This was their third session, and things were going nowhere fast. Despite the fact that Scourge had easily mastered the deep-muscle relaxation technique Faith had taught him, he was completely unable to remain composed when presented with the most innocuous stimulus. Last session, she’d helped him achieve a state of profound relaxation. Then she’d presented him with what she believed to be a remote and safe representation of blood: a paper scribbled in red crayon.
He’d practically levitated off the seat in a full-blown panic attack.
Bottom line: Systematic desensitization therapy wasn’t working.
Her pen bounced faster. The dark circles under his eyes, the pallor of his skin, the pitiful way he picked at his nails signaled a man in genuine distress. Of note, too, was the long-sleeved shirt Scourge always wore and kept buttoned up to the collar. It was hot outside. No air-conditioning in her office, just that whirring fan, so he didn’t need extra layers in here.
He’s hiding something under those long sleeves.
A myriad of possibilities came to mind. At the top of the list: pickers sores. Scourge’s obsessive-compulsive personality traits predisposed him to picking not only his nails but his skin as well. Or perhaps he was hiding track marks. Quickly, she discarded that hypothesis—he hadn’t exhibited any signs of substance abuse, and an addict would never be able to maintain such a highly organized lifestyle. Self-inflicted scars from past suicide attempts? Maybe.
Her body tensed. “How’s your mood?”
His eyes rolled back in his head. He twisted a hair around his finger and yanked it out. “My mood would be perfectly fine if I didn’t have all this blood running through my veins. How much longer is this cure going to take?”
She had no idea. “Been sleeping?”
Bleary-eyed, he merely shook his head. This man needed relief, and he needed it now. She wasn’t a fan of anxiolytics—antianxiety agents—for phobias, because while the drugs provided temporary relief, they did nothing to correct the underlying problem and often led to dependence. In this situation however, maybe tranquilizers could buy her the time she needed to cure Scourge’s hemophobia, which was proving to be quite resistant to behavior therapy.
She scribbled out a prescription for oxazepam and handed it across the desk. Deliberately, she gave him a week’s supply only, just in case he decided to swallow them all at once. “This’ll help you sleep.”
“Thanks.” Relief flashed across his face, lasting mere moments before his eyes began roving the room once more.
“Scourge . . .” She truly hated to call another human being by that moniker, but for whatever reason, he seemed to be highly attached to a name that had not been provided by his parents. A few times, she’d questioned him about the origin of the nickname, but he hadn’t been forthcoming. “Scourge, you’ve done a great job with the deep-muscle relaxation, and I think that will be a good tool for you to have in your arsenal. But—”
“It’s not working,” he said dryly.
“We need to try something different.” She closed one eye, considering. Participant modeling would be just as slow and somewhat more cumbersome than systematic desensitization. So scratch that.
“I saw someone on Dr. Phil who got cured by flooding. How exactly does that work?”
Thanks a bunch, Dr. Phil. “Flooding exposes you to your feared object all at once, in a big way. At first, it’s terrifying, but eventually your adrenaline response burns out. Flooding doesn’t always work, but when it does, it works quickly.” She shook her head. Flooding was a popular, well-established technique, but . . . “I don’t think it’s right for you.”
His expression brightened. “I think it is. Where would we get the blood? Maybe I could cut myself.”
“No.” She kept her voice even, despite the troubling nature of his response. “Fake blood, like the kind in the movies, is what’s generally used, but as I said, flooding isn’t right for you.”
“I don’t want fake blood. I prefer the real thing.” His eyes stopped flitting around the room and fixed on her in a way that made the hairs rise on the back of her neck.
She clenched her pen hard and dropped it onto the desk. “Scourge, has there ever been a time in your life when you felt . . .” Her voice trailed off, and she gulped a breath. “Have you ever felt attracted to blood?”
His body canted forward. His mouth curved into a half smile. A sheen of sweat formed on his brow. He pressed his index finger to his lips like a child guarding a secret. “Why certainly not, Dr. Clancy.”
The way he said her name, drawing out each syllable, that little high-pitched lilt at the end, gave her a creepy, sick feeling in the pit of her stomach. She mentally shook herself back into therapy mode. This man needed relief, and it was her job to help him. “You have to admit some affinity for blood, though. I mean, you were working as a phlebotomist.”
“I’m not sure what you mean.”
“I mean that can’t be a coincidence. First you’re drawn to blood, and then you’re repelled by it. There’s more going on here than a simple phobia. I’m sure of it. Suppose there’s some factor that draws you to blood, but that same factor is responsible for your fear of blood. Like a switch that flips on and off.”
“What kind of factor?”
“A past trauma. Maybe a childhood memory.”
“I’m telling you, I’ve never been drawn to blood.” He smiled a half smile again, and she knew he was lying.
There had to be some way to get around his defenses. “Have you every heard of personal constructs?”
“No.” He yanked another strand of hair.
“According to personal construct theory we all have unique constructs that organize our world in meaningful ways. For example, in my world, love and hate may be opposites, but to another person, indifference might be the emotion that operates in opposition to love. In any case, when we’re challenged by a stressful event, change often comes in the form of what’s called a slot change. We simply slide to the opposing pole of our personal construct.”
“Sounds like psychobabble to me.”
“But it’s not, and you’re smart enough to understand what I’m saying. Think about the radical atheist who suddenly finds religion. He doesn’t become a believer in moderation, he becomes a fanatic about his new belief system, just as he was previously fanatic about his disbelief.”
“Because he’s fanatic by nature. I do see your point. There’s only one problem.”
She leaned forward, waiting.
“I’m not a blood fanatic. I’ve never been attracted to blood.”
“I see. Mmm hmm.” She stalled, gathering her thoughts. Scourge had an unnatural attachment to blood, an obsession perhaps. Only he didn’t want to admit it. Perhaps if she could uncover the traumatic event that led to his obsession, she could alleviate the shame surrounding it and effect a cure. “We’re done with behavior therapy—and that includes flooding. We need to dig deeper to get to the root of your problem.”
“If I agree to the movie blood, then could we try flooding?”
Scourge was too unstable for an extreme technique like flooding. If she doused him with fake blood in his current, fragile state, it might even precipitate a psychotic break.
Too dangerous.
She firmed her voice. “We need a deeper therapy.”
“Like dream analysis.”
“Exactly, along with some other methods. The root of your fears is buried deep within your psyche, and we have to dig it up to get you well.”
“That’s going to take a long time.” His knuckles whitened as he gripped the arms of his chair.
“Perhaps, but the tranquilizers I’ve prescribed will help you, and the sooner we get started, the sooner you’ll get permanent relief. I’d like to start by giving you some tests.”
“Ink blots. I’ve seen those in the movies.
They seem unscientific to me, and I don’t think I’d like that.”
In his own way, Scourge was quite psychologically sophisticated, and yet that only seemed to make her job more difficult. “The inkblot test is called a Rorschach, and yes, that’s one of the tests I’d consider, but we could start with something else if you prefer.”
“I don’t see how taking a psychological test will do any good. You said flooding works fast. All I need is to be exposed to blood, lots of blood, and then I’ll be cured. I don’t want to waste my time with inkblots and dreams. I want the fast way.”
“No you don’t. You want the fastest way that will help you without making things worse. I won’t put you in jeopardy like that, so let’s move on.” She went around to the front of her desk and stood beside him, placed a hand on his shoulder, a gesture that should’ve come naturally to her. Yet somehow, with Scourge, she felt uneasy, as if she were reaching for a fanged creature who might turn and strike her down without warning. Forcing herself to maintain contact long enough to offer him some comfort, she felt his body begin to tremble beneath her palm. “I need to find out how your mind works. That’s my job. You’ve asked for my help, and I need you to trust me in order to do that job.”
“Just ask me whatever you need to know straight out. I’m not a liar.” His voice rose an octave. “Veracity. You can trust in my veracity.”
Scourge had the oddest way of dropping ten-dollar words into conversation. “Look. I’m not doubting your veracity.”
“Then cut the bullshit.”
And then at other times his phraseology strayed to the common side. “It’s not bullshit. I believe you’re being as truthful as you’re able to be. After all, you came to me. You want to get better. You’re motivated to be truthful.”
“Exactly.”
“But . . .” She bent down and tried to look him in the eyes. He averted his gaze. “Everyone has psychological defenses. Unconscious barriers we build up to protect ourselves from sad or frightening or shameful things. These tests are simply a way to get around those barriers.”
“Kind of like psychological truth serum.” He looked up, and his eyes pierced through her. “Let’s just hope the truth turns out to be something you can handle, Dr. Clancy.”
SIXTEEN
Faith went to her office bookcase and retrieved her set of TAT cards before returning to her usual seat behind her desk. Since Scourge was apparently skittish where psychological tests were concerned, she took it nice and easy and slowly placed the closed blue box on the desk for him to examine.
Scourge reached out and, with shaky fingers, traced the embossed gold lettering. “Thematic Apperception Test for adults.” He crossed and uncrossed his legs. “If this TAT test circumvents my defenses like it’s supposed to, you’ll see all those shameful secrets you think I’m hiding.”
“Not to worry. I’m only a psychiatrist, buddy, not Kreskin—and this test is only a tool.” She propped her elbows on her desk. “A tool that may give me insight into your personality, into the way your mind works.”
“You have secrets, too, Dr. Clancy. Shameful ones. I can see them in your eyes.”
Scourge was merely displaying a classic defense mechanism: projection. He was projecting his own guilt onto her. She knew this, and yet her mind immediately turned to Grace. Her face heated. “We all have secrets. We’ve all done things we feel guilty about. All of us. Not just you. Mistakes are part of being human, nothing to be embarrassed about.”
She knew these words by heart because she’d recited them to herself more than once. Hopefully, they wouldn’t ring as hollow in Scourge’s ears as they did in her own. “We’re all human.” Her fingers toyed with the necklace Grace had given her—one-half of a heart. The other half had been buried with Grace.
Scourge’s gaze bounced to her throat, and she suddenly felt like the mouse to his toying cat.
“You show me your secrets, and I’ll show you mine,” he said, his voice a coaxing purr.
Keeping her tone all business, she said, “I’m not the patient, and this is not show-and-tell. Either you’re in or you’re out, but I can’t help you if you’re not willing to trust me.”
His fingers drummed the box. He shifted in his chair, bent, and looked around on the floor as if he’d dropped something, which he certainly had not as far as she could tell. Finally, he straightened and stilled. “What do I have to do?”
“Inside this box is a set of cards.” She held up her hand to block his protest. “Not inkblots. There are pictures on the cards, mostly of people. I show you a picture, and you make up a story about it. Simple and painless and we can stop anytime if anything makes you uncomfortable.”
“But I don’t know what story to make up.”
He needed more reassurance. “Any story you want. Anything at all.”
He jerked a nod. “Fine by me, then.”
Infusing her tone with encouragement, she said, “Try to remember, my job is to help you. I’m on your side.”
His lips trembled, and he wiped his mouth.
“Why don’t you go grab a water, take a pit stop if you need one?” Faith needed time to select the cards she wanted to use with Scourge, and he shouldn’t see them beforehand.
“You’re trying to get rid of me.”
“I certainly am.” She smiled at him. “I have to set the test up privately, or the results will be spoiled. Just give me five or ten minutes, if you don’t mind.”
He hesitated but then complied with her wishes. While he was out of the room, Faith selected ten cards from the assortment in the box, focusing on the subject matter she thought most likely to bring Scourge’s problems to the forefront, all in the safe guise of a make-believe story. She’d just completed her selection when he returned with two styrofoam cups of water.
“Thanks. How thoughtful of you.” She accepted the water he held out and waited for him to take a seat, make himself comfortable. Which was going to take a while, judging from all the repositioning of legs and folding and unfolding of arms.
Finally, he seemed settled in.
“Ready. Here we go.” She handed him a card, and just having something to hold in his hands helped him relax. He breathed in and out slowly. “That’s great. You’re using your relaxation techniques without being prompted.” He actually seemed to be learning to cope with his anxiety in a productive way, and that was a very good sign.
“I’m recording.” She turned on a handheld recorder. Later, she’d use the playback to score and analyze the results.
He turned the card upside down, sideways, looked at the back side, flipped it over again. “This is a very strange-looking picture.”
No argument there. The images on card 13MF were indeed strange—the kind that stirred the imagination . . . and the psychosexual urges. In residency, they not so jokingly called it the sex card. It depicted a woman lying in bed, nude from the chest up. Beside her, a man stood hanging his head, hiding his eyes with his forearm.
Scourge continued to look at the card, but when he didn’t volunteer any more information she prompted him. “I’d like you to make up a story about what you see. It can be any story you like, but it should have a beginning, a middle, and an end. Try to make it as dramatic as you can. Oh, and I’ll want to know what the characters in the story are thinking and feeling.”
“Sure. But what’s going on with the woman in bed. Is she asleep, or is she dead?”
“Up to you. I’m afraid I can’t answer any questions about the cards. There’s no right or wrong story, only what you choose.”
He was quiet a good five minutes. Faith relaxed into her chair and stretched her legs; rushing him would be counterproductive.
At last, he said, “She’s dead.”
Keeping her voice and face neutral, she reminded him, “I need you to tell me a beginning, a middle, and an end. I want to know what the
characters are thinking and feeling.”
“Right. Well, that’s her son, and he killed her. He’s upset, that’s why he’s hiding his eyes. He’s glad she’s dead, but he’s also sad because now he doesn’t have anyone to take care of him. Only he’s stupid because his mother never took care of him in the first place. He’s already forgotten that’s the reason he killed her. Drunks shouldn’t have kids.”
“And?”
“And he runs away and makes a new life for himself and lives happily ever after. The end.”
Faith took mental notes only—she had the recorder to review later. Scourge’s response to the first card lacked the typical elements. Most patients saw the man and woman as being near the same age, and while some described the woman lying in the bed as dead, most said she was sleeping. Typical stories contained either overt or subtle sexual elements. Scourge’s story held none. The fact that his story was so different meant it was very personal and very significant.
Mother issues.
After presenting Scourge with several more cards, he seemed to relax into the task and get the hang of things. She no longer needed to remind him to tell her what the characters were thinking and feeling or tell a complete story. In response to each story, she offered no judgment or evaluation.
But her heart squeezed a little at Scourge’s reactions. While she kept her expressions as neutral as possible, he beamed like a boy who’d just brought home a straight-A report card to his parents. For Scourge, the mere absence of criticism seemed equal to the highest of praise. If only she could touch his sleeve, tell him well done, but that would’ve contaminated the process.
Each story grew more elaborate than the next, and Scourge was on a quite a roll. But it’d been over an hour, and she still had one more card to show him. Card 2 depicted a family—a teenage girl holding books in her arms, a man plowing a field in the background, and a pregnant woman standing to the side. Faith leaned forward, eager to learn his reaction to the family card.
Confession Page 13
