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Case Studies
Nora and Quinn
Nora, a 45-year-old part-time librarian, came to see psychologist Dr. Susan
Kleinfelter and in her first session she tearfully poured out her fear and pain.
“I feel tense all the time,” she sobbed. “And sometimes I feel so scared that I
think I’m either going to pass out or throw up. Then I get even more scared.
It’s getting to the point where I’m starting to stay home, so that I won’t have
to deal with this in public.”
Dr. K asked her if she was worried about something going on in her life. She
swallowed hard. “It’s Quinn, my son. He’s 18 and he’s got asthma. And he’s so
stupid! He won’t take his medication and he’s smoking, for God’s sake! Last week
he had an asthma attack that almost killed him! He’s supposed to go off to
college in a few months—but how can he go if he won’t take care of himself? How
can I make him do what he’s supposed to do?”
Dr. Kleinfelter began to feel frustrated with Quinn right away. How could he put
his life in danger like this and cause his mother so much grief. She realized
her anger was a sign that a therapy triangle was starting to form already
between herself, Nora and Quinn. She was starting to side with Nora against
Quinn and she knew she needed to handle this situation calmly and carefully if
she was going to be truly helpful to Nora.
Nora was coming to Dr. K because she was anxious, frustrated, and wanted her son
to change. She had urged Quinn to come with her to therapy but he refused,
saying he had no problems and she needed to “chill”. Dr. K was drawn to Nora’s
side in this conflict with her son. Being a mother herself, the therapist had
felt some of the frustration of trying to talk to teenagers who knew more than
she did!
If she was going to be truly helpful to Nora, she would need to accept that
Quinn was the way he was and help Nora learn to change the way she dealt with
him. If she joined with Nora against Quinn, she might have told Nora that
the two of them should confront him about his problems and pressure him
to get the help he needs. However, Quinn would not have listened and Nora would
be left with the idea that Quinn was the problem and she could do nothing about
it. This would have left her feeling as helpless, frustrated and anxious as
ever.
Rather than join Nora in her efforts to change Quinn, Dr. K worked with Nora on
accepting Quinn as he was, realizing that he was the one who had to deal with
his asthma, not her. She also worked with Nora on relaxation techniques to help
reduce her anxiety. As she began to control her fears, she gained confidence in
herself and no longer was afraid of being afraid.
Shortly after Quinn left for college, he ended up in the emergency room with a
serious asthma attack. This was terrifying to Nora and she had a very
frightening anxiety attack, her first in a month. She was going backwards, just
like the wavy line theory of change predicted. She was able to pull herself out
of her anxiety and tell him (relatively calmly) that his asthma was his problem
to deal with (not hers) and that she was very supportive of any efforts he would
make to take care of himself better. From this point on (with predictable
relapses) he began to take better care of himself and his asthma
and Nora began to feel more comfortable with him and more able to pursue her own
goals which she had put on hold for so many years.
As they were wrapping up their sessions together, Dr. K asked Nora how she
thought things were going. She thought for a minute before responding, “They’re
going well—but not for the reasons I expected. I thought—I hoped— that you’d
help me find a way to get Quinn straightened out so I wouldn’t have to worry.
Instead, you’ve helped me change some things about myself. And both Quinn and I
are better for it.”
Melanie and Lyle
Melanie came to see me after nearly killing herself. She had sat alone in her
apartment for many days trying to decide if she would take her bottle of
painkillers to finally put an end to her miserable life. Just when she was about
to swallow the pills, her beloved dog, Satchel, jumped in her lap and curled up
contented. Melanie knew then she could not go through with her plans—she was
needed too much. She decided to admit herself to the hospital and figure out how
to live her life rather than end it.
She was hospitalized for about 10 days and put on anti-depressant medications,
which helped elevate her mood and gave her more hope. She was able to put aside
her suicidal plans. Her psychiatrist referred her to me and she came to my
office soon after being discharged from the hospital. She was 30, intelligent,
personable and determined.
Melanie’s most powerful current emotional attachment was with her boyfriend of 5
years, Lyle. He often drank too much and, when he did, he would yell and scream
obscenities at her and blame her for everything that was wrong in his life. On
several occasions, he slapped her, pushed her around and threatened to do worse.
She felt that this abusive treatment was her fault; she accepted Lyle’s blame.
She often felt responsible for the cruel words and the slaps across the face
that he dished out to her.
She worked long hours as a paralegal in a high-pressure law firm, always
striving to please the attorneys she worked for and always willing to take on
more responsibility. Her work left her stressed and exhausted most of the time.
Melanie grew up with an alcoholic father and a depressed mother whose marriage
was filled with fear and anger. Her father was afraid her mother would leave him
and so he controlled and bullied her. Her mother was afraid of being on her own
and so she submitted to him. Melanie’s “job” as a child was to try to make her
parents get along.
She tried being perfect so that they wouldn’t have any trouble with her. She
often got in the middle of their fights and tried to get them to settle down.
She felt intensely responsible for each of them and for their marriage.
As a young adult, she drank heavily, drifted around the country supporting
herself as a bartender and got involved with abusive, critical men. She
eventually returned to her hometown, pushed herself to be responsible, and
finished college. She continued to carry the burden of being perfect in her
work, with her boyfriends and with her parents. She tried to ease her burdens by
drinking too much which relieved her tension while she was drinking but, when
she was sober, it only increased her guilt and her crushing sense of being
responsible for irresponsible others.
A month or so before I first saw her, she decided to quit drinking once and for
all. Without alcohol to ease her pain, she became more and more depressed and
hopeless. After a few weeks of sobriety, she found herself sitting in her
apartment thinking seriously about ending her life.
I met with Melanie for 13 sessions over a four-month period of time. She arrived
in my office with powerful connections to Lyle and to her parents. I could see
clearly what she needed to change: she needed to know that she was not
responsible for Lyle’s anger and she needed to get up the courage to
leave him. She also needed to release herself from the burden of trying to make
her parents happy. How could I help her make the changes she needed to make?
I couldn’t just tell her what to do and expect that she would do it. The
connections with her parents and with Lyle had existed long before she came to
see me and were much more powerful than her connection to me. I couldn’t make
her do anything; I could be her ally and support while she decided
whether or not she needed to make these changes.
She was determined to get better which made it possible for her to make some
progress. She came to realize that her intense feelings of responsibility for
others and her need to take care of them was fueling her depression.
She came to see that she would need to change her way of feeling about and
relating to the important others in her life if her depression and her alcohol
abuse were going to change.
We first worked on her relationship with her boyfriend because that was where
she wanted to start. She came to see that every time she was with him, she felt
weak, controlled and discouraged. And yet she felt that she could not be without
him and she could not “fail” at this relationship. When she told Lyle that she
was seeing a therapist, he felt threatened and tried to stop her from seeing me,
saying that “shrinks” were only in it for the money and that therapy would mess
her up even more than she already was. He would say that the therapist might
tell her to break up with him. Even though Lyle and I had never met, he and I
had opinions and feelings about each other. He felt threatened by me working
with Melanie and I felt he was destructive to her. Melanie, Lyle and I had a
powerful therapy triangle going after only a few sessions! And Lyle and I had
never met!
One day after she and Lyle had gotten into a very tense argument, Melanie asked
me what I thought about her relationship with her boyfriend and I hesitated,
choosing my words carefully, well aware of the triangle between the three of us.
I certainly didn’t want to be part of a triangle the likes of which I’ve seen a
hundred times: an over-protective father tells his daughter to stay away from
her “bad” boyfriend, thus making that boyfriend more attractive to her than
ever.
I didn’t answer her question directly. I said what was important was how she
thought and felt about Lyle. Over the next few weeks, she studied her thoughts
and feelings when she was with Lyle. She came to realize that she felt weak and
controlled while she was with him and discouraged about ever
getting better. She came to see how her connection with Lyle contributed to her
depression.
She talked about how as a child she felt so responsible to get her father to
stop drinking, make her mother happier, and the two of them to get along better.
No matter what she tried, her parents stayed the same, caught up in their own
problems. She felt responsible but powerless. She had to help them but she
couldn’t help them.
She was stunned when she realized that her connection with Lyle was a replica of
her painful and discouraging relationship with her parents. The day she was hit
by this similarity was the day she decided to stop seeing Lyle. It took a while
for her to get past his promises to change and his putdowns of her (“you’ll
never make it without me”) but she got to where she no longer felt responsible
for him and realized that she could not make him be a better person.
She next went to work on how she felt about her parents. Over time, she came to
accept that they had made choices in their lives which she was powerless to
affect. She felt more peace, less burdened and freer to make a good life for
herself.
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