Behind the Therapy Door. Randy Kamen
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depressed and might be thinking of hurting himself.”
When I asked her to elaborate, Anne, face flushed, said that she didn’t think Justin was in immediate danger, but she wanted me to see him soon. I agreed to meet with Justin a few days later. I also asked Anne to meet with me weekly for a few sessions, so I could learn more about the family dynamics and discuss some effective ways for her to improve her communication with her son.
Although she agreed, Anne made a point of telling me she wanted to keep her own history private. I said I would respect her request. I wondered what had happened in Anne’s own life that she could not allow to be spoken. Perhaps she had suffered some earlier trauma and only now, when her son’s emotional well-being seemed in jeopardy, was she willing to seek help. I hoped that eventually Anne would feel more comfortable sharing her own story.
Meeting Justin
As planned, I met with Justin for an initial assessment. His slouched and rounded shoulders did nothing to diminish a tall, lanky frame that sported a faded T-shirt and baggy jeans that rode precariously below his hips. Without a belt, he might have been in serious trouble! Cell phone in hand, Justin gave me a sideways glance and took a seat, his dirty blond bangs almost completely covering his sad eyes.
Much to my surprise, he began to speak candidly about school, his lack of friends, and his miserable relationship with his mother. He struck me as a warm, intelligent, engaging young man with low self-esteem and mild depression. Justin loathed high school and felt rejected by the other kids. Although he used to get invited to some weekend social activities, the invitations had dwindled and now ceased altogether, so he spent his free time in his room getting lost in music, books, and video games. He was embarrassed that his only real friend was his father, although he loved their shared passion for music and photography. In short order, he let me know what was really bothering him at home.
“I know I have issues, but my mom is the sick one. She is obsessive, weird, and afraid of her shadow. She comes home from work, cooks, cleans, and smokes the night away, reading her books or watching her shows. She holds me back from doing anything fun. I can’t wait to get out of the house. My brother is so happy being away at college. He hardly ever comes home. Now I’m the only one home and the singular target of her craziness.”
Justin seemed perceptive and self-aware. He understood that he was struggling socially, but he didn’t appear to be self-destructive and, paradoxically, was worried about his mother’s well-being. He continued, “I don’t know if my mom told you, but my grandmother died about a year ago. I didn’t really know her, but it’s definitely taken a toll on my mom. It’s made her paranoid and her moods way worse.”
Anne was mourning the loss of her mother, which I suspected was complicated and among the private pieces of personal information she did not want to share. I asked Justin how the loss had affected him. “It’s sad, I guess, but I’m okay. My mom, on the other hand, seems to be getting more negative and stressed. Until my grandmother died, she hadn’t seen or spoken to her sisters in more than a decade. As far as I’m concerned, she needs therapy more than me. The truth is, I worry about both my parents. Neither of them takes good care of themselves. Not only does my mother chain-smoke, but she hardly eats. I don’t know if she has anorexia, but to me she looks scary thin. My father lives on junk food, never works out, has a big gut, and both of them have no friends.” Justin’s worry seemed to have merit. While he was definitely angry at his mother’s intrusiveness, he seemed more concerned about the health of his parents.
Bouts of Loneliness
Occasional bouts of loneliness and depression are common and affect most of us at some point. Usually, these episodes are short-lived and occur around periods of transition, such as the loss of a loved one, losing touch with a friend, moving to a new home, or being downsized from a job. While most people are able to move through the difficult feelings associated with life transitions and emerge successfully, some cannot. This is especially true when the transitions are layered upon previous trauma that is not yet sufficiently resolved. Many people find they can benefit from professional support and coping strategies to overcome their dark periods and learn to live their best possible lives.
In my many years of working with patients, I have repeatedly observed that most emotional suffering comes from worrying about the future or ruminating about something from the past. In Anne’s case, unfounded or not, she was worried that her son’s depression might lead him to harm himself. The more she worried and expressed her concerns, the more she alienated him. Although I still did not know the source of her pain, according to Justin’s clues and her own unusually emphatic request for privacy, she was clearly troubled about something. Anne’s method of self-protection was to isolate from friends and family, just as she planned to keep the therapeutic relationship with me at arm’s length. The question was, “Self-protection from what?”
Justin continued, “I know my mother worries I might be suicidal, but I promise, I’m not. I just want friends. I don’t have anyone to hang with anymore. I’m burned out on the stoners, and the nerdy group is too weird for me. I just need to get out of this provincial little town and find my way, without my mother hovering over me, trying to control my every move. My grades haven’t been great this semester, but I think I’ll get into a decent college. I do want help finding some kind of support group, as dorky as that sounds.” He rolled his eyes and sighed. “The truth is I could definitely use a few friends, but please do what you can to help my mother. She’s the scary one, not me.”
Justin’s assessment of the situation struck me as astute. He knew he needed some specific help with his current social situation, whereas his mother was the one hiding from her own pain. I assured Justin that I would do my best, but his mom needed to make the decision to let me in. I promised to remain available to him as a resource, but suggested that he meet with a male colleague who could offer him an adolescent group to help with his social isolation. He agreed.
The First Session
Anne was scheduled for her first session with me later that week. When she came in, she informed me, “I am willing to talk about anything that would help Justin. I might need guidance along the way, but as I told you, I do not want to dig deeply into my own past.” Her guard was up, posture rigid, movements controlled, and there was a measured quality to her speech. Anne shared Justin’s developmental history.
Justin had been an easy delivery, arriving the week of his due date. A healthy, gregarious baby, he had worshipped his older brother from the time he could toddle around after him. Most of the time, they had played well together. He’d also had a little group of friends who would come over periodically for play dates, and he always had a couple of good buddies. Around Justin’s seventh birthday, he began to develop a passion for reading autobiographies and history books. Anne had taken great pleasure in reading Justin’s compositions, as had his teachers. According to Anne, Justin had always been a good boy without any behavioral worries, until he began withdrawing in high school.
Through several conversations, we slowly established a rapport, but Anne remained tight-lipped when it came to discussing her own past. I waited cautiously for an opportunity to dig deeper. About a month into our sessions, Anne said, “I’ve been noticing how much Justin isolates himself from the outside world and how it’s taking a toll. It makes me realize that I do the same. My whole life revolves around my family and work. I never speak with anyone about personal matters. I was taught that family loyalty and privacy were to be upheld at all costs. Even Stephen doesn’t know details of my whole story. I don’t think the secrecy has served me well over the years, but it is all that I ever knew. Justin gets that from me.”
She looked at me directly, as though she had just had some sort of profound revelation, and then rapidly continued: “There’s something else you need to know. My sister Beth committed suicide about thirty years ago. She hanged herself in the basement. By the time she was found, she was gone. I’m terrified that Justin might be entertaining such thoughts. I’ve never spoken to anyone but Stephen about Beth’s death, but I thought you should know. It was all too hideous, and besides, my mother insisted that we never speak about Beth with outsiders.”
The Dark Side of Stress
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