Category: Approach

Real or Imagined Abandonment

Real or imagined abandonment. I read the words out loud in time with my ex-fiancé Dan’s index finger as it moved along his computer screen. The DSM pages that had been all too familiar to me since graduate school felt like a loved one’s obituary following a car accident. The term borderline personality disorder has fit many of my clients over the years and, at the risk of sounding cliché or contrived with “some of my best friends are,” well, some of my best friends have shown signs of BPD. And I have experienced these signs in myself. While my long-standing self-diagnosis of Complex PTSD has often felt like a badge of honor, attachment issues have always been my true Achilles heel. The dull ache of a relationship’s potential for derailment and deterioration has been etched on my mind and present in the throbbing headaches that often settled between my brows. Headaches and worry became as familiar—and as distressing—as red lights and waiting in line.

A glass of ice-cold water in the face could not rival the moment when the man you love asks you to read the word “abandonment” in conjunction with all the associated components of borderline personality disorder, the condition that is the zenith of the experience of pain-by-abandonment. BPD is a testament of pain. Just the phrase stirs in me that same kind of sadness as whenever I look at old family photos, watch the movie Of What Dreams May Come or listen to the song “As Tears Go By” by Marianne Faithful.

My whole body trembled as I forced myself to remain standing steadily enough to continue reading the rest of the diagnostic criteria out loud. We were technically in his living room, which sometimes felt like our living room, standing in the aftermath of one of our all-too-regular fights.

My tears, the white flag of surrender, bonded us. Again. I fell into the warmth of his familiar, coffeeshop-scented Saturday sweatjacket and strong heartbeat as his arms tightened around me, his hands first locked on the middle of my back, gently patting me until finally finding their way to my face in order for him to gently pull the hair away from my tear-bleached eyes until those tears finally stopped.

After a childhood derailed by my parent’s and stepparent’s drug use, along with the twists and turns of moving in and out of assorted relatives’ homes, I had earned my black belt in therapy patienthood by the time I was twelve. And while my vocational pathway was not a carefully pre-planned collaboration but a mystery left for me to solve on my own, I condensed what I knew of life to that point and studied counseling psychology in order to become a therapist. My torturous family history prepared me well to hone in on the essence of what those around me were feeling and what their state of mind was. My direct familiarity with how invalidation stung empowered me with a stance of caution in my work that, paired with curiosity, became a starting point for my work with clients through which I could offer validation and encouragement. With caution, I could spare clients from the therapeutic experience of being pathologized for circumstances that were beyond their control.

The adages of the shoemaker’s children having holes in their shoes or the hairdresser’s hair never quite looking good always seemed to ring true for me. In my personal life, I could not access my own therapy skill set. The never-ending question “What would you tell one of your clients?” was posed like clockwork by those well-meaning people I confided in during moments when my pursuit of comfort overshadowed practicality.

Understanding another’s life is risky business, even with the best of intentions. As a therapist, I have asked clients struggling with abandonment issues to try to make sense of the very same message Dan was trying to convey to me after our most recent fight as he attempted to quiet my own abandonment fears. Even our own couples therapy sessions, which initially seemed promising, resulted in my pained response to Dan’s distancing, deafening silence; with that, those sessions failed to yield a secure structure for the relationship we had co-created.

Why was Dan immersed in his phone at all times, especially right before and during that very therapy session, why was the therapist not acknowledging this, why did we have a constant rotation of bonded togetherness followed by cold detachment, without any seemingly clear catalyst? Why was this the one relationship on any level that I could never figure out? And, most of all, how could a union hold so much potential and goodness, only for me to then feel fleeting and irrelevant to Dan before cycling back to calm and contentment?

The deeper my intimate feelings for Dan became, the more urgent it seemed for me to safeguard our relationship by vigilantly monitoring its emotional climate—and his commitment to me. Priority one was seeking out potential threats along with warning signs of betrayal, loss of interest in me, or perceived slips in my relational ranking compared with his family, friends and co-workers. While Dan brought me into his family fold and once said he would make me part of whatever he was part of, he also said he wanted to protect me from the meanness of the world. And there was always something about his whiskey bar associations that felt like exactly that—the meanness of the world. I suspected that he interpreted my stance as that of the insecure and controlling female who wanted to dominate her guy’s friend time. I’d argue with him that even a broken clock is correct twice a day, but our relationship security, or at least mine, repeatedly seemed to plummet until my frustration turned to rage, and I was then the screaming woman ranting about a few hours at a bar or a house party planned for the weekend. Validation became too emotionally expensive, no matter how much I wanted to participate in making my point of view clear and appreciated for its well-meaning intent.

My favorite quote in Who’s Afraid of Virginia Woolf, “What we are talking about is not what we are talking about,” always seemed to apply during one of these moments. What I was focused on was not what I was focused on. I had my appointment book, my pen-to-paper lists always at the ready in order to securely defend my position of insecurity. And I had my “tangible and legitimate” complaints. His nephew didn't want us to marry or be in a relationship; Dan treated me differently after his nephew called or they spent time together. His friends wanted to see him often and I wasn’t fitting in, his work was demanding, his mother needed him on Sundays. These were real reasons for stress for me, but they weren’t giving us the real reasons for our seemingly predictable conflicts. Even his fluctuating treatment of me felt impossible to describe, except for my feelings about it. Life was the equivalent of reading accurate directions for finding a building, but still not finding its entrance even after circling the building with a Quonset light overhead.

Focusing on Survival Can be a Liability

“In your childhood, you were forced to live a borderline life,” I once said to a client who responded by saying how true it was. The image of baking a cake with the needed ingredients came to mind. Past events, such as her father not showing up to pick her up from the first grade on his various visitation days and a mother who was always traveling for work, were like toxic ingredients in her upbringing used to bake the cake of her later pain, problems, and pathology.

With similar clients, I have been able to offer understanding and to then use this to set goals, but I could never quite develop the same traction in my own relationship with Dan. With my clients who were trauma survivors, I always felt like there was a clear linear strategy that guided the order of our work—first, build rapport; second, accumulate recent history and present life circumstances; third, explore assets and resources, such as friends, talents, finance, hobbies; fourth, assess liabilities, including symptoms, people, events, debt, health; and last was the hook, the motivation. What was it in their darkest and most painful eleventh hour that motivated them to seek the safety net that kept them from hitting bottom and giving up? Could they share this with me? And could I help them to recognize that I valued this very private and fragile inner faultline they’d given me access to?

For trauma survivors, the asset of being good at surviving and focusing on keeping the safety net secure can also be a liability. I have to carefully keep this in mind with my clients. The risk is that the frame of therapy, along with my validation of their status quo and past pain, can become too much of a lifeline. If this happens, a client who is accustomed to getting by on little comfort and relatedness from others may become too comfortable to take social and emotional risks outside of therapy. Here is where the balance of minimal confrontation over avoiding fun or healthy risks must be met with continued acknowledgment of their survival skills and circumstances.

Cindy, my smart and savvy managing director client, was often reluctant to go to her company's happy hours. She emphasized how different she felt from her coworkers because of her family background. She resented the feelings that came up for her whenever others spoke about their lives but, at the same time, she hated feeling alone. Curiosity about others helped create an emotional bridge strong enough for Cindy to give the happy hour—and others—a chance. While she didn’t find much to feel compassion about, she continued acting curious until doing so took her focus from herself and onto the social world around her. Cindy liked this feeling. We named it “Moment Therapy.” We then established a Moment Therapy Quota, where she scheduled three moments per week where she would attend an event that she could bring curiosity to, and through which she could begin to cross the bridge to a safe connection.

Sacrificing Sanity for Connection

My client David wanted his wife to be on his team. He often returned home well after dinnertime, which was upsetting to his wife and led to conflicts. He felt distanced from her at those times but felt more at peace and secure in their relationship whenever he bought her jewelry. Six months into therapy, he described this cycle as one of conflict, followed by estrangement and then presentation of the jewelry, much like a cat triumphantly bringing home its catch of the day to its owner. Then all of a sudden, presents no longer worked. He would try to help around the house, even when he wouldn’t get home until 8 PM, even though his wife was a self-described stay-at-home pet-parent. He always felt like he was failing her until finally, when he would start to give up, she’d turn around and embrace him.

David’s scenario evoked memories of my relationship with Dan, particularly when he would hang out with his friends in whiskey bars. I believed that Dan's relationship with these particular friends was ripe for trouble and fueled my own insecurities, I could just feel it. Being around them made me feel the way I did many years before when I did my internship at a state-run drug and alcohol facility. While some attendees did hard work and were honest, there were also the court ordered system-savvy patients who offered little more than mock compliance at best. The whiskey bar hangout of his friends was a breeding ground for gambling and other so-called hobbies that pair accordingly with sinister people masquerading as friends. Some of the whiskey bar guys were okay, some very likable and even charming, but the setting was rough and some of them were rough with it. Dan had an ability to access people with a combination of book and street smarts. This did not include the people from this whiskey bar party-based petri dish. I believed that I had a right, an obligation, to share my concerns with urgency. The problem was that I was a one-trick pony. My mind had its doctorate in domestic trauma, but not in the imperfections of regular life. I couldn’t communicate to Dan my concerns with an emotional delivery that didn’t push him away.

With my clients such as David, I easily described their behavior as blocking old punches in real time. They typically appreciated and quickly understood this phrase and worked on compiling a weekly list of such events where the analogy applied. Many eventually learned to recognize their pattern of reacting from past conditioning as if it were happening in the present. We would then work on finding the similarities within each event and then the meaning—the core essence that they were responding to. Once my clients demonstrated security in feeling validated and were comfortable challenging their impressions, we questioned the meanings they assigned to the events and wondered together if they could be exchanged for other, less destructive interpretations. Did the original meanings still feel accurate? Or were past meanings from past events being recycled, like a hand-me-down-sweater from a relative that never quite fit and nevertheless compelled wearing during visits from them?

The Illusory Promise of Diagnosis

While I permitted Dan to highlight my flaws in our review of the DSM, I remember having fantasies in which he underwent psychological testing which would provide us with some insight into his behavior and relational style and move the focus from me to him. Dan and I would sit holding hands as a team, ready to face the results as the psychologist spoke. In the calm of this fantasy office, the psychologist would reveal a truth about Dan that lay hidden from him and me that would explain so much about our quixotic relationship and offer it hope for survival.

Asperger’s Disorder—Marked impairment in the use of multiple behaviors such as eye-to-eye gaze, facial expression, body postures and gestures to regulate social interaction, a lack of social or emotional reciprocity. Encompassing preoccupation with one or more stereotyped and restricted patterns of interest. A psychological diagnosis is an odd thing to wish for anyone, let alone your significant other. But more than anything, I wanted answers for why Dan felt out of reach when we were together, why even our phone calls could deteriorate into mini verbal landmines, and why I couldn't somehow find some way to get us to have a shared emotional experience, a mirrored sentimentality of love and life or home and hearth. Something so seemingly trivial as a kiss outside a restaurant where we had just had dinner could be risky. I would be heading home, and Dan wanted to stop off at the bar. I’d make a silly, playful comment about parting being such a sweet sorrow, and Dan found it irksome. Finally, I’d call him out for not caring. “It's not true, Pamela.” That's what he would say to me whenever I accused him of not loving me or wanting me. I missed him much of the time even when we were together, and somehow, I would blame myself in the process. After all, it was me with the diagnosis, not him! Yet when he would leave to meet his friends, I felt like the warden helplessly watching a prisoner escape. I wanted something—anything—a diagnosis to make our reoccurring disconnect make sense. I wanted a diagnosis to take on wearing the hat of the culprit. I wanted a diagnosis to blame, something instead of Dan and me. And though I had my own challenges to still work through, I wanted the diagnosis to belong to Dan.

In retrospect, and into the present, the clarity a diagnosis promises is illusory because ultimately, we all find a way to do what we want in life, especially within our closest relationships. Actions speak the loudest, by themselves. Under the refracting and distracting prism of diagnosis, explanation, or etiology, as we professionals call it, still falls woefully short of explanation. Emotional matters like attachment and love cannot be solved solely by looking at someone’s actions or solely through the lens of a diagnosis. Even combining a person’s actions and their diagnosis doesn't promise all the answers. Nothing can offer that promise, not even time.

Sometimes a diagnosis is validation, affirmation, confirmation. Sometimes, a diagnosis tells a patient, “You've been heard. And here is tangible evidence.” In working with couples, if we all get on the same page as to agreeing about the specific problems and, if then, each is capable of articulating the other’s point of view as well as their own, then we can effectively talk about symptoms of a disorder and what each is experiencing. The result is a combination of mutual personal responsibility and empathy.

Jane felt anxious every time Ben didn’t call on time. The two had recently married after a year of dating. Both were in their early forties. It was Ben’s second marriage and Jane’s first. On the heels of Ben’s ultimatum that Jane seek therapy, she called me for an individual appointment. Following an initial double session, per Jane’s request, I scheduled a session for both her and Ben.

The two sat together on my couch and eagerly faced me. They looked prepared, Jane wide-eyed and Ben holding a notebook and pen. Jane was clear that she was looking for understanding from Ben about her recent behavior, however, she then said that even she didn’t fully understand why she did the things she did. Her latest self-identified “stunt” was shutting off her cell phone and checking into a hotel room when Ben failed to call as scheduled. Jane had waited an hour for Ben to break from hanging out with his friends. By the time an hour passed with still no phone call, Jane made herself unavailable until the middle of the night when she came home.

Ben was not experienced with therapy, but said he was open to trying anything in order to save his marriage or come to terms with another divorce. The last part of his statement led to a marked change in Jane’s physical appearance. She became almost feral, in what seemed a ready- to-pounce position. I let the therapeutic silence communicate my acknowledgment of what Ben said and how Jane reacted. Each looked uncomfortable but ready to continue, waiting for my lead.

We agreed that the initial goal was for Jane’s experience of Ben and life in general to be understood—not declared right or wrong, sustainable or not, but solely to hone in on uncovering what her life and her interactions with Ben felt like. We agreed that our focus did not mean Ben was less important or was exempt from responsibility for contributing to their problems and that, in time, we could shift the spotlight to him. We also agreed that I could take license to use psychological material to help strengthen the meaning of what we would be uncovering. They accepted my request to be seventy-five percent clients and twenty-five percent psychology students, learning terms and doing assigned research online.

Fantasy (and Reality) Therapy

Many people plan fantasy vacations, ones that they never take but experience internally at the mere sight of a palm tree or the fleeting sound of notes from a favorite song. In my mind's eye, I used to picture a therapy session that never happened. A session where Dan went alone and met with a male therapist about ten to fifteen years older, just enough to earn the status of wise older brother. Instead of the therapist taking a passive position, providing a psychoeducational lecture on boundaries and intimacy or encouraging Dan in an unfettered, free association-driven monologue, Dan would be challenged to explore his own role in our tumultuous relationship and not engage in diagnostic finger-pointing at me.

My fantasy therapy session for Dan would also include his feeling the same pain I experienced whenever that familiar and predictable disconnect occurred, and deeply breathing into and accepting his own role in that painful process. After a moment of therapeutic silence, Dan would be encouraged by the therapist to describe the disappointment he felt when his father was preoccupied with work and his own financial struggles to the point that he was unavailable for his family, and the disappointment when his first wife started working long hours and decided that married life was interfering with her career. Where was the pain, the abandonment that Dan felt from his own father and later his wife? Letting my fantasy tape roll, the therapist would highlight Dan’s experiences of having felt let down by his own parent and, later, his spouse, and how those painful feelings and memories played out in his future relationship with me. Empathy would follow, and we would be freed to have a relationship grounded in mutual understanding and respect, and the relational skills needed to weather whatever storms lay ahead.

***

The most valuable part of the fantasy therapy session with Dan has been the way that I have since then been able to apply it in both my own personal life and in my therapeutic work. I have learned how it is essential to help clients, particularly those in tumultuous relationships, to understand the other’s point of view. How the emotional upset in one must be met not with withdrawal and distancing, but with even greater empathy and attempts to remain connected. I have come to appreciate that raw and deeply pained emotional and angry outbursts can be, and often are, pleadings for acknowledgment, validation, and acceptance. I have also come to appreciate how avoidance and distancing are just as credible forms of emotional expression as anger and sorrow. With these insights, hard-earned through my own subsequent relationships and my own therapeutic growth, I have had more to offer clients who are playing out similar cycles of withdrawal, anger, and re-connection within their relationships. Where I might have previously rushed to diagnose the shut-down client, in the shadow of my own experiences with Dan, I now lean forward with far greater empathy and hope that they can learn to do the same. I have also learned the importance of expressing my own pain whenever the specter of abandonment rears its ugly head in my intimate relationships, and teach my clients the importance of remaining whole, even when feeling fractured.