Good Morning, Monster: A Therapist Shares Five Heroic Stories of Emotional Recovery

LAURA

My heart is not a home for cowards.

D. ANTOINETTE FOY

1

SURROUNDED BY THE VILLAGE IDIOTS

THE DAY I OPENED my private practice as a psychologist, I sat smugly in my office. Fortified with the knowledge I’d acquired, taking comfort in the rules I’d learned, I looked forward to having patients I could cure.

I was deluded.

Fortunately, I had no idea at the time what a messy business clinical psychology was or I might have opted for pure research, an area where I’d have control over my subjects and variables. Instead, I had to learn how to be flexible as new information trickled in weekly. I had no idea on that first day that psychotherapy wasn’t the psychologist solving problems but rather two people facing each other, week after week, endeavouring to reach some kind of psychological truth we could agree on.

No one brought this home to me more than Laura Wilkes, my first patient. She was referred to me through a general practitioner, who in his recorded message said, She’ll fill you in on the details. I don’t know who was more frightened, Laura or I. I was newly transformed from a student in jeans and a T-shirt to a professional, decked out in a silk blouse and a designer suit with linebacker shoulder pads, de rigueur in the early eighties. I sat behind my huge mahogany desk looking like a cross between Anna Freud and Joan Crawford. Luckily I had prematurely white hair in my twenties, which added some much-needed gravitas to my demeanour.

Laura was barely five feet high, with an hourglass figure, huge almond eyes, and such full lips that had it been thirty years later, I would have suspected Botox injections. She had masses of shoulder-length blond highlighted hair and her porcelain skin contrasted sharply with her dark eyes. Perfect makeup, with bright red lipstick, set off her features. She was chic in spike heels, a tailored silk blouse, and a black pencil skirt.

She said she was twenty-six, single, and working in a large securities firm. She’d started out as a secretary but had been promoted to the human resources department.

When I asked how I could help her, Laura sat for a long time looking out the window. I waited for her to tell me the problem. I continued to wait in what’s called a therapeutic silence—an uncomfortable quiet that’s supposed to elicit truth from the patient. Finally, she said, I have herpes.

I asked, Herpes zoster or herpes simplex?

The kind you get if you’re totally filthy.

Sexually transmitted, I translated.

When I asked whether her sexual partner knew he had herpes, Laura replied that Ed, her boyfriend of two years, had said he didn’t. However, she’d found a pill vial in his cabinet that she recognized as the same medication she’d been prescribed. When I questioned her about this, she acted as though it was normal and that there wasn’t much she could do about it. She said, That’s Ed. I’ve already ripped a strip off him. What more can I do?

That blasé reaction suggested that Laura was used to selfish and duplicitous behaviour. She’d been referred to me, she said, because the strongest medication wasn’t limiting the constant outbreaks and her doctor thought she needed psychiatric help. But Laura was clear about having no desire to be in therapy. She just wanted to get over the herpes.

I explained that in some people stress is a major trigger for attacks of the latent virus. She said, "I know what the word stress means but I don’t know exactly how it feels. I don’t think I have it. I just keep on keeping on, surrounded by the village idiots." Not much had bothered her in her life, Laura told me, although she did acknowledge that the herpes had shaken her like nothing else.

First, I tried to reassure her by letting her know that one in six people aged fourteen to forty-nine has herpes. Her response was So what? We’re all in the same filthy swamp. Switching tacks, I told her I understood why she was upset. A man who purported to love her had betrayed her. Plus, she was in pain—in fact, she could barely sit. The worst part was the shame; forever after she’d have to tell anyone she ever slept with that she had herpes or was a carrier.

Laura agreed, but the worst aspect for her was that although she’d done everything possible to rise above her family circumstances, she was now wallowing in filth, just as they always had. It’s like quicksand, she said. No matter how hard I try to crawl out of the ooze and slime, I keep getting sucked back in. I know; I’ve almost died trying.

When I asked her to tell me about her family, she said she wasn’t going to go into all that bilge. Laura explained that she was a practical person and wanted to decrease her stress, whatever that was, so that she could get the painful herpes under control. She’d planned to attend this one session, where I’d either give her a pill or cure her of stress. I broke the news to her that stress, or anxiety, was occasionally easy to relieve but could sometimes be intransigent. I explained that we’d need to have a number of appointments so that she could learn what stress is and how she experienced it, uncover its source, and then find ways to alleviate it. It was possible, I told her, that so much of her immune system was fighting stress that there was nothing left to fight the herpes virus.

I can’t believe I have to do this. I feel like I came to have a tooth pulled and by mistake my whole brain came with it. Laura looked disgusted, but she finally capitulated. Okay, just book me for one more appointment.

It’s difficult to treat a patient who isn’t psychologically oriented. Laura just wanted her herpes cured and, in her mind, therapy was a means to that end. Nor did she want to give a family history, since she had no idea how it would be relevant.

There were two things I hadn’t anticipated on my first day of therapy. First, how could this woman not know what stress is? Second, I’d read hundreds of case studies, watched lots of therapy tapes, attended dozens of grand rounds, and in none of them did the patient refuse to give a family history. Even when I worked the night shift in psychiatric hospitals—where they warehoused the lost psychological souls in back wards—I’d never heard anyone object. Even if they said, as one did, that she was from Nazareth and her parents were Mary and Joseph, they gave a history. Now my very first patient had refused! I realized that I’d have to proceed in Laura’s weird way, and at her own pace, or she’d be gone. I remember writing on my clipboard, My first task is to engage Laura.

Freud has a concept called transference—the feelings a patient develops for her therapist—that he said was the cornerstone of therapy. Countertransference is what the therapist comes to feel for a patient. Over my decades in private practice, I’ve found that if you don’t honestly like your patient, if you’re not rooting for her, the patient senses it and the therapy flounders. There’s a chemical bond between patient and therapist that neither of you can will into being. Other therapists may disagree, but I think they’re fooling themselves.

I was in luck. I related to Laura right off the bat. Her plucky stride, her emphatic speech, and her no-nonsense manner reminded me of myself. Despite her sixty-hour work week, she was going to university at night, crawling ahead course by course. At the age of twenty-six, she was moving toward a degree in commerce.

At our next session Laura came in carrying four books on stress; they bristled with yellow Post-it notes. She was also lugging a huge flip chart on which she’d drawn an elaborate color-coded graph. Across the top she’d written Stress?????? Below this were several columns, the first colored in red and titled Dealing with Assholes. A number of assholes were listed in subcategories. One was her boss, Clayton; another was her boyfriend, Ed; a third was her father.

Now that she’d read the books on stress, Laura told me, she was trying to locate the cause of it in her life. She’d worked all week on the chart. When I commented that no women had been included, she looked at it carefully and said, Interesting. That’s true. I don’t know any asshole women. I guess if I meet any, I just avoid them or don’t let them get under my skin. I pointed out that we were coming closer to defining what the word stress meant to her, and asked for an example of what qualified these men to be on her list. They’re people who don’t follow any rules and really don’t give a shit about making things work, she told me.

I said I’d like to construct a history of her life to date, especially since her father was on the list. When Laura heard this, she rolled her eyes almost into her head. I plowed on, asking Laura what her most vivid memory of her father was. She immediately said it was when she’d fallen off a slide when she was four years old and slit her foot on a sharp piece of metal. Her father tenderly picked her up and carried her to the hospital for stitches. When they were in the waiting room, a nurse remarked on the terrible gash Laura had and how she was being a real trooper for not whining. Her father put his arm around Laura, hugged her, and said, That’s my girl. I’m proud of her. She never complains and is as strong as a horse.

Laura was given a powerful message that day, one she’d never forgotten: a declaration of love and affection that depended on her being strong and not complaining. When I pointed out that double edge, Laura said, Everyone is loved for something. Clearly, the notion of unconditional love—the idea that your parents would love you no matter what you did—was a foreign concept to her.

When I asked about her mother, Laura said only that she’d died when she was eight. Then, when I asked what she was like, Laura said only two words, ones that I thought were a bit unusual: remote and Italian. She could not retrieve a single memory of her. After I’d pressed a bit, she said only that when she was four her mother had given her a toy stove for Christmas and had smiled when Laura opened it.

Nor was she sure how her mother had died. I actually had to suggest that she elaborate. She’d been fine in the morning. Then my younger brother and sister and I came home from school and there was no lunch, which was strange. I opened the door to my parents’ bedroom and she was sleeping. I shook her and then rolled her over. I can still visualize the marks on her face from the chenille bedspread. I didn’t call my dad because I didn’t know where he worked. I told my brother and sister to go back to school. Then I called 911.

The police found her father and brought him home in a police car. "They covered my mother’s face with a blanket that was stamped Property of Toronto East General Hospital. I have no idea why I remembered that, she said. Then the men carried her on a gurney down the stairs and my mother’s corpse disappeared."

Wasn’t there a wake or a funeral?

I don’t think so. My father went out and then it was dark, past suppertime, and there was no food made. Laura figured out that it was her job to make the dinner, and to let the younger siblings know that their mother had died. When she told her six-year-old sister she cried, but her five-year-old brother had no reaction other than to ask if Laura was going to be their mother now.

Her mother’s family didn’t come to the funeral, nor did they help their grandchildren. My mother had never talked about it, but I gathered from my dad’s snide comments that they’d basically disowned her, Laura explained. She said they were real Italians—you know, the kind that wandered around Little Italy in black outfits mourning someone for most of their lives. My mother was the only girl in a family of five boys, and she wasn’t allowed out of the house past the age of ten. She had to stay home and cook and clean. She could go shopping with her mother but she could never go out alone. One of the brothers had to walk her to and from school every day.

Despite the strictness of her upbringing, Laura’s mother managed to become pregnant at sixteen. Laura’s father, a Canadian of Scottish descent, was, according to the Italian family, a young hoodlum who impregnated her mom when he was seventeen. Her mom’s brothers beat him to a pulp and said they would kill him if he didn’t marry her. After the wedding day, not one of her family ever saw her again.

Laura was born five months after the wedding, her sister was born twenty months later, and her brother arrived one year after that. When I asked Laura if she ever went to Little Italy to visit her grandparents, she said she had no interest in them.

I wondered if Laura’s mother had been clinically depressed and therefore emotionally unavailable. Who wouldn’t be depressed, if not traumatized, having had an overprotective childhood dominated by violent males and then marrying a man who didn’t want to marry her, who was himself inadequate, possibly emotionally and physically abusive, who resented and ignored her? Her parents had disowned her, never forgiving her for shaming them. She had nowhere to turn. When I questioned Laura about her mother’s death, suspecting a suicide, she said she had no idea what had happened. As far as she knew, there was no autopsy.

Unbelievably, for the duration of her four years in therapy, being given the toy stove would remain Laura’s only memory of her mother. Over that time I had her free-associate, write a journal about her mother, go visit her grave—and still there was only a blank.

We returned to Laura’s father in the following session. He’d been a car salesman, she told me, but had lost that job when she was little. There were always problems with alcohol, gambling, and misunderstandings. Despite being a handsome blue-eyed blond, quite smart and charismatic, he’d become downwardly mobile.

The year after the mother died, the father moved the family to Bobcaygeon, an area northeast of Toronto. Laura thought he was avoiding men in Toronto who were pursuing him, but she wasn’t sure. To make money he opened a chip truck serving the summer cottagers. The sister and brother played in the parking lot while Laura opened the pop and served the fries. Her dad called her his right-hand man. They lived in a small cottage outside of town owned by a family who had a number of modest cabins scattered in isolated spots throughout the woods on their property.

The three siblings began school there in September, when Laura was nine. The chip business dried up when the cottagers left. They bought a small heater for the one-room cottage and huddled around it. Laura recalled that two men appeared at their door on one occasion, demanding money for the chip truck, but her father hid in the bathroom. It was Laura’s job to get rid of them.

Then one day in late November, her father said he was driving into town for cigarettes. He never came back. The children had no food and only two sets of clothes. Laura expressed no fear or anger, or feelings of any sort, when relating this story.

She didn’t want to tell anyone they’d been abandoned for fear of being placed in foster care, so she just kept to their routines. The cabins, deep in the forest in lake country, were owned by a family who had three children. The mother, Glenda, had been nice to Laura when she’d played with their daughter, Kathy. The father, Ron, was a quiet man who had often kindly taken Laura’s six-year-old brother, Craig, fishing with his own son.

Tracy, Laura’s younger sister, whined all the time, Laura said with much annoyance. Tracy wanted to go to Glenda and Ron’s house to say that someone had taken their father and to ask if they could live with them.

Laura, unlike her younger siblings, knew that her father had abandoned them. He was backed into a corner, owing money and God knows what else, she said. When the children misbehaved after their mother died, the father had threatened to leave them with an orphanage, and Laura realized that it wasn’t an idle threat. All she knew was that it was her job to make things work. When I asked how she felt about being abandoned, Laura looked at me as though I were being melodramatic. She said, "We weren’t exactly abandoned. My dad knew I was there to deal with things."

You were nine years old, penniless, and alone in a forest. What would you call it? I said.

I guess technically it was abandonment, but my dad had to get out of Bobcaygeon. He didn’t want to leave us. He had no choice.

At that moment I realized how bonded Laura was to her dad and how carefully she had defended herself from any feelings of loss. Bonding is the universal tendency for animals and humans to attach—to seek closeness to a parent and to feel safe when that person is present. Laura didn’t remember having any feelings at the time; all she had were plans. In other words, she’d let her survival instinct take over. After all, she had two little children to feed and clothe over a Canadian winter in the wilderness. Laura would go on to deride my constant inquiring about her feelings, indicating more than once that feelings are luxuries for people who live a cushy life and don’t have to, as she put it, use their wits.

I could relate to what Laura said about plans versus feelings. When I’d experienced a reversal of fortune in my own life, I had no time to explore my feelings; I had time only to act. I’d grown up in a well-off family, but when I was a young teenager my infinitely sensible father, who owned his own business, began acting mentally ill. We discovered that he had an inoperable brain tumour. When I called his accountant, he revealed that my father had since lost all his money. I had to stay in school and get two jobs to help support the family. I, like Laura, honestly have no memory of any feelings of any sort. My mind was totally occupied with what had to be done to make ends meet.

Early on in Laura’s therapy, I joined a peer supervision group—a group of psychologists who get together to discuss cases and try to give one another pointers—and was surprised when the majority of them thought I wasn’t accessing enough of Laura’s feelings, that I was buying into her defences. I realized that I had to investigate my own mind to make sure that my reaction to trauma hadn’t coloured our therapy. On the one hand, my peers may have been right; on the other, I wanted to ask them if they’d ever been up against the proverbial wall, when without a 24/7 focus on their circumstances they could come to serious harm. Nothing concentrates the mind like the need for survival.

However, there is no denying that not having access to Laura’s feelings made therapy difficult. I quickly realized that my first job wasn’t to interpret her feelings, but to access her feelings. Later I’d interpret them.

When I wrote in my notes that first month, I summed it up this way: I have a client who does not want to engage in therapy, does not clearly remember her mother of eight years, which is unheard of in the literature, has no idea what stress is but wants to get rid of it, and had no accessible feelings when she was abandoned. I’ve got a lot of work ahead.

As Laura continued to describe her ordeal, it was evident that she’d kept a clear head. She realized that most of the cabins had already been cleaned for the winter, so she and her siblings moved to one of the remotest, not likely to be opened till spring. They took the heater with them. She knew they had to keep to their routines or they’d be detected. So they’d walk down the road nearly a mile every day to take the school bus. Laura would talk about her dad to the outside world as though he were back at the cabin and instructed her brother and sister to do the same.

So, you were left alone to live in a cabin at the ages of nine, seven, and six, I said. If you’re looking for stressful events, that could go on the list.

First of all, it’s over, and second, I’m still standing, Laura countered. Nine really isn’t that young.

How long did this go on?

Six or seven months.

At the end of our session I summed up how I viewed the situation. You have been brave. Your life sounds like it’s been difficult and at times frightening. You were abandoned, alone in the woods, and responsible for two younger children whom you were too young to parent. I said, It has all the perils of Hansel and Gretel without the breadcrumbs.

She sat there for a full minute before replying. In what would be almost five years of therapy, it was one of the few times that her eyes filled with tears, albeit angry tears. "What are you saying that stuff for?" she demanded.

When I said that I was empathizing with her, she rebuffed me. That’s what you say to people when someone dies. Listen, Doctor, if I’m ever to come back here, I never want you to do that again, or I’ll walk out. Keep your empathy or whatever it is to yourself.

Why? I asked, genuinely puzzled.

When you say things about feelings, I see a door opening that’s full of hobgoblins and I am never going to enter that room, she said emphatically. I have to keep going. If I ever started to wallow, even once, I’d drown. Plus, it doesn’t make things any better.

While I was nodding, she added, Before I leave today, you have to promise you will never do that again. Otherwise I can’t come back.

So what you’re saying is that you never want any kindness, empathy, or sympathy from me?

Right. If I want sympathy, I’ll get it from Hallmark cards in a dose I can handle.

Remember, Laura was my first patient. I didn’t want to make this bargain with the pathological needs of my client. However, I could see that she was serious about leaving therapy. A tiny shred of empathy from me was too much for her—it terrified her. And it was a deal breaker.

If I hadn’t been a new therapist, I would have presented the conundrum to her just as I felt it. We could, as Fritz Perls, the founder of Gestalt therapy, would have suggested, deal with this in what he called the here and now. Perls believed that the dynamic set up in the session between the therapist and patient is the same dynamic the patient sets up between herself and the rest of world. I could have said, Laura, you’re demanding that I act like the parent you had, the man who was uninterested in your pain. You’re used to no one responding to your sadness, but I don’t want that role. Right now I feel in a bind.

Instead, I said, I agree to respect your wishes, since clearly you’re very determined, and I want to make you comfortable so that we can work together. However, I will not agree to do that for the entire duration of our therapy.

The next week Laura arrived armed with her books again and identifying her workplace as the cause of her stress. There’s a lot to do, but my boss, Clayton, comes in late and then takes a two-hour lunch with the secretary he’s having an affair with, she explained. He goes home at five, so I come in earlier and leave hours later than he does.

Have you ever talked to Clayton about this?

"Of course! I even yell at him. But he doesn’t give a shit."

So you’re taking on too much work.

I really don’t have a choice. I have to do his work and mine.

Feeling you don’t have a choice is stressful, I concluded.

We spent a great deal of time going over how to deal with Clayton. Deep down, Laura didn’t see him changing. As her boyfriend Ed said, Clayton’s got a good thing going. Why should he change?

That’s interesting, coming from Ed, I said.

Why? she asked.

Well, Ed drops things on you as well. While Clayton dumps work, Ed dumps herpes. He just left it for you to deal with. When you got angry with him, he denied knowing he had the virus, and when you caught him with the herpes medication, he made the feeble excuse that he thought it wasn’t contagious. You’d have to be from another planet or else in deep denial to think that.

"At least Ed was sorry. He sent me two dozen roses at work and the card said Because I love you."

Did she think that made up for herpes? What I said was, Doesn’t Ed work for a Jaguar dealership? You told me that whenever a woman comes in to test drive a car, he sends her roses the next day. It’s not that hard to do.

Are you trying to piss me off?

I assured her that it wasn’t my intention to anger her. I said I was just wondering how she felt about Ed’s behaviour.

What am I supposed to do? Never forgive him?

I pointed out that our conversation had started with what Ed, who’s somewhat irresponsible, said about Clayton, who’s also irresponsible. I wanted Laura to see the irony of Ed’s remarking that Clayton didn’t have to change because she did all the work. Laura turned her hands palms-up, indicating that she didn’t get the point. Finally, I asked her who did the work in her relationship with Ed. When she acknowledged that she did, I was silent. Finally she asked me what tree I was barking up.

You forgive Ed for being chronically late, for suspected philandering, and for giving you herpes, I clarified. After a long silence, I asked her why she didn’t expect decent, adult behaviour from men.

At least he says he’s sorry. That’s more than my dad ever did. Then she looked out the window and said, Actually, he wasn’t that bad of a dad. He kept us after our mother died. A lot of men would have called child services.

Well, he did leave you up north in Bobcaygeon to freeze in a tiny cabin.

I told you, we managed. She said this in a dismissive tone, as though I were harping on picayune details. She was using a psychological technique called reframing: taking a concept and relabelling it so as to alter its meaning. She reframed what I perceived as neglect and labelled my concerns overprotective.

When you first came here, you talked about the ‘assholes in your life.’ Can we make that more specific? Laura looked confused, so I refined the question. Is an asshole, as you’re using the term, someone who takes from you but doesn’t give back? Someone who’s only meeting his or her own needs?

Everyone is out for himself; that was one of my dad’s mottoes.

He was normalizing his behaviour. How many dads go out for cigarettes and then keep on going?

"There must be dads like that out there. I mean, there are orphanages. How do thousands of kids wind up in Children’s Aid? Parents leave them, that’s how!"

How many people have bosses who slack off and still keep their jobs because their assistants work overtime to cover for them? I asked.

Yeah, well, if I push Clayton too hard he could fire me.

How many people are lied to by their boyfriend about something as dire as herpes?

Probably as many as spend useless money on shrinks.

As Laura angrily packed up to leave, she shook her head and breathed heavily, saying, Sorry for the attitude, but I can’t believe I have to go over this useless crap. Then she added that, other than a few lapses, her dad had been present in her life. In fact, as she vociferously pointed out, she saw and talked to him often.

Laura was still the reluctant patient defending against the therapy, and I was still the new therapist chipping away too hard at her defences. I was beginning to see that it didn’t matter at all if I knew what was wrong with a client. The art of therapy is getting the client to see it. If you rush it, they’ll snap shut. It had taken Laura a lifetime to build up those defences, and it would take time to peel them away, layer by layer.

I had my own psychological quandary. I needed to exercise patience as a therapist, but buried within me was a Type A personality. There are two types of personalities, Type A and Type B. Whereas Type B’s are laid-back and non-competitive, Type A’s are characterized by ambition, aggression, and a need for control. (This is a broad generalization and many people lie somewhere between A and B.) Type A’s are champing at the bit, and that drive can translate to stress; indeed, these traits are often associated with stress-related ailments. For example, Laura’s stress had exacerbated her herpes