The third phase of treatment was the most difficult and lasted five months. It ushered in a fascinating process where Kathy now enacted in our therapeutic relationship the theme of her family's "refusal to recover." There were two parts to this phase. The first lasted about two months and consisted of Kathy arguing the absolute inevitability of repeating her family's tragic destiny. The second , more difficult part lasted three months and consisted of Kathy enacting with me her own powerful version of refusing to recover from her depression and take the spotlight. One of Kathy's arguments for the inevitability of repeating her family's tragic destiny, used the concept of a "wedge" between her husband and her children to explain that she was unable to enjoy being in the sunshine with both of them. The wedge forced her to choose and she would always choose the children. Her choice was similar to that in the movie "Sophie's Choice," where a mother in a concentration camp has to choose which one of her two children will be executed. I pointed out that in "Sophie's Choice" one child had to die, and questioned why she saw herself in the same dilemma with regard to her husband and children. Kathy traced the roots of the wedge concept to mother and maternal grandmother who both had unhappy marriages and who each lost a child to death. Kathy expressed deep sorrow for mother who always stayed in the background even before Dan died. During the session, Kathy suddenly visualized in her mind a stage. The stage had two spotlights waiting to be filled. One was for mother but the other was for Dan. Kathy cried as she exclaimed that she could never take Dan's spotlight.
Another metaphor Kathy used to describe her fate to repeat her family's tragedies was what she called the "sand sifting through her fingers." This metaphor described Kathy's sense of imminent loss and sadness about losing time with her children. Through my constant questioning and challenging of why she was losing time, Kathy gradually realized that in fact she was assuming she was going to lose one of her children, like mother and grandmother had . She continually feared this inevitable loss was swiftly approaching. We likened this metaphor to her symptom of obsessive worry about losing the children.
The next three months marked the most difficult phase of our work and represented an enactment in the treatment of the central theme of "refusal to recover." After the previous two months of challenging but productive work, Kathy suddenly felt totally hopeless and despondent about her progress. She continually repeated the question "Where was I? I can't remember and I can't do this." Soon she wanted to know if I was annoyed by her inability to remember and did I think she didn't talke our work seriously. This question served as a clue to me that she was focused on my response to her behavior. I told her that while I was not particularly bothered by her difficulty remembering, I was quite curious and interested in it. She looked relieved as she said she was glad I didn't personalize it. She said she didn't know where to go next and hoped I would lead her2E I responded in ways that had previously been successful with her such as questioning her difficulty in focusing on herself or summarizing earlier sessions, but this time Kathy systematically rejected each and every one of my efforts. Over several weeks, the process grew quite frustrating as she remained totally impervious to any of my comments, while constantly demonstrating a deep, agitated despondency. Nothing I said or did had any impact whatsoever.
One extremely puzzling session occurred in the midst of this difficult phase. It was the day following the Tianamen Square Massacre in China. Kathy arrived looking and acting totally dazed. She began by saying once again, "Where was I? I can't remember. I just can't do this work. People are suffering all over the world. How am I supposed to focus on myself? I know I'm overreacting to this event but I just can't help it. I'm totally disoriented.." She spoke of the revolution and killing in China and burst into tears followed by embarassment over her overreaction. She could barely speak and cried instead during much of the session. When I asked her what concerned her most about this event, she replied, "a million youth beaten down and killed." Again she burst into tears and finally was able to articulate, "It represents the loss of innocence where innocent people become blameworthy suddenly - like when Dan died, father and I became blameworthy." She could say no more. As the hour ended, I felt confused, curious, and impressed with the intense emotions. I wondered to myself why she had seen her situation with her brother and family in this particular current event. It would be a full year before the answer to this question would become clear. For the next two months, Kathy began the hours feeling unfocused and claiming deep hopelessness. She continually talked about the inevitable destiny of repeating her family's tragic dramas. She felt hopeless about connecting with her husband just as her mother and grandmother never connected with their husbands. She felt doomed to always feel a wedge between her husband and her children as her mother and grandmother had. Repeatedly, I listened to her feelings while reminding her that she had choices about these matters, though these choices might make her uncomfortable. She completely ignored my comments or else argued relentlessly. Her body, posture, voice, words, and tone all spoke of an impenetrable despondency touched with agitation.
As I reflected on my own feelings of concern, frustration, discouragement, and helplessness together with the early clues Kathy had provided with her questions about how I was reacting to her, I could see in my mind Kathy trying to help her imperviously depressed mother after Dan died. My own feelings then became understandable as I pictured Kathy's futile efforts to revive her mother, her frustrations and profound disappointment waiting for mother to recover. This perspective helped me endure these difficult times with greater calm and interest over time. I tried to walk a fine line of maintaining reasonable involvement without being overly invested in her responses.
Two sessions brought this sequence to an end. The first occurred as Kathy reported - in a rather helpless, victim tone - "My youngest child really does seem just like my mother. My father actually noticed that once." I challenged Kathy strongly on this, "Why are you fitting the present on the past? Why not see your child for who she is, not for who your father sees, and not by putting your past onto her. Look at all the ways she's different from your mother." Kathy appeared to ignore me once again and continued by complaining about her daughter hating Kathy the same way that Kathy hated her own mother as she said, "Whenever I imagine that I get so upset." I asked, "Why imagine that at all?" She answered , "Well, you know, the mother-daughter bond is so fragile that with the tiniest mistake it could all be gone." Rather sarcastically, I replied, "One tiny mistake is all it takes? You mean like ignoring and neglecting your child from the moment her brother dies and treating her as if you hate her for surviving? Is that a tiny mistake?" Kathy paused, looked stunned, and almost began to come to life for a moment at the end of the hour when she said, " I have two choices: I can protect mother by feeling sorry for her and that I owe her so much, or else I can see the truth which was that she was not good to me." The hour was over and she thanked me for what she called my "aggressive stance."
The next and final session that brought this sequence to an end began with Kathy feeling, once again, discouraged and hopeless - this time about her career. I reminded her of how hopeful she had been about these same opportunities just a few months earlier. Relentlessly she brushed off every comment I made. I was getting a strong taste of the profound frustration Kathy must have felt years ago. Somehow the enactment of her mother's refusal to recover became so blatantly obvious at that moment that I suddenly paused, almost in mid-sentence, and asked, "How do you imagine I feel right now?" I was quite surprised to hear the elaborate response that Kathy provided. She said, " You feel frustrated! And like there's a wall. You're throwing a ball to the wall and everytime you throw it, it just bounces back and it won't do any good and you keep throwing it harder and harder until you just try and hurt with it." She burst into tears and said, "I felt like that with mother after Dan died and even with my ex-husband when he was depressed.
But I don't understand what it's related to and why I'm crying now." I told her that it related to a major trauma of her life - her mother's refusal to recover and her refusal to respond to Kathy after Dan died. I told her she was doing to me what her mother did to her. She was showing me graphically how she had felt in the hope she could learn from me how to avoid being paralyzed , enraged, and overwhelmingly responsible for her mother without also withdrawing from her. Kathy cried intensely and said, "I've always worked so hard to hold back from throwing that last ball. I didn't want to give up on her."
Kathy came into the next session excited, enthusiastic, and filled with insight: "My mother hated me even before Dan died. Do you understand what that means? That absolves me of the guilt of killing her favorite son as the motive for her hatred of me. I remember being five-years-old, long before Dan died, when I didn't have many friends. I wanted to be near mother and she used to chase me outside into the cold yelling, 'Get out of here.' I remember her chasing me outside with a wooden spoon in her hand. Mother hated me. And I'm starting to understand my own depression somewhat now. It's complex and I can identify six layers of it: 1)rage at mother for not loving or caring for me; 2) guilt about my rage; 3) making excuses for mother like 'anyone who suffered the losses mother suffered would not be able to care for the surviving children' 4) I am like mother since I worry about losing a child and feel unable to mother the survivors; 5) I AM mother. I have all the same traits: I refuse to recover; I have a bad marriage, a depression; and a 'wedge' between my husband and children; and then 6)self-hatred for all those traits I hate in mother." Once again Kathy repeated with enthusiasm, "It wasn't my fault my mother hated me. She hated me before Dan's death." Immediately following this work, Kathy began to connect more deeply with her husband, began to thrive in a new teaching job where her students adored her, and showed great pride in her eldest son's winning an award at graduation.