THOMAS ~ A Beautiful Story

Thomas’s Intense Yearning for One More Dance with His Father

by Martha Stark, MD / Faculty, Harvard Medical School

 

I worked with Thomas for six years (from 2000 to 2006).  By the time Thomas had terminated, he was no longer a dissociated, alienated, lonely, frightened “control freak” but a wonderfully engaged man who was living his life in an authentic and heartfelt way.

 

When first he came to me, Thomas was 28, a tall, lean, prematurely white-haired, handsome, bespectacled man, a college dropout who had nonetheless managed, by dint of his hard work, to become the owner of a fairly successful restaurant in Brookline.  He presented with an agitated depression, reporting that his personal life had become a total “mess” because of some really bad choices that he had made along the way.  Thomas said he was desperate and needed my help in figuring out what he should do to straighten out his life.

 

Thomas was in a painfully empty marriage to Sandra, whom he had known since high school and with whom he had had two children, Bill and Dan; he was having a passionate affair with a wonderful woman named Molly, whom he considered his soul mate; he was dating Donna on the side because he was afraid to commit to Molly; he was still sexually involved from time to time with Doris, a former girlfriend, because he couldn’t bring himself to break things off with her; and he was the father of an illegitimate child by Jane, a one-night stand some years earlier that had produced a little girl named Autumn, whom Thomas had been allowed to see only a few times.  Thomas, who loved music, was a songwriter, and played guitar, would say to me, with a slight, self-deprecating twinkle in his eye, “There should be songs written about having four women, but, I guess, who would be interested in such songs?”

 

Sometimes when Thomas was feeling especially bad about his “roaming eye,” he would “practice not being attracted to other women,” but he was never able to sustain his abstinence for long because he was so terrified of being alone.  In the meantime, he lived by the rule: “Never get so close that it hurts when they leave.”

 

Thomas was racked with guilt about everything.  He “managed” his complicated life and what he called his “moral badness” and “sinful existence” by engaging in numbers of compulsive rituals and routines, by keeping himself always “at a remove” from too much involvement in life, and by maintaining “rigid robotic-like control” at all times.  He was a “clean freak” who took four showers a day, carefully wiped down the engine in his car every week, and washed the outside of his house three times a year.  Disciplined, structured, regimented, controlled – constructs he lived by.  He loved orderedness, symmetry, balance, organization. 

 

One of Thomas’s rituals centered around managing the delicate strings that he experienced as being attached to his back.  He knew they weren’t really there, but their imagined presence, and their tendency to become entangled, troubled him deeply even so.  Way in advance of his appointment time, Thomas would drive to my office, carefully get out of his car so that the strings wouldn’t get tangled, walk up my driveway using the same number of steps every time, come around to the back of my house, and enter the sun porch waiting room.  Once inside, however, things would get a little more complicated.  He had explained to me that it was easiest for him simply to remain standing quietly at attention inside the sun porch door instead of attempting to sit, because, in turning his body to take a seat, he might create an intolerably anxiety-provoking entangling of the strings.

 

Upon entering my office, he would carefully take a seat, knowing that, at the end of the hour, he would then need to “undo” that process by reversing the order of the actions that had brought him to that spot.  Very carefully, therefore, Thomas would back out of my office, out of my waiting room, and down the driveway (the same number of steps down the driveway as steps up the driveway), and back into his car, without having messed up the strings.  Thomas was a graceful man with a soft elegance, so he was able to manage all of this with such finesse that, unless you watched him closely, you might never notice.

 

Thomas’s goal in life, at that early stage in our treatment, was to keep his “path” as uncomplicated as possible, so that he would be able to avoid the potential for entanglement of the strings and, thereby, a shortening of his life.  He recognized the irony in this, that he, whose life had been immeasurably complicated by virtue of the many “bad choices” he had made along the way, would be now so intent upon simplifying things.  Thomas was desperately afraid of dying.  And were the strings to become entangled and their length thereby shortened, well, the thought of that was terrifying for him and an all-too-poignant reminder of the finitude of life, the terrifying passage of time, and the inevitable end.  He was tormented by thoughts of his own mortality and the knowing that nothing would last, nothing was permanent.

 

Thomas would tell me: “I have always thought that you should not think about things that bother you.  You should pretend the problems are not there.  If you need to, you can have ‘scheduled unhappiness,’ whereby you designate a certain period of time to think about how unhappy you are.  But then it is important to move on.”

 

In a desperate attempt to ease his pain, Thomas had been drinking alcoholically for over 14 years – although, shortly into his treatment, he stopped drinking on a dime when I happened to suggest, as a throwaway comment, that the drinking might be contributing to his agitation and his depression.

 

Not surprisingly, Thomas, for whom “being in control” was a top priority, wanted always to be in control of our sessions and of what he talked about, which was totally fine with me.  And so the “process” between us unfolded gradually, organically, with Thomas always leading the way.  In our sessions, he would share details about his life, speaking always in his “reporter mode”; between our sessions, he would often leave me messages on my voice mail in which he would “report in” with details about his week:  “It’s Thomas, reporting in…” he would always say.  Whether in session or between sessions, never the feelings, simply the facts.  Again, all of this was just fine with me.  Meanwhile, I was becoming very, very fond of this dear man whose vulnerable, tormented soul was so racked with guilt, sadness, and pain.

 

Thomas’s father had been a very successful dentist, universally liked and admired, but he was a demanding father with very high standards.  He was “very exacting,” said Thomas, “good for the teeth but not for the son.”  His mother, an actuary, was a good woman, but with more “head” than “heart.”  Both parents were often absent, physically and emotionally.  Early on in our work, Thomas said very little about them other than that he had loved them and they had loved him – and very little about his childhood.

 

There did come a time in our work, however, when Thomas began to talk about a dear childhood friend, Bobby, with whom he had been very close and whom he had deeply trusted.  He and Bobby had lived next door to each other for many years and would play together for hours on end – make-believe games in which both would have superhuman powers and no vulnerabilities – and they would live forever.

 

Thomas had loved Bobby dearly and was devastated when, with neither advance notice nor explanation, Bobby and his family had suddenly left town when he and Bobby were both nine.  They had never even had a chance to say good-bye.  Thomas, dissociated but clearly in pain, reported to me that he had never fully recovered from his grief about the loss of Bobby, that some part of him had died the day he found out Bobby was simply gone.  As he recounted the details of their very special relationship and then Bobby’s sudden, incomprehensible, and devastating departure, Thomas shed no tears; rather, it was I who began to tear up as Thomas spoke of his heartbreak.

 

Thomas witnessed my tears but made no mention of them, nor did I.  But to the next session he came bearing a poem that he had written over the course of the week in honor of his deep friendship with Bobby.  It was entitled “Sometimes Sad, Forever –”

 

When you and I were young,

We were forever,

We were in control,

And anything, everything was possible.

 

Our lives were as one,

Though not really.

I was you,

Though never quite.

Always, simply, wanting to be.

 

But then you slipped away.

Unscheduled.  Forever.

Leaving me behind

With this sadness, this pain, this loneliness

that never lets up.  Ever.

 

My dreams came crashing down around me

through a frightened void

shattered…

splinters lying, like an abandoned jigsaw

puzzle pieces missing – like my life.

 

I love you, Bobby.

Forever and for always.

But you are gone from me.

Where did you go?

I am lost – and so desperately lonely without you.

 

 

Again and again, Thomas would ask rhetorically: “Why would you want to love someone if they’re going to leave you, anyway?”

 

Thomas had been an only child until he was 11, at which time his younger sister was born.  He reported, “I was mean to her because I always thought that she was smarter than I was.  She was a weird eater, 5’6” and 100 pounds.  I didn’t like her that much, but I was afraid she might die on me because she was so skinny.”

 

His sister hadn’t died, but, when Thomas was 20, his father had – a horrific death, from cancer of the head of the pancreas. 

 

Thomas reported: “I felt responsible for his death.  When I was young, I had been my dad’s pride and joy.  But, in high school, I began to live irresponsibly, drinking, drugging, lots of sex.  I knew I was letting my dad down.  I think he had wanted me to be a dentist, just like him.  I was good with my hands and probably would have made a good dentist.  But, in my late teens, I wasn’t caring much about stuff.  I was just living on the edge – indulgently, destructively.  And drinking a lot.  I got the girl pregnant and then headed off to Europe for a few years.  I was running away from everything.” 

 

It was only after returning from Europe that Thomas had finally told his father about his illegitimate daughter, Autumn.  Father had been devastated and had said that he was not yet ready to meet her.  This was the first, last, and only time they had spoken of Autumn but Thomas could not forgive himself for having given birth to this child out of wedlock in the first place and then for having burdened his father with the knowledge of it.

 

“My dad never asked me what was wrong with me or why my life was such a mess.  We never talked about things like that.  One day, however, just before my 21st birthday, totally unexpectedly, my dad invited me to have lunch with him, which wasn’t something he had ever done before.  But we never had that lunch.  He suddenly got very sick and was diagnosed with bad cancer.  I have always wondered what he would have wanted to talk to me about.  In my life, there is Part 1: the time before my dad got sick.  Then there is Part 2: the time after my dad got sick.”

 

Later Thomas reported: “My dad was so disappointed in me.  I know I let him down terribly.  I think I broke his heart.  I wasn’t the son he had wanted me to be.  He had the cancer, but I think he died from a broken heart.”

 

As Thomas talked about his unresolved grief and tormenting heartache, his pain was palpable – but never any tears.  In fact, as an adult, he had never shed any tears, except during sad movies.  But, as was often the case, when he (ever the reporter) would speak of his pain, his internal turmoil, his racking guilt, his sadness, his heartbreak, his anguish, his loneliness, it was I who would be crying.  And it happened a lot.  Seeing my tears, Thomas would reach for the box of Kleenex beside his chair and hand it to me.  I kept the box of Kleenex beside the patient chair and not my own because, with most of my patients, I myself didn’t really need it.  As I cried, Thomas would sit very still, patiently, gently, tenderly until I had composed myself and my tears had passed and then he would continue.  Again, we never talked about my tears or what they might mean to him, or to me for that matter!  It’s just what we did together.  He would speak of his heartbreak, and I would cry.  And I loved it that he, ever attuned to my face, would offer me that Kleenex.

 

One particularly poignant moment was when Thomas was telling me about how he would regularly visit his father’s gravesite even those many years later, where he would talk for hours and hours on end, softly, lovingly, apologetically, to his dad about his daughter Autumn and his regret and his guilt and his shame and all the things he wished he had been able to talk to his dad about “in the living years.”  Thomas would leave a special bouquet of carefully selected flowers for his dad because he knew how much his dad loved flowers and gardens, an interest they had shared.

 

As Thomas talked about one of the visits to his father’s gravesite, I found myself crying so much – I was sobbing, actually – that Thomas had to stop talking for quite a while.  Once my tears began to subside, Thomas asked me, gently, if it was OK for him to continue.  I said, “I need another moment, please.”  So he sweetly waited.  Again, Thomas and I never talked about my tears or his lack of them.  It worked for us both.

 

Thomas was intrigued when, one day, I suggested to him that “grieving on your own is very inefficient but sharing the grief with someone else will make it so much more efficient.”  He responded: “OK.  You know, I had never really understood how you could complete something with someone who was already dead.  Once you die, you’re dead.  Like a rock.  But maybe I could, you know, share the grief with you.”

 

Shortly thereafter, Thomas brought me another poem, which he had just written for his dad.  It was entitled “A Song to My Dad.”

 

Dad, I’m writing you this letter, pretending you’ll get to know its contents

But, when I imagine your eyes, dried like raisins left lonely in their sockets

I feel the futility of it all, writing a letter that you will never read,

another exercise in self-indulgence

Just time wasted.

 

The last time I wrote to you, when I was 10

or was I starting college?

I guess it doesn’t really matter.

The mandatory letters, meaningless anyway.

 

Now as I prepare to let you in

It is too late

Twelve years or so – too late.

 

When we were told that you would be dying soon,

I climbed, shaking, the stairs to visit you in the hospital,

my guts retching

I, always so good with words,

shrieking inside “Fuck you, God!!”

And there you lay, rotting,

on the Bullfinch Ward at the Mass General, a lobby for the almost dead.

 

I wonder, if you were to sit here with me

If I could make you know how much I love you

and how much I miss you – and how sorry I feel

 

I wonder, if I screamed it in your face,

As I have so many times at the Linwood Cemetery,

if you could ever know how much I ache for you

 

I need you to tell me you love me – in spite of it all

I need you to lie to me if necessary

That would be OK.

 

Then you could hug me like you used to when I was very small

and not yet a disappointment

and you weren’t dead

or like you would have if I had let you

or like we did that time in the garden after we made it so beautiful

and full of life,

or as I should have when you became empty…

your life freshly ripped from its turncoat cocoon

by the bad cancer that would not relent

 

you were dead

you were dead too soon

you are dead forever

 

it feels very empty in here

I was told that after the mourning period, things would feel better

but my mourning period is lasting forever it seems

a just punishment.

 

I have fathered some children you would love

they would love you

they would want to spend some of their lives with you

you could hug them whenever you wanted

I could watch with pride, even as I was feeling envious longing

hoping no one would see my heartbreak

 

I’ve done a lot of disappointing since you left

I can’t seem to shake it

I can’t ever be you

I’m sorry

I didn’t mean to kill you.

 

I love you,

 

Thomas

 

One day Thomas, who had always come on time for every single one of his sessions, in fact, sometimes up to 30 minutes early, Thomas came 5 minutes late, having been stuck in terrible traffic, and was totally distraught.  To complicate matters, he was concerned that, in his haste, the “strings” attached to his back might have become entangled.  Time, of course, every single moment, was so very precious to him.  Ordinarily, I would not make up the time to a “late” patient but, with Thomas, I wanted to and so I told him that I would like to make up those five minutes to him at the end of our session.  He was able to let me know that it meant the world to him, that I would be willing to do this, and, I believe, it marked one of several turning points in the treatment.  For reasons never entirely clear to either of us, after I gave him those five minutes back, Thomas found himself becoming less and less concerned about the strings and their potential entanglement.  In fact, he kind of forgot about the strings altogether, much as a young child, one day, simply lets go of his tattered blankie.

 

Over the course of our six years together, Thomas turned his life around.  As he (and I) grieved the loss of Bobby and, later, the loss of his dad, his heart began to heal and he became more engaged in life, more invested in life, less afraid, more grounded, less terrified of dying, more present, less frantic about the passage of time, more committed to living right and well and authentically, in the moment, and with passion.

 

Some time before the end of our work together, Thomas divorced his wife, had stopped seeing the other girlfriend, and had called things off with his sometime lover.  Meanwhile, he and Molly were getting very serious and building a gorgeous house on a lake, the outside of which Thomas was not planning to wash!  One very special day, as a thank you gift, Thomas proudly presented me with a beautiful photograph of his “family” at their new waterfront home, all of them happily relaxing on their deck overlooking the lake.  The photograph included Molly, his two sons (by Sandra), Autumn (who, much to Thomas and Molly’s delight, now considered their home to be her home), and Thomas, grinning from ear to ear.  Thomas said that it was because of our work together that he was now able to smile.  I was incredibly touched.  More tears.  Mine, of course.  Throughout our time together, Thomas had never once shed a tear.  But that was fine.

 

Thomas told me that one of the most comforting things I had ever told him was when I had shared with him the idea that if you were blessed enough to be in a mutually loving relationship, then inevitably either you would end up losing them (whether to death or to something else) or they would end up losing you.  And that’s just the way it was, an excruciatingly painful and sobering reality with which all of us must eventually make our peace.  Thomas said that my sharing this “fundamental truth” with him had been clarifying and tremendously reassuring; it had helped him to feel less frightened, more grounded, and less alone.

 

And then it was time for us to say good-bye and we were ready for it, sad as it was for us both.  To one of our last sessions, Thomas brought his guitar and played for me Luther van Dross’s heart-wrenching song entitled “Dance with My Father,” about a young boy’s aching to be able to dance, just one more time, with his dearly beloved but long-departed father.  “I never dreamed that he would be gone from me / If I could steal one final glance, one final step, one final dance with him / I’d play a song that would never, ever end / ’Cause I’d love, love, love / To dance with my father again / Every night I fall asleep and this is all I ever dream.”

 

I would like now to share with you what happened in the final moments of our last session.  At the very end, when Thomas stood up to leave for the last time, no longer worried at all about any strings attached, I, with access to lots of tissues, reached out my hand to take ahold of his.  He immediately reached for my hand, and I then placed my second hand around his.  Then after only a moment’s hesitation, he slowly raised his second hand to his face and, as I followed the movement of his arm, I could see that he was pointing to the tears that were welling up in his eyes and beginning to roll down his cheeks.  He smiled sweetly at me through his tears and I, through my own, smiled back.  A very special, tender moment that needed nothing more…

 

Thomas has stayed in touch over the years and periodically comes in for a touch-base session.  He and Molly ended up going into business together and now run a chain of very successful, high-end restaurants.  As Thomas with a twinkle in his eye recently observed, when first he had come to me, he had four women and one restaurant.  Now he has one woman and four restaurants!  We agreed that although you probably wouldn’t want to be writing a song about having four women, you could probably write a pretty interesting one about having four restaurants!

 

Thomas and Molly gave birth to two lovely girls, Christie and Samantha, and their beautiful lakefront house is now home to these girls, Thomas’s two sons, and Autumn.  Thomas is supremely happy and tells me that his life is now filled with moments of intense joy.  He is aging gracefully.  He is no longer afraid.  His heart has healed and he has found internal peace.  He no longer has the loneliness, no longer feels alienated, no longer dissociates, and is no longer a “reporter.”  And sometimes he cries – when he feels like it.  He still visits his dad’s gravesite, but he now feels that he carries his dad inside of him, that, at the end of the day, he did kind of end up being a lot like his dad.  Ever humble, Thomas tells me, with quiet, heartfelt gratitude and pleasure, that he knows his dad would be proud of him.  And I, personally, am quite sure that Thomas is right about that.

 

 

Introjective Identification vs. Projective Identification

 

Psychodynamic psychotherapy offers patients an opportunity, albeit belatedly, to process and integrate unmastered experience.  If early-on trauma or abuse experienced by a child at the hands of his parent cannot be processed and integrated into healthy psychic structure, then the unmastered experience becomes structuralized in the mind of the developing child as internal badness (Stark 1994a, 1994b, 1999).  The clinical challenge is then:  Once traumatizing experience has become internally recorded as badness, how can it later be accessed in the treatment and detoxified?

 

I would like to highlight two ways that toxic experience (internal badness) can be processed, integrated, and detoxified:  projective identification and introjective identification.

 

The Patient as Initiator of the Therapeutic Action

Projective identification has two phases.  The induction phase commences once the patient projects onto the therapist some aspect of the patient’s experience that has been too toxic for the patient to process and integrate and then exerts pressure on the therapist to accept that projection, thereby inducting the therapist into the patient’s enactment.

 

The resolution phase is ushered in once the therapist steps back from her participation in what has become a mutual enactment and brings to bear her own more evolved capacity to process and integrate on behalf of the patient, such that what is then re-internalized by the patient can be more easily assimilated into healthy psychic structure.

 

And, if all goes well, this dynamic will happen repeatedly, the net result of which will be gradual detoxification of the patient’s internal toxicity.

 

The Therapist’s More Evolved Capacity

Sometimes it is the therapist alone who does the processing and integrating on behalf of a patient who truly does not know how, and sometimes it will be patient and therapist working together at their intimate edge, with shared mind and shared heart, who do the processing and integrating – the detoxification – of the patient’s toxic psychic contents.

 

The Poorly Understood Concept of Introjective Identification

Especially in contemporary relational theory, projective identification is a critically important aspect of the therapeutic action.  But let me now speak to the rather poorly understood, and almost completely neglected, topic of introjective identification, an intriguing construct that has been variously and confusingly described in the psychodynamic literature as involving sometimes taking in and identifying with some admired aspect of the object (Freud 1923) and sometimes taking in and identifying with the bad object (Klein 1964).

 

The Therapist as Initiator of the Therapeutic Action

I would like to propose, however, that we use the concept to describe what happens not when the patient initiates the therapeutic action by exerting pressure on the therapist to take on as the therapist’s own some aspect of the patient’s unmastered experience, as happens with projective identification, but rather when the therapist initiates the therapeutic action by voluntarily entering into the patient’s internal world and taking on, as the therapist’s own, some aspect of the patient’s unmastered experience.

 

With introjective identification, here, too, sometimes it will be the therapist alone who does the processing and integrating on behalf of a patient who truly does not know how, and sometimes it will be patient and therapist working together at their intimate edge, with shared mind and shared heart, who do the processing and integrating – the detoxification – of the patient’s toxic psychic contents.

 

In both instances, the therapist will be lending aspects of her own capacity to a processing and integrating of some aspect of the patient’s experience that is overwhelming for the patient, but with projective identification it will be the patient who initiates the therapeutic action, whereas with introjective identification it will be the therapist who initiates it.

 

An Ongoing Relational Dynamic at the Intimate Edge

I believe that introjective identification is a relational dynamic that takes place continuously at the intimate edge of authentic engagement (Ehrenberg 1992) between patient and therapist and most certainly took place in my work with Thomas, especially with respect to his profoundly overwhelming grief and the tears he could not shed.

 

Introjective Identification in the Infant-Mother Relationship

Introjective identification takes place in not only the patient-therapist relationship but also the infant-mother relationship.  Certainly a good mother who is attuned to her infant’s moment-by-moment experience will use introjective identification as a matter of course.  For example, an authentically engaged mother, sensing her infant’s distress, will enter into the infant’s dysregulated affective state and take it on as her own, lending aspects of her more evolved capacity to a processing and integrating of her child’s unmastered experience.  The mother will do this intuitively and repeatedly, the net result of which will be dilution and modulation of her child’s experience of distress and eventual development of the child’s capacity to manage overwhelming affect on his own.  As this process continues, the child’s need for external regulation of the self will become transformed over time into the capacity to be internally self-regulating.

 

 

Conclusion

 

In closing:  I return now to Thomas and his heartbreak.

 

Empathic Attunement vs. Authentic Engagement

But first a point of clarification with respect to the processing and integrating of unresolved grief: I believe that there is an important clinical distinction to be made between empathic attunement in which the therapist decenters from her own experience, joins alongside the patient, and takes on the patient’s experience, but only as if it were her own (it never actually becomes her own) and authentic engagement in which the therapist allows the patient’s experience to enter into her and takes it on as her own.

 

Being Alone in the Presence of Another vs. Sharing the Experience with Another

In the first instance, of empathic attunement, the therapist will resonate with and validate the patient’s experience of grief, but it will be the patient who must do the grieving as he, on his own, confronts the painful reality of his devastating heartbreak.  Borrowing from Winnicott (1965), the patient will be “alone (with his grief) in the presence of (a caring other)” but alone he will be.

 

In the second instance of authentic engagement, the patient will be not “alone in the presence of another” but “sharing the experience with another” who is willing and able with shared mind and shared heart to feel, along with the patient, the pain of the patient’s devastating heartbreak, such that the patient’s experience of grieving need no longer be such a lonely one.

 

From My Tears to His

In my work with Thomas at our intimate edge, I myself by way of introjective identification experienced Thomas’s incredible pain and shed his tears until he himself was eventually able to bear the incredible pain – and shed his own tears.

 

REFERENCE

  

Ehrenberg DB (1992).  The Intimate Edge: Extending the Reach of Psychoanalytic Interaction.  New York, NY: WW Norton & Company.

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


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