Monthly Archives: September 2013

Lock and Key: What Makes a Nightmare Client and a Nightmare Marriage

(This post will make a lot more sense of you’ve read my previous posting, https://thetalkingtherapist.wordpress.com/2013/09/18/the-nightmare-client-who-taught-me-to-be-a-therapist/.  It may also help to know that for years I have been working with couples, together with a female colleague.)

What is it that makes a client behave in the no-prisoners-taken way Ellen found herself behaving?

It’s the same driving force that makes couples behave abominably to one another.

Love.

But not the lovely, Cinderella-and-the-prince romantic love we like to read about and see in movies.

Freud called it transference love.

What love means to us is inevitably shaped by our earliest experiences of it, both positive and negative. We don’t stop loving our parents if they are cruel, abusive, unsympathetic, or cold. Transference love is Cinderella love lived through the distorting lens of our earliest experiences.

These templates of love are inevitably evoked when we find ourselves in an intimate relationship, one which evokes our deepest vulnerabilities.  We repeat (often unwillingly and unconsciously) earlier patterns of relationship, patterns which were set in place in founding relationships.

Often these patterns are destructive, but individuals and couples do not tend to see them as such, at least not initially.  They regard them as understandable reactions to extreme situations.  And there is a truth to this, though the extreme situation in which this reaction would be understandable is not located in the present, but in the past.

What I’m saying is that insofar as she could make sense of her actions (and there is no doubt she knew they were extreme), Ellen felt they were justified by the pain I caused her, her desperate need, and my felt imperviousness to it.

Even before she started therapy, Ellen knew that if she started to love me, we’d both be in trouble.  She knew that “love” would open in a fissure in her, a fissure to the past that would make her — and our relationship — a nightmare.  She told me she’d tried to avoid all this.  “I chose you on purpose because I thought I’d never be attracted to you.  That way, I’d never fall in love with you.”

(Ouch!)

We all know this situation.  You’re attracted to someone, fall in love, and then, as your relationship develops and your mutual dependency deepens, you start to treat your partner differently.  Irrationally.  Worse.

From my work with couples, I would guess that apart from my general unattractiveness, there was another reason Ellen chose me:  she knew I was new to the job and sensed I wasn’t really at home with myself and was too invested in being “good.” In other words, I was like her parents.  My way of being gave her a chance to repeat something that she had tried with her parents unsuccessfully, in the hopes of getting a better outcome.

Why do I say I’ve learned this from my couples work?  Because what we discover again and again in our couples work is that the reason people stay together in nightmarish marriages is that their partners have been chosen unconsciously to “solve” a problem from an earlier founding relationship.  A woman whose father is unforgiving will (unconsciously) choose a judgemental unforgiving partner, in the hope that through the alchemy of their relationship, her partner will be changed and she will get from him what she never got from her father.  And he will have chosen a woman who needs forgiveness so that he can confront his own inability to forgive herself for being vulnerable and human.

Of course, this kind of attempt at resolving a problem from a founding relationship in a couple is much more problematic than attempting it in therapy, because in therapy, there is both distance and sign up.

By distance I mean, the therapist (at least in theory) doesn’t need his client in the same way as a husband needs a wife.  He isn’t having to deal with his own needs in the same way as when he’s a husband/lover.   As the old joke goes, marriage is therapy without the anaesthesia.

By sign up I mean any therapist worth their salt knows that the most they can hope for is to be treated as badly as anyone in a client’s life.  By agreeing to take someone on as a client,, they’ve signed up for the journey.  This cannot be said in couples.  Couples have signed up to be there for one another in sickness and in health, in good times and bad…  But not to sorting out the partner’s primary problems with love.

So though I was deeply affected by Ellen, I didn’t need or depend on her in the way I depend on a partner.  This, in the fullness of time, gave me ability to reflect, get distance, modify my thinking/feeling/behaviour , and change.

If there wasn’t this lock-and-key, fish-and-hook, relationship in a couple (or in a therapy?), it would be much easier to cut the knot.  You’d just be able to say, “This doesn’t work for me. I’m out of here.”

It’s having this choice that makes it possible to make a relationship work.  It’s not something that’s always there.  It has to be won.   In my next post, I’ll talk about how.

The Nightmare Client Who Taught Me To Be A Therapist

When I first started working as a therapist, I had the very good fortune to have a client who was a complete nightmare to work with.   I’ll call her Ellen.

How was Ellen a nightmare?

  • She would reply to my best interpretations by asking “which book did that come from?”
  • She discovered my home phone number and would ring me for hours late at night when she was unhappy with a session or with me.  She couldn’t sleep so she didn’t see why I should.
  • Often, she’d absolutely refuse to leave the room at the end of a session.  I’d have to physically drag her to the door, and out of it.  She’d wail and grab onto anything that would slow her/my progress.

I shared a suite with a number of experienced therapists from my training group. Having a patient leave sessions screaming and protesting as I physically removed her from the room, was completely humiliating for a new therapist. Which, of course, was at least part of the point.

Ellen was humiliated by my lack of understanding.  She was just returning the favour.

When Ellen was unhappy with how I’d responded (or not responded), she would dash from the couch to my desk, jump on on it, open the window and then sit with her legs dangling out.  My room is on the 2nd floor – it was a long way down.  Then she’d threaten to jump if I didn’t give her the answer she wanted.

Sometimes, I’d try to block her on the way to the window.  She’d dodge.  Sometimes I stopped her, sometimes not.

I kept thinking, “this isn’t what doing therapy is supposed to be like.  I’m not meant to be physically stopping a patient from going out of a window! And I’m certainly not supposed to be physically dragging her out of the room!”  (For more on what “should be” the case, https://thetalkingtherapist.wordpress.com/2013/09/11/what-we-shouldnt-be-feeling/.)

I did try to say this to Ellen, in many different ways.  I tried to explain that she was “acting out,” that she should talk about her feelings instead.  To no avail.

I was like a parent telling a child to behave.  Not to help them, but to help me — to stop me feeling useless, humiliated, ashamed, etc.

You’re probably asking yourself:  Why didn’t he just tell Ellen this couldn’t go on and he’d have to “terminate” therapy?

It certainly wasn’t that I didn’t think of this.  I thought of it almost every day.  Many times a day.  Especially during the periods when she was refusing to leave at the end of the session — I’d absolutely dread going to work.

What stopped me?

  • I knew Ellen was putting everything she had into her therapy.  It mattered more to her than anything in her life.  Which was, I recognized even then in my frustration and despair, a tremendous vote of confidence in me or the process.
  • Also, I strongly suspected if her therapy didn’t work, or if I ended it prematurely, she’d commit suicide.
  • And finally, and most importantly, somewhere in me,  I knew she had a point:  I was getting something profoundly wrong.

I sought out different supervisors to give me advice/perspective.  One sympathized with me.   Another told me I should start working towards the end of the session from the very beginning.  Another told me this patient did not feel I was “holding her in my mind.”

Most of this supervisory hand holding mainly served the function of enabling me to keep on keeping on.

I’m not sure now whether I should be embarrassed by, or proud of, how long this went on.  Literally years.

How did it all change?  One day, in frustration and despair at my “not getting it,” she stormed out of a session and sat on the stairs to my office weeping loudly.  I was painfully aware my (incredibly tolerant) colleagues were able to hear this.  And that their next clients, and mine, would be arriving in fifteen minutes.

I went out and sat next to her on the stairs. I was at my wit’s end.  I’d tried everything. Read books on difficult clients.  Sought help and followed it.  And here I was still useless to this client who I knew was in enormous pain and who had put such trust in me.   We sat in silence for a few minutes.  Tears started running down my face.

Ellen looked at me, surprised.  Then she stood up and went back to the consulting room.  I followed her. As the session continued, she seemed unusually open to talking and listening. When our time was up, she got up and left.  Under her own steam.

In the weeks and years that followed, her “acting out” ended. Ellen did the work she needed to do, confronted her demons, formed her first healthy relationship, started to study, and married.

I’m very aware this isn’t your usual case history.  These nightmare stories don’t often make it into print.  For obvious reasons.

All this happened many years ago.  I’ve had plenty of time to reflect on the shift in Ellen’s behaviour, and mine.   (On reflection, this shift had been underway in small ways for some time, as I’d begun to absorb the lessons she was trying to teach me.  The idea of the “one decisive moment” – in therapy or in life, is something I’d want to question.)

Ellen had been adopted and had struggled to get a real response from her dutiful good parents.  Mainly by being a holy terror.  She repeated this struggle with me.  The more I responded to her provocation by interpreting and being a “good” therapist, the farther away the real response she’d needed had seemed.  And the worse she behaved.

She needed my honest and truthful self.  Me.  Not my book-ish attempts to be “good.”  When I reflect on her therapy, I am aware of how acutely attuned she was to the difference.  And how little I was.

It’s not that the interpretations I made were “wrong” or incorrect.  (In fact, after our moment on the stairs, many of them proved very useful indeed.)  The problem was that I was using them defensively, to keep her at a distance, to try to control her.  I was simply not in a “place” to interpret.  And she knew this.

Ellen taught me that interpretation has to be offered freely, with no agenda.   It has to come from a “thinking for” the client.  While I was fighting Ellen, I wasn’t able to do this.  I was too caught up in my concerns/anxieties, in wanting her to be different.

Not all therapists are lucky enough to have a client who teaches them this early in their career.  It takes them years to learn this lesson.  Some never do.

Occasionally, I supervise trainees who have a “nightmare” client.  I always tell them to count their blessings.   That, if they survive (at times, I doubted I would) this person will teach them more than their rest of their training.

It is a therapeutic cliché to say that your clients teach you everything.  In my experience, not all clients need to teach you something.  Some simply need good-enough therapy.  But others really have to make an impression.  Needless to say, I’m enormously grateful to Ellen.  Everyone I’ve seen in the last twenty odd years has benefited from her persistence.

What We Shouldn’t Be Feeling

 How often do you think “this isn’t what I should be feeling/thinking?”  Weekly?  Daily?  Hourly?  Every couple of minutes?

Why don’t you keep track of it for a day?  I suspect you’ll be surprised at how often you aren’t thinking/feeling what you think you should/ought to be…

When you think about it, it’s rather a strange concept.  It implies we know what we should be feeling moment to moment.  How we would know such a thing isn’t specified.  Wouldn’t the ability to do give us the sorts of power ordinarily attributed to God?

But perhaps I’m being deliberately naive here.  “What we should” feel usually means “what we take to be socially acceptable/required.”  Of course, if we said that to ourselves this notion would have much less power, and authority.

We all know that from our earliest days we’re being told what we feel.  Partially this is because we don’t know what we feel until words are put to it.  So a tearful baby will be told he’s unhappy or upset.  There isn’t any great problem with this, given reasonably empathetic and understanding parents. Being able to put our feelings into language is a big part of being human.

But a tearful, frightened or angry baby/child can evoke unwanted feelings even in a “good” parent — inadequacy, anger, fear, shame, guilt — and so many parents don’t just tell their children what they feel, but also what they should feel (so as to not disturb the parent). “Don’t cry.”  “Don’t be sad.”  “Be a brave little soldier.”

Of course, parents are the only the first to tell us what we should feel.  Our peers, teachers, mentors, and sometimes even therapists will continue this process.

And let’s not underestimate how much we’re willing participants in this process.  All this is also serving our own desire to “know,” to be “certain,” to “know who we are.”  It would be quite hard to live without some orientation towards what we feel/think.

The issue here is of degree. And of our one-sided picture of what we should feel/think.  Because, to state the obvious, pretty much everything we imagine we shouldn’t be feeling/thinking is what we take to be “negative”:  aggression, anger, hatred, jealousy, envy, fear, shame, guilt, sadness, “critical” thoughts, etc.

But I’d like, for a moment, to consider the harm knowing what you should feel does:  for example, when you don’t feel what you think you ought to be feeling.

A client for example, claims she never feels anything when she’s with a man.  It’s clear she feels something, but it doesn’t fit her definition of what she should feel.  And so she doesn’t take an interest in it.  Identifies it as “nothing.”  She is therefore denied a starting point in her relationships.

But this serves a purpose.  Because she does this, she doesn’t have to experience the disappointments/joys that any relationship will inevitably involve.

In other words, negating feelings/thoughts by asserting that they’re not what you should feel is a strategy for blocking feelings/thoughts and the effects it is feared they will have.

This is often an issue in therapy.  Because people who come to therapy find it much harder to be concerned with what they do feel and think — which in their definition is “wrong” — than in what they aren’t feeling, or think they ought to be feeling.  They say, “I should be grateful. Not resentful.” Or “I shouldn’t be thinking this about her/him.”  (This last is most often applied to parents, family and partners.)

One way to try to undo this endless avoiding of the starting line (because where can we start except from where we are?), is to question this “should,” this odd but compelling knowledge we have about what ought to be the case.  Where did we get this socially defined awareness?   And when we have some idea of this, does it still ring as true?

There are also more psychoanalytic questions that are useful to ask:  What function does this blocking of feeling serve?  What is the imagined gain?  What do you fear will be the result should you allow yourself to feel/think freely?

In therapy we often find by asking these questions seriously and deeply, that the imagined gain from blocking thoughts and feelings in this way is illusory.  That, for example, you discover that the patient imagines he is forestalling a crippling depression by stopping himself from feeling/thinking what he oughtn’t – but what has brought the client to therapy is… serious depression.

It’s never easy to give up a strategy that is familiar and has benefits that feel tried and tested.  But seeing the costs of such a strategy does make it much easier.

The Therapy Song

When your mother sends back all your invitations
And your father, to your sister, he explains
That you’re tired of yourself and all of your creations,
Won’t you come see me Queen Jane?

I’ve always loved “Queen Jane Approximately,” a Bob Dylan song from the Highway 61 Revisited album.  But lately, I’ve come to consider it as a wonderful poetic evocation of what brings clients to therapy.   Each verse raises the ante, and shows a different reason why someone needs to do something different, something more radical to address their stuckness.    And the last lines nail the point home.

Now when all of the flower ladies want back what they have lent you
And the smell of their roses does not remain
And all of your children start to resent you…

Now when all the clowns that you have commissioned
Have died in battle or in vain
And you’re sick of all this repetition…

When all of your advisers heave their plastic
At your feet to convince you of your pain
Trying to prove that your conclusions should be more drastic…

Now when all the bandits that you turned your other cheek to
All lay down their bandanas and complain
And you want somebody you don’t have to speak to…

highway61revisted

When you’re tired of yourself and all your creations, when your children start to resent you, when you’re sick of all this repetition, when your conclusions should be more drastic, and you want somebody you don’t have to speak to…  That’s a good time to see out a therapist.

I couldn’t put it any better.  So I’ll leave it at that.