Jan's in-depth cases: the story of Sandy

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: Analyze This: the real life case of Sandy : Try to determine her enneatype and (if you have the book) the style according to dr. Oldham's typology. Let us know what you think. : : Start of the therapy session: : T: The last time we met, I asked you a lot of questions and you answered them and at this point I think it would make more sense if we shifted the burden of that and you would be more responsible for telling me all the thoughts that you've had and when we're here to tell me anything that comes into your mind. Anything you think of while you're here: thoughts, feelings, even bodily sensations that occur while you're here so that I'll be able to respond to what you're coming here for. For you to, you know, start telling me as much as you can about why you're here and what's been on your mind and even just if a stray thought crosses your mind, I'd want to know that. : : {This is a standard structuring statement in a dynamically oriented therapy to which every patient responds idiosyncratically. In this case, there is a special irony to the structuring, as the patient is asked to relate everything that comes to her mind to an older female therapist figure, while the chief complaint is that she cannot tell everything to her mother. The patient's response to the structuring is often predictive of the shape and intensity of future resistances in the therapy} : P: Okay. I was thinking a lot about what you said at the end last time about keeping secrets from you or anything like that and I want to do this so that there is someone that I don't have to keep secrets from. I mean it's kind of pointless if I don't tell you things. I mean, that's the whole problem, I'm not telling anyone things and that's why the whole thing is just getting to be kind of a burden and making me very anxious sort of...I felt like last time and then I told you a lot of things but then there are also things that I'm sure I left out. I mean the whole history of my boyfriend and I, well, my husband, my relationship and things that have happened in the past with my parents... : {After the therapist has begun to delineate the expected behavior of the patient, the patient begins to question what she wants from the treatment and more directly what she expects from the therapist} : P: Well maybe I didn't come here to ask for help in telling my parents. I mean maybe I came here just kind of to ask for help in how I'm going to deal with telling my parents, but not necessarily. .. : T: Telling them? P: Well, not necessarily telling them while I'm here. I mean nothing ...I don't think that anything here is gonna help me when I tell them except for preparing me to deal with whatever is gonna happen. I don't think it's gonna make it any easier for me to tell them. ... How do you think being here is gonna help me if I were to tell them now? : T: Well, presumably you came here for help with that, I mean that is what you said and so I would expect that that would be something we would be working on together unless I was mistaken. And I think that you know you've told me about the ways in which you don't want to face what you have to face and that you've been putting off doing something about it in ways that are rationalized in various kinds of ways. "Well, if I wait until after graduation, then I won't have to worry about school." But meanwhile you're very preoccupied with this. So that I think it's a fiction that it's gonna be easier for you after graduation. Things are not easy for you now. And you know it. : P: Huh,"uh. [sighs] Well, how ...I mean how am I gonna do this? : T: And you're asking me? : P: Yeah. I mean if I knew then I would do it. : {The therapist makes explicit what the patient is asking for and the therapist chooses to counter not with advice or role playing of possible ways to tell the parents but by putting, the responsibility on the patient who is struggling for autonomy.} : T: One of them is that you'd like me to tell you how to do it. : P: Well, I'm not, I don't think that you really can tell me how to do it. : T: I agree. : {A few minutes later in the same session the therapist makes a second and key structuring move by letting the patient know that she expects the treatment not to be a mere discussion of the problem but a period of positive action. This interpretive work is aimed at the patient's denial of the hostile and vengeful aspects of her elopement and of the continued secret. To undercut her by now rather exaggerated delaying tactics, the therapist requested she tell her parents during the time of the brief treatment.} : T: And whether you feel differently now, or in three weeks I would assume, I think we'd both agree then that you're not gonna feel much different in three weeks about telling them. : P: No. : T: You may know a little bit more about why it was you needed to keep it a secret more than you know now, but at some point it's got to be done and : waiting doesn't seem to me to be helpful to you. It's just a wish to put off facing it. And if you were to tell them while you were still seeing me, then I would be here. Otherwise, we have a kind of academic treatment. You know what I mean. Sort of, we'll just talk about a lot but nothing happens. : P: Huh,.huh..So, I mean what you're saying is that you really think I should tell them and then we should just deal with whatever happens afterward. Which could be one of [laughs] various things. : T: Like what? P: Well, I mean I don't know exactly how, I know it's gonna be a very big deal, I know it's gonna be a very big scene, I don't know if my father is gonna get violent. I don't know ...I mean, I don't know. : {Once the structure of the therapy is communicated to the patient, in terms of what is expected of the patient and what the patient can and cannot expect from the therapist, the patient's reactions to the structure of the treatment become manifest and the therapist interprets that reaction} : P: No, I mean I'll eventually tell, naturally I'll eventually tell them, but I'm saying I don't know what's gonna make me tell them now. I mean what you're telling me is that I have to tell them, right? But I already know that. : T: So I'm not telling you anything you didn't already know. : P: Right. : T: But you're reacting to it as if l'm forcing you. And then you say, ..Well, maybe I just won't tell them at all." : P: No, not at all. : T: Or maybe I won't tell them. : P: I'm saying maybe I won 't tell them now. : {Focusing the treatment. The therapist then points out how the struggle between patient and therapist over the structure of the treatment mirrors the patient's struggle with her parents currently, a struggle that is the focus of the patient's problem. } : T: You know one thing I noticed when we were having that interchange about when you would be telling your parents, and if you would, that as I pressed you to consider telling them while we were still together you seemed to get firmer about not telling them. : P: Well, because I'm afraid. : T: I had a different take on it. : P: What is that? : T: Which was, it feIt to me as if you didn't like being told what to do. : P: I never like being told what to do. [laughs] : T: Just like your parents told you not to be involved with your husband. : P: Huh. uhm. : {Predictably and optimistically, the resistances just pointed out became more exaggerated over the next several sessions permitting greater ease of interpre- tation. The patient canceled two sessions in a row (4 and 5) and requested to change the time of a third (7).} : P: Well, I have to go to this thing so. .. : T: You would cancel out? : P: Yeah, I would have to. : T: And that would be three cancellations. : P: I know. : T: Cause we didn't meet on a week from today. ... : P: Yeah. : T: Or on last Tuesday. : P: Let's see if they could do it Monday [reschedule the audio-visual room]. : T: Uh hum. : P: I hope so. : T: I think the chances are going to be slim. : P: Really? : T: Yeah, but I don't know for certain. : P: All right, we'll see. How do you want me to start? : T: We've already started. : P: Oh, we had already started, but I mean, you know. ... : T: I think this is part of it, that one ofthe things that's going on right now is, uhm, we started to meet, uhm, and you became, I put some pressure on you to start to deal with this, you became depressed. And then you canceled two meetings and we're meeting now, and there's a third cancellation coming up. : P: Well, the third cancellation has nothing to do with me being sick. [One cancellation was due to patient illness.] So, you know, I don't know what to tell you about that. I did become depressed, that's true. I am depressed. I suppose, uhm, I know I'm, I don't know how to get out of the depression. I don't know how to relieve various pressures. I don't. I mean. I feel kind of lost and isolated and, uhm, depressed. I guess part of it is that I've always considered myself fun, strong, and knew how to deal with whatever it is that I needed to deal with and go on with what I have to do. But it's getting, it's just getting to be a lot. I think I've always put cer- tain amounts of pressure on myself but I'm starting to feel, like, nervous about a lot of things which I didn't, which didn't, you know, use to make me nervous. And sometimes I feel nervous about coming here and, uhm. .. : T: When did you feel nervous about coming here? : P: WeIl, I always feel nervous about coming here. : T: But more than usual? : P: Yeah. : T:When? : P: WeIl, before I come. : T: You said ..I started to feel nervous about coming here," making it sound like there was some change. : P: No, I always feel somewhat nervous about coming here. I mean, I didn't feel nervous when I'm coming for, like, evaluations and stuff like that. Being here, I feel kind of nervous. And, uhm, I don't think I should feel that way about coming here. I guess I'm not sure. : T: Why not? : P: Why shouldn't I? : T: Yeah. : P: Well, I think that I should kind of have a different outlook that this is something that is, that I felt that I was doing for myself to kind of help me out or relieve some of the nervousness or re- lieve some of the tension. But. ... : T: WeIl, but you weren't feeling nervous before. And you had every reason to feel nervous and upset and depressed. And you weren't feeling that. And so we've been working on your not avoiding now what you have been avoiding for a very long time. And it's not going to feel good. Although you are doing what you can now to avoid here. : P: [sighs] Well, I guess I'm also not really sure, I mean, I guess it makes me think about why I react the way I do to certain things and why I, I kind of take on a lot of things. And why I avoid a lot of things. And I'm not, I'm not really sure why that happens. I mean, I guess I should feel nervous coming here, : apprehensive, or whatever. But it also makes me feel more nervous and : apprehensive while not here. Which isn't really a good thing and I guess that I thought that coming here would be a good thing. : T: You did hope, it sounds like you did hope that somehow, magically, you wouldn't have to feel anything about the situation you're in. : {Another aspect for focusing the treatment is the order in which interpretations are made and in which themes are taken up. This young woman had made a slip of the tongue in the second session, saying, "I'm married and I don't want to," adding to the therapist's impression that such a wish was a powerful motivating factor in her elopement and continued secret marriage. She could believe she wasn't married, and in all important objective ways, she wasn't. But the therapist let the slip go by without a remark, deciding that to take it up that early in the treatment would be premature. Only af ter she could admit her hostility and vengefulness, and begin to experience some of the sadness and apathy associated with losing fantasied parents and their surrogates (her in- laws), could she consciously contemplate the relationship with her husband.} : P: l find myself doing things, I find myself not, kind of changing, when you get married you change, I think the ways in which you do certain things. And a lot of your dependencies on parents or whoever and I find myselfnot changing those things. I'm not saying, you know, I'm married, I can't, I don't. The only thing that I don't do because I'm married is go out with other men. I mean that's the only thing, and that's fine because I didn't do that that much in the past either. : T: So it really hasn't meant anything different for you. : P: I guess I just kind of felt that it couldn't really mean anything different until we were together. 'Cause I'm not exactly sure how I'm supposed to be different. I live with people, I'm surrounded by people all day, everyday, who are not married, so, but who are in the same, who are just like me in every other way. So, I'm just kind of, I just, I really did keep my same life-style. : T: And that's the idea. : P: The idea. ... : T: You weren't ready for whatever reasons to accept the idea that you're a married woman so by keeping it a secret, you could keep on going as if you weren't married and keep everything the same.And buy time that way. : P: So if that's true, then the conflict is really not with my parents, and my parents' approval or disapproval of the marriage. It's with myself and : accepting the fact and everything else that goes along with it that I'm married. : T: Did you know that already? : P: Not well enough to say [laughs]. And I guess I would start to think about what I shouldn't be doing as someone who's married. And I couldn't even begin, I don't know what those things are. I feel like, in a way, I feel like I was trying to get in, like the last months that I could have been someone's daughter, and. .. : T: Uh hum. And it didn't work the way you had hoped. : P: Uh, huh. And I guess also, because it didn't work the way I had hoped, I : decided to be my mother and father-in- law's daughter, because that worked, really easily. : {By the sixth session her ambivalence about her dependency on her in-laws has come under scrutiny. } : P: I mean they [her in-laws] treat me like I'm a married woman by : acknowledging the fact that I'm married, but they really treat me like another one of their children, not like an adult friend. And I've also been looking at, you know, but yet I depend on that treatment. : T: That you may in fact like it. : P: I don't think that that's not a good thing. You know, I mean, you know, in a lot of ways, you know of instances, they put me not in the same category , but sometimes they treat me in the same way like they would treat their daughter, but their daughter is 14. And, you know. .. : T: That doesn't fit so easily with you any more? : P: Well, it did, it did. It makes it. .. : T: You probably enjoyed it for a long time. P: Yeah, I've enjoyed it for a really long time, but it's not what should be happening. You know, I was looking at the fact that for Easter, uhm, my husband's father has always given me some kind of stuffed animal, and you know, he did it again this year, and like, the same kind of thing that he gave to his daughter,and it means a lot to me, but I don't think that it should, you know, that it should make me that happy, that it should make me that excited. I don't, you know, I shouldn't be expecting Easter presents any more, or especially of that sort. : T: You sound today a little bit more like you'd like to grow up. You know, it doesn't, it's like a suit of clothes that doesn't fit any more. : P: Well, I think that it's really important that I do, you know, I look at all the things that I get angry or frustrated with my parents for not doing, you know, that his parents do do. Like when I went to ... : T: Neither one and you're not happy with either? : P: Right. When, you know, the morning of the funeral, I, uhm, I was really : hungry. And I hadn't slept at home, but one of the ladies, one of my grandmother's friends that was there, you know, said to my mother, .'Why didn't you feed your daughter this moming? Why didn't you give her breakfast?" She said, ..My daughter is going to be 22 years old this week, you know, she wants breakfast, let her get breakfast" [laughs]. But where, as I was thinking, you know, if I were to be at my husband's house, I would walk downstairs and breakfast would be on the table. And I wouldn't have, you know, I don't have to think about those little things. And they ask me things like, ..When are you going to do your homework? Have you done your schoolwork?" Why should they be asking me that? You know, these are all things that I should be able to take care of without having people tell me. And I've made such a big. ..I always bring my clothes home to wash them, you know, and I always did it myself, and one time this year I asked my mother to do them, to do it 'cause I had a lot of other things to do, and I never really ask her, and she really did, this sounds so ridiculous, but she really did a terrible job, and she didn 't take care of my clothes like she used to. And then a couple of weeks ago, I had. ..I brought them all to my husband's grandmother's house 'cause I wanted to spend the time there, and they only have a washer, so I couldn't really dry them, so my mother-in-law took them all home and did them, and, you know, folded them, and I didn't have to do anything, but these should be all, you know, all these little things I should be perfectly, you know, I should just feel, I should never feel that I want to ask anyone else to do these kinds of things for me, you know, I shouldn't, I get so frustrated when I go home that my mother isn't making meals anymore. : T: And you feel ashamed about that? : P: Yeah, it's kind of, it's ridiculous that I expect these things of her. ... : T: But you do. : {The therapist underscores her nascent changes, all the more convincing for the wistful confessional tone in admitting to the old pleasures. At the same time, as she nourishes these new beginnings, the therapist is attentive for more opportunities to continue the focused line of interpretation. Soon the opportunity arises. } : P: Like half the time I take on responsibilities that are supposed to be adult responsibilities, like, you know, dealing with his grandmother and taking care of her. ... : T: And the other half? : P: It's not consistent. And I think that it really needs to be consistent. : [More unrealistic thinking.] : T: But it will be consistent in time. It's just you have to go through a transition right now, and it sounds like what you're doing. It's going to be a bit uneven, more than a little bit uneven. It's going to be uncomfortably uneven for a long time. : {The patient continues, showing a greater acuity now in her reality testing as a result of the line of interpretations, and she adds an important piece of historical information, the psychological meaning of which is just beginning to dawn on her.} : P: [sighs] And I was also looking at, uhm, like the relationships between my mother and father, and the relationship between like my mother- and father-in- law, and when my mother- and father- in-law don't have a very stable marriage, and part of that is because, you know, throughout their whole marriage, my father-in-law treated my mother-in-law like a child. She was really dependent on him for everything. And then, when he couldn't, you know, didn't really fulfill that need anymore, and she was expected to do a lot of things on her own, she became really bitter and resentful. And the incredible depression that she's going through over the loss of her mother is because she really has to become, she never be- came independent of her at all. Like in any aspect. Whereas my mother didn't even live with her mother till she was 17 and was completely independent of her. : T: Your mother didn't live with her mother until she was 17? Who did she live with? : P: U hm, her father, her father's mother, and her aunt. Her parents were : divorced when she was three years old. So, when she came to go to school in New York, she lived with her mother. : T: So you've got two different models of married women now to look at, too. And you're not sure which one you want to be. : P: Well, I want, I know that I want to be independent of everyone [laughs], but, u hm, it's really hard, and, I guess, you know, part of coming here has made me realize how dependent I am on everyone' : {Relationship between therapist and patient. The patient's magical and childish expectations of the therapeutic relationship are now becoming more overt and open for her inspection. While they work on these aspects of the relationship : between therapist and patient, using the structure of the treatment to highlight her idiosyncratic wishes and fantasies, the focus of the secrets between patient and mother became sharper .} : T: Listening today, I could reconstruct how you were thinking last fall. "If you, my parents. are going to act this way when I try to discuss something with you, there's no point in discussing it, so I'm going to elope without your knowing it and never tell you, and not tell you." Uhm ...as a way of both protecting yourself from getting hit again and also as revenge for their having hit you before. : P: Huh, uh. Yeah, I guess so. And I think, I think there are a lot of things that I just decide not to tell them because I don't feel that I could discuss it with them. ...I learned in the year, I was really sick and, uhm, doctors had first thought that I had a tubal pregnancy and I had to go see a lot of different doctors before they figured out that I had a cyst and, uhm, and in the beginning I was really scared and it was right after my husband had left and people were saying, "Now why don't you tell your mother?" And I just, I never told her. I just didn't want to tell her. In fact, I've never discussed anything, uhm, that had to do with gynecology or , or, me with her. And I guess I also resent her for not asking me. ..I resent her for not asking me about things like birth control and where she knows that I must see a doctor or where I see a doctor, or anything like that. She did know one time when I went to her gynecologist once, last year, and I told her that I wanted to go. I wanted to go before I went to California and he gave me a prescription for the Pill and I told her that and she just kind of made herself feel comfortable with it by saying that it was really for cramps. : {The psychotherapist then proceeds to do what the patient has always wanted (and not wanted) the mother to do, to ask about sexual matters.} : T: What are you using for birth control now? : P: Well, I got off the pill and my husband left so I guess I'll have to go back to using a diaphragm when I see him again. Because the Pill wasn't good for me. : T: Do you have a diaphragm? : P: Yeah. Which also I know that she knows about because it was, I didn't take it with me to California over the summer, I left it in the drawer in my room and when I came back it was thrown in my closet. : {The psychotheraplst makes a 'prophylactic' interpretation designed to prevent any further acting out in a situation rife with acting out. Although it is predictably denied by the patient, the patient will, nonetheless, be less likely to act on this impulse.} : T: The two of you are at a standoff, and there's a vengeful component to your, at this point, being married and keeping it a secret. The part of it that : motivated it is to get back at her for not acknowledging that you are a sexual person. You might even be tempted to get pregnant to. .. : P: I seriously doubt that ...I don't think that. I have no desire to be pregnant now. I really don't. : By this point the patient was visibly depressed, and again, unlike the patient's mother, the therapist commented on it. : T: you look different today. you look depressed today. Are you feeling kind of low? : P: WeIl, one of the main reasons I look different today has been because I guess I didn't get a lot of sleep last night. I got up this morning and went swim- ming and, yeah, I guess I'm also a little bit depressed. : T: What's the content of your depression? Are you aware of it at all? : P: Well, I'm just depressed about facing this whole situation. And maybe I was also a little depressed coming here and knowing that I was going to have to really face it again. So you know [sighs] ...I'll probably go home one day this week. ..'cause usually when I go home I don't stay around them very long, you know, I do what I have to do and I take the car to go to do what I need to do. ..so, Sunday I stayed home all day, which I hadn't done in a long time. I guess maybe inside I expected something miraculous to happen [laughs] but, uhm, it didn't. : T: It never does. P: No, it doesn't. But I guess sometimes I expect them to just maybe come to me and say, ..What is the matter?" You know, ..What's going on?" You can look at me and say, ..you look depressed." They can certainly look at me and say that I look depressed or think that I look depressed. I certainly don't walk around the house smiling and happy. : T: You don't? P: No, and I suppose that at certain points, maybe I even, uhm, consciously don't do that. So that maybe they'll say, ..What's wrong?" but they never do [laughs]. : {Increasingly and repetitively, this patient's sullen, passively hostile, and avoidant attitude toward her parents is taken up alongside her passive and magical wishes for the treatment. As a result of this, the patient becomes more direct about and responsible for her anger. In the fifth meeting, she was able to say the following } : P: Uh hm. I am really angry with them. : T: Yeah, you are. I think you alternate between being very angry about it and very depressed about it. You know, feeling hurt and rejected. And I think it was from that that you made the decision to marry your husband when you did and how you did - keeping it a secret was a way of getting back at them. You felt that they were keeping secrets from you. That they had really excluded you, and so you were going to exclude them to get back to them. And I also think that you're trying to cope with a big transition in your life from being someone else's daughter to being some- one else's wife. And that you somehow, as you said to me at the beginning of the hour, you said, ..I just don't want to feel this way. I don't want to feel this." That you had hoped that you could get through this without feeling any of it. Without feeling depressed, without feeling angry. : P: But I think a big part of it is that I really [sighs] I really want them to be part of it, and I also think that I really, I need them more than I ever thought that I did. I, I really need the help now. And I've needed their help for a long time but I really need it now ...everytime, they hurt me I would always come out of it deciding, well, you know, if they're going to do this then I don't need them. But I really do. Yeah, before I went to California I remember telling you that, uhm, you know, she said ..to go and do what I had to do" and that she would be there for me when I came back and she wasn't. And that really probably has hurt the most out of all of it. And I thought that in the beginning of the year I did, you know, I did make an effort, I asked her to come up to school and took her out to dinner . And we talked, we had a serious talk, and I thought that that would maybe be like the first gesture in a long line of, I mean my mother does not live that far away from me and she sees me and it's not that much for her to get in the car and come up and go out to dinner with me or just come over to my house once in a while. And I thought, I really thought that she would take this opportunity to do that but instead I feel like she's just kind of tending to what my father needs. : T: Had she ever done that before, though? : Just get in the car and come up and see you? : P:No. : T: So you were expecting something more from her now, and back then, you know, last fall. You were expecting more from her than she'd ever given you. : {By focusing on her increased and unrealistic expectations of her mother and the ambiguous and ambivalent move into marriage, the patient can begin to : experience affects she has been suppressing and repressing. Just a few moments later: } : P: I should be prepared for that to happen, instead of, u hm, wanting to have kind of a closer relationship. Well, also, I mean, a part of it is, I felt that we never really had that very close relationship. And I, part of the reason that I wanted to come back was maybe to try to have that kind of relationship. But, it's not, it wasn't going to happen [sighs]. : T: What was that sigh? : P: Well, that doesn't. ..you begin realizing that doesn't stop me from wanting it to happen. : T: And feeling hurt. I had the impression you're feeling quite bad now. : P: Uh hum. I mean, I also, I think that I need [sighs] ...I needed to have that kind of relationship for a while. And I didn't, and I wasn't finding it in my mother and in a lot of ways I found it in my mother-in-law which has led to a kind of dependence on my part and on her part but concentrating on my part, : u hm, that maybe isn't necessarily a good thing either. : : Terminating Treatment : As the end of treatment approached, a number of hazards, common in brief : psychotherapy, became apparent. Chief among them is the patient's attempt to leave in despair, recapitulating in an almost perverse fashion the old behaviors that brought them to treatment. The progress and momentum of the earlier part of treatment are called to a halt, and attention must be paid again to the relationship with the therapist with special attention to the meanings of the imminent separation. To counter the centrifugal pull to undo all the work accomplished so far, therapist and patient alike must review the achievements realistically. Not surprisingly, the harbinger of the termination phase was a broken appointment. All previously missed sessions had been cancelled. Her husband's grandmother had died and the funeral was scheduled during the appointment. At the next meeting, the patient was distant and unable to account for her not calling the therapist. Her husband had flown in for the funeral and stayed with her over the next week. Resistánces were intensified. She had : devoted herself to her in-laws with a vengeance, using the funeral as the : rationalization. With three more sessions left, she had not told her parents about her husband and appeared to be repetitiously engaged in the same behaviors that brought her to treatment. She complained to the therapist: : P: I just wait, and wait, and wait, and sometimes they get done, and sometimes they don't, depending on, I guess, the importance of the situation. And then, at the same time, I also always take on a tremendous amount of, you know, extra activities, extra responsibilities, and I end up rushing to get them all done, so, it's not always at the most opportune time, so. .. : {She is teling the therapist that she will end treatment the same way she came in, procrastinating and feeling fragmented. The ending is near, but she is not fully aware of her reaction. The therapist used this opportunity to reorient and focus the patient on her initial complaint and did not get interested in the broader characterological issues.} : T: Wel1, that may be, from your description, sounds like it's a broader issue than what you brought here. That it's an issue that has to do with your : character in some ways, but I have a feeling, at this point, it may be, you may be using it to try to diffuse our focus on just the specifics of your delay in beginning to rearrange your relationship with your parents. : P: And to accept the fact that I'm married. : {Now that her husband had joined her, one hindrance to the evolution of her : ambivalence was momentarily remedied. Her husband was keenly aware of her : unfinished business:} : P: My husband keeps saying to me now at the basis of every argument is the fact that he feels that I'm not, that he's not like my first priority and that I think I told you that he thinks his parents are but that's not really what it is. [Long pause.] It's scary to say it but I guess after my parents, you know, after I've finished everything I need to with my parents, that's when I'm going to be able to really look at my relationship, I guess. : T: What was scary about saying that? : P: But if that's the point, that I'm going to be able to look at it then there's still a possibility that it's that I'm not going to want it. I guess it's also kind of a question of do I need or do I want a husband or as far as like fulfilling my part of being a wife or do I need a mother, and, you know, then fulfilling my part as being a child. My husband made a comment to me that he thinks his mother and I have what could be considered a marriage, that kind of relationship [laughs]. I mean I thought that was really ridiculous, but he, that's not it at all; it's that we have what could be considered a mother-daughter relationship. : {She and her husband had talked about ending the marriage. The patient reported this in a cursory fashion initially, as if admitting to failure, not aware of how long' overdue such a talk was.} : P: Uhm, he said, well, maybe we just, you know, aren't the right people for each other and, you know, maybe you need something different, maybe I need something different. And I wasn't happy with that and then afterward he said that that wasn't really what he wanted, he wanted for things to work between us but he wanted, you know, needed to be able to understand more of what he needed and, you know, he said that he compared it to when I was in California and that he was working really hard and he was working a lot of hours but he always took out time for me but then again he didn't have anything else there, you know. My classes end, I'm like ...when day ends my school work is hardly over. So I have, I'm thinking about other things. But, you know, he felt that I was thinking about his family too much. So, but we, I mean, that's how the thing about marriage ending came up but then he said that isn't what he wanted. So we kind of dropped that idea but it was just sort of startling to have it even come up. You know, that we shouldn't be together. : T: I don't know how startling it is. You certainly have begun to wonder : yourself with me how much you wanted to be married. : P: Yeah, but I did, I have, you know, I definitely wondered about that but I think that wondering if I want to be married or not is like sort of the same things wondering if I want to break away from being, uhm, a child, or you know, having that security. : At the last session, the patient's affect was stoically depressed. Together, therapist and patient go over what has been accomplished. Of her marriage she says: : P: I think I realized that I wasn't really as ready for it as I thought that I was. But, all in all, it exists and it's not something I want to end so I just have to live up to my part of it. And my parents being included in it isn't really, you know, that's not really where the problem lies whether they're part of it or not. It's completely my own thing, my own doing and they shouldn't really be making it any better or any worse for me. You know, it's kind of looking for them to be able to make it easier for me. And that's not really their, it's not their job. : T: Yeah, well, they're not able to do that. : P: Right. So it's also not fair for me to have those kinds of expectations of them, I guess. : T: You can wish to, but when it's as clear as it is that they cannot be more helpful to you now, then it's a problem if you can't recognize that and do what you have to do. : P: Right. : T: And that was the position you were in when you came. And I think you've changed in that regard. : {The psychotherapist picked up on her stoic affect.} : T: This all sounds right but I'm wondering about a certain flatness in the way you talk about it or I don't know whether you're mildly depressed today? : P: Well, I kind of feellike shit anyway so I'm sure that doesn't help, it doesn't help at all so, yesterday I stayed in bed all day, which is something I haven't done in a really long time and I really didn't feel well [a cold]. And I think it's also kind of everythine: coming, you know, the last couple of weeks just kind of came down on me I guess. The weather and all that doesn't help. But I also know that, now I can take care of my responsibilities and I can do what I have to do, just sort of let everyone else do what they have to do also. : T: Part of the things that are coming down on you is ending. : P: Yeah, that's part of it. School's ending. Lots of things are ending. My husband is back, you know, doing what he has to do, so I have to pick up my end. That's it. [Pause] I don't think there's a lot more to say. [Long pause] I think I've said just about everything there is to say about it. : T: What's the mood you have about all of this? : P: About all, everything that's happened? Uhm, I could let it be really depressing if I chose to but, uhm, so, in a sense maybe, you know, maybe I am trying to ignore it but, you know, that's just kind of the only way I feel like I can get things done. I also don't feel like it's that severe a depression 'cause, you know, whatever I would be depressed about I more or less know how I have to handle, so. It's not like a hopeless depression. : {She ended seeing her mother-in-law with a clearer eye, aware of the gaps in her relationship with her mother. She saw how it had happened. She ended with : apprehension for her future with her husband. She ended sadder but possibly wiser.} : {Follow-Up Interview : For the patient's reaction to the treatment, she was invited for a follow-up : interview with the therapist four months after termination. The patient continued to live apart from her husband, with her paternal grandmother or with her parents a couple of nights a week. She was working, saving money, and planning to move to the West Coast in two months when she and her husband would be provided housing by the military. She had not told her parents of her marriage, but she had told her paternal grandmother, hoping, perhaps, that she would tell for her. She had spoken to the therapist two months earlier asking for the name of a psychiatrist for her mother-in-law. She specified a : psychiatrist because she felt her mother-in- law might need medication. This represented a consolidation ofher new attitude toward her mother-in-law and a clear behavioral change. : P: ...I don't have the power to make everything better for them. I don't have the power to change them. I can't let their problems consume my life and my thoughts because that can only be done by them. ...And I have to keep in mind a distinction between her relationship with her children and her relationship with me. I can't go around seeing her as a mother figure. The whole thing about blood is thicker than water. Well [laughs], it's really true. I have to keep in mind whose mother she really is. : {She saw her mother-in-law much less frequently than before, even though she lived even closer to her after graduation. Symptomatically, the patient was no longer depressed or in crisis. On follow-up, her mood was bright and she had no complaints of disturbed sleep or appetite. She was working as a receptionist for the mailorder department of a nationally known department store. She looked poised, and as if she was enjoying her first job. : -------------------------------------------------------------------------- : Jan's request to you: : a. Post a message on the forum of Sandy's most likely enneatype and/or Oldham-style. : b. Do you know of a similar situation you (or someone you know) was in? How did they react, in relation to their enneatype? : c. Do you like these in-dept cases? Are they too long to read? : Cheers : Jan :

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