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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by mair on January 23, 2007, at 21:39:03
Do you know how tall your T is?
I've been seeing mine for years, and I always had this general sense that she was only slightly shorter than me. I'm almost 5'9", and I had her pegged at about 5'7 1/2." We're rarely standing right next to each other. I usually sort of skulk into her office and immediately sit down. The only time I'm standing face to face with her is when I get up to leave and we're still not right next to each other.
This summer, it started to dawn on me that she really was shorter than I thought she was. Then I realized that I was seeing her differently because she had lost a fair amount of weight.
As some of you know, she now has breast cancer. She started chemo a few weeks ago and is sort of on an every other week work schedule. There was nothing very different about her after her first chemo, but when I walked in the other day, after her 2nd chemo session, she had lost nearly all of her hair, and what there was left, was a different color. She's always had a lot of hair - not necessarily really long, but very thick.
Now she's starting to look tons smaller, and I realize that my sense of her before was a total misperception. I'm guessing now that she's not much more than 5'4", if even that.
I had such a hard time avoiding distraction during the last session. I felt that it was my job to stay focused on my issues, and that this is what she needed me to do, but she looked so shockingly different and it was hard to look at her and think about anything other than how awful this whole experience is for her.
Since last seeing her, I've been dreading the next session. I was supposed to see her today, but she left a message on my voice mail at work telling me that she had a very bad sore throat and couldn't work today. She sounded pretty miserable. I know it's really bad for her to be sick because it means that her doctor will postpone chemo, thereby drawing the whole process out for that much longer. So not only did she sound miserable because she was sick, but I'm sure she's upset about even getting sick. For me, on the other hand, it was almost a relief to have my session cancelled.
If I was seeing her daily, it would be easier to get used to the changes. But now that I'm seeing her sporadically, her appearance comes as a shock. And it's not just having her hair fall out. It's also her pallor and the fact that she's lost even more weight. She's always been very upbeat and vibrant. The upbeat, vibrant part is harder to see now.
I'm also wondering about the height misperception. Is it possible that as she seems smaller, she diminishes for me in other ways? I'd hate to think that I would react that way, but there has been a definite shift in our relationship. I can't and don't rely on her in quite the same way since I'm seeing her less frequently, and when I think about her, I only think about how awful her life is now, and what she can't do and the ways in which she can't be there for others. And I'm ashamed to say that I find myself feeling irked when she doesn't seem to understand what I'm saying or if the response I get from her is really not what I want.
This is harder than I ever even thought it would be.
mair
Posted by annierose on January 23, 2007, at 22:08:16
In reply to My T's Appearance, posted by mair on January 23, 2007, at 21:39:03
Mair -
This is so hard. For you, for her --- it just is sad. I give you both applause for handling this so well.
Of the few friends that have gone through this process, they do appear smaller. When you are sick, you get weak, lose weight, hair thins or disappears --- and when you feel sick, you just don't stand as tall or straight.
I feel for you. It almost feels you are going to therapy as much for her than for you right now. I hear that and I understand that too. I hope she feels better soon and you get your t back.
Posted by mair on January 24, 2007, at 12:52:42
In reply to Re: My T's Appearance » mair, posted by annierose on January 23, 2007, at 22:08:16
"It almost feels you are going to therapy as much for her than for you right now."
You're absolutely right! I do feel this obligation to her, and I don't like the feeling at all. I need another way of looking at therapy now. I'm just not sure what that is.
mair
Posted by Honore on January 24, 2007, at 15:26:52
In reply to Re: My T's Appearance » annierose, posted by mair on January 24, 2007, at 12:52:42
Hi, mair.
Maybe your T isn't handling in the way that could be helpful for you-- and maybe you really need to talk with her about it. I know it could be hard-- but she may be struggling with how is best for you-- and missing you-- but be really eager to hear more about what you do need now.
It's so possible that she's aware of how difficult this is-- no matter how ill she feels, unless she's too sick to be seeing patients-- in which case, she needs to confront that. But she sounds as if she could be more capable of handling your real feelings than you realize..
It's eally important to get to a better place with her, for your own sake-- you do matter here-- I'm sure she would agree--this has to be primarily about /for you, not her (even though she may also get a lot from it, too, of course).
When I've gone through various crises in my life (and in therapy), I've been helped by reading about it in the psychoanalytic journals. There are a lot of thoughtful and very insightful articles, and it occurred to me that I'd seen some on the subject of illness in a therapist.
The articles all address the very real problem that a therapist's illness can be a really damaging experience for a patient. Yet they also point out the potential for growth and deepening of both relationship and the patients' own self-awareness.
---
I had trouble actually accessing any of the articles online-- many are in Journals of Psychoanalysis or Psychotherapy-- which I know I could get through the Medical School here-- but I haven't gotten library privileges there personally. If you're near connected to a University, you might be able to get access through the library. If not, I'll see if I can figure out more about my own access.
Also, I don't know if you've read any psychoanalytic articles. If not, some of the language (which is a private, sort of analytic language) can be hard to interpret-- I could just define a few words that would make it all much clearer. It's really not complicated-- just a specialized terminology.
A couple are:
1. [A Book] "Illness in the Analyst: Implications for the Treatment Relationship": edited by Harvey S. Schwartz, M.D., and Ann-Louise S. Silver, M.D., International Universities Press, Madison, CT, 1990, 347 pp., $24.95.
Review by: George Nicklin, M.D. Author Information
"Cycles of interest on how professionals cope with major illness run through the social fabric. Forty years ago, When Doctors Are Patients (1952) edited by Pinner and Miller, was published. Each chapter was a study of a physician coping with a major illness. Recently (1987) a follow up book, When Doctors Get Sick edited by Mandell and Spiro, was published, and now a book on how 14 analysts—both medical and nonmedical—cope with the onset of major medical problems appears. These problems range from conditions so vivid the patients inevitably become aware (e.g., pregnancy), to obscure situations that force absence from the office in such a way as to leave the patient free to conjecture the illness in the transference neurosis, as the analyst gives minimal information of the etiology of the disruption. Eleven of the contributors are physicians, two are Ph.Ds, and one is an M.S.S.W.
The ailments range from silent heart attack with cardiac arrest and revival to several ..." (no more given)
2. Am J Psychother. 1990 Oct;44(4):590-7.
A patient-therapist's reaction to her therapist's serious illness * Simon JC.Clinical attention to a crisis in the therapist's life has been scant. Both therapist and patient are touched by a significant occurrence in the therapist's life. Impact on the psychotherapy process is unavoidable. This paper traces the patient's (who is also a therapist) reactions, feelings, thoughts, and experiences in response to her therapist's acute cardiac illness. These include denial, abandonment, anger, compassion, and concern. Writing as patient, the author is re-reminded of the importance therapists hold in their patients' lives. She discusses her concurrent distancing from the psychotherapy process and the depth of her involvement in it. Writing as therapist, she raises salient questions for the clinician, offers recommendations stemming from her experience, comments about transference components of the relationship and discusses the place of the real relationship. Included is a brief review of the limited literature on the subject.
PMID: 2285082 [PubMed - indexed for MEDLINE]
3. [In German--but I left it in, because the abstract is pretty good]
Psyche (Stuttg). 1995 Jun;49(6):564-80.
[Physical illness in the transference and countertransference] [Article in German] * Rodewig K. Niedersachsisches andeskrankenhaus Tiefenbrunn, Rosdorf/Gottingen.The significance of severe physical illness in terms of the repercussions it may have on the course of psychoanalytic treatment is a topic that has received very little attention in the literature. The author approaches the problem from the point of view of transference and counter-transference on the one hand, and from a distinction between self and body-self on the other. Rodewig proceeds on the assumption that a physical ailment can have the character of an object and may thus attain the status of third object. Given the threat posed by dangerous physical illness, the ego has recourse to defence mechanisms such as splitting and separate projective identification of positive and negative object- and self-parts, projecting the omnipotent, idealizing desires onto the therapist and the negative desires onto the ailment itself. In a later stage a de-idealization of the therapist sets in and the latter is identified with the illness so that the illness is then bandied back and forth between patient and analyst. The most challenging technical problem for analysts is avoiding the projection of their own illness and death anxieties onto the patient with a view to resolving them there. Instead, they need to be worked in independently and then given back to the patient devoid of their original virulence. The author illustrates the various facets of the problem with brief reference to various case histories.
PMID: 7610265 [PubMed - indexed for MEDLINE]
4. Am J Psychother. 1994 Spring;48(2):221-30.
Countertransference issues when the therapist is ill or disabled. * Dewald PA.
St. Louis University School of Medicine, MO.Multiple external life events and vicissitudes can impinge upon the traditional privacy and isolation of the usual psychotherapy situation and relationship. Among these are major illness and disability in the therapist, which will activate conscious and unconscious responses in both patient and therapist. If worked with and well handled by the participants, such events may stimulate therapeutic growth and working through of multiple issues related to illness, separation, death, anxiety, and fantasies of omnipotence and idealization. However, multiple factors in both patient and therapist may combine to foster avoidance of the conflicts that have been activated. To the extent that countertransference responses in the therapist interfere with his/her ability to bring conscious attention to these issues, a potentially valuable therapeutic opportunity may be lost. It is important for therapists to therapists to anticipate such situations, and to make use of colleague consultation to assist in managing them.
5. * Counselman EF, * Alonso A.
Boston Institute for Psychotherapy, MA.
This paper examines the potential countertransference problems therapists face when they become ill. Personal illness creates conscious and unconscious dilemmas for therapists, and the psychotherapy relationship may be strongly affected by the ways in which the dilemmas are managed. Psychotherapy is a relationship based on trust. A therapist's illness does not necessarily damage the trust that has been developed; however, the handling of the illness and interruption can create a major rupture in the relationship. Alternatively, the therapist's illness can create a useful opportunity for therapeutic work. Successful management of countertransference is a crucial ingredient for the latter outcome. Relatively little has been written until recently on countertransference aspects of therapist illness. Available literature has noted such defenses as denial, omnipotent fantasies, and reaction formation against dependency and weakness. Illness has been seen as a problem for "older" therapists, but, in fact, illness can occur at any age. Illness may cause a defensive withdrawal from one's patients and in its most serious instance lead to total empathic failure. Clinical concerns for the ill therapist fall into two categories: how much (if any) information to give patients about the illness and how to work therapeutically with patients' reactions. While there are no clear guidelines, we recommend a flexible, common sense approach with the central focus always on the patient's reactions to information or to changes in the therapy. The foundation for decisions about information and for subsequent processing of reactions must be the therapist's own awareness of countertransference. We recommend consultation with trusted colleagues or supervisors. In addition, we emphasize the ethical responsibility every therapist has to provide for patients in the event of an emergency ahead of time. Finally, we surveyed a small number of experienced therapists who were known to have had personal experience with illness. The results indicated that decisions about giving information were not difficult. However, the countertransference reactions of anxiety, denial, sadness, and avoidance (of patient anger) were often troublesome. We recommend that psychotherapy training include management of therapist illness. We also recommend that supervisors be familiar with the countertransference aspects as they may be called on suddenly to give consultation. Our conclusion is that therapist illness is as big an event for the therapist as it is for the patient, and we hope that a body of literature will be developed on this important topic.
Hope one or another of these gives you a sense of what's missing now with your T. I'm really sorry you're having such a hard time.
Honore
Posted by Daisym on January 24, 2007, at 19:53:23
In reply to My T's Appearance, posted by mair on January 23, 2007, at 21:39:03
Mair,
I can only imagine how hard all this is. I want to wrap you and your therapist in a thick, warm blanket, safe from all hurt in the world.
I'm sure we all wish we could not notice things like appearance, but we are human and as a species we are programmed to respond better to the familiar. So the changes you describe would be disconcerting. How can you attend to your thoughts or needs when there is such a deregulating experience all around you? And more than the appearance, the life energy has changed. There is fear and sadness and pain and it is all in the room with both of you. From both of you.
Your description of being annoyed with her reminds me of how kids react when they are tense and on edge. One thing goes wrong and that is what they focus on, not the fact that they are in a new setting and missing their moms. So it makes sense to me that your annoyance would flare up at the misattunement, because you can't possibly get upset with her for being unavailable to you. So when she is available, she needs to make it up by being perfect. Not that any of this is conscious, of course. So no need to be ashamed. Easier said than done, I know.
OK - enough analyzing from me. I just feel so bad for you. Let me know if there is anything you need or I can do.
Hugs,
Daisy
Posted by mair on January 24, 2007, at 21:32:03
In reply to Re: My T's Appearance, posted by Honore on January 24, 2007, at 15:26:52
Wow - thanks so much for the cites. From just reading the summaries, it looks like these would be good for me to look at more closely. At least some of what is described are feelings that I can identify with. I've been feeling pretty guilty about the way I'm reacting, but maybe it's not all that unusual.
You'd think there would be a lot of studies on this sort of thing. Ts certainly get sick like the rest of us.
I trust my T's sense of professionalism - I'm pretty confident that she would take a break if she felt that she was bringing too much of her own stuff into the room. The only "stuff" she's bringing into the room now is her seriously altered appearance, and visible fatigue - that's enough.
One thing i hadn't thought about until I read your post was a comment that she made early on about how the truncated scheduling would mean that we couldn't really do the same sort of transference-based therapy. I'm amazingly unmindful of the bigger picture. I rarely think about the type of therapy we're doing and how it's different from anyone else's therapy. So to me, the less we meet, the less I feel like we need to meet. I'm sure part of the reason for this is that I need to meet with her pretty frequently to feel an ongoing sense of connection to her and to therapy. I'm stable enough these days that I'm not going to fall apart if I have to miss a bunch of sessions - but it also means, I guess, that I'm not going to get the benefit of the slow plodding progress we'd make otherwise.
I live very near a good medical school and I'm sure I can get access to the library. I'll try to get over there to take a look at the materials you referenced.
Thank you
mair
Posted by mair on January 24, 2007, at 21:47:43
In reply to Re: My T's Appearance » mair, posted by Daisym on January 24, 2007, at 19:53:23
" I'm sure we all wish we could not notice things like appearance, but we are human and as a species we are programmed to respond better to the familiar. So the changes you describe would be disconcerting. How can you attend to your thoughts or needs when there is such a deregulating experience all around you? And more than the appearance, the life energy has changed. There is fear and sadness and pain and it is all in the room with both of you. From both of you."
This is definitely true. It's also possible that I'm supplying most of the fear and sadness - she tries not to let that seep through. She hasn't sugar-coated the pain though, certainly not the physical pain.
>
"Your description of being annoyed with her reminds me of how kids react when they are tense and on edge. One thing goes wrong and that is what they focus on, not the fact that they are in a new setting and missing their moms. So it makes sense to me that your annoyance would flare up at the misattunement, because you can't possibly get upset with her for being unavailable to you."It feels so awful to feel annoyed - I find myself wanting to pull back but that also seems cruel to me. And it's not like I get the alternative of wrapping her in my friendship like I could do if our relationship was social.
"So when she is available, she needs to make it up by being perfect. Not that any of this is conscious, of course."
I'm the one who's worried about having to be perfect. On the other hand maybe, in my fear, I'm super-attuned to any evidence that she's distracted and not up to her job right now. I'm sure it's not fair to her. After all, even when she was well, I periodically got annoyed with her for not understanding what I was saying. I'm not always convinced that she's the best listener, although I've never really been able to tell her that. Why should I expect her to be a better listener now?
" OK - enough analyzing from me."I think your analysis is pretty good. Thank you.
mair
Posted by Dinah on January 25, 2007, at 9:56:08
In reply to My T's Appearance, posted by mair on January 23, 2007, at 21:39:03
I'm not sure that I can add anything to what others have said. I do think it's perfectly natural to have these feelings.
I would guess that it's also perfectly natural to have a self protective urge to pull back from her.
I know you feel reluctant to bridge these issues with her, but someotimes I've personally found that it's more uncomfortable for me to have the unspoken out there than an actual discussion. Maybe you could stick the toe in the water by saying a bit of how you're feeling and see how she reacts? It's hard to go through these things, but it's harder if you feel like you're in them alone.
((((Mair))))
((((Mair's therapist))))
Posted by zenhussy on January 27, 2007, at 0:42:18
In reply to Re: My T's Appearance » Daisym, posted by mair on January 24, 2007, at 21:47:43
>>It feels so awful to feel annoyed
yeah but it is how you feel.......therapy is that place to have those feelings, or at least talk about the feelings that arise.
been stumbling through life out here. you're heavily on mind and in thoughts. it is hard to read what others are going through and have gone through with their Ts over the years due to illness or other factors but it also helps to frame what's going on personally...helps shed new light and perspectives that otherwise may have not been considered...or not admitted to.
thank you for continuing to share here and glad that there are wise souls who can help with their words.
you're worth the support of course dear mair...perish any other thoughts! you're super worth it!! it feels strange at first to have permission to ask for support or to have it be okay to receive support.... but one can get used to it and more comfortable with it and actually benefit from not being so alone ;)
kindly,
--zh
Posted by mair on January 27, 2007, at 11:07:12
In reply to Re: My T's Appearance » mair, posted by zenhussy on January 27, 2007, at 0:42:18
Zen - I sure wish I knew what I could say to help you as much as you've always helped me. I think you're an incredible person who's friendship and support I value deeply.
mair
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