At John’s appointment time, my green light goes on. I walk down the hall to the waiting room, but when I open the door, the chair John usually takes is empty, save for a bag of takeout. For a minute I think he might be in the restroom down the hall, but the public key is still hanging on the hook. I wonder if John’s running late—after all, presumably he ordered the food—or if he’s decided not to come today because of what happened last week.
That session had started off uneventfully. As usual, the delivery guy brought our Chinese chicken salads, and after John complained about the dressing (“too saturated”) and the chopsticks (“too flimsy”), he got right down to business.
“I was thinking,” John began, “about the word therapist.” He took a bite of his salad. “You know, if you break it in two . . .”
I knew where this was going. Therapist is spelled the same way as the rapist. It’s a common joke in the therapy world.
I smiled. “I wonder if you’re trying to tell me that sometimes it’s hard to be here.” I’ve certainly felt that with Wendell, especially when his eyes seem to bore into me and there’s no place to hide. By day, therapists hear people’s secrets and fantasies, their shame and their failures, invading the spaces they normally keep private. Then—boom—the hour’s over. Just like that.
Are we emotional rapists?
“Hard to be here?” John said. “Nah. You can be a pain in the ass, but this isn’t the worst place to be.”
“So you think I’m a pain in the ass?” It took some effort not to emphasize the I, as in “So you think I’m a pain in the ass?”
“Of course,” John said. “You ask too many damn questions.”
“Oh? Like what?”
“Like that.”
I nodded. “I can see how that might annoy you.”
John brightened. “You can?”
“I can. I think you’d rather keep me at a distance when I’m trying to get to know you.”
“And heeeeeere we go again.” John rolled his eyes dramatically. At least once a session, I bring up our pattern: my trying to connect with him; his trying to flee. He may be resistant to acknowledging it now, but I welcome his resistance because resistance is a clue to where the crux of the work lies; it signals what a therapist needs to pay attention to. During training, whenever we interns felt frustrated by resistant patients, our supervisors would counsel, “Resistance is a therapist’s friend. Don’t fight it—follow it.” In other words, try to figure out why it’s there in the first place.
Meanwhile, I was interested in the second part of what John had said. “Just to be more annoying,” I continued, “I’m going to ask you another question. You said this isn’t the worst place to be. What’s the worst?”
“You don’t know?”
I shrugged. No.
John’s eyes bugged out. “Really?”
I nodded.
“Oh, come on, you know,” he said. “Just guess.”
I didn’t want to get into a power struggle with John, so I took a guess.
“At work when you don’t feel that people understand you? At home with Margo when you feel you’re disappointing her?”
John made the sound of a game-show buzzer. “Wrong!” He took a bite of salad, swallowed, then lifted his chopsticks into the air to punctuate his words. “I came here, you may or may not remember, because I was having trouble sleeping.”
I noticed his dig: May not.
“I remember,” I said.
He let out a huge sigh, as if summoning the patience of Gandhi. “So, Sherlock, if sleeping is a problem for me, where do you think it’s hard for me to be right now?”
Here, I wanted to say. You’re having trouble being here. But in good time, we’ll talk about that.
“Bed,” I said.
“Bingo!”
I waited for him to elaborate, but he went back to his salad. We sat together while he ate and swore at his chopsticks.
“Aren’t you going to say anything?”
“I’d like to hear more,” I said. “What are you thinking about as you’re trying to fall asleep?”
“Jesus Christ! Is something wrong with your memory today? What do you think I’m thinking about—everything I come in here telling you each week! Work, my kids, Margo—”
John went on to relate an argument he’d had with Margo the night before about whether their older daughter should get a cell phone for her eleventh birthday. Margo wanted her to have it for safety, now that Grace was going to be walking home from school with her friends, and John thought that Margo was being overprotective.
“It’s two blocks!” John said he told Margo. “Besides, if someone tries to kidnap her, it’s not like Grace is going to say, ‘Hey, excuse me, Mr. Kidnapper, let me just pause here for a second, get my phone out of my backpack, and call my mom!’ And unless the kidnapper is a complete idiot—which he could be, okay, but he’s probably just a sick motherfucker—the first thing he’s going to do if he steals someone’s kid is look in her backpack for a cell phone and dump it or destroy it so we can’t track her location. So what’s the point of the phone?” John’s face had turned red. He was really worked up.
Since our Skype call the day after Margo had insinuated that she might leave, things between them had calmed down. As John described it, he tried to listen more. He tried to get home from work earlier. But really, it seemed to me that he was, as he said, “appeasing her,” whereas what she likely wanted was the very thing John and I struggled with together: his presence.
John packed the remnants of his lunch into the takeout bag and tossed it across the room, where it landed with a thud in the trash can.
“And that’s why I couldn’t sleep,” he went on. “Because an eleven-year-old doesn’t need a cell phone and you know what? She’ll get one anyway because if I put my foot down, Margo will sulk and tell me in some passive-aggressive way that she wants to leave again. And you know why that is? Because of her IDIOT THERAPIST!”
Wendell.
I tried to imagine Wendell hearing Margo’s version of this story: We were talking about getting Grace a cell phone for her birthday and John just went ballistic. I pictured Wendell in position C, wearing his khakis and cardigan, giving Margo the head-tilted look. I imagined him asking a Buddha-like question about whether she might be curious why John had had such a strong reaction. I figured that by the time their session was over, Margo would have a slightly different take on John’s motives, just as I had come to see Boyfriend’s actions as less than sociopathic.
“And you know what else she’s going to tell her idiot therapist?” John continued. “She’s going to tell him that her fucking husband can’t fucking have sex with her, because when I got in bed at the same time she did instead of finishing up my emails—another thing I’m doing to make her happy, by the way—I was so pissed off that I wouldn’t have sex with her. She approached me but I told her I was tired and didn’t feel well. Like a housewife in the fifties with a headache. Jesus Christ, right?”
“Sometimes our emotional states can really affect our bodies,” I said, trying to normalize this for John.
“Can we keep my penis out of this? That’s not the point of the story.”
Sex comes up with almost every patient I see, the same way that love does. Earlier on, I’d asked John about his sex life with Margo, given the difficulties in their relationship. It’s a common belief that people’s sex lives reflect their relationships, that a good relationship equals a good sex life and vice versa. But that’s only true sometimes. Just as often, there are people who have extremely problematic relationships and fantastic sex, and there are people who are deeply in love but who don’t click with the same intensity in the bedroom.
John had told me then that their sex life was “okay.” When I’d asked what “okay” meant, he said that he was attracted to Margo and enjoyed sex with her but that they went to bed at different times so it was less frequent than in the past. But often he contradicted himself. At one point he said that he tended to initiate sex but Margo didn’t want it; another time he said that she often initiated “but only if I do what she wants during the day.” Once he said that they’d talked about their sexual desires and needs; another time he said, “We’ve been having sex with each other for over a decade. What’s there to talk about? We know what the other person wants.” Now I got the sense that John was having trouble getting an erection and that he felt humiliated.
“The point of the story,” John went on, “is that there’s a double standard in our house. If Margo’s too tired to have sex one night, I let it go. I don’t corner her with a toothbrush in her mouth the next morning and say”—here he did the Oprah impression again—“‘I’m sorry you weren’t feeling well last night. Maybe we can find some time to connect tonight.’”
John looked up at the ceiling and shook his head.
“Men don’t talk like that. They don’t dissect every little thing and think it has ‘meaning.’” He made air quotes when he said the word meaning.
“It feels like picking a scab instead of letting it be.”
“Exactly!” John nodded. “And now I’m the bad guy unless she gets to make all the decisions! If I have an opinion, I’m not ‘seeing’”—more air quotes—“what Margo’s ‘needs’ are. So then Grace gets into this and says that I’m being unreasonable, that ‘everyone’ has a phone, and that it’s two to one, girls win! She actually said that: ‘Girls win.’”
He lowered his arms now that he was done with the air quotes. “And that’s when I realize that part of what’s driving me nuts and making it hard to sleep is that there’s too much estrogen in the house and nobody understands my perspective! Ruby’s starting elementary school next year but already acts like her older sister. And Gabe’s getting so emotional, like a teenager. I’m outnumbered in my own home and everyone wants something from me every minute and nobody understands that I might need something too—like peace and quiet and some say in what goes on!”
“Gabe?”
John sat up. “What?”
“You said Gabe was getting so emotional. Did you mean Grace?” I did a quick memory check: his four-year-old’s name was Ruby and his older daughter was Grace. Didn’t he just say Grace wanted a phone for her birthday? Or did I have that wrong? Was it Gabriella? Gabby shortened to Gabe, the way some girls named Charlotte are called Charlie nowadays? I’d once confused Ruby with Rosie, their dog, but I was pretty sure I had Grace’s name right.
“I did?” He seemed flustered but recovered quickly. “Well, I meant Grace. Obviously I’m sleep-deprived. Like I told you.”
“But you know a Gabe?” Something about John’s reaction made me suspect that this wasn’t just about insomnia. I wondered if Gabe was somebody significant in his life—one of his brothers, a childhood friend? The name of his father?
“This is an idiotic conversation,” John said, looking away. “I meant Grace. Sometimes a cigar is just a cigar, Dr. Freud.”
We both sat there.
“Who’s Gabe?” I asked gently.
John was quiet for a long while. His face went through a series of expressions in rapid succession, like a time-lapse video of a storm. This was new; he generally had two modes, angry and jokey. Eventually he looked at his shoes—the same checkered sneakers I’d seen on our Skype call—and shifted into the safest gear, neutral.
“Gabe is my son,” John said so quietly that I could barely hear him. “How’s that for a twist in the case, Sherlock?”
Then he grabbed his phone, walked out the door, and shut it behind him.
Now here I am, a week later, standing in the empty waiting room, and I’m not sure what to make of the fact that our lunches have arrived but John hasn’t. I haven’t heard from him since the revelation, but I’ve been thinking about him. Gabe is my son rang through my mind at the most random of moments, especially at bedtime.
This felt like a classic example of projective identification. In projection, a patient attributes his beliefs to another person; in projective identification, he sends them into another person. For instance, a man may feel angry at his boss at work, then come home and say to his spouse, “You seem angry.” He’s projecting, because the spouse isn’t angry. In projective identification, on the other hand, the man may feel angry at his boss, return home, and essentially insert his anger into his partner, actually making the partner feel angry. Projective identification is like tossing a hot potato to the other person. The man no longer has to feel his anger, since it’s now living inside his partner.
I talked about John’s session in my Friday consultation group. Just as he had been lying in bed with a metaphorical circus in his mind, I told the group that now I’d been doing the same thing—and since I was holding all of his anxiety, he was probably sleeping like a baby.
Meanwhile, my mind reeled. What to do with this bomb that John had detonated before walking out the door? John has a son? From his youth? Is he living a double life? Does Margo know? I flashed back to our session after the Lakers game when he’d commented on the handholding with my son. Enjoy it while it lasts.
What John did—the walking-out part, at least—isn’t uncommon. Especially in couples therapy, patients occasionally walk out if they feel besieged by intense feelings. Sometimes that person benefits from a phone call from the therapist, particularly if the reason he or she bolted had to do with feeling misunderstood or injured. Often, though, it’s best to let patients sit with their feelings, get their bearings, and then work through it with them the following session.
My consultation group believed that if John was already feeling cornered by the people around him, a call from me might be too much. Everyone agreed: Back off. Don’t push him. Wait for him to come back.
Except today he’s not here.
I pick up the unmarked takeout bag in the waiting room and look to make sure it’s ours. Inside are two Chinese chicken salads and John’s soda. Did he forget to cancel the order, or is he using the food to communicate with me, making his absence known? Sometimes when people don’t show, they do it to punish the therapist and send a message: You’ve upset me. And sometimes they do it to avoid not just the therapist but themselves, to avoid confronting their shame or pain or the truth they know they need to tell. People communicate through their attendance—whether they’re prompt or late, cancel an hour beforehand, or don’t show up at all.
I walk back into our suite, place the food bag in the fridge, and decide to use the hour to catch up on chart notes. When I get to my desk, I notice that I have some voicemails.
The first is from John.
“Hi, it’s me,” his message begins. “Shit, I completely forgot to cancel until my phone beeped just now with our, um, appointment. Usually my assistant schedules everything but since I do the shrink thing myself . . . anyway, I can’t make it today. Work is insane and I can’t get away. Sorry about that.”
My initial thought is that John needs some space and will be back next week. I imagine that he wrestled up to the last minute with whether or not to come today, and that’s why he didn’t call in advance—and also why the standing food order appeared here without him.
But then I play my next message.
“Hi, it’s me again. So, um, I didn’t forget to call, actually.” There’s a long pause, so long that I think John may have hung up. I’m about to hit Delete when finally he continues. “I was going to tell you that, um, I’m not going to do therapy anymore, but don’t worry, it’s not because you’re an idiot. I realized that if I’m not sleeping, I should get sleep medication. Obviously. So I did and—problem solved! Better living through chemistry, ha-ha! And, uh, as for the other stuff we talked about, you know, all the stress I’m under, I guess that’s just life and if I get some sleep, I’ll be less annoyed by it all. Idiots will always be idiots and there’s no pill for that, right? We’d have to medicate half the city if there were!” He laughs at his joke, the same laugh I remember from when he said I’d be like his mistress. His laugh is his shelter.
“Anyway,” he goes on, “sorry for the late notice. And I know I owe you for today—don’t worry, I’m good for it.” He laughs again, then hangs up.
I stare at the phone. That’s it? No Thank you or even a Goodbye at the end, just . . . done? I had expected that something like this might happen after the first few sessions, but now that I’ve been seeing him for nearly six months, I’m surprised by his sudden departure. In his own way, John seemed to be forming an attachment to me. Or maybe it’s that I’ve been forming an attachment to him. I’ve come to feel real affection for John, to see flashes of humanity behind his obnoxious façade.
I think about John and his son Gabe, some boy or grown man who may or may not know his father. I wonder if on some level John wants to leave me with the burden of this mystery, a big fuck-you for not helping him feel better quickly enough. Take that, Sherlock, you idiot.
I want to let John know that I’m here, to somehow communicate that he—and I—can handle whatever he brings to therapy. I want him to know it’s safe to talk about Gabe here, however tricky that situation or relationship might be. At the same time, I want to respect where he is right now.
I don’t want to be the rapist.
It would be so much better to say all of this in person, though. In my informed-consent paperwork that I give to patients before they start treatment, I recommend that they participate in at least two termination sessions. I discuss this with new patients at the outset so that if something upsets them during treatment, they don’t act impulsively to rid themselves of the uncomfortable feelings. Even if they do feel it’s best to stop, at least the decision will have been reflected upon so they can leave feeling that they made a thoughtful and considered choice.
As I pull out some patient charts, I remember something John said while making the slip about Gabe. There’s too much estrogen in the house and nobody understands my perspective . . . I’m outnumbered . . . everyone wants something from me . . . nobody understands that I might need something too—like peace and quiet and some say in what goes on!
Now it makes sense; Gabe could counteract some of the estrogen. Maybe John believes that Gabe understands him—or would, if he were in John’s life.
I put down my pen and dial John’s number. When his voicemail beeps, I say, “Hi, John. It’s Lori. I got your message, and thanks for letting me know. I just put our lunches in the fridge, and I thought of last week when you said that nobody understands that you might need something too. I think you’re right that you need something, but I’m not so sure that nobody understands this. Everyone needs something—often, lots of things. I’d like to hear what it is that you need. You mentioned needing peace and quiet, and maybe finding peace and quieting down the noise in your head will involve Gabe, and maybe it won’t, but we don’t have to talk about Gabe if you don’t want to. I’m here if you change your mind and decide you want to come in next week to continue our conversation, even if it’s just one last time. My door is open to you. Bye for now.”
I make a note in John’s chart and then close it, but as I lean over the file cabinet, I decide not to move it into the Terminated Patients section today. I remember in medical school how hard it was for us students to accept that somebody had died and that there was nothing else we could do, to have to be the person to “call it”—to say aloud those dreaded words Time of death . . . I look at the clock—3:17.
Let’s give it one more week, I think. I’m not ready to call it just yet.