Kathy's Therapy

Consistent with the latter interpretation was one of her symptoms: crying. When asked what triggered the crying, Kathy said that it occurred when she viewed scenes of high achievement. "I allowed myself the indulgence to think about what triggered my crying and I found it to be happy, joyous times that somehow mark a person’s specialness, and I linked it to my earlier life in that I probably felt that way about my own life at some point."

Second "crazy" period. Everything seemed to get back to normal for Kathy until her eldest son announced that he wanted to live with his father. This announcement came four months before Kathy was to remarry, and may have been prompted by the prospect of having a new father. Kathy, however, took the announcement as a sign of rejection of her and her mothering efforts. Soon afterwards, she started having her "crazy" feelings again.

Why the return of these feelings? I believe one of the best ways of discovering the unconscious reason for the production of a symptom is to observe what the symptom motivates the person to do as a consequence. The devastation Kathy felt at the "loss" of her son showed her that nothing really had changed, so she created the symptoms as a way of motivating herself to seek therapy, this time with a therapist who could help her understand what was going on: Polly Bloomberg-Fretter.

Kathy made it clear from the start that what she wanted from therapy was to be able to feel alive and open to feelings, without the accompanying debilitating depression. At the start of therapy she could only feel one of two possible states: guarded, efficient, and functional or alive, vulnerable, and able to function only with great difficulty. During her son’s move, she returned to "everyday functioning" and dealt with the underlying issues "by not thinking about them." Notice that all of her goals related to her quest for a new life, at the center of which was an opportunity to explore and confirm her abilities.

Interventions. Kathy worked hard to disconfirm her belief that she was undeserving of focusing on her goal to grow, feel alive, recognized, prized, and "in the spotlight," a belief that arose from her parents' indifference and Kathy's lack of confirming experience. Her therapist helped her to recognize the importance of her goal and kept it in focus throughout the treatment. Kathy continually "forgot" the goal and would ask her therapist to keep track of it for her. Much of this forgetting was a test. "From the moment Kathy met me, she tested to see if I could maintain the focus of our relationship on her needs, unlike her parents," her therapist said.

Her therapist responded by sometimes summarizing Kathy’s goals, sometimes questioning her difficulty focusing on herself, and sometimes pointing out how she sacrificed her own goals due to fears of hurting others.

This fear of hurting others arose out of her guilt of having hurt her father, mother, husband, possibly Dan, and possibly her eldest son. It is a guilt that arose precisely because she did not let the possibility of that guilt stop her from taking growth initiatives. Nevertheless, it was an important concern, because her sense of badness could become a limiting factor in the future, so it was crucial that her therapist deal with it.

Subsequent sessions focused on her inability to feel entitled to recapture her aliveness. Sometimes Kathy put herself down with references to her "self-indulgence;" a phrase that probably came from her mother. Her therapist invariably challenged these ideas by presenting contrary evidence. Kathy then explored how she destroyed her ex-husband by being so much more competent than he was. Patiently, her therapist challenged this viewpoint by questioning, for example, why she viewed the problem as stemming from her competence rather than from his envy and need to blame others for his own inadequacies. This was an extremely valuable lesson that taught her she should free herself from the ways she perceived the reactions of others when a child.

Realizations of her need to be more generous with herself, however, were often followed by feelings of unworthiness and fears of humiliation for what Kathy saw as her boasting. This kind of switching back and forth I interpret as being due to the participation of childhood learnings as a critical force during sleep.

During the fourth session, Kathy began to outline some of the achievements she had made during her adolescent period, but kept most of them hidden, as she had with her parents. Over the next 10 sessions, she continued to hide her achievements and required that her therapist discover her talents, as well as fight for Kathy’s right to nurture them. I see this as mainly a continuing test to see whether her therapist was truly interested and nonthreatened and therefore apt to respond positively.

Her therapist finally won her over when Kathy started talking about her lifetime interest in writing as evidenced by a book of short stories she had written. Although Kathy claimed the stories were nothing special, her therapist asked if she could read them, and found them deeply moving.

Two sessions later, Kathy once again forgot her goals, arguing aggressively, that she had changed her mind about her need to be more generous with herself. She decided that she was too generous with herself and that she did not deserve any more in her life. Her therapist indicated that she disagreed, using evidence to demonstrate the significance of Kathy’s problem with self-generosity. She told Kathy how impressive the stories were in communicating her outstanding talent as a writer storyteller, and communicator of intense emotion, especially in the face of her claim not to have talent, skills, or creativity.

What was going on during this by-play? Kathy probably "changed her mind" because she feared a negative or lukewarm response to her writing. The praise she received helped confirm her assessment of her abilities, which led eventually to Kathy returning to her original decision to pursue her goal of recapturing the special times. Another thing that was going on was that Kathy was relearning how to think about herself, using her therapist's interventions as a model.

Another extremely important area dealt with in therapy concerned mothering issues. This work was partially directed at demonstrating to Kathy her right to have had better mothering herself, as well as showing her that she had the right to be a better mother than her mother had been without the fear of hurting mother.

At an early point in the treatment, her son returned to live at home following a disastrous attempt to live with his father. His father’s alcoholism had increased to the point that he was unable to care for his son adequately, and he blamed Kathy for all his failures. Her son returned feeling severely depressed, rejected, and angry at Kathy. Her therapist encouraged Kathy to stand up for herself by protecting herself and her son from alcoholic blame and denial. Kathy responded by saying that she felt paralyzed and incapable of even comforting her son. "I’ve been as bad a mother to James as my mother was to me," she said.

Her therapist then role-played with Kathy ways to comfort her depressed son no matter how angry he was with her. She also demonstrated how, for the well being of her son, Kathy must be a better mother to her son than her mother was to her. Kathy followed the suggestions with great success and made excellent progress in comforting James over the next months.

Somewhat later, an occasion arose to teach Kathy about the limits of how far she had to go in helping James. Kathy’s ex-husband frequently phoned to talk to his children, complaining what a mess his life was. James took these phone contacts badly, as he felt excessively responsible for his father s misery. Depressed and withdrawn, he began to have serious school problems. To help Kathy meet this kind of situation, her therapist taught her how to take appropriate levels of responsibility without overstepping those levels.

During one particular period, James remained severely depressed and refused all Kathy’s efforts to revive him. Kathy then became severely depressed herself, much as her mother did after Dan died. Her therapist told Kathy that if James "refused to recover," she was at first to attempt to comfort him, but if he persisted, she was to demonstrate to him that she could both love him and still maintain a separate mood from him. She was to teach James that she could tolerate his pain without feeling overwhelming responsibility for it. "Try to reach James and if he refuses, let him be. Go ahead and be happy with the rest of the family," her therapist said.

At first Kathy claimed that such action felt mean and cruel. Her therapist responded by explaining that James needed to learn to be able to go on with his own life despite his father’s alcoholism, and that he could learn that best if Kathy did that with him. Kathy then began to remember vividly her own trauma after Dan died, when her entire extended family fell apart and never recovered. At this point, Kathy was convinced of the importance of teaching James to go on with his life. She proceeded with great success with James. Within a year of these interventions, Kathy was able to maintain consistently good mothering. James, who showed excellent progress by improving academically and socially, later told his mother how much he appreciated her steady love and support, which had enabled him to face his father’s alcoholism.

I think the importance of this intervention went beyond the teaching of mothering skills, because the way James responded to his father was the same way that Kathy and her family responded when Dan died. Kathy learned how to go on with her own life, too, in difficult circumstances and confirmed her self-worth as a mother.

The End