“I just heard, Irene,” I began a session one afternoon, “that my brother-in-law died a few hours ago. Suddenly. A coronary. I’m obviously shaken and not at full strength”—I heard my voice quaver—“I’ll do my best to stay present with you.”
It was hard to say, hard to do, but I felt I had no choice.
Morton, the husband of my only sister, had been a dear friend and an important presence in my life since I was fifteen. I had been staggered by my sister’s midday call and immediately booked the next flight to Washington to join her. As I set about canceling my appointments for the next few days, I saw that I had one with Irene in two hours that would still leave me time to catch my flight. Should I keep that appointment?
In our three years together, Irene had never come late for an appointment or missed one, not even during the time of horror when Jack’s tumor was ravaging his brain and persona. Despite the nightmare of witnessing her husband’s relentless deconstitution, Irene had throughout been faithful to our work. And I had been too. Since our first session, when I promised her, “I will see this through with you,” I had committed myself to engaging her as genuinely as I could. My choice, then, on this day of grief, seemed clear: I would meet with her, and I would be honest.
But Irene didn’t respond. After we had sat together in silence a couple of minutes, I prodded: “Where do your thoughts go?”
“I was wondering how old he was.”
“Seventy. He was just about to retire from his medical practice.” I paused and waited. For what? Perhaps just the common decency of a brief condolence. Or even an expression of gratitude for my willingness to see her despite my grief.
Silence. Irene sat unspeaking, her eyes apparently fixed on a small pale coffee stain on the carpet.
“Irene, what’s happening in the space between us today?” Without fail I asked this question every session, in accordance with my conviction that nothing took precedence over exploring our relationship.
“Well, he must have been a nice man,” she said, her eyes never moving. “Otherwise you wouldn’t feel so sad.”
“Oh, come on, Irene. The truth. What’s going on inside?”
Suddenly she looked up, her eyes blazing. “My husband died at forty-five, and if I can go into the OR every day and operate on my patients and run my office and teach my students, then you sure as hell can come in here and see me!”
It wasn’t her words that stunned me but the sound of them. That harsh, deep timbre was not Irene. It was not her voice. It was like the preternaturally guttural voice of the young girl in The Exorcist. Before I could remark on it, Irene leaned down to pick up her purse.
“I’m leaving!” she said.
My calf muscles tensed—I believe I was preparing myself to tackle her if she bolted for the door. “Oh, no, you’re not. Not after that. You’re staying right here and talking this out.”
“I can’t. Can’t work, can’t stay here with you. Not fit to be with anyone.”
“There’s only one rule here in this office: that you say exactly what’s on your mind. You’re doing your job. You’ve never done it better.”
Dropping her purse on the floor, Irene slumped back in her chair. “I told you that after my brother died I always ended my relationships with men the same way.”
“How? Tell me again.”
“They’d have some mishap, some problem, maybe get sick, and I’d get nasty and cut them out of my life. A quick surgical incision! I cut clean. And I cut sharp.”
“Because you’d compare their problem to the immensity of losing Allen? That would make you bitter?”
She nodded her appreciation. “That was most of it, I’m pretty sure. Also that I just didn’t want them to matter to me. I didn’t want to hear about their puny problems.”
“And with me today?”
“Color it red! Rage! I wanted to throw something at you!”
“Because it felt like I was comparing my loss with yours?”
“Yes. And then I thought that when we finish our session, you’ll take your loss up your little garden path to your wife, who’ll be there waiting with the rest of your tidy, cozy life. That’s when it turns red.”
My office, only a couple hundred feet from my house, is a comfortable red-tile-roofed cottage enveloped in the lush greens and violets of lupine, wisteria, frangipani, and Spanish lavender. Though Irene loved the serenity of my office, she often made sarcastic comments about my picture-book life.
“It’s not just you I feel angry at,” she continued. “It’s everyone whose life is intact. You’ve told me about widows who hate being without a role, who hate being the fifth wheel at dinner parties. But it’s not the role or being the fifth wheel that matters: it’s hating everyone else for having a life; it’s envy; it’s being filled with bitterness. Do you think I like feeling this way?”
“A little while ago when you were preparing to walk out of here, you said you weren’t fit to be with anyone.”
“Well, am I? Do you want to be with someone who hates you because your wife is alive? Does anyone want that kind of person around? The black ooze—remember? No one wants to be tarred, do they?”
“I stopped you from leaving, didn’t I?”
No answer.
“I’m thinking of how dizzy you must feel to be so angry at me and yet so close, so grateful.”
She nodded.
“A little louder, Irene. Can’t quite hear you.”
“Well, I got dizzy thinking about why you told me about your brother-in-law today.”
“You seem suspicious.”
“Very.”
“You have a hunch?”
“More than a hunch. I think you were trying to manipulate me. See how I would react. Giving me a test.”
“No wonder you exploded. Maybe it’ll help if I tell you exactly what was going on inside of me today after I got the news of Morton’s death.” I told her how I canceled the rest of my schedule but decided to see her, and why. “I couldn’t cancel it—not after your courage in always coming here no matter what. But,” I continued, “I still had to face the question of how to be with you and deal with my loss at the same time.
“So what options did I have today, Irene? To shut down and withdraw from you? That would have been worse than canceling. To try to stay close and honest with you and not tell you about it? Impossible—a recipe for disaster: I learned long ago that when two people have something big between them and don’t talk about it, they don’t talk of anything else of importance either. This area here”—I gestured toward the air space between us—“we need to keep it clean and free, and that’s my job as well as yours. So that’s why I told you what was happening to me straight. Straight as I could—no manipulation, no test, no ulterior motive.”
Once again Irene nodded to let me know that I had made a reasonably intelligent response.
Later in the session, just before we ended, Irene apologized for her remark. The following week she told me of describing the incident to a friend who was aghast at her cruelty toward me, and apologized once again.
“No apology was needed,” I reassured her, and I meant it, really meant it. In fact, in a curious way I had welcomed her telling me I sure as hell could see her: it was enlivening; it was real; it brought me closer to her. It was the truth about how she felt toward me. Or part of the truth—and I hoped the time would come when I would hear the rest of it.
Irene’s rage, which I first encountered in our second month of therapy, was deep and pervasive. Though it flared only occasionally into the open, it always rumbled just below the surface. At first I wasn’t much concerned about it. My research had reassured me that such anger was no more worrisome than persistent guilt or regret or denial and would soon dissipate. But in this instance, as often in my work with Irene, the research was misleading. Again and again I have found that “statistically significant” truth (often with the exceptions—the “outliers”—excluded from the calculation for statistical reasons) had little relevance to the truth of my unique encounter with the person of flesh and blood before me.
In a session during our third year, I asked, “What feelings did you take home from our last session? Any thoughts about me during the week?” I pose this type of question often as part of my campaign to focus therapeutic attention on the here-and-now—on the encounter between me and the patient.
She sat in silence for a while, then asked, “Do you think about me between sessions?” Although this question from a patient, which most therapists dread, is not uncommon, I somehow hadn’t expected it from Irene. Perhaps I hadn’t expected her to care, or at least to acknowledge she cared.
“I—I—I often think about your situation,” I stuttered. Wrong answer!
She sat for a moment, then stood. “I’m leaving,” she said and stomped out, not failing to slam the door behind her.
I saw her through the window, pacing in the garden and smoking a cigarette. I sat and waited. How easy it is for noninteractive therapists, I thought, to deflect that question of hers by such ploys as: “Why do you ask?” or “Why now?” or “What are your fantasies or your wishes about that?” For therapists who are, like me, committed to a more egalitarian, mutually transparent relationship, it’s not so easy. Perhaps because the question reveals the limits of therapeutic authenticity: no matter how genuine therapists try to be, how intimate, how honest, there remains an unbridgeable gap, a fundamental inequality between therapist and patient.
I knew that Irene hated my thinking of her as a “situation”—and hated too that she’d allowed me to mean so much to her. I might, of course, have been more sensitive and used a warmer and more personal word than situation. But I believe that no appropriate response of mine would have given her what she wanted. She wanted me to be thinking other thoughts—loving, admiring, sensual ones or, perhaps, doting. Yes, doting—that’s the word.
When she had finished her cigarette, she walked back in with great aplomb and took her seat as though nothing unusual had happened. I continued by appealing to her sense of reality.
“Of course,” I pointed out matter-of-factly, “patients think more often about their therapists than therapists think about them. After all, the therapist has many patients, whereas a patient has only one therapist. The same thing was true for me when I was in therapy, and isn’t it true for your own surgery patients, and for your students? Don’t you loom larger in their minds than they in yours?”
The situation is not really so clear-cut. I didn’t talk about the fact that therapists do think about patients between sessions—especially about the problematic ones who, in one way or another, vex the therapist. Therapists may ponder their strong emotional reactions to a patient or puzzle about the best technical approach. (A therapist who becomes overly caught up in angry, vindictive, loving, or erotic fantasies about a patient should, of course, seek a discussion with a colleague-friend, a professional consultant, or a personal therapist.)
Of course, I didn’t tell Irene that I often thought about her between sessions. She puzzled me. I worried about her. Why was she not getting better? The great majority of widows I had treated began to improve after the first year; every one showed significant improvement by the end of the second year. But not Irene. Her despair and hopelessness continued to deepen. She experienced no joy in her life. After putting her daughter to bed, she wept every evening; she persisted in engaging in lengthy conversations with her dead husband; she rejected all invitations to meet new people and refused even to consider the possibility of another important relationship with a man.
I’m an impatient therapist, and my frustration grew. And so did my concern for Irene: the magnitude of her suffering began to alarm me. I worried about suicide—I am convinced that she would have taken her life if it had not been for her daughter. On two occasions I sent her to colleagues for formal consultation.
Though I was taxed by Irene’s major eruptions of grief rage, I found it even more difficult to deal with her milder but more pervasive expressions of rage. Her list of grievances about me was long and growing, and we rarely got through an hour without some expression of anger.
She was angry at me for attempting to help her to detach from Jack and direct her energy elsewhere and for encouraging her to meet other men. And angry at me for not being Jack. As a result of our deep engagement, our intimate exchanges, our fighting, our mutual caring, it was with me that she most approximated the feelings she had had with her husband. And then, at the end of the hour, she hated having to go back to a life with neither me nor Jack. That’s what made the ending of every session so tumultuous. She hated the reminder that our relationship had formal boundaries, and no matter how I signaled that we were at the end of our hour, she often exploded: “You call this a real relationship? This is not real! You look at the clock and just kick me out, throw me away!”
Sometimes she sat there at the end of the hour, glaring and refusing to budge. Any appeals to reason—to pointing out the necessity for schedules, to her own scheduling of patients, to suggestions that she watch the clock and end the hour, to repeating that my ending the hour was not a signal of rejection—all these fell on deaf ears. Far more often than not, she left my office angry.
She was angry at me for being important to her and angry that I wouldn’t do some of the things Jack had done; for example, compliment her on all her good points—her appearance, her resourcefulness, her intelligence. We often had pitched battles about compliments. I felt that a recitation of compliments would infantilize her, but she put so much emphasis on it, was so insistent, that I often complied. I asked her what she wanted me to say and practically repeated her words back, always trying to include some original observation. Yet what seemed like a bizarre charade to me almost without fail raised her spirits. But only temporarily: she had holes in her pockets, and by the next session she insisted that I do it again.
She was angry at my presuming to understand her. If I tried to combat her pessimism by reminding her that she was in the midst of a process that had a beginning and an end and by offering reassurance from some of the results of my research, she responded angrily, “You’re depersonalizing me. You’re disregarding what’s unique in my experience.”
Any optimism I expressed about her recovery she invariably turned into an accusation that I wanted her to forget Jack.
Any mention of the possibility of her meeting another man was a minefield. For the most part she was contemptuous of the men she met and angry at me for suggesting she examine her judgmentalism. Any practical suggestion I offered ignited a major eruption. “If I want to date,” she said furiously, “I can figure out how to do it! Why pay you good money for dating advice when my friends can give me the same thing?”
She grew angry if I offered concrete suggestions about anything: “Stop trying to ‘fix’ things!” she said. “That’s what my father tried to do my whole life.”
She was angry at my impatience with her slow progress and at my failing to acknowledge the efforts she had made to help herself (but never mentioned to me).
Irene wanted me strong and healthy. Any infirmity—a sprained back, a knee injury requiring meniscus surgery, a cold, a case of flu—elicited much annoyance. I knew that she was apprehensive as well, but she kept that well concealed.
Most of all, she was angry at my being alive when Jack was dead.
None of this was easy for me. I have never relished angry confrontations and, in my personal life, generally avoid angry people. Because I am a deliberate thinker and writer, and confrontation tends to slow my thoughts, I have throughout my career declined public debate and discouraged all inquiries about my becoming a departmental chairman.
So how did I cope with Irene’s anger? For one thing, I leaned on the old therapy adage that one must separate role and person. Often much of a patient’s anger toward a therapist is related to his or her role, not person. “Don’t take it personally,” young therapists are taught. Or at least, don’t take everything personally. Make an attempt to discriminate between what belongs to your person and what to your role. It seemed self-evident that much of Irene’s anger belonged elsewhere—life, destiny, God, cosmic indifference—but she simply discharged it upon her nearest target: me, her therapist. Irene knew that her anger oppressed me and let me know in many ways. One day, for example, when my secretary called her to reschedule an appointment because I had to see the dentist, Irene replied, “Oh, well, seeing the dentist is probably a pleasure for him compared to seeing me.”
But perhaps the main reason I was not ground down by Irene’s rage was that I always knew that it masked her profound sadness, despair, and fear. When she expressed anger toward me, I sometimes responded with reflexive irritation and impatience, but more often with compassion. Many of Irene’s images or phrases haunted me. One, in particular, set up housekeeping in my mind and never failed to soften my experience of her grief rage. It was in one of her airport dreams (during the first two years after her husband’s death, she often wandered through airports in her dreams).
I am dashing through a terminal. Looking for Jack. I don’t know the airline. I don’t know the flight number. I am desperate . . . scanning the lists of departure flights for some clue—but nothing makes sense—all the destinations are written in nonsense syllables. Then hope appears—I can read one sign over a departure gate: ‘Mikado,’ it says. I rush to the gate. But too late. The plane has just left, and I wake up crying.
“That destination—Mikado? What are your associations to Mikado?” I asked.
“I don’t need associations,” she said, flicking away my question. “I know exactly why I dreamed of Mikado. I used to sing the operetta when I was a child. There’s a verse in it that will not go away:
Though the night may come too soon
we have years and years of afternoon.
Irene stopped and looked at me, eyes glistening with tears. No point in saying any more. Not for her. Not for me. She was beyond comforting. From that day on, the line “we have years and years of afternoon” reverberated in my mind. She and Jack had never had their share of afternoons, and for that I could forgive her everything.
My third advanced lesson, grief rage, proved of great value in other clinical situations. Where in the past I had generally veered too quickly away from anger, attempting to understand and resolve it as expeditiously as possible, now I was learning how to contain anger, how to seek it out and plunge into it. And the lesson’s specific vehicle? That’s where the black ooze comes in.