Therapist: I don't know what you might want to talk about, but I'm very ready to hear. We have half an hour, and I hope we can get to know each other. Do you want to tell me whatever is on your mind?
Client: I'm having a lot of problems dealing with my daughter. She's 20 years old; she's in college; I'm having a lot of trouble letting her go...Yeah, I can really feel her stepping back.
T: Umm-Hmm, Umm-Hmm.
PAUSE
T: Pulling away from you.
C: Yeah...Going away.
T: You feel her sort of slipping away...and it hurts...
C: Yeah, I'm sort of sitting here alone. I guess, like, you know, I can feel her gone and I'm just left here.
T: Umm-Hmm. Umm-Hmm. You're experiencing it right now.
C: Yeah. Yeah. Yeah. I feel really lonely. [Cries.]
T: [hands C a box of Kleenex.]
C: Thank you. [Laughs.]
Therapist: All right, what do you want to start on first?
Client: I don't know. I'm petrified at the moment!
T: You're petrified--of what?
C: Of you!
T: No, surely not of me--perhaps of yourself.
C: [Laughs nervously.]
T: Because of what I am going to do to you?
C: Right! You are threatening me, I guess.
T: But how? What am I doing? Obviously I am not going to take out a knife and stab you. Now, in what way am I threatening you?
C: I guess I'm afraid, perhaps, of what I'm going to find out--about me.
T: Well, so let's suppose you find out something dreadful about you--that you're thinking foolishly or something. Now why would that be awful?
C: Because I, I guess I'm the most important thing to me at the moment.
T: No, I don't think that's the answer. It's, I believe, the opposite! You're really the least important thing to you. You are prepared to beat yourself over the head if I tell you that you're acting foolishly. If you were not a self-blamer, then you wouldn't care what I said. It would be important to you--but you'd just go around correcting it. But if I tell you something really negative about you, you're going to beat yourself mercilessly. Aren't you?
C: Yes, I generally do.
Therapist: Tell me about your holiday weekend.
Patient: I am not sure I am happy to be back in treatment. I didn't enjoy my visit to my parents. I feel so confined when I'm there. My mother was bossy, aggressive, manipulative, as always. I feel sorry for my father. She watches over him like a hawk. She has such a sharp tongue and cruel mouth. She makes people feel small. She is like a hawk. I always feel like she is hovering over me ready to swoop down on me. She intimidates me just like my wife.
T: Go on.
P: I feel restrained in the city. I need the open fresh air; I have to stretch my legs. I'm sorry I gave up the house I had in the country. I have to get away from the city.
T: You seem to be describing various situations in which you feel confined. You are afraid of being trapped. Tell me more about that.
P: I do get symptoms of claustrophobia from time to time. They're mild, just a slight anxiety. It happens when the elevator stops between floors or when a train gets stuck between stations. I begin to worry about how I will get out.
T: [Makes note to self about patient feeling claustrophobic about the therapy. Also, notes connection to the idea of being controlled by his mother. ] Let's talk more about your mother.
P: I'm really chicken. It's a wonder I was ever able to have relations at all and to get married. My mother was always after me, 'Be careful about getting involved with girls; they'll get you into trouble. They'll be after your money.' She made it all sound so dangerous. You can get hurt from this, you can get hurt from that.
T: Your fear of enclosed spaces is a conscious expression of your unconscious desire to have a relationship with your mother, and of your fear, stemming from her threatening personality, that like a hawk, she will swoop down and devour you.
Therapist: What types of situations are most upsetting to you?
Patient: When I do poorly in sports, particularly swimming. I'm on the swim team. Also, if I make a mistake , even when I play cards with my roommates. I feel really upset if I get rejects by a girl.
T: What thoughts go through your mind, let's say, when you don't do so well at swimming?
P: I think people will think much less of me if I'm not on top, a winner.
T: And how about if you make a mistake playing cards?
P: I doubt my own intelligence.
T: And if a girl rejects you?
P: It means I'm not special. I lose value as a person.
T: Do you see any connections here, among these thoughts?
P: Well, I guess my mood depends on what other people think of me. But that's important. I don't want to be lonely.
T: What would that mean to you, to be lonely?
P: It would mean there's something wrong with me, that I'm a loser.