The Dance of Therapy: Duets

ATTACHMENT

When Mitchell first came to see me, I knew from his self-description that he struggled with depression and anxiety.  A small, thin, dark- haired man of 30, who appeared in every way much younger than his chronological age, Mitchell described a history punctuated by extreme loss and fear.

The death of both his mother and grandmother when he was ten-years-old left him emotionally devastated. Subsequently raised by an evangelical father, by the time he reached adolescence he desperately searched for female replacements, generally attaching himself to girls and later to unavailable woman such as lesbians, prostitutes and married women with whom the loss was continually repeated.

Not surprisingly, Mitchell quickly attached to me. Given the nature of the therapeutic relationship, I was similarly unavailable making his attachment fraught with ambivalence. Would I abandon him as other woman had done?  Was my caring and concern for him genuine or did I only continue to see him because he paid me?

There is no doubt that Mitchell is working hard in therapy and has been for the last 2 years I have been seeing him but I find myself still, after all this time, feeling as emotionally challenged as the first time we met, when the undercurrent of his pain, anger and need felt like it could pull me under.

With Mitchell the transference was heightened.  I became a central part of his fantasies in a way that I am not with other clients.  Alyssa the mother.  The mother that he never had and so desperately wishes he did.   Alyssa the woman who seems to have her shit pretty well together.  Alyssa.  The therapist with dark hair and light eyes and a presentation all her own. The person he can never have, save for the time we sit together, with no physical contact, in my office.

But at the same time, Mitchell, who has more than one personality, will explode, with insults toward me, once removed, as he assumes another persona. “Sam thinks you’re a whore. He knows you think about sex all the time or fuck every man you meet.”

Many times, Mitchell or one of his alters; brave Sam or cocky David, has told me about his thoughts of raping me, even killing me, intrusive thoughts born from the fleeting fantasy of relief that he could find a way to terminate; that is, to leave me before I leave him. Of course, these are always immediately followed by the terror of the sound of his own words, and the results of such actions. I would be gone.

I wonder, more than I do with anyone else, if there are times in which I am sacrificing myself, compromising my beliefs and values, in order to stay present with him. While he desperately longs for a connection with women, ultimately his intense, even obsessive need to control these women and his verbal chastising of them when they fail to meet his unrealistic expectations pushes them away just as it threatens to do with me.

But this what I must honor  if I am to work with someone whose pain  and rage is so intense that he cannot bear it himself and must – in order to survive – share the weight of it with two other personalities, as well as with me.

Continually managing my discomfort, I have committed myself to the long haul and every week regardless of his railing and rage, and the constant challenge by him that I “don’t really care,” I stay.  Even when I feel triggered.  Even when the energy in the room feels so toxic I begin to feel sick. I stay because I imagine being the one living with those kinds of emotions.  Because asking him not to share these thoughts won’t keep him from having them.  And because blocking him from seeing me won’t either.

But talking about them over time, and sitting with them when they come in, sitting with them until they pass and he finds himself having survived them, has diminished them, their power and their impact on both of us.  And because in this relationship, I am the one more capable of handling my own triggers, I must believe that he will not act out his sometimes violent fantasies.

AUTHENTICITY

At times, with Mitchell and with other clients, I’ve wondered to what extent my physical appearance influences their projections and fantasies, especially in instances when the transference is expressed as romantic or sexual.

I am a woman of 37, with obvious tattoos and piercings who possesses what has been described as a natural “sexiness.”  While this may serve me well in my personal life,  in my work as a therapist, especially in public clinics, I’ve been criticized because my physical presentation is too far from the neutral character a therapist is supposed to represent.

Yet none of us can ever be neutral. We can never present ourselves as a truly blank screen. We are always broadcasting the essence of who we are via our skin color, gender, last name, wedding ring, body type and mannerism, all of which tell stories of who we are.  Despite the self-doubt once raised by past criticism, I’ve come to feel that how I look and who I am should neither be feared nor neutered, but instead embraced for its individuality and authenticity, qualities that I hope to convey so that my clients can also come to honor and respect themselves.

I stopped questioning my style. Rather than dodging the reality of what was happening in sessions as was suggested by past supervisors, I  took chances exploring the effect of my appearance on clients whenever it seemed relevant. I stayed aware of its influence and dealt with it as I would with any other of a client’s projections or fantasies that may surface in the course of therapy.

I learned to have faith that when I model honesty and authenticity in sessions something amazing happens.  Over time, my clients learn that they can do the same.  They can come closer to being themselves.  Themselves how they truly are. Their full selves – messy, beautiful, terrified.

RIVALRY AND ENVY

How remarkable that, as human beings, we store an infinite number of human interactions deep within us and use this information, often unconsciously, to guide our expectations and inform our choices, for better and worse.

How wonderful that therapy helps therapist and client alike, to discover and open a window into the hidden catalysts that shape our lives, those that feel like our instinctual responses to people, but are actually artifacts of our history.

I remember the first time I met Fiona.  She wore her hair cropped short and had colored it with streaks of blue.  Her chest and arms were covered with tattoos that were both beautiful and savage. I couldn’t help but want to look, to study her skin like I would any other work of art.

Fiona was at the same time delicate yet hard, or perhaps just trying to convey a toughness or strength that she didn’t actually feel she possessed.  When Fiona first came to see me, I could tell that she was sizing me up in the way women have been taught do to others in their general demographic. Was I someone she could trust?  Was I an ally or an enemy?  A supporter or the competition?

As a woman, I know how the tendency to compare oneself to other women is so instinctual.  I also know how the wounds inflicted by members of our same gender penetrate so deeply. I’ve learned that this rivalry and envy gets burned into our psyches through what is fed to us  about the role and place of the female in our culture. Survival of the prettiest, never trust another woman.

It has taken me years to work through this myself, through a complex process of self-acceptance. This involved a heightened appreciation of the strength possessed by both my mother and grandmother, along with a rejection of patriarchal ideas of femininity.  Upon finding communities of like-minded women, I challenged my fear of my own gender and reached a place in which love and community now define my relationships and interactions with other women.

But I can immediately detect when someone like Fiona, is not yet there, when the larger part of her is removed and watching the proceedings with great caution.  In cases like this, I have to fight my own instincts to prove that I am not a rival and instead allow the process to unfold the way I would with any other client, however long it takes.

With Fiona, I respected her need to protect herself while she assessed whether our relationship would develop into a familiar hierarchy, never wavering in my pursuit of collaboration and partnership.

INTIMACY

The level of emotional intimacy felt by a client in therapy may be unlike any experienced before. Despite the inherent imbalance of the dynamic, therapeutic intimacy is deeply genuine for me as well.

Many come to therapy because they are lonely and isolated. Because I truly listen, warmly engage and accept, it is not unusual for a client to romanticize, even eroticize our encounters.

Usually I can tell when this happening; a client will start to ask more questions about me, trying to balance the level of sharing. When I sense this shift is taking place, I address it openly.  Sometimes, however, a client will beat me to the chase  by making seductive offerings such as bringing an extra coffee to sessions or outrightly confessing their fantasy as if I were a priest.

My client Jeff, a tall 43-year-old Japanese man, the oldest son of first generation parents, was not accustomed to speaking so openly with a woman, nor with anyone for that matter.

His worry over his increasing alcohol consumption led him to seek therapy,  the first time anyone in his family had.   He felt deeply unhappy in his marriage and had been recently fired from his job due to tardiness, most often a result of being hungover. He said he had lost all motivation for living.  He perceived this addiction as a character weakness, an unwelcome blow to his masculinity and pride.

Visibly shaken as he spoke, Jeff confessed that he feared greatly what he was about to reveal to me because it might make it necessary to terminate therapy. Still, he could not longer sustain the pressure of keeping his secret.

So why then did he tell me he fantasized making love to me?

Not in the hopes that we would tear our clothes off then and there, but instead, because he was practicing the level of intimacy I hoped I had modeled in therapy.  I thanked him for his trust, honesty and authenticity.

Almost immediately, Jeff told me that he understood that sex between us was not possible. And while I affirmed this, rather than reviewing the reasons why, I took the time needed to process his feelings with him. Without judgment, we talked through what his fantasies meant and together determined that they functioned as alcohol did, creating an alternate reality and substitute high in which he could romanticize a new and different life for himself.

In time, he understood, that like alcohol, sex between us was not in his best interest.

UNCERTAINTY

When I invite a stranger to sit in my consultation room and close the door behind me, I have no idea what will be disclosed or discovered.

The range of each individual’s adaptations as well as the means and forms of his/her expression are beautifully varied and finely nuanced. Even with clients with whom I have consulted at prior times, there is simply no way to predict what will ultimately surface.  I only know that we are embarking upon a journey together that is potentially vast and deep.

Sadly, the field of psychology is defined by theories that try to name, categorize and give clean, orderly explanations for what is complex and highly original human behavior. We prefer answers to questions.  We respect the result and not the process because it feels so concrete and so tangibly comforting.

For me, the time I share with clients in therapy is always full of   creative challenges.  Perhaps the greatest challenge is to continually find ways to resist searching for a “right” answer and eliminating a “wrong” one in an effort to reach some sort of ultimate truth.

Personally, the only higher truth that I can embrace is that there are many truths and that no single theory of narrative is absolute. I have   come to appreciate the unexplainable,  the imperfect, the unpredictable that make up my clients’ feelings, my own and our explanations for them. In my works as a therapist I strive to offer an alternative perspective to a problem or symptom that may be more meaningful and useful than the one a client holds.

On days when my personal life may be in turmoil, my worries inevitably dissolve as soon as I sit down across from my client. The intensity, focus and empathy involved take me away from my own distractions.

Often, conducting therapy nurtures me; sometimes it takes its toll.

It might be when the rage between a couple  is expressed in angry attacks or when a client’s  unthinkable memories of abuse are put into  words.  I go home feeling weary and exhausted, wishing for a fleeting moment that I did anything else, but therapy.

But later, when I am tucking my son into bed, I am reminded that there is nothing more meaningful and profound as the impact we have on each other – whether its over the course of a lifetime or just for a brief moment.