The client had been away for two weeks on vacation and had initially scheduled session for the day following her return. But a few days beforehand, she called to cancel and said she would call back to reschedule. I followed up with her a few days later. She said she’s going to hold off on treatment for now and is not sure if she’ll resume. I said I respected her decision and would wait to hear from her further, that my door is always open for her to resume our work.

She contacted me two weeks later to say she wanted to come in to explain. When we ultimately met in session she says she didn’t want me to think she had taken therapy lightly; that she had really been trying. But she alluded to way sessions would always start: that she had nothing to say and was upset she had to be the one starting- that she cannot just talk about nonsense, why must I force her to make such silly small talk about her week, and that she needed to go deeper into her psyche, complaining that I never asked her deep questions, that I never made deep interpretations. Now, I know for certain that we had had some incredibly deep sessions, filled with flowing tears, marked with revelatory “aha” moments, moments of contemplative silence following an interpretation I would give which linked lifelong disparate events, and many sessions in which she expressed her better understanding of why she is coming to treatment. In addition, over time I realized that her difficulty starting sessions and coming up with things to talk about would have to be, in itself, the focal “crisis” we use as our starting point for many sessions.

Yet, she continued to complain that our sessions were doing nothing for her- she was getting nothing out of therapy, that she didn’t know why she continued to come.

So it occurred to me in both this session as well as throughout most of our work, a major factor (the major factor?) was the way she experienced me as “stuck in my box,” to use her words, and not connecting with her, understanding her, saying anything to inspire her… In essence, she was still hungry at the end of session, wanting more. In fact, she was starving! And after every session she would experience a “void,” as she put it: she was never satiated. I realized that no matter how I practiced therapy, she would always experience me as being “stuck in a box” and not able – or willing- to help her. But the point of coming to that last session was to explain that she was doing her part- she was doing everything she could to make the therapy work- to get herself fed. Yet, she was leaving hungry! “How could this be?” she asked herself. Perhaps she answered unconsciously, “It must be that I wasn’t doing my part well enough, that I wasn’t doing ALL I could, that I was stuck in my own box, I wasn’t perfect, etc.” But, she felt, she was!

I decided to share this idea with her. I reflected to her that it’s as if she was telling me, “How can it be that you’re failing me?!” I interpreted that perhaps this was at the core of her ongoing personal dynamic which she repeats over and over again- she walks away from every encounter still hungry. She can find no truly satisfying nourishment, AND she can’t accept that the other person has given all they can. IT CANNOT BE! It cannot be that I have hit up against the absolute limitations of my caregiver, my parent, my friend, my husband, and my therapist. Either they have more to give that they are mercilessly withholding OR I must not be obeying or conforming myself to what they need from me in order for them to provide. To truly acknowledge that she will never get all she ever wanted from the necessarily-limited “other” would be most devastating to her; she would have to acknowledge that she truly is all alone: that she is her own person, separate, and different from anyone and everyone else.  

I reflected to her that this session was a really microcosm of the whole of treatment so far. She rarely talked about things occurring in her own life. She would almost exclusively talk about how the therapy doesn’t make sense, isn’t working, isn’t being done right; that I’m not understanding her, taking things too personally, being too rigid, etc… The overarching theme had always been how I’m failing her. And yet she kept on coming in and making further appointments. She said she could never explain why she was coming in. She had always said that she liked me as a person, liked coming in, and yet felt so empty during and after sessions. And so I reflected further that she might need to learn to be able to tolerate two conflicting emotions simultaneously: the experience of disappointment, which could engender hate, as well as a fondness, at the same time.

To my interpretations this evening, she responded that what I was saying made sense to her—and proceeded to complain why I hadn’t said these kinds of things earlier. In truth 1) I had done so, in other ways, but 2) It didn’t matter- she was determined to repeat/reenact the dynamic of her being left starving no matter what. I reflected that to her as well.

At the very outset of that session, she very quickly told me about a dream she had had a little over a week ago, shortly after she had elected not to continue treatment. She said she found herself at a concert and exceptionally close with one particular country music singer. She spoke with him a bit, but then asked him if he was going to remember her after she left. He said, “honestly, probably not.” She then tried to take a picture with him, but for some reason her image wasn’t coming out in the photograph, despite several attempts. He then gets a phone call regarding his daughter, discovers there’s something amiss with her and excuses himself.

I am the country music singer she fears will not give her enough attention; that she would be so insignificant that I have no lingering place for her in my own mind, and worries she’ll be forgotten just as soon as my next client walks through the door. Maybe after exploring this angle, we would also discover her simultaneous fear that I (or anyone else) could possibly have an image of her in their own mind- one of which she is not in control.

Ironically, my writing this is a testament to the unique image I indeed have of her, lingering, in my own mind.