16

Mr. Mead Starts Couples Therapy

SYLVIA RANDALL

 

 

 

 

 

All names have been altered to protect the identity of my clients.

I have specialized in couples therapy for several decades now and a few couples stand out in my memory. One couple I recall, Patsy and Howard, entered therapy feeling they had fallen out of love. They were able, with their commitment and some therapeutic guidance, to rekindle their mutual respect and to re-experience their love for each other. Then, two years after we had completed our sessions, I received a sweet baby announcement in the mail. In the card, Patsy thanked me for our work together and wrote: “Without our therapy sessions, this precious little being, wouldn’t be in the world.” I wept a little.

Another couple I will always remember, Nina and Simon, basically hated each other by the time they came to therapy. Both came with the hope that I would magically transform their partner into the original fantasy person they had each created during their initial whirlwind romance and erase all the hurts and disappointments experienced in the years since then. We could have worked with the hurts and disappointments, had it not been the case that the original good feeling had now become real mutual dislike. They had little in common and they were not a good match. This work successfully ended with separation and then divorce. Interestingly, I met Simon in the grocery store years later, and heard that they had become pleasant friends who saw each other on occasion with their new partners.

And then there is Andrew Mead. I have chosen to write up two sessions of my work with Andrew because each session is an initial conjoint meeting with Andrew and his two different working assistants. Thus, it illustrates how different aspects of a person’s psyche will emerge in different interactions, especially close ones.

I had heard of Andrew Mead, since his name was often mentioned in the newspaper for reasons related to his profession, which I cannot specify in order to maintain his anonymity. He had, I learned in our initial telephone consultation, lost his beloved wife, Terry, several years before, through a violent crime. That crime had never been fully solved, and Mead was still obsessed, understandably, with the details of her death. I have worked with survivors of a loved ones’ murder before, so was prepared to deal with possible “survivor’s guilt” and the common anhedonic reaction—the lack of experiencing joy. The survivor often feels, because his loved one can’t feel anymore, he or she also should not allow those feelings of joy. It feels like a betrayal to the memory of their lost beloved.

Mead was interested in getting help in his relationship with his nurse-assistant, with whom he had been working for some time, and I was thinking that the relationship between them must be quite interesting and complicated.

 

It’s Monday morning at 8:00 A.M., my first appointment of the day. Mead and his assistant Sheila are in my waiting room when I arrive. I notice they’re sitting in chairs as far away from each other as possible. Andrew looks very rigid—sitting up as if at attention. He looks clearly uncomfortable. Sheila is in a more relaxed posture, but I see anger and impatience on her face. She’s nervously tapping her right toe. When I introduce myself, Sheila perks up and smiles warmly. Andrew stands up stiffly and nods. I notice he doesn’t extend his hand—I remember after a moment that he mentioned on the phone he has severe OCD.

SYLVIA: Good morning, please help yourself to coffee and come on in.

(They sit in the two chairs provided.)

SYLVIA: So, what’s going on that brings you here?

(Sheila gestures to Andrew to start. I see a look of resignation on her face.)

ANDREW: I’m very uncomfortable with Sheila’s feelings towards me—though, I do realize I’m not the easiest person to spend time with.

SYLVIA: Can you tell me more about those feelings and your discomfort?

ANDREW: Yes, of course. I really need to depend on her being there for me, and sometimes she is, but other times she gets critical and impatient—especially when my compulsions come up.

SYLVIA: How do you feel at those times?

ANDREW: Most of all, I feel afraid—afraid that she will leave me. I really need her.

(Andrew told me in our phone call that his wife, Terry, died violently several years ago—his fear of losing Sheila may be partly due to his loss of Terry. I also wonder if there were earlier losses in his life, maybe of a parent. It could have been a loss by death or abandonment, or a psychological rather than literal loss—such as in the case of poor parenting or neglect. I’ll get back to that later.)

 

SYLVIA: Sheila, is there some truth in Andrew’s perceptions that you feel critical and impatient at times?

SHEILA: Of course, anyone in their right mind would! I mean, he has a brilliant mind, and yet he acts like a five-year-old afraid his mommy is mad at him! And other times he can’t focus on anything or anyone because he has to put objects on the mantelpiece in a perfect row. He drives me crazy!

Actually, his self-centeredness is one of my major complaints. I am his assistant, so we work closely together, but he is totally insensitive to my feelings and incapable of empathy. He is always thinking of Andrew Mead first and foremost. It’s disgusting.

ANDREW: That’s not always true. Especially after you point out my failings, like at the circus with your fear of elephants. I make a real effort to consider how you must be thinking and feeling.

SHEILA: Yes, at times, but I think that’s mostly motivated by your desire to keep me from getting angry with you. Remember how before you tried to listen, you just said “suck it up.” What a dumb-ass comment that was.

SYLVIA: Hold on a minute! Is this a familiar dynamic between you? I see you blaming each other and wanting the other to do the changing. This is about the most common cyclical pattern I see between couples. Often, the feelings underlying blaming and anger are hurt and disappointment. Does that fit for either of you?

SHEILA: Well, it sure fits for me sometimes.

SYLVIA: Do you let Andrew know when you feel that way?

SHEILA: Yes, of course. I ask him how great he would feel if I acted that way with him.

SYLVIA: It sounds as if you like to use sarcasm—is that right?

SHEILA: Well, no shit! Wouldn’t you?

SYLVIA: The problem with sarcasm is it evokes either an angry response or withdrawal—fight or flight. If you want Andrew to really hear you, including when you are angry, it might work better to tell him how you’re feeling. For example, you might have said “When you said ‘Suck it up’, I felt totally uncared about and hurt. Then I got angry, because I felt so vulnerable.”

Do those feelings, or something similar, fit?

SHEILA: Yeah.

SYLVIA: Would you be willing to share, in your own words, how you felt with Andrew—please speak to him directly.

SHEILA: Okay. (She turns towards Andrew.) Andrew, it’s true, when you said that, I felt lousy—like you couldn’t care less about me and you just wanted to not be bothered with my feelings.

SYLVIA: Andrew, what is it like for you to hear that? Please answer Sheila directly.

ANDREW: Thank you for telling me that, Sheila. I don’t want you to feel badly or hurt by what I say. You seem so tough, I had no idea that you would react that way. Now, I feel closer to you and will really try to think about how you might respond to things I say and do.

SHEILA: Thanks. (Looks at me.) Hey, you know I think he really got it this time.

SYLVIA: Yes, I felt that too. Sheila, I’d like to do a bit more work with you, if that’s okay with both of you, and then get back, Andrew, to your side of this interaction.

(They both nod.)

SYLVIA: Sheila, I don’t know anything about your early life, but often these types of reactions, while totally normal, have a root in the past, which is why different areas are particularly sensitive to different degrees in different people. Being aware of the old associations can help you understand your reactions and help to lower the charge on the old triggers. Also in a couple, this awareness can be helpful to your partner—you, Andrew—to understand Sheila better, and this makes it much easier to empathize with her.

So, Sheila, was there a time in your early life, maybe with family or friends, that you felt deeply hurt by impatience and criticism?

SHEILA: (Tears come to her eyes.) Well, my family was basically chaotic. Mom was probably bipolar—she was occasionally totally high and a blast to be around, but mostly she was depressed, drank too much and was just interested in herself. She just wasn’t interested in my achievements at school or my disappointments if I lost a swim meet. Actually, I guess her basic message too was “suck it up.”

(Sheila begins loud sobbing and difficulty catching her breath. Andrew sits even further back in his chair and looks down at the carpet.)

I had to grow myself up essentially, and the tougher I felt, the better I felt.

SYLVIA: So, you built a protective wall around those feelings.

SHEILA: Yes. It makes me sad to think about it.

SYLVIA: Andrew, would you look at Sheila. (He does, stiffly turning in his chair.) What do you see?

ANDREW: I see Sheila crying. Sheila, could you please stop doing that?

SYLVIA: Andrew, what are you feeling as you look at Sheila—look inside yourself before you answer me.

ANDREW: I feel very uncomfortable and helpless. What am I supposed to do?

SYLVIA: Would you be willing to ask Sheila that? If you really want to be there for her, she is the expert on what she needs from you right now.

ANDREW: Sheila, what should I do?

SHEILA: Just listening with concern is really all I want—what I didn’t get from my mother, I guess.

ANDREW: Is that it? I think I can do that. (He shifts his position so that he’s looking directly at her.) I’m sad that you experienced that with your mother, and I certainly don’t want to give you those same feelings. Thanks for telling me. You know, I do care a lot about you.

SHEILA: Wow—thanks. (She smiles warmly at Andrew.)

Hey, enough about me, let’s talk about Andrew. Andrew, you act like a five-year-old when I even have to leave you to go to the store—what’s up with that?

ANDREW: Oh, I just get scared that something will happen to me while you’re gone and I won’t know what to do. Maybe, if you help me write some notes of things I can do if something goes wrong, then I can consult my list. Actually, that would make me feel a lot better.

SYLVIA: It sounds as if you feel very alone and out of control when Sheila leaves—having a list gives you a little sense of control, just as performing your compulsions do. Does that feel right?

ANDREW: I’m a psychological disaster, I know!

SYLVIA: Let’s look at your past experiences, as we did with Sheila. Andrew, were you abandoned or neglected in your early years?

ANDREW: My father left our family when I was eight—and if you think I’m in bad shape, you should meet my brother, Anthony. He’s still waiting for our father to return.

SYLVIA: What was that like for you when your father left?

ANDREW: It was terrible. At home, my mother went crazy.

SYLVIA: What do you mean?

ANDREW: I realize now that she suffered from OCD even before he left—everything, including Anthony and me, had to be perfect. That probably drove him crazy actually. I never thought of that before—I always thought he left because he couldn’t stand me.

SYLVIA: What a devastating thought for a small boy to have, to feel you were the cause of his rejection. You must have felt helpless then and out of control—both very realistic feelings in reponse to that thought.

ANDREW: Yes. Maybe that’s when I began feeling so anxious.

SYLVIA: You said your mother went crazy—tell me more about that.

ANDREW: Well, her OCD really got terrible after my father left. She paid even less attention to me, and I felt like an outsider at home as well as at school.

SYLVIA: What was happening at school?

ANDREW: It was awful. The kids teased me mercilessly about not having a father. They shunned me at recess and I sat alone at lunchtime. I just wanted more than anything to be part of “the gang.” So, I withdrew in to my own world of ideas, scholastic achievement, and my OCD rituals.

SHEILA: Oh, Andrew, that sounds really bad. Now, it makes more sense to me that when I leave it sparks off all these old patterns. But, I still can’t be by your side twenty-four, seven!

ANDREW: Yes, I realize that. Dr. Randall, how can I get over these old associations?

SYLVIA: Actually, the word associations is one of the keys. We have just made a beginning today by bringing to awareness some of the unconscious associations between stimuli in the present and earlier stimulus-response patterns. We will need to spend much more time revealing these memories and bringing them in to consciousness. Then we can examine them with fresh, adult eyes, which will help lower the emotional charge that originally became associated with the events. When the charge is lower, you will find an array of new behaviors that become available to you.

ANDREW: Can you give me an example?

SYLVIA: Of course. Let’s take your insight today that your father’s leaving the family may well have been more about his dislike and intolerance of your mother’s behavior than of yours or your brother’s. As you allow this to sink in to your thoughts and your reality, it will create a shifting of your lifeview. If you no longer feel responsible for his desertion, that also means you were not responsible for your mother’s worsening condition—or your brother’s for that matter. As you let this in, do you notice anything?

ANDREW: This is ridiculous—but, I must admit I feel lighter, as if I can breathe more freely. I almost feel I could tell you, Sheila, to leave early today and have a good evening!

SHEILA: Are you serious? Hey, I could go for that idea—(She pauses.) Now, this is weird, but I feel a little sadness in losing the Mead I know and love. Am I crazy or what?

SYLVIA: Change can be a mixed blessing sometimes. (We all laugh. The feeling in the room is light and the sun and its warmth, seems a little brighter.)

I’m afraid our time is up for today. Shall we meet same time next week?

I worked with Andrew and Sheila for six months. Their communication improved and Sheila softened. As she softened, Andrew was able to show more caring and empathy to her. They decided to stop their visits and I agreed that they had learned a lot and wished them all the best.

Then, about nine months after that, I received a call from Andrew. He told me Sheila had left to return to her ex-husband. It had been a difficult loss for him but he was now working with a new assistant; Naomi. New issues had come up in this relationship and they wanted to meet with me. We set up an appointment for the following week.

As I saw Andrew and Naomi in the waiting room, I noticed a rather different “vibe” in the room. Andrew looked less rigid than I remembered him to be, and he and Naomi were sitting quietly conversing with each other. I saw that Naomi is an attractive woman, probably in her mid-thirties, dressed rather conservatively and professionally.

 

SYLVIA: Hi Andrew, nice to see you again. And you must be Naomi—nice to meet you. Please come in.

 

ANDREW: It’s good to see you, Dr. Randall.

 

SYLVIA: Maybe we can start by you both telling me a little about your relationship and the areas on which you would like to focus.

 

NAOMI: Well, as you know, we work together. I am Mr. Mead’s assistant. We have been working together for about six months now, and I think very highly of my boss—he is amazingly astute. I just love to watch him work and also to work with him.

 

ANDREW: I depend quite a bit on Naomi’s help.

 

SYLVIA: Naomi, I notice that, even though you have worked together closely for some time now, that you still address Andrew as Mr. Mead. Why is this?

 

NAOMI: Oh, I wouldn’t feel comfortable calling him anything else! I mean, even though I love him, he is my boss and I respect our roles.

 

SYLVIA: Does it bother you that he calls you by your first name?

 

NAOMI: No, that seems appropriate since he hired me to help him.

 

SYLVIA: I notice a little bit of formality in this—I’m assuming this feels comfortable to both of you.

(They both nod.)

 

SYLVIA: So, what are the issues that you would each like to focus on?

 

NAOMI: Well, I just love and like Mr. Mead so much, and I try to give him help in every way I can both in our work and personally, when he is upset or anxious. I try to boost his spirits when he’s down. I include him in family activities with Jody, my daughter. I think I give him a lot and, my issue is, that I don’t get any verbal appreciation back. It’s as if all that I give is expected by him and he barely notices it. It would be nice if he could tell me once in a while that he thought I did a good job and was helpful to him, or, even that he likes being around me.

 

SYLVIA: Andrew, can you share with Naomi your reactions to what she just said—your thoughts and your feelings?

 

ANDREW: (He hesitates.) Um, she does a good job.

 

SYLVIA: It looks as if that’s very hard for you to say. Is that because you don’t really feel it, or is it just difficult for you to give Naomi this positive feedback?

 

ANDREW: I feel criticized—I suppose I am just deficient.

 

SYLVIA: How does that feel to you, Naomi?

 

NAOMI: I’m very annoyed right now. This is exactly what I’m talking about. Everything gets turned around, so that it’s all about Mr. Mead again, and I get nothing.

 

SYLVIA: Can you make a direct request of Andrew? Please speak to him.

 

NAOMI: Actually, that’s hard for me. In my family, if we didn’t get what we wanted, we were taught to accept that and move on. I grew up being very independent. I knew I was loved at home, but I didn’t get a lot of praise.

 

SYLVIA: So, here you are feeling in a similar situation. I know it’s a stretch for you to ask for what you want, but would you be willing to do so here?

 

NAOMI: Well, I’ll try. (She looks at Andrew—a little shyly.) Mr. Mead, remember when you were sick in bed, and I just took over some of the work for you, did you appreciate that?

ANDREW: Yes, I did.

 

NAOMI: And did you think I did a good job?

 

ANDREW: Of course.

 

NAOMI: Why is it so hard for you to tell me?

 

SYLVIA: Andrew, can you look inside for a minute—how are you feeling right now?

 

ANDREW: Scared.

 

SYLVIA: Would you close your eyes for a minute—(He does with some hesitancy.)—if you let a memory come up from earlier in your life of a time when you felt that same fear, what comes up?

 

ANDREW: (A few seconds go by.) Well, two memories pop up, both with the thought that life only gives you disappointments and hurt when you open your heart to someone.

First, I think of my father. I loved him and he left us. And then Terry.

 

(I glance at Naomi, who now has tears in her eyes.)

 

SYLVIA: Are you willing to risk a new behavior that might contribute to breaking that association between love and loss?

 

ANDREW: It sounds impossible.

 

SYLVIA: One step at a time. Maybe you could look at Naomi, and tell her a few things you appreciate and like about her?

 

ANDREW: (He turns to Naomi.) Naomi, I feel very uncomfortable telling you this, but you have a very good mind and often think of things that I haven’t even thought of when we are trying to figure out a case. Thank you. Also, I really love to be included in your life with Jody—I don’t often feel included with people, so it does mean a lot to me. Thank you.

 

NAOMI: (She still has wet eyes.) Oh, that feels so nice to hear. I do sense it from you, but I need to hear it in words occasionally.

 

ANDREW: It feels good to say, surprisingly.

 

SYLVIA: Thank you both for the risks you just took. Andrew, I want to ask you what issues you came in with today.

 

ANDREW: What just happened here, actually, relates to my major issue. I realize that since Terry’s death, I have been in a pretty deep depression and closed myself off from feeling joy. That’s part of why I don’t have the energy or motivation to give to others, including Naomi.

 

SYLVIA: This may sound like a crazy question, but would it be okay for you to feel joy again, even though Terry can’t?

 

ANDREW: I’ve thought of that many, many times! Why did I get to survive when she, doing nothing wrong, didn’t?

 

SYLVIA: Yes, exactly. Survivors often feel just this way. Can I ask you to close your eyes again just for a moment?

 

ANDREW: I don’t like it. It’s so dark with my eyes closed, and I can’t see anything! But all right. (He closes his eyes.)

 

SYLVIA: Would you imagine Terry is here, talking with you, and would you ask her how she feels about your allowing joy back in your life? Take as much time as you like, and when you are done, please open your eyes.

 

ANDREW: (There are several minutes of silence, followed by Andrew opening his eyes.) She was sweet and tender at first and then she got a little angry with me. She wants me to start living again, and especially to have fun and experience joy again. I am so surprised!

 

(There is a quiet pause in the room. Then, Andrew half-turns towards Naomi.)

Naomi, could you, Jody and me go out for pizza and a movie tonight?

 

NAOMI: (Naomi’s eyes are wide open and she is smiling.) I would love to!

 

ANDREW: And, would you start calling me Andrew?

 

NAOMI: (She laughs with a little shyness.) I’ll try—Andrew.

 

SYLVIA: I can’t believe how much you have both risked—and gained. Have a great evening. I am here, if you would like to continue with this work.

(Both nod and say they will call for another session.)

And this is why I love my work so much—seeing good people push through some of their self-made barriers to allow room for those feeling that, for different reasons, have been restricting the breadth of their thoughts and emotions.

In both sessions, we see clear illustrations of the therapeutic connection between making unconscious material conscious, and the resulting lowering of the charge on that usually fearful memory, fantasy, belief, or thought. This allows the client to expand the boundaries of their behavioral repertoire and to experience new feelings and take more behavioral risks—thus, feeling more alive, energetic and joyful.

In our culture, we share with others (especially women share with other women) many of our personal issues and concerns. While this is not therapy, it is very helpful and supportive. However, there is an unspoken taboo in our culture against sharing the details of our issues and concerns relating to our most intimate relationship. Therefore, couples therapy, and especially couple group therapy, offers a unique opportunity to share as a couple these most private areas of our lives, and to learn ways to work with troublesome couples issues.

The most common goal of couples who seek couples therapy is to feel more closely connected and more harmonious with their partner. Recurring conflicts may be a problem or a lack of the initial closeness that was so fulfilling at the beginning of the relationship. An important part of closeness comes from the ability to share with each other our internal worlds—our feelings and our thoughts. Since our personal feeling and thoughts are constantly changing, this is a crucial aspect in keeping the relationship interesting and alive. For many people this intimate communication comes naturally, but for others thoughts are easy to share but feelings are not.

The first task of couples therapy is usually to teach intimate communication skills. This task involves two sub-tasks: awareness and direct, clear verbal communication. (Non-verbal communication is, of course also crucial, but I will not focus on that here). We cannot communicate clearly without being aware of what we’re feeling. So, the therapist will work with both partners to identify underlying feelings. They may learn to become aware of bodily sensations connected to specific feeling. For example, when I feel a tightness in my abdomen, I am often experiencing fear.

Secondly, we will practice clear and direct communication between the partners. For example: “When you forgot it was my birthday last week, I felt hurt and very sad.” We often work with changing critical or blaming statements in to non-blaming “I statements.” A blaming version of the previous example would sound like: “You always forget days that are important to me. You are thoughtless and uncaring.” Blaming statements tend to lead to defensiveness and growing distance between the partners. The “I statements,” however, increase closeness and intimacy.

These are just a few of the basics of couples therapy work. This work is endlessly fascinating and the help that couples can receive from this work is most meaningful. After all, what is more nurturing and life-affirming than a partner who is, not only the closest to you, but also your best friend!⁹⁴