ’ she pees on the bed. Ruined the mattress. She hasn’t peed on anything since she was a baby.”
This story concerns me. There’s a myth that therapists are trained to be neutral, but how can we be? We’re humans, not robots. In fact, instead of being neutral, we therapists strive to notice our very un-neutral feelings and biases and opinions (what we call countertransference), so that we can step back and figure out what to do with them. We use, rather than suppress, our feelings to help guide the treatment. And this story about Rosie raises my hackles. Many parents have yelled at their kids in their less-than-glorious parenting moments, but I wonder about John’s relationship with his daughter. When working with couples on empathy, often I’ll say, “Before you speak, ask yourself, What is this going to feel like to the person I’m speaking to? ” I make a mental note to share this with John one day.
“That sounds frustrating,” I say. “Do you think you might have scared her? A loud voice can be frightening.”
“Nah, I yell at her all the time,” he says. “The louder the better. Only way she listens.”
“The only way?” I ask.
“Well, when she was younger I would go outside and run around with her, let her blow off some steam. Sometimes she just needed to be outside. But lately she’s been a real pain in the ass. She even tried to bite me.”
“Why?”
“She wanted to play with me, but . . . oh, you’ll love this.”
I know what’s coming.
“I was texting, so she had to wait, and she just lost her shit. Margo was out of town, so Rosie was spending her days with her Danny, and—”
“Remind me, who’s Danny?”
“Not Danny. Her danny. You know, a dog nanny?”
I stare back blankly.
“A dog sitter. A nanny for the dog. A danny.”
“Oh, so Rosie is your dog,” I say.
“Well, who the hell did you think I was talking about?”
“I thought your daughter’s name was—”
“Ruby,” he says. “The little one is Ruby. Wasn’t it obvious that I was talking about a dog here?” He sighs and shakes his head as if I’m the biggest idiot in his kingdom of idiots.
He never mentioned having a dog before. The fact that I remembered the first letter of his daughter’s name, which was referenced only in passing two sessions ago, feels like a victory to me. But more than John’s entitlement, what strikes me is this: he’s showing me a softer side I haven’t seen yet.
“You really love her,” I say.
“Of course I do. She’s my daughter.”
“No, I mean Rosie. You care about her deeply.” I’m trying to touch him in some way, to bring him closer to his emotions, which I know are there but atrophied, like a neglected muscle.
He waves me away with his hand. “She’s a dog.”
“What kind of dog is she?”
His face brightens. “A mix. She’s a rescue dog. She was a mess when we got her because of those idiots who were supposed to be taking care of her, but now she’s—I’ll show you a photo if you’ll let me use my goddamned phone.”
I nod.
As he scrolls through his pictures, he smiles to himself. “I’m looking for a good one,” he says. “So you can see how cute she really is.” With each photo, he beams a bit more, and I glimpse his perfect teeth again.
“Here she is!” he says proudly, handing me the phone.
I look down at the picture. I happen to love dogs, but Rosie, God bless her, is one of the ugliest dogs I’ve ever seen. She has sagging jowls, uneven eyes, multiple bald patches, and a missing tail. John is still beaming, smitten.
“I can see how much you love her,” I say, handing back the phone.
“I don’t love her. She’s a fucking dog.” He sounds like a fifth-grade boy denying a crush on a classmate. John and Rosie sitting in a tree . . .
“Oh,” I say gently. “The way you talk about her, I hear a lot of love there.”
“Would you stop saying that?” His tone is irritated, but I see pain in his eyes. I think back to our previous session—something about love or caring must feel painful for him. With a different patient, I might ask why what I’m saying is so upsetting. But I know that John will avoid the topic by arguing with me about whether he loves his dog. Instead, I say, “Most people who have pets care about them deeply.” I lower my voice so that he almost has to lean in to hear me. Neuroscientists discovered that humans have brain cells called mirror neurons that cause them to mimic others, and when people are in a heightened state of emotion, a soothing voice can calm their nervous systems and help them stay present. “Whether it’s called love or something else, it doesn’t really matter.”
“This is a ridiculous conversation,” John says.
He’s looking down at the floor, but I can see that I’ve got his full attention. “You brought up Rosie for a reason today. She matters to you, and now she’s acting in a way that concerns you—because you care.”
“People matter to me,” John says. “My wife, my kids. People.”
He glances toward his cell, which is vibrating again, but I don’t follow his gaze. I stay with him, trying to hold on so he won’t get pulled away whenever an unwanted feeling appears and go numb. People often mistake numbness for nothingness, but numbness isn’t the absence of feelings; it’s a response to being overwhelmed by too many feelings.
John looks from his cell back to me.
“You know what I love about Rosie?” he says. “She’s the only one who doesn’t ask things of me. The only one who isn’t, in one way or another, disappointed with me—or at least, she wasn’t before she bit me! Who wouldn’t love that?”
He laughs loudly, like we’re at a bar and he’s just tossed out a breezy one-liner. I try to talk about the disappointment—who’s disappointed with him and why?—but he claims it was just a joke and can’t I take a joke? And though we get nowhere with this today, we both know what he told me: he has a heart under those quills, and the capacity for love.
For starters, he adores that hideous dog.
9
Snapshots of Ourselves
People who come to therapy present snapshots of themselves, and from these snapshots, a therapist has to extrapolate. Patients arrive, if not at their worst, then certainly not at their best. They might be despairing or defensive, confused or chaotic. Generally, they’re in very bad moods.
So they sit on the therapist’s couch and look up expectantly, hoping to find some understanding and, eventually (but preferably immediately), a cure. But therapists don’t have an immediate cure because these people are complete strangers to us. We need time to acquaint ourselves with their hopes and dreams, their feelings and behavior patterns, sometimes more deeply than even they have. If it takes from birth to the day they arrive in our offices to develop whatever is troubling them or if a problem has been incubating for many months, it makes sense that they might need more than a couple of fifty-minute sessions to attain the desired relief.
But when people are in extremis, they want their therapists, these professionals, to do something. Patients want our patience but may not have much patience themselves. Their demands can be overt or tacit, and—especially in the beginning—they can weigh heavily on the therapist.
Why would we choose a profession that requires us to meet unhappy, distressed, abrasive, or unaware people and sit with them, one after the other, alone in a room? The answer is this: Because therapists know that at first, each patient is simply a snapshot, a person captured in a particular moment. It’s like a photo of you taken from an unfortunate angle and with a sour expression on your face. There might also be a p
hoto in which you’re glowing, caught opening a present or mid-laugh with a lover. Both are you in that fraction of time, and neither is you in your entirety.
So therapists listen, suggest, nudge, guide, and occasionally cajole our patients to bring other snapshots into view, to shift their experience of what’s happening inside and around them. We sort through the snapshots, and before long it becomes apparent that these seemingly discrete images all revolve around a common theme, one that might not have been in our patients’ fields of vision when they decided to come in.
Some snapshots are disturbing, and glimpsing them reminds me that we all have a dark side. Others are blurry. People don’t always remember events or conversations clearly, but they do remember with great accuracy how an experience made them feel. Therapists have to be interpreters of these blurry snapshots, aware that patients need to be fuzzy to some extent, because those first snapshots help to gloss over painful feelings that might be invading their peaceful inner territory. In time, they find out that they aren’t at war after all, that the path to peace is to call a truce with themselves.
Which is why when people first come in, we’re imagining them down the line. We do this not just on that first day but in every single session, because that image allows us to hold for them the hope that they can’t yet muster themselves, and it informs how the treatment unfolds.
I once heard creativity described as being the ability to grasp the essence of one thing and the essence of some very different thing and smash them together to create some entirely new thing. That’s what therapists do too. We take the essence of the initial snapshot and the essence of an imagined snapshot and smash them together to create an entirely new one.
I have this in mind each time I meet a new patient.
I hope that Wendell does too, because in those early sessions, my snapshots are, well—not flattering.
10
The Future Is Also the Present
Maybe You Should Talk to Someone Page 6