««—»»
Therapy Note 7/8/2001
Patient L. Spivey
Despite Ms. Spivey’s prior admissions she seems to have no awareness of how to use therapy. She is punctual, sits erect, refrains from eye contact, and attempts to have a “social conversation.” On this date she discussed her persistent feelings of worthlessness, her husband’s continuing infidelity, the family’s economic problems, and her desire to receive job training as a hairdresser.
Her affect was flat and her posture rigid. She denied any feelings of hostility regarding her husband’s behavior, adding that she did not know for a fact that he was unfaithful, simply that since their trailer had become infested with roaches he was short-tempered and seldom home.
She indicated that the couple had ceased martial relations some time ago.
Ms. Spivey commented that she felt like she was “all tangled up” with the house-cleaning problem, and she does seem somewhat obsessed, reporting that she spends most of her waking hours engaged in activity calculated toward that issue. In fact, house cleaning holds a kind of secondary gain for her in that it has come to provide a distraction from her buried feelings of abandonment and rage.
««—»»
“I have a case for you.”
Dr. Eugene Markoff smiles pleasantly enough, but his bright eyes contain a hint of professional condescension.
Markoff opens a file and hands it to Simmons, taps the summary page. He clears his throat. “You’ve been complaining about feeling underused since you returned from your…sabbatical.”
A fucking ‘sabbatical.’ What a nice way to describe a forced leave of absence due to post-divorce stress
. Dr. Markoff is being unctuous and pedantic. Kevin Simmons has slowly come to despise him.
“Excuse me, doctor,” Simmons says. “My mind wandered. You were saying?”
“I was saying that I think you’ll find this patient intriguing.”
After speed-reading the document, Simmons leans back in the chair. He is a big man, and the wood complains beneath him. “I don’t see a DSM IV diagnosis, Gene. Why is that?”
“Well, if you are going to be treating her, maybe it’s best if you do the full assessment.” Dr. Markoff’s voice holds a hint of pique; he dislikes it when juniors call him by his first name. “Even Medicaid allows us to defer diagnosis for thirty days. Besides, she’s not on involuntary anymore, read the chart. She agreed to hospitalization, says she wants a rest.”
“Did she mention anything else about why she might want to stay with us?” Simmons squints, grimaces. He can barely read Markoff’s handwriting.
Markoff sighs dramatically. “It’s in the chart. Something about the hospital being so clean, pleasant and cool… Oh, and she feels ‘a lot less lonesome for people’ in here.”
««—»»
Yet now Luanne seems to be isolated. She doesn’t care for the groups. She only leaves her room for mandatory treatment activities and the meals she seldom eats; or for quick, furtive trips to the smoking lounge. She only shows enthusiasm when standing silently on the edge of the crowd waiting her turn with the tech that lights the patient’s cigarettes. Betty also thinks Luanne is still far too thin.
Betty decides to look in on her. Poor little thing, bless her heart. To Betty, she is like a tiny, lost sparrow. Betty creeps down the hall to avoid waking Mr. Hamilton, who is paranoid and will shriek in terror if his nap is disturbed. As she approaches Luanne’s room she hears an odd rustling sound.
Good heavens…
Betty stops in the doorway. She hasn’t been this flabbergasted since the former medical director got arrested at Richland Mall for shop-lifting ladies underwear in a size suspiciously close to his own. Inside, Luanne stands in front of the mirror, painstakingly applying lip-liner. The girl is nude, naked as a jaybird…except for those ridiculously high heels.
Betty scurries off to make a chart note.
Luanne puts down her eyeliner and smiles at her face in the mirror. Then she walks carefully around the room in tiny little circles; tongue protruding slightly, squinting eyes riveted to the floor like a woman very concerned about stepping on something.
««—»»
Markoff is a putz
, Kevin Simmons grumbles. He pulls a renegade string from the worn cuff of his shirt. Silly men like Markoff inevitably miss what is really going on unless the patient presents a classic, textbook case or something generic. They have no imagination, no gift. Worse still, they lack compassion, empathy, and maybe even the ability to hear what anyone says. How can anyone be so completely blind? It is no wonder Luanne had been unable to confide in him! Christ, even his office is sterile, forbidding, cold.
Simmons rearranges the herbs in terracotta pots on his window and continues to stroke his own ego. I’ll break through to her, I promise you.
He crumples Markoff’s recent memo; drivel about forbidding personal objects in hospital space because patients might use picture frames and potted plants as weapons. How ludicrous! Simmons pops a CD into the player on his desk. Vivaldi’s Four Seasons fills the air, drowning out the medicated mumbling shuffle of his patients and the metallic squawk of loudspeakers. Vivaldi creates a lovely, calming white-noise barrier. This is a trick necessary for therapy the way he practices it; unlike that Freud-up-the-ass Markoff.
He senses, rather than hears, that Luanne is standing in the doorway. Running his fingers through his floppy bangs, Simmons looks up and smiles. “Please come in,” he intones, gently indicating the two chairs facing each other.
Luanne sits stiffly in one chair, her bony knees pressed chastely together; still-tangled hair veiling her face. She keeps her thin hands folded in her lap. Simmons is surprised to find himself more than a bit attracted to her.
“I am Dr. Simmons, Luanne. You can call me Kevin.”
No response. After a moment of consideration, he extends his hand for her to shake, but she doesn’t appear to notice. He pauses, licks his lips, and clears his throat. “Luanne, you’ll find that I operate differently from the way Dr. Markoff does. I believe that good therapy is both teamwork and a kind of disciplined love.”
Head down, she whispers the word. “Love.”
Simmons presses his point. “Indeed, therapy is not something I do to you; it’s a journey I take with you. We’re in this together.”
She looks up abruptly, as if someone has jabbed her in the back with a fork. Something brittle and edgy flashes through those empty eyes. She takes his measure with scorn curling her lips.
“Then why am I the one locked up?” she snaps.
Before he can label the response; find safety in a phrase like “projective identification” or “splitting,” or even the ever-popular “counter-transference,” her features go blank again.
“I don’t need your kind of love. Not anymore.”
“Excuse me?”
Simmons is too unsure of what he has seen to respond, and thus knows an opportunity has been lost. Luanne blushes and drops her head.
She does not speak again for the rest of the fifty-minute hour.
««—»»
7/15/01
Therapy Note
Patient: L. Spivey
Luanne came in and apologized for her behavior during our last session. I was encouraged that she even recalled her hostility. I then explained that the therapy time was her time, to use as she liked and that no apology was necessary. From her self-effacing manner I suspect that she has been the victim of long-term emotional abuse likely beginning in childhood. She seems to have multiple Adult Child issues and may possibly be a battered wife. She has no self-esteem.
She commented several times that her husband first became angry with her for the constant mess in the trailer. Her own goals seem to revolve around caricatures of typical female roles; she wants to keep the trailer spotless and to become a hairdresser; she’d like more and prettier clothing. It is obvious that this patient has never had the opportunity to consider choices beyond a tradi
tional female paradigm; it seems that she has spent her entire life in a pink-collar ghetto.
««—»»
Case Note, in re: L. Spivey
Patient did not receive any visitors this date. She did not seem upset by this. She has had no visits from family members during this hospitalization. She has totally withdrawn from participation in this group. Muttered “they’re my only friends” or words to that effect.
««—»»
Therapy Note
7/23/01
L. Spivey
Today the patient had a real breakthrough and felt some resentment. She stated that she often wished that her husband would have helped her with the housework and cleaning and that she felt drained by her responsibilities. She stated that “I want my life back, I feel like it’s been hijacked or something.” After making this announcement she seemed frightened, became hypervigilant, tense and scanned the environment. I was struck by her close examination of all four sides of the room, also floors and ceilings and corners. In fact, I was reminded of a child terrified of facing the ‘boogeyman.’ I immediately intervened and reassured her that hers had been a healthy statement, that anger needs expression. I told her that it indicated she was getting better. She said, “Am I?” I reassured her that she was.
««—»»
Betty stands in the doorway of Simmons’ office. “Can you spare a minute?”
“I wish I could,” he replies, briskly. “But we’ve got a stupid chart review next week. You know, we treat paper, not people. Can’t it wait?”
“No, I don’t think so,” Betty says, quietly. “It’s about Luanne.” She clutches a mug of coffee. “I’d really like to talk about her.”
Simmons forces himself to disguise his growing annoyance. What part of ‘no’ does this woman not understand? Instead, he barks: “Shoot.”
“I’ll be brief,” Betty assures him. “I think the only thing wrong with this girl is that she needs to be let alone.”
Simmons sighs. He rubs his temples. He has often considered writing a scholarly paper on the irritation of ward staff as a frequent cause of headaches in overworked psychologists. Damn. Does everyone in the hospital have to approve every treatment plan? “I don’t agree.”
Betty seems too determined to let it go. “Doctor, what will be your criterion for approving a discharge in her case? What she needs is to know she’s wanted somewhere.”
Simmons does not allow himself to notice the genuine dismay her statement causes him. An uncomfortable silence follows.
“Doctor?”
“Betty, really,” Simmons replies, startled back to reality. His very tone and expression soothe; eyes warm, body leaning forward. “I appreciate your concern but I don’t have a minute free until a week from Wednesday.” Betty stares at him with ice in her look. It strikes Simmons she looks rather like a poker player with a full house. She nods blankly for a few seconds before spinning on one heel and thumping down on the hallway in those sensible shoes.
Simmons sticks out his tongue and crosses his eyes like a child. He realizes that he can’t wait for her to retire.
««—»»
Therapy
Therapy Notes on Lu...
Note…
Simmons stops scribbling. Even writing about Luanne suddenly seems a betrayal of sorts. He massages his temples and stares down at the desk. In the spiraling wood grain, he sees her fragile features; eyebrows arched like birds in flight, sharp cheekbones over alarmingly soft lips, soft hair spilling onto slim shoulders. She never wears a bra. At least he does not think so.
…Luanne arrived five minutes early for her session. She wilted into a chair and shivered as though feverish; a trembling he knew came from a struggle with some internal demon. “I really have to tell you what it’s like,” she’d said. Her head hung down, chin almost on chest; she twisted her cheap wedding band round and round on her slender finger. Simmons noted that it left a greenish stain. Luanne looked up and pinned his eyes with hers.
“I want to be free again,” she said. “I want to get close with people. I want to feel…love.”
“Good,” Simmons replied. “I think that’s good.”
“Only I saw a movie on television a while ago about these two girls who were planning a trip to Hawaii or somewhere like that and they decided to go to Thailand, I think that’s where it was instead. Anyway, they got there and it was real pretty but they didn’t have all that much money or something and one of them got hooked up with this real good-looking guy and instead of really liking her he used her to slip drugs in her suitcase and they both—both the girls—got locked up in this horrible jail.”
Luanne stopped long enough to breathe. Simmons, meanwhile, was struggling to follow her train of thought. He had begun to undress her without even realizing it. He kept his features blank: Shrink 101. Am I as desperate for love as she is?
“Anyway,” she continued. “The two girls went to jail and the good-looking guy left the country. It wasn’t like jail here. I had to go bail my old man out often enough so that I know what jail looks like. There was a nasty place with rotten food and nasty water and they had to do hard work all day.”
Simmons nodded. Thinking: She makes me feel like some dirty old man. He forced himself to focus. He was unsure of where she was going but certain that something important was taking place.
“When I saw that movie, I thought that is what my life is like. Somehow I got tricked into some kind of prison where I just do hard work all the time instead of being with people and my old man he just slips out and leaves me alone with them.”
Simmons makes a note: Them? Explore that reference.
“I mean, I know that no one is going to kill me for this or anything but I kind of really wish they would. See, I get up and try to clean and it doesn’t make any difference. The more laundry I do, the more laundry there is, it seems to grow like a great big old pile of some sour smelling something. And I scrub the sink and the shower but the mildew grows back before I’m done and even the dishes got weird old yellow and reddish stains on them and nothing I do seems to make any difference. And all of them itty bitty bugs…”
Luanne wrapped her arms around herself for comfort. She rocked back and forth in her chair. “The world is a dirty place,” she said, softly. Eyes down, twisting the wedding ring. “You know?”
“I think so,” Simmons ventured, motioning for her to continue. “Please go on.”
“Nothing I do makes a dent in anything. I just work all day and half the night and no one cares, no one appreciates me.” She looked up again. “In fact, no one but you even listens to me.”
Simmons felt his face redden and cursed his hormones. “I’m glad you feel safe here,” he said. “I certainly try to…”
She cut him off without realizing. “I know nothing could ever come of it. I mean, I don’t have any education. I’m married and all even though I’m gonna be divorced. But, it’s just when you listen to me I feel pretty. I don’t just feel pretty—I feel important.”
Simmons, like all therapists, had been through this sort of thing before. He knew that she should explain to Luanne, in simple words that she could understand, about transference. People often became confused about strong feelings for their therapists. But those feelings actually belonged to other people in their lives, sometimes from childhood. Simmons had the response down pat, actually; usually said the same thing each time. He often said people practiced relationship skills in therapy because it was safer than risking such fledging efforts in the real world. Safer because the therapist and the client were never allowed such personal contact in the so-called ‘real’ world.
He started to make that pitch, but waited for a fatal moment.
He knew he should say all that.
But he didn’t.
Luanne started crying. Gently, softly. This was not the hideous, sniffling, red-eyed and most unattractive wailing most patients did; her sobbing was more an infantile demand for love than a real expression of emotion.
No, she was a lady. A few tears that simply drifted down her smooth, pale cheeks.
Luanne stopped hugging herself and grasped the arms of the chair. She was white-knuckled; a nervous, infrequent flyer on a jet for the first time. “You see,” she said, her gaze never leaving his, “when you listen to me, I feel like I exist. Most of the time I don’t even feel like I’m here, in the world with people. In fact, most of the time I feel like a shell, like everything has been sucked out of me. Like I ain’t even wanted anywhere there’s people.”
The bittersweet tears still spilled and ran. Simmons got up from his chair and knelt beside her, he wrapped his arms around her. She melted into his chest still crying softly. Simmons flashed on the last time he and his ex-wife had had sex. He felt himself harden. His heart kicked, rabbit fast, as he groped for something to offer besides his own errant member.
Finally, weakly, he merely reinterpreted her statement: “It sounds like you often feel invisible.”
Simmons, flushed with shame, hated himself for that lame verbal response more than anything that followed. He’d been confused, aroused, thrown off balance. Now, looking back, finding himself prepared to lie in his own notes, Simmons thought that maybe it was forgivable on his part. Maybe.
But stroking her silky hair was most certainly not. And when she kissed his cheek, he should have pulled away at once, but a wave of adrenaline had shot through him; an electrifyingly forbidden lust. He had allowed her to kiss him, even touched her breast with his trembling fingers. We all need love.
A Host of Shadows Page 14
