YVONNE ~ The Fear of Being Found
by Martha Stark, MD / Faculty, Harvard Medical School
When first I saw Yvonne in consultation, she had been in treatment with a colleague of mine for five years. Although, over the course of that time, the patient had made considerable progress in certain areas of her life, her major concern (namely, her “phobia” about sexual intimacy with a man) had never been effectively addressed and understood. My colleague asked that I see Yvonne in consultation because my colleague was feeling that, although she and Yvonne had a good relationship, there was a point of engagement beyond which they just could not get. Furthermore, Yvonne, though denying that it meant anything other than a “busy schedule,” was now beginning to cancel some of their therapy sessions.
So I saw Yvonne in consultation. Interestingly, Yvonne’s complaint about her therapy was that she couldn’t stand the experience of being in a therapy session and feeling all torn apart inside because of what was being stirred up inside of her – and then, when the session was over, feeling abjectly bereft and heartbreakingly alone with her agitation and her distress. Of note is the fact that, in the therapy session itself, Yvonne would be unable to cry; but, the night after her session, she would inevitably sob herself to sleep. She tormented herself continuously with the thought that she was not normal and that she would never be able to have either intercourse or an intimate relationship with a man.
In her session with me, Yvonne spoke at length about her father, a man who had been emotionally abusive to her. He would tease her mercilessly until he had brought her to her knees and to tears, and then he would laugh at her for “being pathetic” and a crybaby. Yvonne would be left feeling totally exposed and deeply ashamed of her raw vulnerability – and her “weakness.”
Yvonne went on to tell me that she sometimes wished her therapist would force her to talk more about her fears of sex and of intimacy. Yvonne expressed concern that her therapist might be afraid of her, intimidated by her. Then, with a flash of anger, Yvonne recalled the many times her mother had faulted her for being a cold fish, selfish, nasty, provocative. Yvonne explained that when her therapist did not press her to “open up,” she was left with the feeling that perhaps her therapist didn’t really want to know her because maybe she (the patient) was all those bad things her mother had accused her of being. Yvonne told me: “I want my therapist to call me on how closed I am. I want her to be tough. I don’t want her to be put off by me when I get mean. I keep thinking to myself, ‘Please don’t let me do this. And please don’t give up on me!’” It was becoming increasingly painful for Yvonne to go to her therapy sessions because of how awful it was making her feel about herself.
As Yvonne continued to talk about her experience of being in treatment, it became clear that she hated the person she became when she was with her therapist (closed, difficult, inaccessible, unengaged) – it really was way too much like the person her mother had always accused her of being. Because her therapist was neither insisting that Yvonne become more fully engaged in the treatment nor holding her accountable for her “provocative enactments,” Yvonne was left with the horrid feeling that the therapist agreed with her mother that Yvonne was inherently a bad person and not someone worth knowing.
In my consultation with Yvonne, I initially held back a bit, as I was getting a feel for Yvonne and deciding how best to position myself in relation to her. The danger, of course, was that were I to push too much, I would run the risk of being too much like her bullying father – who would push and push until he had forced his daughter to submit. And yet were I not to push enough, I knew that I would then run the risk of being too much like her uninvolved mother – who had never really gone out of her way much to “find” her daughter.
As the session progressed, I found myself becoming more aggressive in my efforts to reach Yvonne – understanding, all the while, that, in my efforts to engage Yvonne more deeply, I was running the risk of becoming rather like her domineering, demanding, and humiliating father.
Because of scheduling constraints, Yvonne and I had originally agreed that instead of doing a three-session consultation over the course of a week or two, we would do first a double session and then a single session. The only time we could find for that initial double session was late one Monday evening.
As we approached the end of our double session (a difficult one, I think, for us both), Yvonne stated that she was getting very tired and that she (with 10 minutes to go) wanted to stop; she said that she knew she would be coming back for a follow-up session at the end of the week and that we could finish up then.
In response to this, I found myself telling Yvonne that I was not yet ready to stop, that I thought our work for the evening had not yet been completed. She told me that my saying this made her angry and made her feel cornered, trapped. But I did not relent; I told her that she didn’t really have a choice – because I was between her and the door. (She, meanwhile, is a very tall, fairly substantial woman – I, not so big.)
Yvonne actually laughed in response to that and then, just as suddenly, burst into tears. Softly, she protested, “I don’t have it in me anymore. I’m on my own, and I just can’t do it any longer.” As she spoke of her exhaustion and her despair, she began to sob more intensely – deep, heartrending sobs. As I listened, I could feel myself suddenly choking up as well.
Yvonne had let me in (which is something that always touches me very deeply – when I am let in). I had had to do it by way of being a bit of a bully – somewhat controlling, somewhat pushy – but she had let me in. And she, no longer the cold, unfeeling fish, was now showing me her softer, more vulnerable underside.
As Yvonne continued to cry, she became much more accessible, much more appealing, much more endearing. Her whole demeanor changed; her body visibly relaxed; and at one point she actually smiled at me through her tears – a somewhat bashful but very sweet, soft, vulnerable smile that touched me greatly. I smiled back through some of my own tears.
Yvonne and I sat there quietly for some time. Yvonne remarked that she had always wanted her therapist to make her cry; she explained, “I guess that’s how my father showed me that he cared.” Yvonne went on to say, “I have always wanted to be called on my toughness; I am not really cold and unfeeling.” Interestingly, although her father had been abusive to her at times, Yvonne and I came to realize that her connection with him had always been much more substantial than the rather superficial connection with her mother, a narcissistic woman who had always been so caught up in her own self-centered concerns that she had never been all that interested in, or available to, her daughter.
In pushing Yvonne as I had, in being (for the moment) her bullying father, I had been able at last to “find” her. I had been willing to take a risk on her behalf – she could feel that and appreciated that I would have cared enough to put myself out there like that.
Yes, in doing what I did, I initially became like her father; but both by letting her know that I was committed to doing whatever I needed to do in order to reach her and by letting her see my own vulnerability and softness in response to her having finally let me in, I was demonstrating that I was not ultimately as intimidating or as frightening as her father had been. I was giving her the corrective relational experience of bad-become-good.
I was also willing to risk being experienced as her “bad” bullying father because the alternative was that I would be experienced as her “bad” emotionally inaccessible mother, with whom she had had no real relationship – which was the dynamic that I suspected was transpiring between Yvonne and her cautious therapist.
I present the above example because it speaks to how important it is that the therapist allow herself to be drawn in to participating in a certain way by a patient who is needing her to be that way in order to feel truly engaged. The contemporary relational model gives permission to patient and therapist to do what they must in order to find each other – and, in the process, to rekindle hope.
As a consultant, you don’t, sadly, always get to know what ends up happening down the road – but, from the feedback that I later received from Yvonne’s therapist, it would seem that, in the aftermath of Yvonne’s consultation with me, Yvonne began to “reframe” her relationship with her father, whom she now recognized had loved her very dearly – although his way of demonstrating that love was way too abusive. As the therapist overcame her need to “play it safe” and accessed her capacity to “put herself more out there,” Yvonne herself began to put herself more out there and to talk more openly, and more lovingly, about her father – at the same time that she was beginning to confront the irrational component of her fears about men, dating, and sex.
That was it until a little while ago, when Yvonne sent me a wedding announcement with a little note that said simply “Thank you.”