Annie Session 4 Wednesday October 15, 1982
General: This session is rich in material, including a dream and towards the end, an important experience of which the patient is ashamed. The session clearly illustrates the importance of both support and interpretation, in helping the patient understand the nature of her anxiety, as well as feel understood by him.
1 T: Hello.
2 P: (pause) Still don’t like this.
3 T: Still uneasy about it. Okay. Mmm hmm.
4 P: Yeah. It’s comfortable when I got up yesterday, I almost, uh–got up too fast. I didn’t want to come here today. (laughs) I wanted to stay home and work in the yard. It’s really nice outside.
5 T: You have a feeling you’re supposed to want to come?
6 P: Uh – yeah. (laughs)
7 T: Why?
8 P: I don’t know. I guess I did the other days and today was just so nice out there, I just wanted to stay home and get something done, you know.
9 T: Is a person supposed to enjoy going to the doctor? [comment]
10 P: I guess not. Especially since my mother said something yesterday that’s really been, uh–everyday I go back to pick up my son and she asks me, “What happened? What did he ask? What did you say?” and you know, it’s–you can’t tell her. You can’t explain what happens in an hour, you know–myself, I don’t know. But, uh, she said something Monday or Tuesday that (sighs) really–she says–you know, she had a lady friend that went to a psychiatrist and, uh, all you do is go and lay there on the couch and do all the talking and cure yourself and that’s–uh-uh–that’s sometimes.. I feel like that’s what I’m doing just, you know, doing all the talking, just whatever, you know, comes to my mind and–is that–is that part of finding out what the problem is. I mean, uh, is that the way, uh, you can find out maybe, possibly, what could be causing the other problem.
11 T: Sure.
12 P: Okay.
13 T: But I don’t have the impression I’m sitting here not saying anything.
14 P: No. I don’t, you know, I can’t explain to her….the only thing I could explain to her yesterday was that like when I’m at a loss for words and I have a feeling about something, he can–he can understand and he says it in the words, you know, when I can’t find the words to say it and I says, “that’s a great help.” I says, uh, you know, you can’t expect a person to–you know, it’s different–I don’t know–when you talk to other people you talk about someone or something and you’ve got a conversation going back and forth but just to lay here and talk about yourself, that’s different. (laughs)
15 T: Yes. This is different.
16 P: That’s-that is different. It, uh–even I told *Nick yesterday that I’m kinda tired going there and talking about myself, uh–just, uh–you know, it’s kinda, I don’t know in a way it sort of feels degrading in a way.
17 T: Oh, how’s that?
18 P: I don’t know, it, uh–maybe ‘cause I’m only telling you all the bad stuff or-or you know, I’m telling you things–I’m worrying about what you’re thinking about me, I guess that’s what it is but….
19 T: Yes. I think you may have the idea that that’s what this is for–that you’re supposed to fish out all the terrible things about yourself and I’m just waiting to hear them and then I’ll be real critical. [comment]
20 P: Yeah. And, uh–but you explained it wasn’t that way so it’s something I have to keep remembering, you know–it’s not gonna be that way. This is, you know (laughs) I’m glad I’m off tomorrow. I’ve got a few things I want to do. I hope the weather is nice and, you know, just uh–well, he asked me–*Nick even asked me, he said, “What do you tell him?” I said…”Did you tell him about your brother running away?” I said,”Yeah. I told him that already.” I said, “There’s a lot of things I haven’t told him” you know. I mean, how does a person lay here and just say every thought that’s supposed to come to his head to someone when they normally don’t do that, you know. A lot of things a person keeps inside, they think but they don’t say it and that’s different too. That, uh–that’s getting to be unusual. It, uh–I mean, some things you think and you say and the other things you think and you just don’t say ’em, you know. You just, uh–they stay in but like the last two days or so, it, uh–I mean, everything that came to my head, I was saying and, uh, when you start thinking about saying everything you’re thinking, it’s–you know, you wonder–gee….mmmmm.
21 T: Gee what?
22 P: You know, what does the person think of you, you know, that’s–I shouldn’t be worrying about that, you know.
23 T: You’re right. People very often, uh, don’t say certain things because they, they think that if they do the other person will have a reaction that they don’t want them to have but here, you are being asked to say everything so I guess the only way you can do that with any comfort at all would be if you had some conviction that I’m not using what you say to judge you or be critical or whatever.
24 P: Are you using it to (sighs) maybe, in the long run, uh….
25 T: To the best of my ability, I’ll use it to try to understand you. [comment]
26 P: Yeah. To get back to that-that one problem. It seems like we talk about everything else and I’m wondering if everything else has got to do with that problem, you know. It does and it doesn’t ’cause most of my life is, you know–I enjoy being a housewife, I love my kids and I like all that. The only part is that one part when I get very, uh very nervous, upset to go somewhere-
27 T: Mmm hmm.
28 P: …that’s the only part, you know.
29 T: Yes. You are right. That’s one thing that seems strange about this procedure. You have this major symptom and we don’t attack it directly-
30 P: Yeah. Right.
31 T: …so naturally, you’re wondering, Well is all this gonna result in helping that.
32 P: Right.
33 T: Hopefully, yes. That’s the idea. We go at it indirectly.
34 P: Indirectly to get it–that, uh–I hope it works. (laughs) Really, I do.
35 T: That doesn’t mean we may not, now and again, come to the symptom as such.
36 P: I wish it would happen. I doubt that it will because you could say, I’m not under that pressure or that, uh, situation, you know.
37 T: No. I meant that you’ll be talking about the symptom too directly.
38 P: Yeah. When it happens–when it comes out.
39 T: And as I also explained to you and you know, there are things one–you have to learn about this process as you go along. I do not intend to direct you in any way in so far as your behavior is concerned. What effects will come from the treatment will be applications you will make of what you have learned.
40 P: mm….(pause) You know, it’s–I guess when you hear like my mother or *Nick saying things, you start wondering and you start feeling like this–you know, like am I wasting my time, am I wasting his time–but, uh, I’ve got to–it’s getting somewhere where it’s like between you and me, really, uh–no one else knows–I don’t lay or talk to anybody like this (laughs) and tell them things I feel or things that go through my mind and you talk with your husband and your mother or your sister but this is different.. This is, uh, getting to take a different, uh–I don’t know–something different in my life, that’s for sure. (laughs) Uh, mmmm – you know, uh, I have to say my mind is kinda distracted. I’ve got a lot of things on it. Both the kids are–they seem to be congested and I’ve been giving them aspirin and rubbing them down at night. The last two days–everyday, I figure I’m gonna wake up and one of them’s gonna have a high fever and they’re both gonna be home from school. It’ll probably happen tomorrow when I don’t have to go anywhere and they’ll both be home sick. Mmmm – I’ve been trying to snip it in the bud so they don’t get, uh, worse. They’re sneezing and got nose-fuls and, uh, kinda miserable. They get overtired earlier, uh – mmmm – my mind is a blank. I can’t believe it. [comment]
41 T: You’re right. One’s mind never is a blank. [comment]
42 P: Well, I’m looking at the ceiling but, uh, you know, lots of times thoughts come through your mind automatically and now it sort of, you know, just, uh – must be part of being overtired honestly.
43 T: Part of what?
44 P: Being overtired. I was really tired yesterday. Not so much today but I was really tired yesterday. Do you think dreams have any significance in things or they’re just–I had a dream last night. It was kinda terrible. I woke up with a–with a moan. It didn’t have any significance other than the two children–they were on top of a big palm tree and-
45 T: A big what?
46 P: Palm tree.
47 T: Pound tree?
48 P: A palm tree.
49 T: Oh, a palm tree. Yes.
50 P: Yeah. Like a coconut tree. And they were at the top and they were having a good time–it was really kind of funny, in a way, and, uh, *Sparky had, I don’t know, some canteens and a box or something and I told him to drop it, otherwise, he’d fall and lose his balance. Well, he leaned over to drop it which was really–if he would have just dropped it straight down, it would have been different but he leaned down and he started falling and I just woke up there–just, you know, I was almost ready to go into his bedroom and check and see if he was still there.
51 T: It woke you up with a moan.
52 P: Yeah. It, uh–I went–uhhhhh, and I woke up immediately, you know. All I could see was him starting to fall from the top and *Ericka was still up there. Other than that, I was yawning from 9 to 10 o’clock. I was so tired I went to bed at 10 and fell asleep almost instantly and then woke up with that dream, you know, and then I was wide awake, tossing and turning, the rest of the night too.
53 T: You asked me if ever I think dreams have any meaning.
54 P: Yeah.
55 T: Yes. I think they do and, uh–and I suggested you–that you tell whatever occurs to you, if a dream occurs to you, then that’s the thing to tell–just like you did.
56 P: Mmmm.
57 T: And we have a particular way of working with dreams which is really very similar to just the general thing you do–say whatever comes to your mind. That is to say, you take the individual parts of the dream–and just say whatever they make you think of and sometimes that brings light on it. [comment]
58 P: I thought maybe-
59 T: What?
60 P: …I thought maybe you–I thought maybe looking back at the dream this morning and I was wondering why it was that type with the two children and I thought–well, maybe because they’ve been sick–sort of–the last two days–not seriously but enough where they fevered, you know–say, a hundred or so I didn’t ever–I didn’t take their temperatures, it wasn’t that high but enough that they were warm enough and they do have these colds coming and thoughts are going through my mind like I’m gonna get it, my husband’s gonna get it and it’s gonna go round and round in a circle all winter long, uh, I thought maybe the two of them up there was kind of like–and *Sparky, he just got the symptom yesterday so–I thought–well, maybe that was part of it the two children–you know, worrying about them.
61 T: Well, if we take the individual parts of the dream–what does it make you think of that they were on a palm tree.
62 P: I haven’t (laughs) I don’t know–I thought maybe–well, they were using that ramp with the bricks and a little board to go up and they were doing their bicycles and *Sparky was doing his Big Wheel and maybe the height part of it…
63 T: *Sparky was doing his Big Wheel?
64 P: Yeah. Do you know what a Big Wheel is?
65 T: I’m afraid I don’t know that.
66 P: It’s, uh – it’s a toy–it’s not a tricycle but it has two big wheels on the back and a large wheel on the front….Uh…
67 T: How is it not a tricycle then?
68 P: It’s-it’s low and the wheels in the back are very wide-
69 T: Yeah. But anyhow, it’s-it’s…
70 P: …and it’s–I mean, he goes two forty on it and he spins it around and everything-I mean, every kid in the neighborhood has got one. It’s advertised on TV.
71 T: He goes two forty?
72 P: Two-for–fast.
73 T: Is that what two forty means?
74 P: Yeah. I thought it did.
75 T: Well, it may very well, it’s just that I’m not familiar with that expression. Two forty.
76 P: I always thought that was just going extra fast.
77 T: Uh huh.
78 P: Compared to a tricycle, uh…
79 T: And he went over this Evil Knievel thing that way?
80 P: Yeah. This wooden board and it’s funny to see them going over it. They’re not even taking off in the air, they’re just going over it and, you know, I thought maybe that was–I was starting to think–well, gee, I’m letting them do this tiny, little dangerous thing, you know, maybe they’ll try something higher or more dangerous because, uh, *Nick’s father was over Saturday when they were doing this and, uh, they had mentioned that there was a neighborhood boy that was doing it–but I don’t know, I think they were doing it much more severely–higher up and gettin’ up in the air–and he didn’t land his bicycle right and his face went right into the pavement so, uh, you know, they were kinda frowning on the fact that *Nick and *Ericka–*Sparky and *Ericka were doing that. Uh…
81 T: Who was frowning on it?
82 P: *Nick’s Dad and also his brother, *George.
83 T: I see.
84 P: That the kids could get hurt that way. It wasn’t that high. It just–they weren’t flying over twelve cars or anything like that. They weren’t even flying a foot off. They went over it and right on to the ground again.
85 T: Now let’s take another part of it. You say he had canteens and things with him…
86 P: Well, he’s always got something with him. (laughs)
87 T: What did you say?
88 P: He’s always got something. He’s the type of little boy that has to have his car or his gun or paper or pencil or crayons or a game. You know, he’s always doing something, uh, so, uh–well, canteens, they had–*Davey next door–the little boy, he’s–he just turned seven and, uh he has like a camping out backpack and they were–we have–we live on a corner house off *Oak and there’s a field in the back of the house and they play in there like they pretend they have, uh, logs that are fire and they’re camping out, you know, and, uh–I don’t know why the canteens but it was something *Sparky had with him.
89 T: And why in the dream did you want him to drop them? [comment]
90 P: Well, I thought he’d lose his balance and he’d fall and, you know, he just had too much plus trying to hold his hands onto the tree so I told him to drop them and when I meant drop them, I just meant let them go and go straight down but being four years old, he leaned over to drop them and that lost his balance and all I could see was this–starting to fall and I woke up before he hit. I always wake up before anybody hits. I…
91 T: I have an idea about the dream. Uh-
92 P: Okay.
93 T: …but I put it that way because I think you should know about this and a lot of other things.
94 P: Okay.
95 T: When I express an idea, that’s all it is, it’s an idea. It could be right. It could be wrong and you’ll react to it in one way or another. If you think it’s right, you’ll agree, if you think it’s wrong and so on. [comment]
96 P: All right.
97 T: The idea I have comes partly from one of the things you said earlier today and what happened at the end of the hour when you were dizzy because when you talked about his losing his balance and falling possibly, I thought of that.
98 P: Mmm.
99 T: Another thing that gave me the idea was that when you said that, uh, some relatives of yours objected to the kids’ activities for fear they might go higher and higher and maybe fall and really hurt themselves.
100 P: Mmm hmm.
101 T: And I put that together with your telling me that you have some sense that your parents don’t exactly approve of this treatment.
102 P: I don’t think my mother does.
103 T: In other words, my idea is–what?
104 P: I know my mother doesn’t.
105 T: All right. So there again, there are relatives disapproving of something that somebody is doing so the idea I have is that that may represent–the kids may represent you in the dream and that you are afraid about this treatment and you say to yourself–oh, my goodness, if I–if I do this, how do I know what I’m going to do next. I’m going to go higher and higher. If I tell Dr. *Johnson the intimate, personal things about myself and dig up all of this stuff–my God, how do I know what’s going to come next and I’m afraid that I might–I might go too far and I might lose my balance and fall and really do myself some damage. [comment]
106 P: Yeah. I agree with you there because like I don’t want to talk about my mom and dad, you know–the bad things all the time but it seems like sometimes that’s what happens. They were always–or my father mostly would, uh–was very over cautious and he used to call us stupid and idiots and we had no brains and no–just wave his hand like that at us–like give up, uh, and when you do things in your own life that you’ve made mistakes or something didn’t work out the way he thought it should be, uh–how am I gonna tie this in? Uh, oh, I had the train of thought and it just–I don’t know where it went. I was tying it in to what you had said–that personally that I thought–I take it personally that I myself fail. Failure’s got a lot to do with my life, I’ll tell you.
107 T: Say that again. You take it…
108 P: As a failure.
109 T: At what?
110 P: Uh, oh, I don’t know. That when things–people, uh….
111 T: Oh, you mean, your father treated you in such a way that if something goes wrong,-
112 P: I feel like a failure.
113 T: …you always feel it’s your fault.
114 P: Right.
115 T: Or that you have failed.
116 P: Right. And to myself, I really feel that way. I mean, if–even if it’s something minor, it’s, (sighs)
117 T: Or you do something that other people would say is not your fault? [comment]
118 P: Right. Like if the kids–like–well, I start feeling guilty–like, well maybe they shouldn’t be doing that but then I don’t want to be like my father. I don’t want to be overcautious. If the kids are having a good time and it’s not that dangerous, I’ve got to make that judgment myself and let them continue doing what they’re doing but make sure they don’t, you know, overdo it and really end up doing something that may hurt. But if my father would have seen that–Holy Christmas It was *Nick’s father who had seen it, uh, the kids Saturday but I guess, I feel guilty and then if something would happen, you know, and someone told me about it and suggested that they could get hurt and yet, they still got hurt, then I’d feel guilty and a failure that I should have listened, you know. It’s, uh – something minor but it’s–and I take my life a lot like that–very seriously–very over sensitive, you know, uh…
119 T: I thought maybe the palm tree, uh….
120 P: Well, my father, uh–we used to go every summer–his family–his mother and dad and all his sisters live in *Naples, Florida and, uh-uh, we would stay with them-I’ve seen palm trees–I mean, I’ve physically seen them.
121 T: So the idea of a palm tree is sort of associated with your father….
122 P: I don’t know if it’s that–possibly, possibly. ‘Cause he-he-if he would have seen the kids up that high, he would have had a conniption. Uh, I thought maybe a tree that was higher than the tree we have in front of the house–the children are always climbing on that–it’s not really that high…It’s about a foot over my head the branch they sit on and they’re always climbing that and *Sparky’s always in that more than *Ericka is. I thought maybe that tree being smaller, I picked a higher tree, you know. Something they could really fall from. I-I….
123 T: One of the reasons I-I was suggesting that maybe that’s tied up with your father is that, as you know–as I said, I think that since the dream may have something to do with your own fear of what will happen here, that would be a connection too because you have already said a few things that indicate that you’re afraid that I will treat you like he did-
124 P: Yeah.
125 T: …I will be critical and scolding and say you’re worthless and a nothing and wave my hand and heaven knows what else. [comment]
126 P: Possibly. And, uh – and it–I just feel that a lot of things he has done and my mother had done, (sighs) really kinda changed my attitude about people and the way I do things. I mean–like it’s always like I’m out for approval. Uh, even in myself, you know, I’m out for my own approval..Uh, it’s….
127 T: Were you puzzled about what to do with your purse when you came in today?
128 P: Yeah. But I–I wanted to lay it there (laughs) but it’s like-like when you were up there before I thought maybe you disappeared and I didn’t want this to disappear so I just wanted–it’s such a force of habit–we live in a neighborhood on *Fifth and *Oak and–that the northwest corner is completely black and I’m so used to–when I’m carrying this, I’m holding it constantly ’cause I’ve heard stories of women, uh, you know–they just grab their purse and run and knives have been pulled on some women down there. These are stories I’ve heard. I haven’t, uh, you know–and so it’s just a habit of carrying my purse too, you know, ’cause, uh….
129 T: I’ll tell you why I asked. I was trying to understand that business of carrying a canteen-
130 P: Yeah.
131 T: …and being told to drop it and so on and after all, a canteen is, how shall I say–it’s something that a person needs in case there will be danger or he’ll be hungry or thirsty or whatever, and I think you may be referring to the fact that you’d been asked to say everything that comes to your mind, which is sort of like saying–drop your inhibitions here-
132 P: Mmm hmm.
133 T: …drop those things that you carry around with you that-that–for a kind of security and to make sure things are okay, you know (laughs) Be free, you know, and let her rip two forty- (pt. laughs) and so I thought maybe you clutched your purse like, uh….
134 P: It was–it was a type of security– it was like a teddy bear type of thing, you know.
135 T: You feel this is a scary situation ’cause you’re being asked to let go of those things and see what comes. [comment]
136 P: No. I can understand now sort of why it has to take longer than I imagined, uh, it–you know, I’m beginning to understand that and I’m beginning to see that time element I had set in my mind, doesn’t really matter, uh…..
137 T: What is it that makes you feel it might have to take a little longer?
138 P: Well, I just wanted that one part cured really quickly, you know. I-I-I–you know, just like when you go to a dentist, he’s working on your teeth, he’s getting done–progressing or you just don’t have any cavities and you get a cleanup–like when you go to the doctor and you have a cold, you might get a shot of penicillin, you know–cut and dry, you know (laughs) When you go to the store, you get your groceries–you come back, uh, this is different. This is…
139 T: And here we are horsing around with dreams and….
140 P: No….
141 T: …and talking about everything under the sun, huh? [comment]
142 P: No. I don’t think it’s gonna bother me as much as if, uh, I have to go–I just hope my mother doesn’t get on the–I think she’s taking it personally. I think she feels like she failed somewhere in her life and that’s why I’m here and…I’ve read enough books and I’ve tried to tell her, it doesn’t have to be her personally, it could be a situation I take differently or words I take differently. It’s not necessarily what she’s done, you know, and I’m trying to reassure her that nothing is her fault. It’s mostly the way I took my life or the way I took words or things that happened and, uh, I just hope she doesn’t–she can get awfully–mmm–she can end up crying and screaming and saying–you kids this and you kids that–I just don’t want to go through a scene like that. She’s done that a few times. Uh, like my brother’s left home–I’ve mentioned and she gets on me and says, “Doesn’t he care about us–about our feelings? Isn’t he worried about us? I mean, we’ve done so much in our life for him” And I’m trying to tell her, “Mother, I don’t know. I haven’t talked to him.” you know, uh-uh, I understand he went and stayed with my brother and my brother is in Wyoming now–these two weeks–and, uh, *Louis’s kinda taking care of the house and his two German Shepherds so – I’m sure *Louis, himself, has enough to keep himself busy with-with getting his own clothes ready–his own food–getting himself to work. I mean, to me, he’s been dependent upon my mom for all his clothes and his food. When he comes in, he eats–he sits down and eats and leaves. Well, this to him, is gonna be extra work. I’m sure he’s busy enough trying to take care of himself. I–and I don’t think he’s out to hurt their feelings intentionally. I just think he got fed up with the situation and left. He just doesn’t like all that third degree which is, uh–I think a lot of that is uncalled for but, uh–I should tape my father one time when he comes over and gets on his kids–you wouldn’t believe it. Mmmm – I wish he’d talk about something else except his kids. The other–the only other thing he talks about is, uh–he was born and raised in a little town–and he’s wanted a farm all his life, you know, and he’s-he’s progressed from that a little, hill-billy type place to getting himself an education–he got two years of college in and he was an accountant for a work at a time–he was a bookkeeper there, you know. He always brings up, you know–like he’s done this, he’s done that, you know. (sighs) I–you can’t get him to talk about something. If he doesn’t agree with you, he flies off the handle and shouts and hollers real loud. Like you can’t really discuss anything with him. It, uh….I really wish he was different (laughs) ’cause that would have made me different. Mmmm – like I told *Nick, he-he wanted to know what I was talking about, you know and I said, “It’s hard to say, you know. You just can’t explain what goes on here.” I said, “It’s different.” In a way, I was kinda gettin’ disgusted just talking about whatever came into my head. Yesterday, I guess, I was just tired and just, uh–I don’t know–well, I think what my mother had said Monday was on my mind too, you know. You just don’t go lay down and tell somebody anything that comes in your mind, it just is different. Uh – there’s a lot of things–I was thinking–well, maybe we should start from like what I can remember and work up in my life–you know, something like that, uh–then that would be like telling everything I’ve ever done in my life–or felt or, you know….
143 T: Are you afraid your parents may try to block your continuing with the treatment?
144 P: Uh, they won’t stop it. I don’t think my father even knows. Just my mother ’cause she’s watching *Nicky–*Sparky and, uh, she’ll just voice an opinion, I just won’t like, you know, I just know it. Uh, like the one she said about this woman, down at work, going all the time and she just laid there and talked and talked and she would, you know–I thought–well, maybe it was the psychiatrist, you know, she was going to–maybe he just didn’t ever say anything.
145 T: See, I did notice that in that article you brought yesterday.
146 P: Yes. It said some sense their direction but I think each one has their own way of doing it, you know?
147 T: Yes. But I–that article said that there are psychiatrists–as I remember the article–there are psychiatrists who don’t say anything and don’t help and don’t give the patient any direction and so on and I wondered if one of the reasons you brought the article was that you were afraid that I’d be that way.
148 P: Possibly. Uh – but it was something like I had read, uh–and I thought maybe if you read it, you’ll know what I read, you know. Uh, it’s a bit of knowledge….
149 T: The article also recommends that the patient should demand from the doctor explanations and so on.
150 P: Yeah.
151 T: Had you thought you might want to do that too?
152 P: In a way, but like you’re reassuring when-when you talk and, uh–I don’t know, uh–I did tell *Nick, “I don’t know what I expected. I guess I expected some theories he’d pour out and make sense.” I said, “But it’s not taking it on that way.” You know, I never went to a psychiatrist before, you know, and you see them in the movies–they just lay there and talk and every once awhile, the doctor says…
153 T: They just lay there?
154 P: Well, the actor or actress…you know.
155 T: Oh, I see.
156 P: And, you know, it’s just–it’s really different. It’s unusual for me. It’s not a normal part of our life. It’s something I’ve never done before I guess, like I explained before, it’s not something cut and dry. It’s something that takes time, I guess. I guess I am adjusting–I guess adjusting to the daily, uh–not just the fifty minutes or the hour but just adjusting to the way things are gonna be or (sighs) well, I don’t know. I guess, what I was gonna say was that–what was expected of me but, uh–it’s hard to put it in words, so…..(sighs) Just, uh-uh, unusual. It’s–I should think of something so I get off this because it’s just something I have to adjust to–going four times a week to lay down and talk about myself.
157 T: I think–yeah–I think maybe you’re also sort of wanting me to know that this is a strange and unusual and very new situation for you and you are sort of wanting me to know that I should have some degree of patience and give you time to get–to get used to do it. To know how to do it. You’re perhaps afraid that I’ll expect you to jump in and do everything exactly right the first minute and so on. [comment]
158 P: Yeah. I guess it goes back to what we discussed too. Uh–geez, my mind ( laughs) I forgot. I think of something when you’re saying and then-then I forget it (sighs) Must start taking up my vitamin pills again. Uh – it’s like, uh, I don’t want you to give up on me, you know, that’s what it is.
159 T: Oh, yes. That’s a better way to put it than I did.
160 P: Yeah.
161 T: You don’t want me to give up on you… [comment]
162 P: How could I forget that? You know, I’m laying here…..
163 T: Huh? What?
164 P: How could I forget that? That’s what I wanted to say and then I forget it and a minute later, I remember it.
165 T: How did you forget it?
166 P: Yeah.
167 T: I think, maybe in a way, you forget it because it’s so terribly, terribly important to you that you’re almost afraid to say it–that you’re scared–and so you’re saying to me–”look, this is new and I’m trying and I’m doing my best. Now, don’t get so impatient and don’t be ready to write me off and say–oh, she’s not suitable for this and whatever.”
168 P: Oh. Like I want to ask you (sighs) gosh–that’s hard to say. I’ll say it anyway. Do you really feel like I have a problem–I mean, like (sighs) that I’m not really like-like wasting your time and my time–that there really is something there. If I have to ask you this everyday, that’s gonna be bad.
169 T: (laughs) (pt. laughs) You think you’re going to have to ask everyday, huh? [comment]
170 P: Well, it seems like I think I remember asking you this once before or I’ve asked it so many times in my mind that I was going to ask you….
171 T: No. You never directly asked me but you are, I think, directly asking me now and I will answer it–yes. [comment]
172 P: Okay. That’s all I wanted to know. It hurts in a way and yet, it’s good to know. Uh…
173 T: It’s really–in a way, it–there’s something interesting about this that I don’t think we quite understand. I don’t understand you’re having to ask. It’s so obvious that you have a problem.
174 P: I know. But it just…
175 T: Every time you try to go out, you have to run to the toilet, isn’t that a problem?
176 P: I think that’s the first time you ever really put it that way, uh–that I-I realize that you really realize that part of it.
177 T: The toilet part?
178 P: Yeah.
179 T: You think I hadn’t heard that?
180 P: I don’t know. I guess you’ve never said it….
181 T: You used a very dramatic phrase–you said, “I get instant diarrhea.” (both laugh)
182 P: It is too. It’s unreal. It’s just (sighs) you know, I almost want to put myself in a situation and tell *Nick, “Take me out to dinner or something” and see if it’s gonna happen (laughs) ’cause it hasn’t happened since Saturday night. I–how could I forget that. Uh, you know, it’s like when I go somewhere, I gotta keep myself busy. Like we talked about–the block club meeting is coming–it is October 23rd–well, I won’t be that scared ’cause I’m in my own home but-and I’m doing things–I’m keeping myself busy. I was wondering like if I have–if I go somewhere without the children and I don’t have to get up and serve people or do anything and I’ve got all this, to me, free time, uh, I just sit and relax and take it easy but my mind has a chance to escape and get to – can the subconscious and the conscious–I don’t know–I’m not putting it right. Uh, when I’ve got nothing else to do and I’m just sitting there or, you know – it gives my mind a chance to go get nervous or – I don’t know. I think I’m inadequate or don’t have the confidence and then it brings it on.
183 T: I think it’s true if you’re busy with something, you sort of have a little less time for-for your mind to start dwelling on those thoughts but the real problem is–why is it that when you’re free, your mind goes to such thoughts.
184 P: Right.
185 T: Why do you have, essentially, this very poor opinion of yourself? [comment]
186 P: (pause) Well, I guess, all I can remember are things I’ve done wrong but I–you know, I get–and when I do things, I guess I feel I don’t–when they are right, they’re not 100% right–they’re not perfect in my eyes–that, uh, I’m sat–I’m never satisfied, in a way, and that’s, you know–that’s-that’s bad.
187 T: You see, one way of putting that would be to say–you treat yourself like your father treated you.
188 P: Right. I expect a lot and when I don’t live up to it or….
189 T: You’re always ready to criticize yourself like he did. [comment]
190 P: Right. And he’s still around (laughs) I don’t know. It just, uh–like I was saying the other day, uh, when he comes over, he, uh, doesn’t see anything we’ve done or acknowledge it. He’ll–like with my garden, he says, “Oh, you’ve planted this too late. Why didn’t you plant this? Why didn’t you do it this way?” you know, and yet, when you go to his house, he planted tomatoes and he’s let the weeds grow tremendously. He never picked up any of the tomatoes on a stick and I went there one afternoon and I pulled this–these long boards out and I used a saw and I picked up about six or eight plants, you know, and picked them up with yarn and pruned them and–which he didn’t even do, you know, and I tell myself–well, he comes over and complains about yours and he doesn’t keep his own up–and, uh, my mother isn’t exactly the greatest housekeeper in the world, my dad collects junk to high heaven, I think if he had to throw out a piece of paper–he feels like he-he saves everything like and, uh, you know, I see this–I see his faults and yet, he comes over and tells *Nick and I what we didn’t do or what we should do, you know. It….(sighs) you know, it just irritates. i know this and I know all my life, you know, like I think part of it, I always tried to please him, you know, and then when I didn’t, I felt really bad about it and, you know, like you say I’m bringing it on into my own life. How do you cut something like that off, you know? How do you not let it bother you so much? Like *Nick says–he don’t give a darn what people think–he don’t let it bother him. I envy *Nick in a way. I envy he can go out and be happy and have a good time and, uh–how do you be a person like that–how do you cut off that-oh, just caring so much or that–wanting to please everybody and wanting to be perfect or wanting to have everything right. How do you calm down and just take everything in your stride and not let it effect you? (pause) It’s very hard for me to do that.
191 T: Yes. And I know it’s very hard for you to see how it’s possible, but that’s one of the purposes of this treatment, to enable you to do that. [comment]
192 P: Oh, I just, uh–I remember all the (sighs) – I don’t know the yelling and the spankings. I don’t remember anything, I try to remember something in my youth or growing up that I’ve really liked my father for. Hmmm – try to pinpoint, you know, maybe one (sighs) happening where the two of us laughed together and enjoyed it. I think there was only one time that I felt that he confided in me–that I was really shocked in a way–uh, and it was already after I’d had *Ericka, my daughter. Uh, and he went over to my uncle’s house which is just down the block and he came back after being there a few hours and he was just so upset with my uncle–my aunt was already in her forties–almost fifty–and my uncle was complaining to my father about her not getting pregnant, you know, that, uh, he wanted her–and she had five children already–and my father just couldn’t see that, you know. What was wrong with that man, you know, he was just so jealous of her and made her quit work and how come she’s not getting pregnant and he let this out to me like-like I understood, you know, uh, life then and that-that-that outstood in my mind that my father actually talked to me on his level, you know, before he used to always put us down, you know. He never said anything–he really felt, just belittled us, in a way. And one other time was, uh, I, uh–I wonder if I did this just to please my parents too. I, uh–I decorate cakes–I bake and decorate cakes and I did a wedding cake for my cousin and it was three tiers and I had the water fountain and had it decorated with orange roses all over and we were at the wedding reception and I was a wreck–oh, gee-I had such a pain in my chest, I couldn’t move. I was just–my nerves were shot, I guess, and my father actually said that was a beautiful cake. I just–you know, I just, you know, couldn’t believe he said something like that. He can, you know, but he just doesn’t give it. Uh….
193 T: And these events are so few that they stand out in your memory so sharply. [comment]
194 P: Yeah. And most of the other ones are always ones I don’t even want to say or bring up because, uh, I don’t want to talk about my father that way, you know, it’s–I guess, I respect him so much. That was one big thing, they used to always harp on the word “respect your parents” “respect, respect” that, uh, to talk about them, uh, in a way that I thought they hurt me or did something wrong would be disrespect then to them and maybe that’s why I sort of don’t want to come here–don’t want to talk about my mom or my dad in a bad way. (pause) It, uh–it hurts.
195 T: Yes. I think that might even have something to do with the dream–that, uh, you have a feeling if you start to talk freely, you might say just terrible things, it would be awful. [comment]
196 P: Mmmm – there’s a lot–like-like I told Nick, I haven’t even told you. Uh, this is terrible–yet, it’s good for me. Uh-oh (sighs) *Nick and I were not married until *Ericka was like a year and a half old–I had–I got pregnant and *Nick and I were gonna get married and then he just decided he couldn’t do it and copped out and then I was all by myself and I was living at home with my parents and it was my decision one way or the other and I wanted to keep the baby ’cause I just couldn’t see how I could live with myself if I did give her up so I just decided to keep her and believe it or not, my parents had decided the same way. They were glad I was doing this and, uh–that was rough–it was a little hell then, uh, being pregnant. I quit work, I guess, about seven months and, uh, all I did was seem to stay in the house and make supper and do the dishes, clean up the whole kitchen and immediately go upstairs to my room and just stay there the rest of the evening and then, uh-uh, she was born and, uh, you know, being next to a girl whose got a husband and you don’t have anyone, that was rough but, uh–then seeing her was kind of different too–a reassuring thing that I was doing the right thing. If I loved her so much–I–right now, my life I–she’s seven already–gonna be eight in November–I do not want her to know this has ever happened–when *Nick and I were married, uh, we had all the paper work changed–the priest even backdated the marriage certificate for us. Uh, I don’t know–that was a big, traumatic thing in my life and then *Nick–about November–let’s see, *Ericka was born November and in February of the next year I got a letter from *Nick saying that, uh, you know, he knew he really did wrong and he wanted to make it up to both of us and–well, in May of that year we were married and I went back with him to Georgia and, uh…
197 T: And during that time, did your parents talk as if you were a dreadful person….
198 P: Oh, there were times when my mother just–wow, you know when you’re pregnant and big or even afterwards, when *Ericka was born, uh, she’d get on the subject and you know–what a bitch and whore and all this, you know, terrible words. You know, things like this were happening sort of in my youth too where, you know, I’d go out with someone that I thought was a fantastic person but they were older so this older man was just out for one thing and I was forbidden to date that certain man ever again and it was the first date. One day we had gone–we started out in the morning horseback riding, we had breakfast, we went to his house, I met his parents, had coffee and then we came back or-or–no, we went to some friend’s house–we had some coffee–I met some of his friends–I think I was like about nineteen and this man was twenty-eight–he was a very nice person–he just talked a lot, you know…uh…
199 T: I’m sorry to interrupt you. I know you have much more to tell but the time is up.
200 P: (laughs) That’s okay. Tomorrow I’ll work in my garden (laughs) I’m looking forward to that. Okay. Can I, uh….
201 T: Sure.
202 P: Thank you.
203 T: Goodbye.
#3, 5, 7, 9: The therapist’s combination of encouraging elaboration and gentle, clarifying questions prepares the way for the patient’s subsequent elaboration of her uneasiness in coming to the session. LR+SW
#19: The therapist makes a summary interpretation about the pattern of how they have related to one another. This colorful, vivid remark captures the imagination of the patient, going to the heart of her ongoing, anxious reaction to her therapist. By clarifying her feelings this way, it invites her to reflect on this starkly negative picture. LR+SW
#23, 25: By his reassuring comments while describing what she feels, the therapist helps her to distinguish between her anxious conviction of impending criticism and the exploration she is doing in treatment. This allows the patient to feel safer in exploring her own feelings. LR+SW
#29, 31, 33, 35, 37, 39, 40: The therapist does his best to treat her doubts about the technique of treatment respectfully, while at the same time encouraging her to remain hopeful. When he articulates her fear of criticism once again, in #40, she is tentatively able to reveal her own criticisms about his treatment approach, to which he responds supportively and informatively. LR+SW
#41: The therapist subtly and supportively clarifies that the patient’s mind has perhaps ‘gone blank’ for some meaningful reason in the course of this discussion. This also encourages her to elaborate, and she does by means of the important dream she had. LR+SW
#53, 55, 57: Attuned to the patient’s worries that the therapist might not find her interesting, he provides supportive orientation for how to proceed. As he often does, he invites her to understand with him the therapeutic work and become more closely aligned in their goals. LR+SW
#63-65, #71, #89: The therapist’s conversational skill is evident in his drawing the patient out about her dream, and in his comfort revealing himself as he goes along, including his areas of ignorance.
#95: The therapist’s respectful approach in discussing a dream is used to foster the therapeutic alliance. LR+SW
#105: Freud discovered that different characters in a dream may each represent different aspects of the dreamer. With that in mind, the therapist resonates to the feeling of jeopardy in this dream and ties this in with the patient’s prior discussions about her anxiety in putting her purse down or lying down on the couch, and her frightening, painful experience of falling in childhood. Making use of both his resonance with her and his stitching-together of these various subjects, he interprets the dream as a reflection of her overall experience in her relationship with him, again providing transparency into his thought process and using evocative language to invite the patient to think collaboratively with him. By interpreting the dangers associated with her not checking her impulses with him (i.e. ‘horsing around’), exposing her personal side to him (i.e. ‘dig up all this stuff’), and the inevitable criticism and painful fall from grace associated with this, the therapist allows the patient to more meaningfully contextualize her dream and the pervasive anxiety associated with it in her waking life. Note that the therapist does not directly refer to the sexual aspect of her preoccupations, but instead uses related imagery (‘going to go higher and higher. If I tell Dr. Johnson the intimate, personal things about myself…I might go too far…lose my balance and fall and really do myself some damage’). This evokes in the patient further resonance to the feelings she finds so frightening and shameful (cf. priming, in Helm, 2018), which facilitates the patient’s confession that she has become a fallen woman toward the end of the session. LR+SW
#117: The therapist picks up on the patient feeling like a failure whenever she does something that is later deemed wrong, and how the related, painful feeling of being at-fault seems to interrupt the patient’s ability to think clearly about what she is saying. His question supportively clarifies that failure and ‘fault’ is a subjective matter. In response, the patient is able to continue to elaborate on this painful feeling of failure. LR+SW
#121, 123, 125: The therapist links her relationship with him with her relationship with her father, but in a way that the patient is neither a helpless victim, nor shamefully at-fault. Note that the patient increasingly discusses her anxiety in terms of what she worries about herself (‘even in myself—out for my own approval’), rather than worries about external dangers. Through the therapist’s timely, gentle communication and the transparency with which he frames his interpretations of the dream, the patient feels increasingly comfortable owning the role she plays in either perpetuating her suffering, or eventually dreaming up a new way of managing her distressing anxieties. LR+SW
#127, 129, 131, 133, 135: Again, the therapist chooses to provide the patient a window into his thought process, engaging the patient with his interpretation and encouraging her to elaborate on it. He does this in a way that both respects the crucial, protective function of her defenses, while also encouraging her to question how they arose and reflect on the appropriateness of them for a given interpersonal context. LR+SW
#137, 139, 141: The therapist responds to her wish to reduce the intensity and duration of her work with him by making an indirect interpretation that she should not be enjoying talking and being with him. The metaphor of ‘horsing around’ continues to resonate in their discussion. LR+SW
#157: The therapist explicitly recognizes the patient is trying her best to negotiate an unfamiliar situation, but he also interprets that in this negotiation, she makes an assumption about him that reveals more about her past experiences with her parents and others criticizing her to the point of giving up on her. His acknowledging of her strengths and her courage in undertaking the treatment is supportive and strengthens the therapeutic alliance. LR+SW
#159, 161: The therapist acknowledges the value of the patient’s contributions, adopting her language in the discussion. LR+SW
#167, 169: Noticing the patient shying away from saying something, the therapist clarifies and interprets the patient’s effort to protect herself from the distressing feelings that arise in the discussion about others giving up on her. His initial articulation of her feelings brings them together in a shared laugh (#168-169). LR+SW
#171: The therapist is refreshingly direct and straightforward. LR+SW
#183, 185: The therapist realizes how important it is to keep on revisiting the patient’s central problems, in this instance, coming back with a question rather than a declaration to encourage her to continue engaging with the painful issue. This repetitive process is what is called working-through a problem. LR+SW
#187, 189: With all the work preceding this, the therapist is able to make a central, clear interpretation (‘you treat yourself like your father treated you’), and the patient is ready for this. LR+SW
#191: In the midst of the patient elaborating on her past, the therapist senses a renewed impatience and hopelessness in her, and he responds by providing a supportive statement about his purpose in their relationship. LR+SW
#193: The therapist is immediately able to articulate the patient’s account, with regard to her central problem of how she views herself and the relation to her father. LR+SW
#195: This final interpretation of her feelings proves to be the last push on the door, which helps the patient to make a vital confession of that which she is most ashamed in the next paragraph. LR+SW