THE GUN:  A Riveting Story

by Martha Stark, MD / Faculty, Harvard Medical School

 

I worked for six months with Cindy, a 50-year-old therapist (whose specialty is domestic violence).  She presented to treatment after a devastatingly painful breakup with a man, Scott, who had abused her both emotionally and physically.  As a child, Cindy had also been abused by her alcoholic mother, a woman who was prone to murderously rageful, screaming fits.  Cindy, terrified, would run from her mother, her only place of refuge a little nook in the corner of their dusty attic, where she would huddle on the floor beside an old bureau.  Her father, a quiet, ineffectual man, was often absent and, when present, offered little protection from her mother's annihilating tantrums.

 

In our early work together, I attempted as best I could to immerse myself empathically in Cindy’s experience and came to understand both how important Scott had been to her (despite his abusiveness) and why she had been so devastated by the loss of him.  It was by way of positioning myself alongside of her that I was truly able to appreciate why she felt she could not live without Scott in her life.  Even though there were times when he made her feel awful, there were other times when he would do things for her to show her how deeply and how passionately he loved her.  He made Cindy feel very special, sharing with her that he had never before allowed himself to get this close to anyone.

 

And then there were moments when I would step back from Cindy, the better to observe her and piece together some of the recurring themes and patterns in her life.  I was able to interpret her current loneliness as the loneliness she must have felt in relation to her mother, whom she had wanted so desperately to love her.  I was able to suggest that perhaps being with Scott had enabled her to cling to her hope that maybe someday, somehow, some way, were she to try hard enough, she might yet be able to get him (a stand-in for her mother) to treat her lovingly.  Clearly, Cindy did not like Scott's abusiveness but was willing to put up with it – if it meant being able to hold on to her hope that perhaps she might eventually be able to change Scott and then be able to find the non-abusive love for which she had been searching her entire life.

 

Some months into our work, Cindy began to grieve the loss of Scott, belatedly grieving as well how unloved and how unprotected she had always felt in relation to her parents.  It was excruciatingly difficult, painful work – but Cindy demonstrated an incredible courage, tenacity, and determination to deal with her outrage and her devastation.

 

But in a session at the end of the half-year mark, Cindy one day made passing reference to her gun.  I thought I must have misheard her and asked her to repeat what she had just said.  Rather awkwardly, I'm sure, I pressed her for details and found out that, indeed, she had a gun, which she carried with her at all times – as she had for years now.  Somewhat haltingly, I asked her where the gun was right then.  She pointed rather matter-of-factly to her jacket on the floor beside her chair.

 

I didn't tell her that I had suddenly become afraid, but I had – and she knew it.  Knowing that she had a loaded gun beside her made me very anxious.

 

In the short time that was left in the session, I tried as best I could to propose a compromise with respect to her gun.  I said I understood that she wanted to be able to feel safe but wondered if she would be willing, during her time with me, to dismantle her gun – perhaps leaving the bullets in her car.  But she said that she did not feel comfortable with that arrangement, that she felt the need to have her gun with her at all times, as she had for years now.

 

Unfortunately, we were unable to reach any kind of resolution by the time the session was over.  At one point near the end, I said I understood that Cindy, defenseless as a child, was now able to protect herself in a way that enabled her to feel safe; I said I appreciated that having the gun with her at all times was empowering for her.  She said that I was absolutely right.

 

As she was leaving, I said something to the effect that I was sure we would be able to figure out a solution that would work for us both – but my "reassurance" rang hollow even in my ears.

 

That was the last session we ever had.

 

Cindy called before her next appointment to say that she was not going to be coming back.  In the message she left for me on my voice mail, she reiterated her need for the gun and said that even were I to agree that she could have the (loaded) gun in the sessions, she did not at this point think that it would be fair to subject me to that.

 

I called her back several times and, unable to reach her and sensing that she wanted to avoid direct contact with me, I ended up finally leaving her a message on her voice mail.  I acknowledged the anxiety I had felt in the session; but I also shared with her my equally intense desire to be able to negotiate some kind of resolution to our dilemma, one that would enable us both to feel safe.  I suggested that while we were in the process of trying to reach an agreement, we consider doing our sessions by phone.

 

Several days later, Cindy left me a message in which she said that she appreciated my effort to negotiate a compromise but that doing the sessions by phone would not work because she had liked being able to see me in person.  She thanked me, more generally, for the work we had done and said that she thought she would be fine.

 

It makes me very sad that I was not able to contain the fear that I felt about Cindy's gun, that I was so drawn into her internal drama that I was not able to wend my way out – by providing some kind of containment that would have enabled us both to feel safe.  I knew it was important that I be able to contain my fear in relation to Cindy – which is something Cindy had never been able to manage in relation to her mother; but I couldn't quite pull it off in time.

 

I think that by way of projective identification, Cindy had been unconsciously communicating to me something very important about what her experience as a child must have been like; she was now getting me to feel in relation to her the fear she must have felt as a child in relation to her mother.  Had I done a better job of tolerating and containing my own fear, then I might have been able to demonstrate to Cindy how fear could be mastered.  But I was not able to control the fear I felt.

 

I wish I had not failed Cindy in the way that I did.  I have the feeling that I brought something of my own (subjectivity) to the interaction, which made it particularly difficult for me to recover my balance in time.  I was not exposed to violence as I was growing up, but perhaps the presence of the loaded gun tapped into fears I have about "losing control."  I was not aware of being concerned that she would suddenly, impulsively, angrily pick up her gun to shoot me; but I do remember fearing that the gun might simply go off of its own accord.

 

I think that another therapist might have done a better job than I did of tolerating and containing the uncertainty and the fear in the room during that last session.  Although there have been clinical situations I was able to tolerate that colleagues of mine have told me they would not have been able to tolerate (several of which, for example, involved a patient's suicidality), in this instance – with the gun – I was not able to have my wits about me enough to intervene in an analytically useful way, whether interpretively, empathically, or authentically.

 

I see the failure of the treatment as having resulted, in large part, from my difficulty tolerating and containing the fear the patient had induced in me by way of her provocative behavior.  I think that she was needing me to be able to deal with my fear, which I was not able to do.  Although there was certainly a significant component of my countertransferential reaction of anxiety that was objective, it is the piece that was subjective that still haunts me.

© 2020  Martha Stark, MD ~ Founder / CEO, SynergyMed for MindBodyHealth ~ 617.244.7188 ~ MarthaStarkMD@HMS.Harvard.edu


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