Bruno Bettelheim once bemoaned that however successful his books for the general public may have been, he could not successfully write a novel. I think we psychotherapists too often learn to revise the scripts we mentally compose about our patients for it to be easy for us to complete a narrative with confidence. At least, that has been on my mind in regard to Laura for the last couple of weeks.
A couple of weeks ago, Laura's mother arranged for an opportunity for Laura to get at least part-time work in Laura's field. (Laura presently works in a responsible, grueling occupation of quite another sort.) Laura followed through and was hired. Afterwards, I did not hear from Laura as I expected to make our next appointment. My thoughts were that Laura had trouble inwardly accommodating the sudden idea of two good mothers and that I might hear from her when her list of complaints against her mother grew again. Just about when I wondered whether I should call Laura, she called me. It seems that her father had gone into the hospital with critical symptoms, her mother went into another crisis, her regular job required her to do double work and she needed to appear for her new, auxiliary job. She was eager to resume our sessions.
In a similar way to my assumptions about why I had not heard from Laura, Vic's speculations about Laura's motivations and behavior are perfectly logical. Just as logical are previous speculations by women who offered ideas that valued Laura's mother and suggested that Laura was a victim of men.
Gender is not the only organizer of our thoughts, of course. We all approach the synopses on BOL with whatever theoretical framework we prefer in trying to understand our patients. As I hope has been clear in previous communications from me, I try to remember that the therapist who is sharing information about a case always relies on more promptings and clues from the patient than it is possible to document in the synopses we offer.
In the case of Laura, my sense that behavior is ultimately problem-solving sets my perceptions at a rather concrete level. Thus, I more see Laura as dealing with confusing impulses from within herself than floundering because of clearly defined parental imagoes. On the other hand, I have really not described Laura's parents:
Her mother is narcissistic and controlling, competitive with Laura for the father although contemptuous of him. She also is proud of Laura, showing dependence on her within the home--although she also demands recognition of her talents as a cook. Her interest in Laura's appearance tends toward an image of a little doll. She is exceptionally competent outside of the home.
Her father is a good provider, but he drinks heavily when he is at home. In parallel with Laura's mother's closeness with Laura's older brother, the father is close with Laura. He treats her with affection and respect, contrasting with the mother in his accuracy regarding Laura's communications. He stops short of specifically sexual contact with Laura, but his hugging and kissing of her feel excessive to Laura.
Laura's father and mother fight constantly. The brother is now living far away, but he and Laura have a warm and close relationship.
I think that had Mr. Y not been on the scene, Laura would not have developed the intensity of symptoms that plagued her. I say that because as far as I know, her ego strengths have come increasingly into focus as she gradually allowed herself to deal with the significance to her of Mr. Y's actions.
Nonetheless, it is a challenge for her to discern for herself that she is a good person, that she is lovable, that her growing up does not endanger anyone else. As the next vignette will illustrate, I believe, Tom does fit into her present life according to her need for playing out her version of her parents' relationship (as Vic suggested). It may be that this includes the good aspects of her relationship with Tom, too, but I do not know enough about what Laura might have observed about her parents at a better time in their lives.
The good aspects of Laura's relationship with Tom are important. They both experience happiness in being with each other. This has included sexuality at times.
Tom was not ready to get married, but he is committed to Laura. He was willing enough to formalize an engagement to her; and at least outwardly comfortable to postpone it. He does feel as if she might reject him completely at any time. She does not feel sure of him--nor of her wish to continue with him.
Tom was adopted and always felt less accepted by his parents than a sister was. Apparently brilliant and able to form friendships, he is too untrusting, too vulnerable to feeling cast off to be able to sustain a presence when Laura reaches out to him. For now, their mutual needs seem to dovetail enough that Laura is able to try to understand herself better in the relationship; and finally, Tom has begun work with an excellent therapist. He made it clear to Laura that he has come to see that his own happiness depends upon catching hold of his "old stuff." perhaps he recognizes that Laura is beginning to react in more constructive ways and gains hope for himself on that basis. Or perhaps he tells her about his motivation to hide how much he is proceeding with therapy because he is terrified of losing her. Nonetheless, it might even be that they will continue to find each other valuable.
Back to Laura and Vic's suggestions about the meaning of some of her behavior, I have trouble with the idea of so primitive and unpleasant a mechanism as bulimia being merely a test for someone else's loyalty. Such symptoms are to me activated through the child layers of our minds. Laura's mother's pride in her cooking and demand for attention because of it could only reinforce, I believe, an equation of food=mother that most babies learn. I can see bulimia as a demonstration of her own loyalty to the man that she throws off her "mother," but I do not know how often it has mattered that a man in her life be aware of her throwing up. For Laura specifically, this is a long-standing symptom from the time that Laura was sixteen.
The matter of control in relation to sexuality is a tremendous one, of course. Maybe Mr. Y's seductive tenderness when Laura was very young safeguarded her ability to enjoy sex in spite of what happened later, when Mr. Y acted more bizarrely and at times brutally. In any case, the control issue seems to be at a conscious level for Laura now. She recognizes and reacts self-protectively when she feels that Tom is ignoring her feelings. At times when he accepts her limit-setting sexually, their rapport is good generally, and he approaches her with sensitivity, she is able to enjoy their lovemaking. So far this has coincided with times when Laura has held her mother away. I think we will be at a significant point for Laura when her relationship with Tom will not reflect the state of her ongoing relationship with her mother, either way.