She sat in the chair farthest from me and flatly starred at the wall. Normally she would chitchat a bit bit before asking me questions about how to care for her ailing mother, often taking notes in a small notebook. This time she said very little in the first couple of minutes of her session before withdrawing into the absolute picture of not wanting to be here. While it is not unusual for a patient’s resistance to prevent them from speaking much in the first few sessions, and this particular patient was only on her third session, her presentation today represents a stark difference from her prior sessions. So I decided to break my own rule and the silence by asking her a question.

“How are you feeling right now?” I ask.

“Well,” she began still starring at the wall, “I feel like I am waisting my time, and yours (she said this after a marked pause which punctuated the afterthought nature of her concern for my time), by being here.”

Genuinely surprised by her answer given our prior sessions I more fumbled out my response than I would have liked, “Why would you be thinking that?” In the silence which followed I sincerely hoped my response was less accusatory than it felt.

“I was expecting more dialogue to start,” she began, then taking a deep breath and making eye contact for the first time, “and honestly when I came here I was expecting to get some coping skills and I don’t know if you never gave them to me or if I forgot to write them down, but I would like them now.” She clicked her pen and placed the point on the page in her open notebook and remained in what appeared to be an expectation of profound insight to be momentarily delivered.

“I’m not sure what you are expecting me to tell you right now,” I stated, “we only just began your treatment and as I recall I already told you to nurture yourself and maintain your boundaries with your mother.”

This patient (lets call her Sally), like many of my patients has an elderly parent at home, in this case her mother, but unfortunately like many of my patient, Sally was not treated very well by her mother. In fact she was molested by her mother’s second husband. The abuse started when Sally was five years old and continued until she was eleven when the marriage ended. It turns out in addition to sexually abusing Sally, this man was also physically abusing Sally’s mother and her older brother. The only person in the house not being abused by this man was the child he and Sally’s mother had together, which is unfortunately often the casein step parent abuse cases.

As I recall of the story, which Sally recounted with such speed and ferocity it could better be described as emotional vomit than the telling of a story, Sally’s older brother was discovered selling drugs at school but confessed to the campus officer he was not only being abused by his step father but he was being forced to sell the cannabis at school by his step father under both the threat of being kicked out of the house if he couldn’t pay his rent but also his mother would be murdered by the cartel who the step father got the pot from. There was some sort of sting operation and the step father went to prison for 20 years. By the time he got out of prison Sally’s mother had moved the family across the country.

To make her family life even more traumatic, in addition to the years of sexual abuse and the abrupt move across the country, at first her mother blamed her older brother for the step father’s incarceration and refused to take him when the family moved, instead opting to “dump him” as Sally put it, with his grandmother. Sally was too afraid to tell her mother what her step father had been doing to her for years and the forced separation from her brother removed the only positive male presence in her life, but eventually she did tell her mother who not only did not believe the abuse occurred at first telling, eventually blamed Sally not only for the step father’s arrest but for her brother’s exit from the family as well.

Fast forward several decades and Sally’s mother had aged to the point of needing someone to take care of her, though I don’t recall at present if I ever was told the reason for this, but something in the first two sessions suggested her mother had had a stroke. I know she was confined to a wheelchair but that isn’t the important part of the story.

What the important part is that after continued verbal abuse by her mother Sally eventually left for college and while earning her degree she also healed old wounds and developed a sense of self. A sense that she was not the piece of shit who would never amount to nothing as her mother told her but a smart and capable woman. Sally found her independence and with the possible exception of the few months after college before she found a job “as fucking far away from that woman as I could get,” she never went back to her mother’s house. For twenty or thirty years anyway.

That’s when, “it happened.” Sally’s mother had some sort of medical issue and was no longer capable of living on her own. Sally felt she had no choice but to move back to California and in with her mother. And that, as they say, is when the problems started.

It took about 15 minutes for Sally’s mom to start up again with the verbal abuse and about a year for Sally’s unprocessed trauma to resurface and another six months or so for her to find my office.

Three sessions after that moment we have today’s session.

Sally raised her pen and defiantly clicked it closed. While placing the pen in her purse she stated, “Maybe you didn’t understand my question.”

She was still searching for the perfect place in her purse for her pen to be placed when I answered, “I don’t recall you asking me a question.” I had regained my professional composure but had not recovered from my confusion at her statements.

She fixed her eyes on me and did not say anything for a long enough period of time for me to strongly consider again breaking the silence myself.

“I guess I didn’t but I can tell you I expected a lot more guidance when I came here for counseling.”

While I openly admit in this case the difference between counseling and psychotherapy was probably not important. It is a bit of a pet peeve for me but I normally let it slide. Apparently I will not be letting it slide today, probably because I feel like she is attacking me.

“As I have told you before, I am not a counselor, and giving you guidance is not what psychotherapy is about.”

The quickness of her response almost startled me but honestly I have seen this before. Often when someone comes to see a psychologist (or really any of the many flavors of psychotherapists) they are in a bit of a desperate state for answers to a question which roughly paraphrases as, what am I supposed to do now? Today’s paraphrase was, “Well what is psychotherapy about?”

I take a couple of slow deep breaths to reduce my own anxiety, “One way of describing psychotherapy would be to say you come here and talk about whatever you are inspired to discuss and then together you and I will look through what you talk about to see first that you are making decisions and second how those decisions are playing a role in your current situation. If you can first accept that you are making decisions, then you can learn to make different decisions.”

Sally started telling a story about her mother but she really only spoke for a minute or two before stopping, but she didn’t abruptly stop speaking so much as slowly lower her speech volume until she was no longer making a sound. Like a toy whose battery was running out of charge, her speech slowed to a stop and did not begin again for almost ten minutes.

My primary style of therapy, Jungian Analysis, I will openly admit is not for every person in every situation. Traditional psychotherapy such as Freudian or Object Relations works for almost everyone in almost every situation, as my favorite professor used to say, ‘psychodynamic psychotherapy is like mathematics, it works on almost everything. Jungian Analysis is like Calculus, it really is only necessary in certain situations. but when you need calculus nothing else will work.

Like many psychologists I know, I do branch into other discipline when it comes working with patients, unfortunately in the third session I will not necessarily have a good understanding of what issue or issues brought a particular patient in for treatment. In Sally’s case there was a history of sexual abuse and alcoholism, so some work in Erikson’s stages may be in order as will some 12-Step type work which for those you unfamiliar with the history of Alcoholics Anonymous was developed in part through correspondence between Bill Wilson (the founder of Alcoholics Anonymous) and Carl Jung (founder of Jungian Analytic psychology), but there was also some inability for Sally to love appropriately which would fall under the Object Relations category and maybe another half dozen issues she brought up in the first session and who knows how many other issues she has yet to bring up which need to be dealt with.

Sally, like many traumatized patients, came in for her first session and spoke so much and so fast that I barely got word in. She spoke well past her allotted time and I ended up having to interrupt her to get some scheduling issues resolved before seeing her out so my next patient could be brought in.

Her second session was equally productive, verbally speaking, but she really did not talk about herself at all. She talked about her mother, her child, and her dog but did not mention herself in more than as a passing character. This isn’t uncommon as far as treatment flow goes. A person comes to treatment after perhaps years of putting it off. So much anxiety and internal pressure builds up that by the time the first session takes place the patient can barely contain information. It comes out like a spillway in a dam, a raging torrent of emotions and memories and tears a lot of the time. The second session, being the first after some o the pressure has blown off tends to be a bit distraction based. The patients resistance usually has returned with the power of slamming gate and allows very little of direct substance through. Of course the patient cannot help but discussing things that are relevant to their current state, it is what humans do, but they often do not know they are doing at this stage and it does little good for me to point things out at this stage, so really after the first session the next few sessions are fact finding sessions for me.

Often during the fact finding sessions the patient’s resistance will start to become more combative than protective and that combativeness often comes out in the form of why aren’t you telling me what to do to fix my life?

That was what was happening today. My patient’s fear she actually was the person her mother had told her her whole life she was mixed in with her resistance and was being directed at me like a shot. I was the person she had chosen to give her the advice she so desperately needed to get her life to a state where it made sense again. I was the person she had decided would be saving her and I was not being forthcoming with the advice, the guidance to use her word, nearly fast enough and so I was to be punished.

The problem with Sally’s prospected was rather simple really–I had no idea what issue had actually brought her to my office and even if I did how was I to know what question to ask or statement to make to fix her? I promise you if I had any idea how to fix my patients I would do so on the very first session. In fact, with a bit of pride I can say honestly that most of my patients come into my office for only one or two sessions. Most people just need someone to tell them they are not in fact losing their mind and that any reasonable person having gone through what they have would react in much the same way. Once they hear these magic words, no you are not broken/crazy/losing it, you have been thought extraordinary circumstances and are trying to make sense of these experiences the best way you know how.

Unfortunately for my patient those words were not enough. She had decided I was to blame for her not being fixed after her two previous sessions and she could not even bring herself to tell me what a horrible psychologist I am, which happens much more often than you might believe. No she would not be speaking to me anymore today and instead would be studying the wall directly to her right.

I was fairly certain she was trying to figure out a way to get out of my office when suddenly she stood up and said, “Well I’m gonna head out,” and walked out of my office.

I don’t know if she’ll be back. I hope she will. I hope she won’t give up on the process because if she were to do so it would also mean she would be given up on herself. I hope she finds another office to go to if she decides mine is unacceptable.

Mostly I hope she will find a place inside herself where she can be at peace.