The intake form says “the fifteen-year old Caucasian female ingested 100+ Tylenol tablets,” an apparent suicide attempt. The referral for outpatient family therapy was from MacLean Hospital, a premiere mental-health facility in the Boston area. ” The intake form says nothing about the circumstances of this suicidal gesture, no storyline specifying cause and effect”, no reference to “triggers” or family dysfunctions, really nothing at all useful. And so it most certainly says nothing to warn me that when Dana Cantrell smiles a certain smile, a smile dripping with supercilious insincerity, it stings. Even with her perfect teeth.
I have the intake form in one hand when I step across the threshold, the other hand holding the door open, and call out her name. She doesn’t bother to look up. I know it is her on the sofa, as she is the only adolescent in the waiting room. And I know she heard me. I decide to watch her silently, marveling at how hypnotic a cell phone can be. An elderly man sitting at the other end of the couch notices me looking and smiles. “Young lady,” he says to Dana, “you’re being summoned.”
She looks up at the man but doesn’t acknowledge him. She grips the cell phone like it is a sword handle before pushing herself off the chair. She walks towards me, head bent forward, airy, bouncy hair, like a patch of glowing wheat yielding to a gentle wind, covering her face. She jets through the doorway without a word and strides down the hallway as if she knows where she is going and then abruptly twists her head around and says, “So, you going to tell me what room?”
“How you doing?” I ask, soon after I situate myself in a chair, a few feet from Dana, who is on the couch. She is wearing an immaculate white fleece pullover sweater and lavender sweatpants. Her thighs are hiked up against her chest and her chin rests on her knees.
“Fine.” Her response is sharp, like a thrown dart. “My mom will be up in a minute.”
She is studying her phone. I let her be. Her mother enters, dressed in business attire, bluish-black pinstripe, and wearing tan sneakers, stylish Vans, the kind my daughter loves. She sits in a chair to the left of mine, leaving Dana alone on the couch. She sits primly, like a Downton Abbey character, with both feet planted and her hands clasped and resting on her thighs. She is trim, attractive, with deep blue eyes and boyish short hair parted on the side.
The three of us fumble through the usual therapy dance. Typically, I ask questions to elicit the client’s point of view about why we’re here together and the client explains how life hurts. Sometimes a client will even say why it hurts. But Dana stonewalls. She mumbles something.
“What did you say, sweetie?” Mom asks.
“I’m saying this, this whatever you call it, therapy, this therapy isn’t important.” She lifts herself from a slouch and spreads out her hands, palms down, and waves them, a kind of magician-like maneuver, the kind that serves as a prelude to astonishing the audience by making something either appear or disappear.
“My understanding is that you tried to kill yourself,” I say.
“Who cares.”
“You mean, no one cares?”
“No, I don’t mean that. I mean it isn’t important.”
“Trying to kill yourself isn’t something important to discuss?” I say.
“Not anymore.”
“Not anymore because, what?”
“Because it just isn’t,” she says. “It’s wasting my time. I’ve got homework. I’m busy. I already told you, I’m fine.”
“She’s been hospitalized, I guess you know that,” Mom says. “She took some Tylenol.” She reaches for the tissue box on the table in front of her.
“Get over it, Mom,” Dana says.
“I don’t know why in the world she’d do that,” Mom says. “Really, I don’t.”
I believe that to be the truth.
A Session at Dana’s Dad’s House
I notice The Great Gatsby on a table next to the front door of her father’s house, a small Cape-Cod style structure near an ocean bay, an apparent haven for seagulls. Dana’s parents had undergone a bitter divorce—an experience familiar to me—and it would have been folly to bring them both into a session together. But I wanted to round out the family picture so I arranged to meet with Dana at her father’s home, where she spends about a third of her time.
Her father, a mildly affable man with a reddish, leathery face, thinning brown hair, and solid build, ushers me in and asks if I’d like something to drink. He’s wearing pale-blue wrinkled shorts that go down to the knee caps and a faded light-purple t-shirt that says “Life is Good”. I see Dana lying on the couch, one bare leg hiked up so the ankle is hooked onto the couch back. She’s studying her phone. She doesn’t acknowledge my entry into the home. I signal to her father to go into the kitchen. I pick up the book without a clear idea why and follow him. He pours me iced tea.
“Thanks for letting me meet the two of you here,” I say.
Her father resumes slicing zucchini and some leafy green vegetable. “Well, I’m glad you could come,” he says. Then he says, “I’m sorry.”
“About what?”
He slices and without looking up he says, “It’s just that I forgot about the session. I had the impression it was tomorrow. I spent the day working on my boat.” He stops slicing and retrieves something from the refrigerator, a vegetable I don’t recognize. “So I’m quite disheveled, as you can see. You caught me in the middle of preparing dinner.”
“Probably should have texted or called, I guess.”
“Not at all. My bad.” He chuckles. “Jesus, did I just say that? I’m sounding like my son. But seriously—glad you’re here.”
“Is she?” I say.
He looks up, as if he could see Dana through the wall. “Dana? What kid enjoys therapy?”
He’s right. Therapy is for people who find themselves sufficiently unsatisfied with how it feels to be alive that they’ll bracket time to seek out a stranger to talk to. Not many teens find that appealing.
“How is she managing?” I say.
“Should I be worried that I’m not worried?”
“Depends on your level of attentiveness, I suppose.”
“Meaning?” he asks.
“I mean, if you’re not worried but you haven’t been paying attention to what’s happening with Dana, then maybe you should be worried that you’re not worried.”
“I’m observing. I’m asking questions. So I don’t think that’s an issue. The kid’s doing great, from the looks of it.”
“That’s good,” I say. “We want our kids to do great.”
“Yeah, but I thought she was doing great a few months ago. And look what happened."
True to form, Dana is still outstretched on the couch looking at her phone. She’s wearing gym shorts and what is clearly her Dad’s shirt, a light blue sweatshirt with “Martha’s Vineyard” written on it. It makes her head look small, her features more childlike. I place The Great Gatsby on the glass coffee table and retrieve a dining-room chair. This time, unlike at our previous session, I position it some distance away. I intend for there to be a chasm between us. I intend for the communication today to require vocal effort. She pretends to ignore me; she seems determined to stare at her phone. I reach for the book and examine the cover, making a show of it, hoping to get a reaction from her; it is a promotional issue, with “Now a Major Motion Picture” written across the top and Leonardo DiCaprio looking directly at the reader. Serendipity, I think to myself, has delivered this book, at this moment, with this girl outstretched on a couch, throw-blanket covering one leg, the other bare leg still stretched upward at a forty-five degree angle, this girl pretending she’s on the other end of the planet.
” I often use movies and literature as a gateway into therapeutic matters, and sometimes the results are profound” (results hinging on the client’s capacity and willingness to go deep), so I rarely bypass an opportunity that presents itself. But I never know how things will go.I don’t wait for eye contact. I ask Dana if she’s already read the book. She nods, still absorbed in her phone. “And?” I ask. She tells me it was boring, pointless, and the movie version “sucked.” She still hasn’t looked at me. I’m undaunted by her negative review and ask her what she thinks of Gatsby himself. She says he was rich, filthy rich. “And?” I ask again. She mumbles something about the fact that he still couldn’t get what he wanted.
“Meaning Daisy?” I say.
Finally, she looks my way. “Obviously.”
I tell her it isn’t so obvious. “Daisy might be a stand-in for something else.”
“Like what?” she asks. I’m surprised. I detect a tone of genuine sincerity.
“That’s what I’d like to know. Something more vital than Daisy—maybe that’s what he’s after.”
“He was rich,” she repeats.
“So?” I say.
“What else does he need? Makes no sense, that book. He died because he couldn’t get what he wanted. Makes no sense.”
“How so?” I ask.
“What do you mean, how so?”
“I mean, how did that happen, you know, Gatsby dying because he couldn’t get what he wanted. I mean, I know the plot really well, so I’m not asking about that. I was wondering about your view of how the two things—death and wanting-and-not-getting—are connected.”
“I don’t know,” she answers swiftly. “Who cares anyway? I thought this was therapy, not a literature class.”
I tell her that I like talking about books, that great novels are the best way to understand human psychology, definitely better than psychology textbooks. She is unmoved.
“Why was Gatsby so persistent? Why did he obsess over winning Daisy back?”
“Boys are like that,” Dana says.
“But he’s filthy rich, like you say. He’s handsome.”
Dana mulls that over and mutters that guys get obsessed over girls and the whole thing is stupid. “Guys are stupid.”
“But I’m wondering what you think about this: Do you think something was missing in Gatsby’s life? Did he think Daisy could fulfill him in some way?”
“Look, Gatsby’s a rich guy. Rich guys are used to getting what they want. End of story.”
“No, Dana. Not the end of the story. Not by a long shot.”
“Yeah. End of story.”
Dana’s Marvelous Plan
Dana likes to say she’s “back on track.” I had asked her what that means and she looked at me in astonishment. Then she said, “Well, you do this for a living, so I suppose you wouldn’t understand.” She presumes to know me, so she thinks I don’t get it.
Her Marvelous Plan—I understand it well: Ivy League college as a segue to a fancy grad school, medical research, professional recognition, big money, big home, big trips to exotic places with lodging in big fancy hotels. Life lived on a big canvas with a reliable, high-achieving husband with unbounded aspirations and gorgeous, high-vocabulary children inheriting more of the same unbounded aspirations. The world always bending to your will. The world, this life, under your control.
If only she knew of the poster on my dorm-room wall, the one with big italicized print, saying “Living Well is the Best Revenge.” The picture on which this line was superimposed put a particular materialistic gloss on the notion of “living well.” A vivid photograph of a juiced-up, vibrantly-colored sports car, with a scantily clad blonde woman contorting her sculpted body over the hood, as if to say, “I’m your reward.” “Success” as a kind of retaliation. You’ll get what’s coming to you—thrills, pleasure—if you just bear down with grim determination. The poster was a kind of beckoning—get to that point in my life where I can say, ”I prevailed, I fucking prevailed.”
“What about the Tylenol?” I had asked her.
I’m thinking: “What about your Marvelous Plan?”
“What about it?”
“What led up to it?”
“Who cares? Typical shit—ooh, sorry. I’m not supposed to curse, am I?”
“What sort of shit?”
“Typical shit,” she said. “You know, my BFF broke up with her boyfriend and he starts hitting on me and . . . . Why am I telling you this? Who cares, come on, really—who cares?”
“Typical teenage shit, you got this future all planned out, because you’re going to be Ms. Hotshot someday, and you down a hundred Tylenol pills.”
“While my mom was watching Netflix in her room. Yup.”
Lessons from Literature
I know what I’d like to do, in terms of where to take the discussion, but I don’t know how. I want to discuss the relationship between life and the way we experience this ineffable thing, this illusion we call the self.
“There are things we can say about who Gatsby is on the inside by looking at the externals of his life. Do you agree with that?”
“He’s a rich guy,” Dana says. “I guess that means he’s driven. Motivated.”
“And that’s a good thing, as you see it.”
“I’m not into losers,” she says.
Her phone dings. A text alert. She pulls it out from the couch cushion, taps out a response.” She looks at me. “Sorry.”
“Back to Gatsby,” I say.
“Seriously?” she says. She leans her head back, exposing her white throat. “Dad!” she yells out. “I thought this was supposed to be therapy!” Dad steps into the doorframe of the kitchen and tells her to focus.
I wonder if he’s going to join us. “I’m curious, Dana. Actually I’m a little confused.”
“About what?” she says.
“You say Gatsby’s rich—and he does have a lot of money . . . .”
“Which makes him rich, so don’t play games with me, okay?”
“No doubt. He’s rich, and that makes him a winner.”
“Right,” she says.
“So it’s easy to tell the difference between winners and losers?”
“Not always,” she says. “He dies at the end, right? So that complicates things.”
“Are you saying he’s a loser because he allowed himself to be destroyed by his demons?”
“A person could be both. I’m right, right?”
“You tell me,” I say.
“He got caught up in bullshit. Drama, as you like to say.”
“Yeah, definitely drama. But at least at the outset, Gatsby’s outer situation—his wealthy lifestyle—reflected who he was on the inside. You believe that.”
Dana becomes more tentative, warier, if not defensive. And yet, most importantly, I sense from her wrinkled brow she is intrigued by the colloquy. “I guess so,” she says. “Being rich does say something positive about you. Come on. I’m right, right?”
“But that’s incomplete, isn’t it? I mean, that’s the point when it comes to Jay Gatsby, right? That’s why you can’t tag him definitively as a winner or a loser.”
“What I remember is that he lies about his past. He’s ashamed of it. I’m right, right?” I nod to validate her memory. “So he’s living a lie. People in my class talked about how he was living a lie.”
“You mean he’s lost his grip on reality? He lives in an illusion?”
Dana thinks for a minute. “I’d say he had false hopes. Are false hopes illusions?”
I tell her they are. I don’t tell her that maybe the whole enterprise of hoping rests on illusions. Maybe, as Buddhist teacher Pema Chodron says, “we’re addicted to hope.” I take her to mean that, in this culture, we have lost the ability to find contentment in the present, and thus we have become dependent on, grasp at, some hoped-for future outcome to fulfill us.
Dana says, “Then that’s what did him in.”
“I agree. Illusions end up leading to harm.” As does grasping, clinging, the relentless pursuit of something “better” within one’s advantage-seeking scheme. I’m hoping she will say something about Gatsby’s pursuit of riches as a stratagem to get what he thinks he really wants, which is Daisy’s love, but that his actual quest is for something beyond Daisy. ” I’m hoping that I can use that literary analysis as leverage to get Dana to consider what her achievement-oriented mindset is really about.”
The simplest lesson to draw from The Great Gatsby—simplest in terms of most obvious, as it superficially relates to Dana’s psychological profile—is Gatsby’s foolish mental model that things of value in this life can be purchased. If I was inclined to moralize with Dana, I might well push the point that American consumerism corrodes the soul, breeds psychological dysfunction, and generates emotional discontent. But I’m interested in something a bit more recondite. Fundamentally, Gatsby feels inadequate and his pursuit of extraordinary wealth is a palliative for, as well as a defense against, that feeling. I suspect something like that is true for Dana. The fact that Dana is like the vast majority of Americans, equating purchasing power with value, commodifying all of life, is no doubt important to address, if she is to achieve meaningful growth.
“So then you think he’s a loser in the end,” Dana says.
“Do we have to lump people into categories like that?”
“Why not? Makes things easier.” She lowers her raised leg, slides it under the throw-blanket. She scoots down the couch slightly so as to be in a fully reclining position. She’s indicating that she’s losing interest.
“Are you open to the possibility, Dana, that often it isn’t helpful to lump and divide people and experiences into simple categories because it often gets in our way of seeing things clearly.”
Dana shrugs. She pulls out her phone from the couch cushion, peeks at it, and puts it on her stomach. “Are we done yet?” she asks.
I ignore the question. I had her plugged in for a while, but no longer. If I keep going, which I so much want to do, I fear I will be satisfying my needs and not attending to hers. Which is why, when she pulls out her phone, I say nothing. I rise, as if in defeat, and walk over to a side window, long and narrow, to see if I can see the bay. A fence blocks the view. I stand by the window, nonetheless. I look over my shoulder and see that the phone has thoroughly arrested Dana’s attention. I’m not so much seeing Dana with a phone in her hand as I’m perceiving what life has turned into. It’s a sad sight. Very sad.
I return to the chair, heavy-hearted, near tears, thinking I’ll give the session one more push. “I’m wondering,” I plead to Dana, “if we can forget about evaluating Gatsby and just explore whether his struggles might speak to your struggles.” I can’t rid myself of the feeling that I need this girl to talk to me. As if I see the sorrow up ahead for her and I’m the only one to warn her.
She lowers the phone and glares at me, as if I’ve just insulted her. “I don’t have struggles,” she declaims in a low register. She lifts the device to her face once again, obliterating me from her world. “Not anymore. Things are fine now.”
Reflections on Literature in Therapy
Gratifying therapy, as I experience it, is like reading high-brow modernist literature, books by writers like Joyce, Faulkner, Woolf, books that demand the reader’s collaboration, books where the first read is only preparation for the second read, which allows for you to then read the book for the first time. Things unseen, hidden within ambiguities that once seemed so transparent, become visible, sometimes even shocking, with that third-first read. As with therapist and client, the reader must work collaboratively with the writer to construct a version of truth, in contrast to the run-of-the-mill novelist who spoon-feeds plot to the passive entertainment-seeking reader. The former experience, the more arduous one, is truer to life because life itself does not deliver us experiences with ready-made interpretations; our life experiences come to us in fragments, their connections to other fragments opaque, hidden, ambiguous. ” Our lives, and especially our falls and failings, our sorrows and frustrations, are like literary texts, awaiting second- and third-read interpretations.” Much therapy and counseling, however, is of the latter variety, all plot and quick judgments. With the most gratifying therapy experiences, the first swipe through the “presenting problem” is only preparatory for the second swipe. And then finally, deep into the process, the client and I can finally look at the whole life-drama as if for the first time, a thick and rich drama that resists synopsis and boiled-down diagnoses, a drama that, absurdly, was once distilled as a “presenting problem” in insurance paperwork.
It’s in that spirit that I use quality literature and film in a therapy session. It’s a device for collaborating with the client to “read” their own life-story multiple times, with each read penetrating deeper into the “text,” because one’s life experiences are exactly that—texts to be read. It’s a high-wire act because, as can be seen in my experience with Dana, you just don’t know if the whole thing is going to go kaput. I guess I’m saying it takes a bit of moxie to do it. Easier, for sure, to stick to a CBT script. But the chances of professional burnout diminish, because sometimes magic can happen, because this kind of therapy can be fun, adventurous. I intentionally provided this vignette, where nothing momentous happened, where the effort to engage with Dana was met with resistance, to provide something realistic. I dislike the usual emphasis on heroic success stories that make the rest of us feel inadequate.
Dana graduated high school with honors, scored high on the SAT exam, and got into an elite college, which means she’s off and running in pursuit of her Marvelous Plan to be rich and envied. She sent me an invitation to her graduation. I sent her a card, thanking her but declining the invitation. She is doing what we all endeavor to do in those tender years: construct ourselves into a Somebody. But what happens when our Somebody-ness project goes awry? What happens when things fall apart (when, not if)? Maybe in that moment of trying to cope with whatever shock and tribulation hits her, Dana will have a flashing recollection of her adolescent self and this odd man talking in her father’s living room about The Great Gatsby.
