Elizabeth’s looks were almost characterless.  She was of standard European descent, medium sized and solid.  Her mind however was of rare design.  Initially she was raised by a secession of nannies.  By the age of eight she had failed to emotionally attach to any of them, or anyone else really.  This inability to attach concerned her parents and so Elizabeth’s rearing was transferred from nannies to therapists. 

     Elizabeth’s institutional upbringing did not help to change her, but she did find the psychologist far more intriguing than the nannies.  They labeled her a high functioning autistic for years, and later with attachment disorder.  Finally she was said to be an atypical schizoid, but they knew that none of these diagnoses were complete. 

     Elizabeth did have the need and desire to feel normal connections with other humans and being absent the required circuitry to do so did cause her pain.  This want was the trait that kept her from fitting into the constructs of psychological diagnosis.  With great consternation her caregivers finally accepted that she could not be categorized.  In the end they never understood her, but Elizabeth herself, perhaps pathologically so, didn’t really care.  

     Elizabeth was her parent’s only child.  Her eyes vacantly scanned the carpet’s pattern as the team of therapist attempted to define for them their daughter’s deficit.  Her mother said that she felt guilty over Elizabeth’s problem, and that she blamed herself.  Elizabeth wondered why someone who experienced guilt, which she understood to feel something like implosion, wouldn’t be grateful that her child did not suffer such an emotion. 

     The psychologist tried to console Elizabeth’s parents with the news that their daughter was highly gifted, a savant in several areas.  Elizabeth drifted away, distracted by her father’s off centered tiepin.  She regained focus when he stood up and blurted out, “So what you’re telling us is that our daughter is a very smart potted plant.” 

     After this meeting Elizabeth had little more to do with them. Her father’s potted plant analogy did stay with her though.  She hadn’t processed it as an insult, but rather as another piece of therapeutic advice to employ.

     Years before one of the nannies had taken Elizabeth to some sort of religious service.  She recalled the speaker quoting the apostle Paul.  Paul was discussing a seed and the fruit of the spirit.  There was also much talk of vines and vineyards.  Remembering those images and her father’s words, Elizabeth began to visualize herself as a plant.  She found this image confronting. 

     When she felt afraid of loud noises Elizabeth would sit very still and remind herself that trees don’t have ears.  When the other children touched her she would balance her weight between her big toes and heals, and then imagine that her feet were slowly sinking into cool damp soil.  When she was twelve she began looking for her special seed, and speculating about what sort of fruit she would bare.    

     As she matured, Elizabeth’s faith in her methodical botanical powers grew steadily stronger.  She once saw a sidewalk poured.  A few years later she realized that the cement had been poured over an acorn, and now an oak had grown, splitting the concrete.  She strongly related to the victory of her brethren. 

         By late adolescences Elizabeth’s more standard emotions began to faintly materialize.  There were many times during college when Elizabeth had moments of feeling for another student.  However even positive interactions were painfully overwhelming for her.  She would try and remember the words of her therapists and breathe.  She then would bravely attempt to take a step towards normalcy and friendship.  But Elizabeth’s jerky manor, flat line voice, and social retardation made other students avoid, reject and taunt her. 

     Finally, another student even managed to make Elizabeth cry.  Elizabeth had approached a girl from her dorm in the cafeteria.  The previous morning the girl had loaned Elizabeth her carpet sweeper and agreed with her that vacuums “make an obnoxious noise”.  Elizabeth mistook this exchange as a great act of friendship.

     Without looking up at them or speaking Elizabeth decided to join the girl and a large group of her friends for lunch.  When Elizabeth tried to sit down, under the table the girl shoved Elizabeth’s chair away with her foot.  Elizabeth fell.  Everyone in the room was looking at her. 

     Elizabeth then continued trying to sit down as the childish joke was repeated several more times.  Elizabeth became so confused by the laughter and stares that she could only focus on successfully sitting.  She just kept repeating her attempt until the girls realized that she was not a geek, but rather pathological.  Sick enough that pushing the chair away wasn’t funny, but cruel.

     When they stopped and Elizabeth finally sat, the cafeteria was entirely silent.  The table of girls mumbled “sorry” and slowly got up and left.  Everyone else in the room looked away from her.  Elizabeth considered the fact that all she had done was try and sit down near a friend and somehow had misinterpret some social cue so badly that now a room of almost forty people had withdrawn. 

     The person who made Elizabeth cry however was not her believed to be friend, but rather a very confident freshman who left her friends to sit with her.

     As she sat down next to Elizabeth she said, “Who cares what those girls think.  They are mean to everyone.”

     It was then that Elizabeth began to cry.  She was so confused that she was afraid to interpret even this as an act of friendship.  She could not understand what she had done wrong, why everyone withdrew, or the intentions of the girl now sitting next to her.  That was her final attempt to socialize in school.  It had been confusing and harmful. 

     After this incident she decided that her pain and isolation would not be without meaning.  She decided that emotionally retreating would serve to keep her pure.  Being rejected by others would only preserve her untainted soil.  Elizabeth made the decision to hang onto her distant place, not only out of comfort, but now also vindication.  She had faith that the result of her suffering would somehow elevate her above her peers and tormentors.

     Once she made it through college, Elizabeth realized how she could adapt to her disorder and begin bearing fruit.  She enrolled in graduate school to become a psychologist.  Practicing psychology would also provide for her a way around social pain, but still allow her to meet her emotional needs with its distinct brand of controlled intimacy.  She could now clearly see that her seed was her suffering, and its fruit would be her practice. 

     On Elizabeth’s first day of grad school a professor said to her class, “To be an honorable therapist you must be neutral.”  Elizabeth knew that she defined neutrality, to the point that she was diagnosably so.  It wasn’t only her temperament that was perfect for this profession, but also her cognitions.  Having been raised in the culture of psychology she was incapable of judging.  Rather than making judgments she was taught to merely draw associations, and at the most to make interpretations of them. 

     Elizabeth was even more encouraged when a professor pointed out to her that she was savantly gifted with an eidetic memory.  This put all relevant research on file in her mind.  Her photographic recall was so precise that she even kept a list in her mind of her favorite quotes, which she was able to mentally sort based on their word count.

          Elizabeth also had an exceptional ability to formulate the connections between abstract concepts, and by the time her dissertation was complete, her linguistic and sequencing skills were highly developed.  These odd combinations of strengths and atypical gifts, coupled with her life long indoctrination, had breed Elizabeth into a genius clinician.  And her motivation was as pure as the gospel.  She completed her program at the top of her class.

     At the end of each client filled workday Elizabeth felt emotionally and intellectually satisfied.  She was perfectly happy to go home and be alone until her next session.  Elizabeth had spent two days arranging and semi-decorating her house.  That was ten years ago and she had not changed a thing since.  

     Elizabeth would arrive home by 7:15.  She would prepare her nutritious meal and listen to music while she ate it.  Her only CD was of Beethoven sonatas played by Glenn Gould.  As she listened, she would become preoccupied by the fact that the pianist had been diagnosed with obsessive compulsive disorder and try to analyze how this affected his tremolos.  She would then do some light exercise, tend her garden, and sleep flat on her back until morning.

     Each morning she would spend one and one half hour caring for her fish tanks.  She started with one tank, but had an aggressive banner wrasse and so set up a second tank to protect the others.  Babies were born, and additional behavior problems developed.  Eventually she had nine large tanks, plus a small one in the kitchen. 

     On the occasional weekend Elizabeth went to Clagett's to listen to music and have one drink.  Clagett’s was lit by small spotlights, which were covered with thick blue-green gels.  The tables were a deep reddish faux wood with industrially consistent patterns in the grain.  These elements appealed to Elizabeth, and so she never troubled herself to sample another pub.  This in spite of the fact that the sound system at Clagett’s made her cluck her tongue in order to vent the anxiety its reverb caused her.

     Elizabeth had defeated a major fear and came to sit with a group of women at Clagett’s.  They grew to be her closest friends although they did not know her last name.  They called her Doc, and she liked that bit of affection.  However, that was the maximum bit of affection she could accept without feeling corrupted.

     That was it.  That’s all she was and all she did, but she had changed and even saved lives.  Elizabeth had spared so many people so much pain and in the process ended generational curses of family abuse and manipulation.  She had taken desperate people whose minds were piles of tangled rope, and methodically picked at the knots until her clients were free and well. 

     Hundreds of former clients thought of her each day.  They heard her comforting voice in times of crisis, and her words guided them when choices arose.  Once terminated however, Elizabeth never thought of her clients again.  She concentrated hard during each session.  She kept up with research and conferred with psychopharmacologist, but once a client left her office that ministry was complete. 

     Elizabeth could diagnosis sometimes just by looking at the client’s dress or listening to the quality of their voice.  She rarely had to try a different treatment method.  Her first choice was usually correct.  Elizabeth almost always helped her clients reach their treatment goals terminating them on schedule completely healed.  If Elizabeth had more imagination she would have become quite bored.

     In the beginning Elizabeth logically scheduled her clients based on the amount of energy she expected to have during that hour of the day.  After a few years she stopped thinking about it.  Each person was just as easy as the last for her. 

     Elizabeth would explain her work using the analogy that in medicine if a patient has a runny nose the practitioner knows that they either have an allergy or a cold.  A few questions later and they know which the problem is, and so now there are only a couple of treatments to try.  Practicing psychotherapy had become that formulaic for Elizabeth.  Diagnosis was that quick and that simple. 

     The work was so easy to Elizabeth that she had never pondered the significance that she held for her clients.  She merely admired the efficacy of her fruit.  Her life had become avoidant and her work was never a surprise.  It had all become so stress less that her roots had now grown shallow.  All was well until the first Monday in November when the wind began to threaten.  On that day without warning she would face a client who was not only sick, but evil.

 

 

 

 

 

NOVEMBER 1^st, 2006

 

MONDAY

 

8:00 Insurance forms filed

Write cue quotes.

 

9:00 Peter (Sexual Fetishist)

True guilt is the guilt at the obligation one owes to oneself to be oneself.

 

10:00 Interview receptionist

Katie

 

11:00 M (Dysthymic)

Beauty is a curse.

 

12:00 Lunch

Increase dietary intake of niacin.

 

1:00 Emanuel (Bi-Polar)

It is the very energy of thought which keeps thee from thy God.

 

2:00 Verna (Major Depression, no features)

If you are going through hell, keep going.

 

3:00 OPEN Brian (Pedophile- Court Ordered)

Where God hath a temple, the devil will have a chapel.

 

4:00 Martin (Narcissistic Personality Disorder)

There is a great difference between seeking God and creating God.

 

5:15 Dr. Klien (Supervision)

Knowledge speaks, but wisdom listens.

 

Evening: Clagett- Thelonius Monk cover Pianist.

 

      That morning Elizabeth arrived at her office to be met by her client Emanuel.  He came in before 8:00 A.M. as usual.  His appointment was at 1:00 that day, but he was always terribly early.  Sometimes Elizabeth would find him sitting on the stoop when she arrived looking as though he had been waiting since dawn. 

     Elizabeth had begun seeing court-ordered clients on a sliding scale.  This was how she came to treat Emanuel.  The town where she had almost randomly set up practice was fairly small and so there were few counselors.  Elizabeth served her community by accepting several court-ordered clients per year.  Emanuel was the only court-ordered patient Elizabeth had seen who actually worked diligently towards his own healing.  It was not Elizabeth’s favorite way to build her practice, but she wanted to be a good citizen.

     Elizabeth felt a lower level of responsibility towards most court-ordered clients.  Instead of focusing on them, she tried to consider their loved ones and co-workers.  The people affected by their pathology.  Based on this principle, she would devise a treatment plan that would simply make them less harmful to others.  She had made the ethical call that the courts were society, and so society was her real concern.  She cared little for the perpetrators themselves, except for Emanuel whose experience with the law had genuinely opened his eyes. 

     Accepting court-ordered clients was a mundane practice which kept her patient load full.  Elizabeth did not know that today it would cause her to face evil himself.  She had never believed in evil.  She had never even contemplated its existence.  Now out of the blue it would arrive, and create the change in Elizabeth that her professional parents had failed to impart. 

     The phone rang.  It was the out patient services supervisor from the local mental health clinic.  As Emanuel eavesdropped, the clinic’s supervisor Soseanaic explained that they had no more room on their schedule and asked Elizabeth to please take a court-ordered fellow.  Elizabeth agreed and instructed Soseanaic to have the client call and book an appointment.  

     As Elizabeth moved the receiver away from her ear, Soseanaic called out to her “Hey Elizabeth, why do you never say goodbye when our phone calls are over?” 

     Elizabeth explained, “Oh, I don’t mean to be rude.  I just find the practice odd and I refuse to participate.” 

     Soseanaic laughed, mistaking her earnest explanation for dry humor. 

     When Elizabeth realized that he did not take her literally, she went on to say,

I think that the telephone is like a letter or a fax.  It is designed to send and retrieve information.  You are a psychologist; you too must know that telephone communication only uses two out of the seven primary characteristics of psychodynamic interaction.  There is no goodbye when we have not really been together to begin with.  I think it’s important not to perpetuate unhealthy interaction styles by using language that validates them as being emotionally nutritional.

     Sadly, this was Elizabeth’s abysmal attempt to make chitchat.

    Soseanaic responded,

I know exactly what you mean.  Society is becoming more and more removed and people are not connecting on a real level anymore.  Email and texting and all these things are keeping people from feeling isolated and lonely, but they are like relational junk food.  Empty emotional calories, no sustenance.

     Elizabeth said “Yes, that is what I mean.” and then just hung-up.

     After Elizabeth hung-up she wondered again if the counselor had been flirting with her.  She always missed social cues and only in retrospect realized when someone was interested.  She made a mental note to pay attention next time, but then remembered that even attempting to flirt would only cause that feeling of a lactic acid burn in her outer extremities.  Elizabeth was correct about Soseanaic being interested, but his attraction was based solely on the fact that she was the only professional who always pronounced his name correctly.

     Elizabeth convinced herself that the only viable men she would ever encountered where either at the pet store, or other professionals who shared an interest in one of her clients.  Clients were of course strictly off limits ethically, although she had never even been tempted.  Elizabeth decided that the pet store clerks were undereducated.  She believed other professionals would lead to inevitably awkward future interaction.  Not having an acceptable mate was an excuse that relieved Elizabeth from the stress of attempting a relationship, and the risk of adulterating her gift.  She told her own therapist that intellectually she was curious, but that her id experienced no need. 

     Her deep down truth was that she did not want to wake herself up from her sleeping beauty sexual slumber.  She was afraid that her emaciated emotions still could not bare the weight of an adult relationship.  Elizabeth’s clients were enough to satisfy her skinny need for interaction, while remaining predictably under control.  Elizabeth was unequipped for any other kind of interface.  In reality her closest emotional tie was to Emanuel, but only for as long as he was in treatment.

     Elizabeth’s previous receptionist had quit weeks earlier to marry a man she had met only two days before they wed.  Since then Elizabeth had to spend an hour each morning in the outer office filing insurance forms.  She would then print her schedule and write in her cue quotes, as she called them, to keep track of clients in her own sort of code. 

     Emanuel tried to take advantage of this early access and start his session right then and there.  Elizabeth calmly followed protocol, explaining to Emanuel that she could not respond to him yet.  She would only converse with him during his scheduled 45 minutes in her private office beginning at 1:00 pm.  Elizabeth had made a verbal contract with Emanuel stating that he would wait silently until session.  However, she did understand that his anxiety level was currently high, and so this day she went uncharacteristically easy on him.

     After beating out a drum solo with two pens on the edge of the coffee table, Emanuel tried staring at Elizabeth to make her say something.  When that failed he sneezed as hard as he could. 

     When he still was given no response he said, “Dang Elizabeth, don’t you even say God bless you?” 

     Rather than maintaining silence Elizabeth decided to answer without looking up, “I do not wish to participate in faith, ritual, or superstition.  It was just a sneeze.  I’m sure your fine.” 

     Elizabeth intellectually appreciated Emanuel.  He was a bi-polar visual artist who was currently experiencing an upswing.  He also had severe traumas from his childhood, but the symptoms of his PTSD were currently inactive, and so she focused their work on shoring him up to manage his mania.  She would let him tell her when he was ready to unlock his memories.

     While Elizabeth hated conferring with Emanuel’s arrogant psychiatrist about his meds, she did enjoy being his therapist.  She knew precisely where he was in his course of treatment, and she had watched him slowly improve.  However Emanuel’s mood would become so intense every thirteen weeks that he would fall back a step.  Thirteen weeks like clockwork.  He would then be arrested, and usually for a violent act.  Even so, Elizabeth found this consistency comforting.

     Emanuel was almost panting as he stared at out the window at a group of women passing by.  Like most bi-polars during the hypo-manic phase Emanuel was intensely sexual, but of course that never distracted Elizabeth.  Emanuel had even made an advance once.  He grabbed Elizabeth by the waist, and kissed her.  Elizabeth had expected this reaction two weeks prior.  She had even noted the prediction in her day planner, quoting, “It is difficult to know at what point love begins; it is less difficult to know that it has begun.” 

     Although she hated being touched, Elizabeth was expecting it and so handled the incident with ease.  Emanuel’s therapy had moved far beyond the projection of his sexual desire.  However, Elizabeth still referred to the “kissing incident” to facilitate their work.  It was helpful in illustrating to Emanuel how he projected the pace of his own needs onto his women.  From this he learned to be more aware of how his girlfriends’ needs differed from his own. 

     Elizabeth understood that Emanuel was her emotional opposite.  As she needed consistence, he thrived on chaos.  As she reserved her emotional account balance he traded his in and out like waves.  She respected their differences, but still she worried that all of his romantic conflicts would wear on him, and his art would eventually suffer.         

     When Elizabeth referenced the kissing incident it embarrassed Emanuel terribly.  Not because he had been inappropriate, but because Elizabeth had become a maternal figure to him.  It was as if he had gone after his own mother.  Remembering it made him shudder with self loathing.

     Elizabeth in turn was pleased that Emanuel’s cathexis for her had waned.  She noted in his chart that his instincts and their vicissitudes were integrating well into his cognitive map.  Elizabeth had never envisioned herself being more to Emanuel than his therapist.  She had no way of knowing how powerful their relationship would soon become.

     Elizabeth was thankful that Emanuel was being treated by her and not by a weaker woman.  Not only was she virtually impossible to tempt, Elizabeth was also very strict ethically.  Ethics were the cornerstone of her work.  Ethics were the only way to do no harm, and the only way to monitor ones self in a profession that allowed ones personal perceptions and needs to intrude.  From the smallest standard to the largest rules of conduct, Elizabeth had never slipped once.  She never even went a minute over time or started a minute early.  She may have gone down the wrong road with a client when she was starting out, or initially focused on the wrong issue, but she had never made a mistake.  She had never yet caused harm. 

 

     9:00 A.M.

 

     Peter entered abruptly.  He then re-closed the outside door several times to be certain it was shut.  He was almost trembling as he scanned the room.  Emanuel sensed his nervousness, and so greeted him with compassion.  This was Emanuel’s second home, and so he wanted to make Peter feel as comfortable as possible.  Emanuel’s warm greeting only confused Peter.  He mistook him for an office manager, or receptionist, and so explained that he had a 9:00 A.M. appointment and hoped he wasn’t late.  As Emanuel checked his watch, Elizabeth quickly introduced herself and guided Peter into her private office.

     From their phone conversations Elizabeth had no inclining what was wrong with Peter, but he had made and canceled three appointments.  That was the limit.  Elizabeth told him that if he did not attend this one, he could not make another.  Today Peter had found the courage to show up. 

     Peter was wearing a brown suit fresh from the dry cleaners.  His clothes were worn and outdated, but clean and put together.  Elizabeth noticed that he had missed a patch on his cheek while shaving, but overall looked high functioning.

     Peter was clearly intimidated by Elizabeth, afraid that she could tell his problem just by looking.  She could not, however Elizabeth could see across his face the guilt of a secret born of shame.  She knew it was a big secret, or at least to Peter it was, so she started off slowly with some standard, “What brings you here?” type questions. 

     As Peter confessed step by step it appeared as if he had begun to sweat oil.  He began by saying that he was married, but that he hired a prostitute every Friday from 1:00 to 2:00 P.M. during his lunch hour.  Elizabeth asked if he used safe sex, because this was relevant as to how risky his behavior would clinically rate. 

     Peter answered her loudly, clearly offended by the question, “We don’t have sex!”

     He collected himself, and smeared the shine across his face with his pressed handkerchief.  As he did he realized that he had missed shaving part of his right cheek.  Peter exhaled hard, disappointed in himself.  He then quickly revealed the reason for his visit.

     Peter explained that there was one old hotel downtown with old-fashioned keyholes.  The big kind you can see through.  Peter would rent a suite and stay in the living room area.  The prostitute would then go into the bedroom area and close the door.  Peter would get on his hands and knees (he made it clear that he did not squat or kneel, he had to be on his hands and knees) and watch her through the keyhole.  Peter again mopped the thick sweat off his brow. 

     “What does she do while you’re watching her?” Elizabeth asked him, affecting a nonchalant voice. 

     Peter blurted his fetish out as quickly as he could, “I have the prostitute put on black pumps, nothing else, and role a cantaloupe around the room with her nose.” 

     Elizabeth was shocked by this story, but only because she had heard it before.  She had a client her first year in private practice with the same fetish, only the shoes had to be red. 

     Without much pause Elizabeth asked Peter, “Why doesn’t your wife do this for you?”  

     Peter explained that his wife might be offended.  Elizabeth explored the possibility that it needed to be a hired prostitute to satisfy him.  Peter confessed that he wished it were his wife pushing the cantaloupe. 

     Peter said, “I can only, you know, become aroused with my wife if I visualize that week’s cantaloupe pushing appointment.”

     Elizabeth pondered if it was technically a fetish if he could become aroused by only recalling the cantaloupe pushing.  She believed to meet the fetish diagnostic criterion Peter would need the actual pushing each time.  She would have to check the DSM.

 

10:00 A.M.

 

     Elizabeth had seen three receptionist interviewees so far.  One was so nervous that Elizabeth felt certain her clients would be made to feel anxious by her presents alone.  The second applicant had obsessive compulsive disorder.  Elizabeth considered him because the pathology might be adaptive to the work.  However, she feared that he would be too idiosyncratic in his filing system, and so decided against him.  The third candidate kept repeating, “I’m fine with crazy people!” and, “One of my uncles is nuts.” 

     The applicant who came in at 10:00 was a younger woman named Katie.  Katie was apparently unaware that she had baby spit-up down her back, but she seemed to be stable and knew how to use the computer and the printer.  Elizabeth hired her on the spot, and hoped that the baby wouldn’t keep her out too much.    

     The new girl Katie scheduled Brian the court-ordered client under his first name only as she had been instructed to do with all clients.  When Elizabeth looked at the new print out of her schedule she assumed that her 3:00 was a long-term client also named Brian.  She had no idea what she would be facing at 3:00.

     For now Elizabeth prepared for her next client named M.  Elizabeth did so next to Katie as she got situated at the front desk.  Elizabeth didn’t stay upfront to make Katie more comfortable but rather to shield M from Emanuel’s advances.

 

11:00 P.M.

 

     M was a beautiful woman and this was practically her diagnosis.  She had been a fairly successful model at which time she changed her name from Emma to the letter M only.  Technically she was dysthymic, (or mildly depressed).  She had no major personality disorder, nor serious neurosis, and this made her Elizabeth’s most challenging client.

     Elizabeth believed that the more severe the illness, the easier the work.  The more dramatic and florid diagnoses attract the most research, plus extreme conditions can overtake the personality leaving only predictable symptom clusters.  M only suffered from mild depression and adjustment disorder.  This made her very complicated.  Elizabeth knew M’s treatment meant delving into her whole belief system, history, and perceptions.  In the first five minutes of their first session Elizabeth realized that this one would take a while. 

     M’s beauty was an attribute that Elizabeth could not grasp on a societal level.  However, Elizabeth was able to intellectually understand that M possessed one of the four archetypal standards of female beauty.  However, what Elizabeth found most aesthetically pleasing about M was that she applied a mat pink color onto her check bones and precisely the same tint but with a sparkling shimmer onto her eyelids.  Sometimes Elizabeth would become distracted by the shininess.

     The question of why beauty would incite hostility was another issue Elizabeth could not grasp.  To prepare for thirty-eight year old M, Elizabeth had to read additional research on adolescent socialization.  Surprisingly to Elizabeth, who herself had failed to be socialized; she found that the more beautiful girls were consistently the more popular.  Relationships being of prime importance to an adolescent female’s self-worth, each seeks the friendship of the highest socially ranking female rather than that of the most compatible. 

     Socially unskilled during their teen years, these more popular girls tend to develop the need to keep significant friendship to a manageable minimum, and so become harsh toward their excess of friendship suitors.  Elizabeth assumed that many adults still associate this uninviting stance with beautiful adult females or else continue to seek their approval without cause.

     M began this session by angrily ranting,

People who were the ugly, geeky kids grow-up to be hyper ambitious to prove their worth!  They are living their lives around what high school kids thought of them twenty years ago.  They see me and assume that I am one of their, what’s the word…victimizers.  They instantly judge me as cruel, or stupid, or unworthy.  How can someone who has been unfairly judged, grow-up to judge unfairly?  It’s like a black man being a racist.  I’m not stupid, or mean, or shallow.  I am so sick of being judged and used.

     M became teary and Elizabeth counted to five in her head as was her habit.  “M, I am glad to hear you describe yourself.  ‘Not stupid’ is a little vague, but at least you’re defining yourself.” Elizabeth praised. 

     Because of her beauty, M had been misjudged all her life.  Half the world resented her, and the other half accepted her, each for no reason.  Each unwarranted reaction was equally harmful to M.  She had no sense of self at all because everyone she met had stamped her a saint or a sinner on sight.  She was judged by all instantly, without so much as smiling or speaking.  M had been given no genuine feedback in her life and now Elizabeth had to remain neutral to do her job. 

     Elizabeth wondered once if she should switch from analyzing M to re-parenting her.  M’s mother was also a beautiful woman and had raised M to find her fortune there as she had.  M’s father treated her like a china doll, but never like a person.  Re-parenting would have given M a base, but Elizabeth decided that it was ethically correct to have M create her own base.  This would be a much more difficult process but Elizabeth did not wish to play God, and frankly she had no idea how to play Mommy.

     M was thirty-eight years old and Elizabeth wondered if she hadn’t started therapy partially in anticipation of loosing the perfection of her looks.  Her beauty had been her only defining trait.  Elizabeth assumed that M was terribly frightened of aging, but hadn’t approached the topic yet. 

     M had also just left her rich older husband and was trying to get her first job.  Having no skills or résumé, she could only apply for lower level positions.  Still no one would hire her.  Elizabeth had begun to wonder if M’s resentment theory was true.  If M was perceived to be too good for the job, or else the bitter middle-aged manager wanted a moment of power over a beauty, and so relished telling her they were going with another applicant. 

     M said, “I guess I’m also having trouble being hired because I’m just not a people person.  I think I’m more of a car person.”

    Unfortunately M still occasionally played dumb when she felt challenged by Elizabeth, but she was finally defining herself, in curd terms, but still using adjectives when discussing herself and feelings.  M was beginning to see her place in the world and her obstacles.  She was making painful, but very steady progress.  After taking her notes on M, Elizabeth prepared for the consistently erratic Emanuel.

 

1:00 P.M.

 

     After begging for her attention, 1:00 P.M. finally arrived and Emanuel came bounding into Elizabeth’s private office.  He was holding one of his pieces that was so freshly painted it still glistened.  Emanuel proudly proclaimed that the painting was a gift for Elizabeth because she had cured him.  Elizabeth switched into her therapist voice and asked him to sit down.  Even sitting, Emanuel’s wiry frame kept in motion between the armrests.

     Elizabeth yet again explained to him that she could not accept gifts of any kind from a client.  She explained that they must work within the agreed upon exchange and that giving more or less would change the balance of their dynamic.   Emanuel’s dark eyes became round with hurt.

     Then she noted, “We have had this conversation before.  Do you remember when?”   

     Emanuel had a flash of recognition across his face that told Elizabeth progress was being made.  Emanuel was just beginning to be able to recognizing that he was in the same state of mind that he had been in thirteen weeks earlier, and thirteen before that, and every thirteen weeks since they had begun treatment.  To any observer his mania was obvious, but up until now for Emanuel it was just life.

     While Elizabeth was pleased with Emanuel’s growing self-awareness, for the sake of reinforcement, she decided to outline Emanuel’s cycle for him in brief.  She took a deep breath and began,

You feel an elevated mood fueled by self-confidence.  You consistently announce that you have been cured, or healed.  You begin to stay up all night painting.  You begin writing hot checks.  You start dating several new women at the same time, and stop sleeping almost entirely.  Then you convince several people to invest in a business plan that you have been recently inspired to create.  Finally, when you’ve got the most chaos going that you can possibly stir up in a week or so, you crash into a deep depression.  Usually while so deep in this depression that you are barely able to function, you are evicted, sued, and deal day and night with the heartbroken women left in the wake of your manic state.

     Elizabeth exhaled, fatigued just from thinking about it.  She knew the pace of their work had been well calculated, but she also wanted to spare Emanuel as much pain as possible.  She wished she could suffer this episode for him.  At times, she even wanted to comfort him, but at this point in treatment she didn’t know how to do that without halting his progression.

     Emanuel was listening hard.  Elizabeth could see that he wanted to hear the truth and so she continued,

You then suffer several days of intense anger.  At this point, you are either arrested for assault or vandalism; or else, you must be committed for seventy-two hours in the hospital’s psych ward.  After your angry crescendo, you level off and begin cleaning up your own mess until your next manic round.

     Emanuel had reached the point in his treatment that he was able to see that his reactions were not always provoked by reality.  He understood this clearly when he was on a plateau.  However, now he was beginning the elevated point in his cycle.  This state pitted his emotional perceptions against his intellect and discipline. 

     Emanuel slapped his thighs in iambic pentameter as he rambled about the self he was currently battling,

Like you taught me, I am still able to stop myself and breath and count in my head when my feelings start to fly around.  I mean when I think of something happy or look at something beautiful, I feel great and kind of weightless.  Then just as fast someone disrespects me, or I see something sad in the news and I get hot and angry.  My arms get light and my chest gets tight and I can feel every muscle in my face like they have been strained.  Like I’ve been lifting weights with my face, does that sound crazy?  Anyway, I’m okay when I’m totally awake, but that in between part, just before you completely wake up is scary for me right now.  I kind of dream this vision of black liquid filling up my spine and then my back really does start to ache, and I feel like I am this evil worthless busted thing.  I feel like I need to run to church, or to just do it, just rob a bank or fight the first guy I see, or jump out a window...” 

     Elizabeth asked him how long the in between part lasted, and how he pulled out of this state cognitively.  While she listened to his answer, she was trying to think of ways to manageably bring forth his preconscious mind.  She did not want him to feel fear like that again, even if only for a few minutes a morning.  She knew what he was describing was a painful repressed memory beginning to emerge.  The fact that it was emerging non-verbally and tactilely, suggested that it was an incident from his early childhood.

     Emanuel leaped over this topic and began to tell Elizabeth that he had a new life goal.  As Elizabeth discussed Emanuel’s need not to act on his desires at this point in time, Emanuel began to argue that he had created a new and brilliant business proposal.  It would allow him to finally own an art gallery.  Elizabeth conceded that the plan was logical this time, but convinced him to wait until he leveled off emotionally before acting on it. 

     Emanuel was trying to process all of this crucial information.  A part of him heard and understood Elizabeth, but another part of him only felt.  At this point in the session, Elizabeth was just trying to keep up with him, at least in her notes.

     Emanuel let this topic go too.  He then continued on speaking so rapidly that Elizabeth kept looking at the clock thinking that they were almost finished, but seeing that only a few minutes had passed with each glance.  They again reviewed his pattern in detail and made a plan to prevent pitfalls caused by faulty judgment.  Then they discussed how he would prepare for the inevitable depression and anger that was to come.  Again Elizabeth looked at the clock and saw that a full twenty minutes of his session remained. 

     Elizabeth tried to occupy his mind for a moment, if only to give herself a break.  She asked Emanuel the first innocuous off topic question that popped into her hyper-logical head. 

     “Emanuel, why do they call it a sunrise, when in fact the earth rotates around a stationary sun and nothing rises, least of all the sun?” 

     Elizabeth had actually been seeking an alternative phrase for many years, and still had yet to come up with one.  Until she did, she refused to say sunrise or sunset.  Unfortunately, this idea did not quiet Emanuel for even a moment, or provide Elizabeth with a logical replacement name.  Instead, it lead Emanuel to free associate about J.M.W. Turner.

     Elizabeth moved on to the topic of medication.  Elizabeth deeply disrespected Emanuel’s psychiatrist Dr. Paterson, but she had to speak professionally of him.  It is very difficult to medicate someone with bi-polar disorder, and Dr. Paterson wasn’t one of the best to begin with.  He also still referred to the illness as “manic depression”, which showed that he did not keep up with psychological research or literature. 

     Emanuel complained about Paterson during each session, but never managed to switch to a psychopharmacologist, an alternative Elizabeth had suggested.  Emanuel exclaimed that smoking pot when he was down, and drinking when he was up, worked better than the drugs the doctor gave him.  Elizabeth wasn’t sure that he was wrong, but she again discussed his legal options other than seeing Dr. Paterson. 

     When the session finally ended, Elizabeth was tired and thought about moving Emanuel to the end of the day.  She considered again arrange her schedule from least to most exhausting client, as she had when she was first starting out.  Then she realized that he would probably still arrive at 8:00 A.M., and stay in her waiting room all day long hitting on her female clients. 

     As Elizabeth took down her notes on his session, she could hear Emanuel loudly praising her talents.  She quickly went to her outer office to retrieve her next client before Emanuel scared her away.  She sent Verna down the hall, and then ushered Emanuel out the door.

   

2:00 P.M.

 

     Verna was a new client.  She came in saying that her treatment goal was, “Just to be happy.”  Elizabeth wondered why clients were always seeking happiness, rather than peace or insight.  In her younger years, Elizabeth only sought wisdom.  Then she majored in it.  Elizabeth never accepted happiness as a goal for herself or for her clients.  When clients asked for happiness, Elizabeth switched happiness in her mind and notes to the word acceptance.

     Elizabeth looked Verna over as subtly as she could.  Verna had dull dry hair and appeared very underweight.  It was afternoon, but she looked as if she had just woken up.  She reeked of cigarette smoke, both stale and fresh.  Her clothes were clean but the sweater she wore was covered in bits of lint and cat hair.  It looked as if she wore it twenty-four hours a day.  She had small fresh bruises covering her legs due to her recent clumsiness, but remained convinced that they were symptomatic of some rare and serious illness.  

     Verna had reportedly lost interest in every aspect of life, even her love of photography and scrap booking.  Now she said that her days were filled with stressful feelings and so she functioned as little as possible.  She described alternated between the feelings of frightening emptiness and consuming guilt.  She would obsessively ruminate over every social mistake, even insignificant interactions.  Verna provided Elizabeth with a clear list of symptoms, not only by the content of her words but by the quality and difficulty with which she spoke them. 

     Elizabeth diagnosed Verna with “major depression”.  As painful as it was, it was treatable.  The trick was to find the roots of the depression, and carefully extirpate them at a pace that would be bearable for Verna.  Elizabeth prepared Verna for the length and difficulty of the work ahead of them.  She also gave her a sincere and positive prognosis. 

     Verna slowly said, in an almost inaudibly soft voice, “I want you to know that it’s not your fault if I don’t get better.  I know there is something broken or missing inside me.”

     In truth, Elizabeth had a deep seated fear that if she did experience emotions as her childhood therapist wanted her to, that she could possibly experience depression.  She never had, but she knew from the other children, and now her clients just how painful and frightening it could be.  Having no idea what feelings might be dormant within her, this was one of the possibilities she found most distressing.  However, she overcame her unease with the knowledge that she had the skills to free herself from such an entrapment and she had come to think of treating depressed people as a kind of practice just in case.  She also took great pleasure in seeing them return to life.

     Once the girls at Clagett’s had asked Elizabeth if working with depressed people depressed her.  Elizabeth said that they did not because they progress and bloom.  Having conversation like this with the girls made Elizabeth want to describe to them her gift for restoration and the joy of sharing the produce of her talents, but she just did not know where to begin without giving them more of her history than she would be comfortable revealing.  For this reason her answers were typically brief.  Still, the girls would continue trying to get a good shrink quote out of her; a quote that they could throw around at their office, or use against their husbands. 

     Once Elizabeth had said that, “Depression is sometimes anger turned inward.”

     They didn’t like that one, and thinking about it seemed to make them drink more.

 

3:00 P.M.

 

     Elizabeth was surprised when her 3:00 walked in.  She had expected the other Brian.  She had never seen this face before.  This Brian had a soft smile with arched brows and dimples that forced you to smile back at him.  His eyelids sort of sat at half-mast, as if he were always daydreaming.  He shook Elizabeth’s hand and sat down.  

     Usually new clients were nervous, with wet palms and confused expressions.  They wondered where to sit, afraid of making even a small mistake in front of a therapist.  Brian sat as if he were in his own living room. 

     Elizabeth explained to Brian that he had been scheduled by his first name only, and she was confused as to exactly who he was.  Brian stood up and looked out the window.  No client had ever done that before.  Brian, calmly and without shame, said that he was just released from prison and had to see a shrink to meet his parole requirements.   

     Naturally, Elizabeth asked what he had been convicted of, and he answered her, “Child molestation.” 

     Elizabeth waited for Brian to add the standard claim that he was falsely accused and wrongfully convicted, but he said nothing else.  Elizabeth quickly guessed that Brian was an anti-social personality or a “sociopath” as the news still calls them.  He had no sign of nerves, no anxiety.  He showed no guilt or regret. 

     Elizabeth had seen anti-social clients before.  They usually robbed a store because they felt the world owed them, or had punched their boss because they felt betrayed.  They were always caught right away and usually weren’t at all bright about how they had gone about their crime.  This one was different.  Elizabeth sensed that he was intelligent.  The dumb ones were predictable.  The smart ones were scary.  Elizabeth had never had a smart one before.

     Breathing deliberately slowly, Elizabeth asked Brian in response, “Why don’t you tell me about that.” 

     Brian sat down and asked for a cup of coffee.  Elizabeth said that there was none, and noted an inappropriately apologetic tone in her voice.  Brian shifted in the chair to be comfortable and smiled at Elizabeth again.  She didn’t smile back and held his gaze a moment, but not so long as to be challenging. 

     Brian seemed to be reading her, “So you’re the type of shrink who sits in silence until I speak, right?” 

     Elizabeth was for the first time the one who felt awkward. 

      Brian smiled as if he were accommodating her and said,

OK, let’s see Elizabeth.  Ah, what happened is my daughter became sexually attracted to me when she was around five years old.  I ignored it at first as a passing phase.  Then it just grew stronger.  She would give me looks and turn her head and smile.  She always wanted to sit by me and even sleep in my bed.  She told me how much she loved me everyday and wouldn’t leave my side.  We even had trouble getting her to go to preschool because she wanted to stay home with Daddy.

 Brian smiled nostalgically. 

     Elizabeth wrote on her pad, possible delusion, non-bizarre type.  This meant that Brian might have one isolated delusion about his child that was not outside the scope of time and space.  He might function normally at his job.  He might have friends who think he is just swell, never able to imagine that in this one area he is out of touch with reality. 

     Elizabeth felt herself becoming disgusted.  She began to wonder if Brian could muster an expression that didn’t involve him making that gummy narcissistic smile.  Elizabeth maintained her composure, as she asked him about the mother of his daughter.  As she feared, they were still married, and Mom did not believe the charges.  Now Elizabeth had to ask the hardest question.  Where was the daughter now?  As Elizabeth feared, Brian had served his time, and was complying with treatment, and so the girl was again living with him.

     Elizabeth asked, “What is your relationship with your daughter like now?”  

     Brian worded his answer carefully, but seemed to want Elizabeth to know without question that he was still raping his daughter.  Brian answered crystal clear that he was still an active pedophile, and yet stated it so that Elizabeth had nothing quotable.  Nothing she could use legally.  Elizabeth crossed out the word delusion and circled anti-social on her pad. 

     Elizabeth had no choice but to ride out the remaining twenty-seven minutes left in their session.  She asked Brian what he expected to get out of his therapy, and a whole ream of other standard questions that in this situation where pointless. 

     Elizabeth asked yet another standard question, “What did you learn from your conviction and time served?” 

     When he answered, she regretted having asked the question. 

     Brian said that he had learned that people are judgmental.  He said that morality was legislated, and both the Bible and constitution were against that.  He said that people couldn’t understand him or his daughter, and that doesn’t make them wrong. 

     “Only beautiful things happen between us and that should not be a crime.” Brian stated coldly, before he attempted to use up his remaining time on the topic of civil liberty. 

     During this rant Elizabeth tried again to get Brian to state that he was currently causing harm to his daughter.  She would need an admission to put him back in jail, but he was brilliant in how he dodged her.  She regretted going this far without preparation.  Elizabeth also regretted being hit with his presence out of the blue.  The session finally ended.  Brian said that he would book his next appointment on his way out.

     The moment clients left Elizabeth’s office she took copious notes.  She had developed carpal tunnel just from the few minutes of rapid writing she did between clients.  She wrote single cue words and phrases during sessions, and then afterward fast and furiously she detailed their work.  This time she sat still and empty. 

     Elizabeth looked down at her pad.  Anti-social was written down twice.  She doodled the word evil over the letters of Brian’s diagnosis.  No one had ever given Elizabeth this dark feeling before.  It was a mixture of fear and repulsion.  Her body reacted with a strange hollow tension.

     When Katie buzzed her, Elizabeth jumped.  She drank a small bottle of water all at once, suddenly dehydrated.  She wiped her mouth and cleared her expression before the next client walked in.  Martin would require all of her energy.

 

4:00 P.M.

 

     Like every therapist, Elizabeth had a narcissistic client who wanted an audience more than treatment.  Martin came in as often as scheduling would allow.  Elizabeth felt that she was gradually chipping away at his defense, but as gradually as wind erodes a mountain range.

     Martin had been on a new spiritual kick for six weeks or so and was exploring it in his typical self-absorbed fashion.  He claimed no one faith, but was rather sampling from each.  Martin would spend most of each session saying what his God thought about Martin’s favorite subjects.  Usually it was gays, or the government, or whatever else was making him angry that week.  Martin had always been his own god, but now he had split this defense into a named personification.  (On a certain level, Elizabeth did fear that he might run away and begin a successful cult). 

     Elizabeth’s ongoing challenge with Martin was to really listen to each word that he said.  It was never a problem with her other clients, but when Martin tried to force her to listen in his self-serving fashion she instinctually wished to ignore him.  Still Elizabeth was committed to helping Martin, whether he intended to be changed or not. 

     With great discipline she listened carefully.  Martin’s fears and needs could be found just a few layers beneath his sermons.  For example, Elizabeth guessed that Martin resented open homosexuals because they accepted the prospects of rejection and persecution and these were Martin’s deepest fears.  The other possibility was reaction formation.  Martin might resent gays because he himself may be a dormant homosexual.  This was a real possibility in Martin’s case because he adored himself so much, that he might only be attracted to his own reflection. 

     Elizabeth’s second greatest challenge was to not stare at Martin’s hair.  It must have taken a good half hour to quaff.  Plus, he drove a convertible, yet still arrived with every hair in place.  The physics of it distracted her.  Martin was in his late fifties, but dressed and carried himself as if he were still twenty-five.  Elizabeth assumed that at twenty-five he probably wore an equally misplaced air of knowing.  She decided that today went she looked away from his eyes she would glance down at his knees.  This would keep the hair and graphic tee out of range.

     Elizabeth believed that someone who is a diagnosable narcissist is in fact so insecure and so fearful, that to feel safe they create an imaginary reality in which they are of great importance.  All those who live in their world, i.e. their friends, coworkers etc., become collaborators in the production that is their life, or else an extensions of the narcissist themselves.  They are living their daydreams.  All centers on their ability to maintain this world.  It is a complex and very fragile design.  So fragile that Elizabeth knew if she said something directly confrontational even once to Martin that he would never return.

     Martin picked up from their last session as though he kept session notes of his own.  “I tried Christianity but it doesn’t work.  I prayed to Jesus for a specific job, but never got so much as an interview.  That’s when I realized that my God wants me to be free to create my own magazine.” 

     Martin continued on, revealing his God’s will from the fait of his ex-wife, to who God wills to win the next election.

     Elizabeth spent the minutes after Martin’s session trying to take notes but kept drifting back to Brian.  Was Brian a full-blown narcissist who saw his daughter as a part of himself, and therefore existing perhaps only to serve his needs?  Elizabeth decided to be disciplined about this and assign herself a specific time to mull over Brian’s treatment.  She felt responsible for the fact that Brian had affected her session with Martin, and more than a bit frightened that Brian had incited emotion in her.

 

5:15 P.M.

 

     Now it was time for Elizabeth’s appointment with her supervisor Dr. Klien.  It was meant to be both her therapy, and also a time to receive his feed back on her clients.  Elizabeth primarily used their time together to gain insight into her work.  There was little to report and review from her virtually non-existent personal life. 

     Dr. Klien had been supervising Elizabeth for more than ten years.  He had become an expert on tropical fish, but still didn’t have a handle on Elizabeth.  At first he tried to get her more involved with the outside world.  Eventually he saw that she experienced no real subjective distress and so he let it go. 

     Dr. Klien knew Elizabeth was an excellent therapist and years ago felt that she had surpassed him.  However he continued seeing her because all she needed was an objective voice which he could provide.  In his mind Dr. Klien saw Elizabeth as a blank slate and believed her to be neutral in almost every sense.  She defined objective, and he envied that.

     Elizabeth had anticipated her supervision since meeting Brian.  Dr. Klien had worked with a pedophilic client in grad school, and she was feeling desperate for some guidance.  Elizabeth reviewed her clients, and when her time was up she left.  She had driven almost two miles when she realized that she had not said one word to Dr. Klien about Brian.  Elizabeth was very disturbed because she knew that in this instance forgetting was a defense reaction. 

     When Elizabeth reached her home she put down her keys and checked the tank by the door.  Her Athena’s fish was dead.  She fell on the floor and wept until she could barley catch her breath.  She noted to herself that it was the first time that she had cried in almost six years.  She had not planned to do so in advance, but she washed her face and went to Clagett’s to have a drink anyway.

 

6:45 P.M.

 

     At Clagett’s Elizabeth found one of her acquaintances.  She was comforted when she saw her face.  Elizabeth drank as Rena complained about her husband’s bathroom habits and how he parallel parked.  It relaxed Elizabeth to listen to Rena and her normal problems.  The funny thing was that Elizabeth never knew what to say in response to a balanced person.  This lead Rena to secretly believe that Elizabeth was an incompetent shrink, but she did appreciate the fact that she listened.

 

TUESDAY 2^nd

8:00 Call MD about Transsexual male client-

The truth is more important than the facts.

 

9:00 Brian “The Other Brian” (Passive Aggressive Personality Disorder)

Evil is unspectacular, always human.

 

10:00 Martha (Adjustment Disorder)

Youth would be an ideal state if it came a little later in life.

 

11:00 Bebe (Bulimic Eating Disorder)

Everything in moderation.

 

12:00 Lunch

Add 44 grams of whey protein.

 

1:00 Nathan (Post Traumatic Stress Disorder)

There are more things in heaven and earth than dreamt of in our philosophy.

 

2:00 Carol (Personality Disorder/ Mixed Features NOS)

Those who have the power to see the future, have the power to change it.

 

3:00 Crystal (Body Dysmorphic Disorder)

No one can make you feel inferior without your consent.

 

4:00 Anna (Defenses/Denial)

 A little knowledge is a dangerous thing.

 

5:00 Sean (Transsexual)

Never trust a man without a vice.

 

Evening: _____________________________________________.

 

8:00 A.M.

 

     Elizabeth sat looking over her schedule for the day as she wrote in her cue quotes.  Tuesday would be a full and varied experience.  As she reflected on Brian and the residue left by him, she wondered what she really did and did not absorb from her clients.

     Katie buzzed Elizabeth with a call from a Canadian MD.  It was an interesting referral which Elizabeth said she would have to consider carefully.  The client was a local man who was planning to have sex reassignment surgery in Ontario.  There were strict guidelines called the Harry Benjamin International Sex Reassignment Pre-Surgery Protocol.  They required that the client had to attend six months of pre-surgery counseling.  Additionally, before surgery he had to begin estrogen hormone therapy and live as a female for one year.  The MD informed Elizabeth that his patient had been cross-dressing successfully for eight months and on estrogen for seven.

     Elizabeth wanted to think it over, but not because she was afraid of handling such an unusual case.  She in fact presumed that it would be fairly simple therapy.  The German’s have a saying, “Never trust a man without a vice.”  Elizabeth had refined this saying to “Never trust anyone whose pathology isn’t visible.”  Extreme clients usually didn’t go any deeper than their presenting problems.  When someone has a blatant issue, it is blatant because it is conscious and integrated, therefore few complications.  

     Elizabeth gave pause only because of her ethical concerns.  It was a tricky issue.  The American Psychiatric Association still classified transgender issues as pathological.  Of course, only a few years ago homosexuality was also considered a mental illness.  Elizabeth’s real ethical concern was to do no harm to the client.  Elizabeth’s question was; is it ethically valid to assist in sexual reassignment surgery, or was it tantamount to encouraging an anorexic to have their stomach stapled?  Was the surgery a valid medical intervention that would cure a chronic problem, or was it the doorway to deeper troubles by pormorphizing the pathology?  Elizabeth did not judge if it was right or wrong, strange or valid, she just wanted to know if she would be truly helping. 

     Elizabeth downloaded and reviewed the available literature to help weigh her decision.  She discovered that post-morbid research had found that the BSTC in the male trans-gender’s hypothalamus was female sized.  The researchers concluded from this that these people were transgender from birth.  However, Elizabeth believed strongly that cognition could change neurochemistry, and in the end the mass and structure of the human brain.  Which came first, a physiological precursor, or a cognition that created a permanent change wasn’t the actual issue for Elizabeth.  What mattered to her was how this information suggested the level of integration into the self the trans-gender tendency held. 

     Based on the information Elizabeth found, she assessed that this client was most likely experiencing the need to change gender on a direct level.  His desire to be a woman was probably not an unresolved conflict.  He probably was not identifying with a female victimizer, or trying to gain societal permission to express emotion.  This client had a specific need that was possibly only resolvable through surgery. 

     Elizabeth also found that 85% of post-operative clients were pleased with their surgery and satisfied with their decision to do so.  However if she took him, Elizabeth knew she must screen the client closely to be certain that he would not be one of the 15% who would regret the irreversible decision. 

     Elizabeth pondered that transgender disorder could be a natural phenomenon as yet unexplained.  However, for 15% who regret their choice, it could also be a self hatred formed so early that it grew into the sense of self only to be elevated by self mutilation.   

     Elizabeth hoped that if she worked with this client it would only involve preparing him for the inevitable sense of loss and the second adolescence that he would be stepping into.  She did not want two versions of body dysmorphic disorder in her client load.  Crystal was enough.

     After analyzing the possibilities, Elizabeth came to believe that she could help and protect the client, and most importantly to her, do so without causing harm.  Elizabeth called the MD back and agreed to take him.  In less than five minutes the client named Sean called Katie to schedule his first session that very day.

     Elizabeth made a mental note to herself not to discuss this client’s issue with the girls at Clagett.  Of course Elizabeth always maintained confidentiality. 

     However, when the girl’s asked, “What did you do today Doc?”  

     Elizabeth would respond with answers like, “Two borderlines, a depressive, and a bi-polar.”  If she added, “and one pre-op transgender”, Elizabeth knew that they would begin asking questions which would be exploitive, and therefore irritating to her.   

     Elizabeth despised the sideshow appeal that mental illness held for the general population.  It was her ability not to judge, coupled with her ability to see the mockers own pathology that made it so irritating to her.  Elizabeth suspected that this transgender fellow had a better prognosis than M, and he might not even be mentally ill at all.  She noted to herself that ironically society would never mock M. 

     These thoughts made Elizabeth wish she had a close friend she could discuss such topics with.  She was struck with an unfamiliar sense of want.  The Clagett girls weren’t real friends.  Elizabeth had never rated them before, but she felt a new gnawing need that they did not come close to meeting. 

     In truth, the girls basically looked down on Elizabeth because they had misinterpreted her distracted air to be stupidity.  To them her intellectual references seemed like random non-sequiturs.  Plus, she embarrassed them slightly when she clucked her tongue.  Elizabeth could heal the mentally ill, but she still missed common social cues.

     As Elizabeth pondered the massive struggle a transsexual would face she felt what was almost envy.  She wished she could step out of herself also, but she did not have an idea of whom to become next?  This was another new need.  It crossed her mind that she felt unequipped to handle what she was faced with.  Upon exploring this aspect of possible incompetence she realized it was not working with Sean that concerned her, but again Brian. 

 

9:00 A.M.

 

     “The Other Brian” was Elizabeth’s first client of the day.  He was a thin nervous man who was nothing like Brian the pedophile.  The Other Brian was a nickname that actually suited him.  He was a seemingly insignificant fellow who no one ever noticed.  He was a quiet recluse who seemed weak and harmless.  He usually spoke too softly to be heard, and never made eye contact.  However, Elizabeth knew that his withdrawn manor was actually part of his passive aggressive expression of hatred.  He hated the world and clung tightly to his festering anger. 

     Initially Elizabeth delved into The Other Brian’s capabilities.  Her concern was that he might be the type to end up on a bell tower shooting at strangers.  Everyone knows when a serial killer’s neighbors describe the captured killer they always say, “He was a shy quiet man.”  That was the extreme version of this Brian’s type of displaced anger.        

     Elizabeth believed that this Brian was not a killer or even violent, but over the months he did confess that he occasionally scratched his co-workers cars with his keys.  He trained his dog to go in his neighbor’s yard, and woke at 4:30 A.M. to have him do so.  He would empty out the coffee tin at work so that the next morning everyone would have to go without.  His vengeance was unimaginative, but methodical and surely irritating. 

     The Other Brian had recently forwarded his boss’ mail to a fake address hoping that this would make his bill payments late.  Brian tried not to smile as he recounted all of his recent acts of revenge.  Revenge for the imagined wrongs which he constantly suffered.

     Elizabeth reviewed The Other Brian’s homework for the week which was to honestly and appropriately express his anger verbally to his boss.  Elizabeth was disappointed when Brian said that he had lost his temper while explaining to his boss that he felt taunted and unappreciated.  The boss had laughed at him and told him to get a life.

     As Elizabeth reviewed his actions, this Brian seemed to be bursting to tell her some news which had clearly given him great joy.  Elizabeth knew it was going to be a biggy, and it was. 

     The Other Brian gleefully said, “I went on the Internet and downloaded child pornography.  Then I photographed the screen with a disposable camera.  I went to a film drop off box and filled in my boss’ name and address on the pick up form.  Get it?  Now the people who developed the film will notify the police.” 

     Elizabeth had to think this through for a minute while The Other Brian giggled and shook.  Did this fall under the duty to warn law?  Yes, but only if the photos could be developed.  Elizabeth wondered if you could photograph a computer screen with a cheap camera.  Elizabeth didn’t want The Other Brian arrested.  Incarceration would only make him angrier and therefore more of a menace to others once released.  She also didn’t want the innocent boss arrested, but the boss was her secondary concern.

     Elizabeth considered doing a camera test at home before taking action.  She then imagined she herself doing the same thing to the pedophile Brian.  Elizabeth was shocked by her dark thought.  She wondered if this Brian could be affecting her too.   She took hold of herself and decided to speak with Dr. Klien about this Brian.  She trusted that the two of them together could figure out what steps to take to protect the boss.  This Brian never showed up in her office again.  Elizabeth called him twice, but got no answer.  She let this one go.

 

10:00 A.M.

 

     Martha was seventeen.  While not yet court-ordered into counseling, she was being parentally forced which made her even less cooperative.  Martha had become pregnant.  Instead of telling her parents she found a woman who gave her a potion, as she called it, and then pressed on her belly for $150.  It did not abort the baby but it did send her to the ER.  Her parents took her a few days later to a real doctor to have an abortion.   

     Martha had spent her first eight sessions trying to get Elizabeth to state if she thought abortion was, or was not a sin.  Elizabeth explained to Martha again and again that it would be unethical for her to state her own beliefs.  In reality Elizabeth did not fully grasp the definition of sin, nor had she contemplated the topic of abortion.  However, even if Elizabeth had beliefs outside her field she would have handled Martha just the same.

     Seventeen-year-olds are difficult to argue with, even for a professional psychologist.  When Elizabeth would adequately state the perimeters of the therapeutic relationship and purpose of neutrality, Martha would still persist.  Elizabeth knew she couldn’t wait her out and logic did not work.  She finally put a moratorium on the topic of sin until their final session.  Elizabeth thought of this as being sort of a trick but felt it was the only way to make progress.

     Elizabeth told Martha that the point of their therapeutic relationship was to give Martha a neutral sounding board so that she could understand herself on a level that would facilitate the development of her own morality.  Being absent any socially induced principles of her own made Elizabeth an exceptional match for this need of Martha’s.

     Martha usually spent the first few minutes of each session silent while she wrapped and unwrapped a rubber band from around her index finger.  However, on this day she came in talking before she sat. 

     Martha began by challenging Elizabeth, asking, “OK, so if you have some wacko in here who’s wearing garlic to keep aliens away, you act like their OK, right?  If an ax murdered comes in here you don’t say, ‘You sicko, you’re an ax murder, get out of my office’.  Right?”

     Elizabeth repressed a grin.  She truly did enjoy Martha. 

Elizabeth carefully began,

Well, if an ax murder came in to my office and stated that he was a danger to others, I would notify the police.  If anyone who is mentally ill becomes a danger to themselves or others they will be hospitalized or incarcerated.  That’s the law.  Your garlic sporting man is probably a paranoid schizophrenic and so I would consult social services and try to have him hospitalized until he stabilized on meds.  Then yes, I would treat him and not judge him.

     The words “Not judge him” were still hanging in the air when Martha came back at her.  “So first of all if I am crazy, you won’t even tell me, so how does this help!  Secondly, you promised not to talk about what happens in here, so how can you tell the cops?” 

     Elizabeth yet again explained the law about being a danger to self or others called the Duty to Warn law.  It means that if someone is planning to or is currently harming someone else the police are to be notified.  If someone were actively suicidal the police would also pick him or her up and transport him or her to an in-patient facility. 

     Elizabeth assured Martha that nothing beyond the rules about endangering self or others would ever leave the office.  Martha had to trust Elizabeth before they would make any progress.  This trust had to be based on ethics, and not emotions.

     After years of following rules, laws, and ethics, Elizabeth was unable to think beyond them.  Discussing them with Martha gave Elizabeth a new and oddly helpless feeling.  Elizabeth again became distracted by thoughts of Brian, but Martha demanded her full attention. 

     “So what about me being crazy?  You skipped over that.  Hum, how interesting.”    

     Elizabeth was amused by Martha’s impression of her.  Elizabeth ran through a standard list of questions, “Give me your definition of crazy…Are you concerned that I think you’re crazy?  Do you think you’re crazy?”

     As Elizabeth went through the rigmarole with Martha, she was trying hard to imagine ways of stopping Brian.  She could not report him to authorities if he would not confess.  She did feel it was her duty to warn authorities and she needed to protect his child, but her hands were tied.  A therapist suspicion, however measured, is not evidence. 

 

11:00 A.M.

 

     Bebe had been seeing Elizabeth for several months but had just begun to open up.  The first moment Elizabeth laid eyes on her she knew that she was a bulimic.  Bulimics who vomit after binge eating will have eroded gums and thin chipped teeth due to their regular exposure to regurgitated stomach acids.  Bebe had not yet confessed her eating disorder to Elizabeth.  Elizabeth knew it was best to let her bring it up in her own time.   

     Elizabeth was confident that the psychological root of Bebe’s bulimia was her fear of being controlled by others, while at the same time fearing the loss of control over herself.  Elizabeth had assessed early on that Bebe was this standard type therefore Elizabeth allowed Bebe to control the pace of her therapy, but did stop her when she began revealing too much in one session. 

     Bebe’s parents watched and controlled her every step.  They were well meaning parents, but also fearful and anxious.  Bebe never learned limits of any kind because she never had a choice of any kind.  She never had an opportunity to make a mistake or experience the repercussions of one.  Now as a young adult she intuitively understood that being controlled was dangerous, but was still unable to see why.  She was riddled with irrational fears, all of which centered on her ability to control her own impulses.  After weeks of dead silence interspersed with rapid chitchat, Bebe began to reveal herself to Elizabeth.

     Bebe cleared her throat and said in a modulated voice, “I work on the twenty-second floor of my office.  It is the tallest building in town.  I stand at the window sometimes and feel afraid that I will jump.  I know I can’t go through the glass, but I’m afraid that one day I will try.” 

     Bebe stared hard at Elizabeth hoping for a reaction. 

     Elizabeth gave none but responded flatly, “So you know that you cannot do this, yet you fear it anyway?  Do you have other fears which involve loosing control of your impulses that are irrational?” 

     Bebe had a long list from shoplifting to going to work in her pajamas.

     Elizabeth took the next step and asked her, “Do you ever act on an impulse and then feel out of control?” 

     Bebe looked genuinely frightened by the question.  She hurriedly answered Elizabeth in a trembling voice, “Sometimes I eat a lot all at once.” she said.  Then Bebe stared at the floor until her time ran out.

 

1:00 P.M.

 

     Elizabeth’s next client was highly motivated.  Nathan’s mind was genuinely open.  His diagnosis was post traumatic stress disorder, brought on by a plane crash in Peru.  The trauma was being dealt with fairly quickly.  However, Nathan not only craved healing, but also self-actualization, and so they planned to work together long term.

     When Nathan’s airplane began going down he had tried to get into the cockpit but found the door bolted.  This added element of helplessness over his situation had intensified the severity of his PTSD.  Nathan suffered recurrent and intrusive thoughts of the moment when the plane struck down.  He now had to drink himself into oblivion to get on a plane, and the sight of snow gave him heart palpitations.  Elizabeth was using some basic behavioral techniques to help him with his anxiety and to manage the intrusive thoughts that plagued him.  These techniques were working as predicted.

     Elizabeth always kept up with research in order to best serve each client.  She had learned that experiencing trauma was proven to cause the hippocampus region of the brain to emaciate.  This is the area of the brain is responsible for learning.  Therefore part of Nathan’s treatment was simply to learn for learning sake.  Learning had been proven to improve the type of brain functioning damaged by trauma, and so improve the mind’s own capability to heal itself. 

     Nathan was instructed by Elizabeth to study something new to him.  This was now an important part of his treatment plan.  It was an acceptable task to Nathan because he was by nature profoundly curious.  However, narrowing down his choice of study took up several sessions.  Finally, he let go this avoidance tactic and enrolled in a cooking class.

     Nathan understood his diagnosis better than most trauma victims.  He accepted that the block to his healing involved an animal need to maintain an irrationally fearful response to any elements relating to his trauma.  However, survival instinct does not obey logic and the most intellectual clients have the most difficult time putting their human ego aside and grasping that reason alone won’t get them out of this one.  The most autonomous have the most difficult time with the fact of human helplessness.  Nathan was both academic and self-governing, but Elizabeth still had faith in his courage and in her skill.

     Nathan clearly stated to Elizabeth that instinct verses reason was a battle that he was willing to fight.  Nathan was additionally motivated by the prospect that understanding this part of himself would earn him a greater understanding of the animal mind for the sake of his work.  Expressing her greatest level of affection, Elizabeth told Nathan that he was “compliant.”

     Nathan was a crypto-zoologist and had recently returned from the Himalayas.  He was with a sincere team of well-trained researchers who sought evidence of the existence of the Yeti.  Elizabeth didn’t flinch when she heard what Nathan did for a living.  What did amaze her was how intellectually and scientifically his expeditions were conducted. 

     It may seem a laughable profession, seeking the Abominable Snowman or the Lock Ness Monster, but on occasion some mythical creature does turn out to exist.  Nathan had reported that in the past twenty years two prehistoric fish believed to be extinct for over ten thousand years were found alive.  The giant squid was a sailor’s myth ranked with mermaids until one washed up on a shore in Norway during the early 1980’s.  Nathan himself had been involved with the discovery of a believed to be extinct boar in South America.  Elizabeth was intrigued by his work, but did not allow him to use it as a distraction or avoidance tactic.

     Nathan sat quietly for a moment and then asked Elizabeth, “Do you think I should seek a new creature, maybe a less grand one?  The Yeti has great religious significance to the Hindu of the Himalayans.  Maybe there is an equally elusive less publicized beast I could locate?  One that is unknown to the western world.” 

     Elizabeth stopped him and questioned if he really wanted to spend their time together reflecting on his career goals, or if it wouldn’t be better to work on his remaining trauma symptoms.  Nathan’s avoidance of the topic of his trauma was a symptom of the trauma itself.

     Elizabeth took down her after session notes on Nathan, and then looked ahead to her next client Carol.  Elizabeth wrote down that Carol might be Nathan’s mirror opposite.  Carol did not seek the unknown; she created it.  Carol did not fear real and present danger, but rather primeval lies.

 

2:00 P.M.

 

     Carol was an interesting case.  Not a beginner’s client.  Her diagnosis could not quite be named as one of the personality disorders.  However, she employed both “borderline personality disorder” and “schizotypal disorder” defense techniques. 

     Carol was a virtuoso at the borderline technique of “social splitting.”  This splitting is a defense in which the perpetrator manages to pit everyone in their lives against everyone else in their lives, while remaining seemingly uninvolved.  This was probably adaptive for someone who grew-up in a household with revolving fathers, but as an adult it made Carol treacherous. 

     Carol also had a schizotypal symptom called “magical thinking”, which like most symptoms runs on a continuum.  At worst, someone with magical thinking may believe that they can will major events to occur.  In Carol’s case it was less extreme.  She merely believed that she was supernaturally gifted.

     Having been abused as a child it was a necessity for Carol to develop exceptional intuition.  Her intuition, splitting, and magical thinking morphed into a practical defense system.  Carol had grown-up to now believe that she was a psychic, and she had a ream of devoted followers who agreed.     

     Carol had a busy practice as a psychic, and charged thirty dollars more per session than Elizabeth did.  While her intuitive skills no doubt could have served her clients, her splitting defense wreaked havoc in their lives.  She was performing borderline behaviors by proxy.  The chaos Carol created in her client’s lives served her by making them even more dependent on her.  She would predict their future turmoil, set them up to create it, and then advise them on how manage it. 

     Carol was not consciously aware of her manipulations.  Her work and defenses were entirely unconscious.  She just saw her client interactions as consistent evidence of her extra sensory abilities, as did they.

     In their first two sessions Elizabeth ignored Carol’s profession, or gift, as irrelevant to their work.  Elizabeth never pondered if psychic abilities did, or did not exist for anyone.  She was only focused on what it all meant to Carol.  However, Elizabeth quickly saw that for Carol, psychic abilities were in fact the expression of her complex defense system. 

     Elizabeth realized that for someone with an erratic childhood the ability to predict the future would be highly appealing.  The ability to control others would be the antidote to her deepest fears.  Elizabeth also knew that Carol used these defenses to not only wield power, but to function on a daily basis.  She knew that to remove Carol’s false belief she would have to replace it with a healthy truth that would somehow also serve to protect her.  Otherwise, Carol would be naked in a world that was entirely foreign to her.  She was a tricky case.

     During this session, Elizabeth took baby steps as Carol discussed father number four.  Elizabeth slowly highlighted Carols need to master other peoples relationships for her own sense of protection.  Elizabeth wrapped up the session by saying the key to healing is sometimes seeing that, “That was then, and this is now.” 

     Carol’s ability to grasp the abstruse was exercised daily, and so Elizabeth often ended their sessions with metaphors or analogies for Carol to contemplate.  The advantage of this was that Carol’s unconscious would decide when she was ready to accept it. 

     As Carol stood up to leave, she seemed to loose her balance for a moment.  She then announced in a projected voice, “Wait, I’m getting something.”  Carol made a humming noise and then said, “Elizabeth, you are about to come into unexpected wealth.”

     Elizabeth thanked her and hoped that this meant Carol was finally going to pay her bill.  Carol left and Elizabeth began taking her after session notes.  Elizabeth reminded herself that like her work with Bebe, she must let Carol choose the pace of her own healing.  She wrote down that like M, Carol had no genuine sense of self, but unlike M she compensated by absorbing the lives of others as her own. 

     Elizabeth assessed that not having control over others was even more terrifying for Carol now than it had been when she was a child.  It crossed Elizabeth’s mind that this trait she realized in Carol was uncomfortably familiar.  Yet she couldn’t place which client to associate it with.

     In truth, the fact that Carol was in therapy was the only sign of hope Elizabeth could see in her.  Of course Carol said she was only in therapy to be certain that she would progress on the karmic wheel and so be higher in her next life.  Elizabeth knew that this was an excuse and therefore on some level Carol did know that she was sick, but could not yet face it.

     Elizabeth believed that everyone knew on some level their truth.  Elizabeth had worked in a mental hospital while an undergraduate.  She saw there that even the sickest in-patients could control their impulses if the right consequences were present.  She felt hope for a moment that perhaps she could help, or stop, Brian.  Then she thought about the fact that prison was not enough of a consequence to stop him and so what else was there? 

     Elizabeth suddenly had a headache.  If it did not go away, at least she knew that her next client would have a wide selection of painkillers to share.  Elizabeth looked over her treatment plan notes to prepare for Crystal.

 

3:00 P.M.

 

     Crystal began seeing Elizabeth due to a simple phobia.  Her fear was of birds.  Its intensity waxed and waned with her stress level.  When she began treatment the phobia was genuinely interfering with her daily functioning.  Elizabeth knew anyone who came in with a non-trauma based phobia always had an underlying issue.  Once the phobia was resolved this issue would quickly emerge, or else a new and more complex defense would arise. 

     The bird phobia was resolved quickly and psychoanalytically.  Elizabeth asked Crystal to describe birds.  Crystal said that, “They were these prehistoric creatures who had the gift of flight.”  They were in Crystal’s mind, “flying snakes.” 

     Crystal went on with an elaborate description of how scales had evolved into feathers, and the creepy fact that their bones are hollow.  She spoke as though she were trying to convert Elizabeth into a fellow bird hater.  Crystal then revealed that what frightened her most was the way that they, “Came out of no where, and without warning”! 

     What Crystal feared were lesser beings with an advantage over her, who could appear and attack out of the blue.  Crystal had no memories of ever having been attacked, but Elizabeth suspected on some level she had been attacked out of the blue, and by a person that she considered to be base. 

     Elizabeth gave Crystal some behavioral exercises to help her with the specific fear.  The systematic desensitization relieved her phobia quickly.  Unfortunately Crystal was so far into the progression of her illness that the very next week nose job number one was performed.  Once her phobias were resolved, the next layer had been revealed.  Elizabeth wished that she could have gotten to her sooner.

     Once healed of her fear of birds, Crystal had quickly made the switch from phobic to body dysmorphic disordered.  Crystal was now incapable of viewing her own form without becoming obsessively preoccupied with her imagined defects.  Elizabeth knew that whatever Crystal was burying must be intense. 

     Crystal had to have an outlet for her unconscious fear.  This vent had to be non-reality based and so irresolvable and of concealed content, concealed even from Crystal’s conscious self.  Once birds no longer sufficed, she had moved on to hating her own body.  Elizabeth methodically pealed at each layer waiting patiently to reach the core of Crystal’s troubles.

     Crystal came to session with a bandaged nose and black eyes.  She skipped over the topic of her rhinoplasty and began discussing her up coming tummy tuck.  Crystal was not beautiful, but pleasant looking.  She had no exceptionally bad or exceptionally good features but she was now obsessed with her looks and every detail of her body. 

     Elizabeth initially pondered if the less harmful bird phobia should have been allowed to remain as a vent for Crystal’s underlying fear and anxiety while they started from the foundation and worked their way up to the surface.  However, Elizabeth concluded that Crystal would not have lasted that route.  She would have quit and seen a hypnotist, or started an anti-phobia drug and gotten nowhere.  Now the phobia was gone and so body dysmorphic disorder had emerged.  Crystal’s perception of her looks was now even more bizarre than her previous views on birds.

     Elizabeth had to decide if she should approach Crystal’s need to control her body directly, or approach from an angle.  She decided to make Crystal aware of her preoccupation with the slight defects of her appearance but offer no interpretation.  She asked Crystal to define her old and perfectly ordinary nose. 

     Crystal said her old nose was so disproportionate, “It was gross.”  Crystal explained that she had finally realized that everyone stared at it when she spoke to them.  She went on to say her tummy was “deformed” and “had to be repaired.” 

     She had also recently realized that she had asymmetrical cheekbones and planned collagen injections or else implants.  Crystal added that if she went with cheekbone implants that she would have to also have her chin done for the sake of balance. 

     Elizabeth asked if this new preoccupation with her appearance was getting in the way of her social interactions.  Crystal explained that it wasn’t that her looks interfered; they just lessened the quality of her peer group.  Elizabeth restated the question so that Crystal could understand that she was referring to the energy and distraction used by the preoccupation, not the goal of the changes.  Crystal thought for a minute and said her best friend at work was jealous of her new nose and didn’t seem to like her anymore.  She also said that her Mom felt hurt because Crystal had inherited her original nose from her.

     Crystal than began discussing her second toe being longer than her first, and that she did believe there was a surgery for that, but it would be the last one she had done.   

     Elizabeth pointed out, “These concerns are new and appeared immediately after you overcame your bird phobia.” 

     Crystal retorted, “The bird phobia was distracting me from the real issue of my freakish appearance.”  She then rolled her eyes to show her irritation with Elizabeth’s lack of understanding. 

     Elizabeth carefully drew the connection between both preoccupations being centered on “control, fear, and repulsion.”  Crystal rejected the relationship between the two, but continued her treatment.  Elizabeth believed Crystal would heal and even after difficult sessions with her was always left with a sense of hope.

      After Crystal left, on her way to yet another medical consultation, Elizabeth realized that she had not followed her treatment plan progression.  She had notes on her pad which even though she glanced at during session she had somehow ignored.  Elizabeth believed Crystal might have been sexually abused as a child.  She had planned to ask her outright during this session if she had any memories or suspicions. 

     Elizabeth was always careful with the timing of this question.  She never guided a client to relive sexual abuse.  Even though false memories are difficult to plant, a client repressing abuse memories will themselves suspect their therapist of confusing them.  The possibility of deception is easier to deal with than the truth for the client, so Elizabeth was always very explicit and direct with this topic.

     Elizabeth had thought out and planned the session.  She was disturbed that she had made a mistake.  She knew she had repressed the question.  She was again feeling invaded by Brian and now was unconsciously protecting herself from this disturbing subject.  After treating countless victims of sexual abuse, the topic was suddenly too close to home for her.

 

4:00 P.M.

 

     There was one client that Elizabeth found hopeless, perhaps the only one before Brian.  The factor that blocked their work together was that Anna was also a psychologist.  She knew the language and methods well.  She knew them so well that she could fool herself into believing that she was sane.  Sadly, she was slipping deeper and deeper into delusion.  The fact that she could redefine, label and trace her own pathology protected her entirely from the truth. 

     Anna was one of those crazy psychologists who rather than healing themselves, earns a degree as some sort of evidence that they are sane; a sanity certification.  They then embedded themselves deep inside the ultimate defense, psychology itself. 

     Anna represented everything wrong with the field.  Elizabeth was certain that Anna caused all of her clients harm, because she could only see others through her own narrow lens.  When Anna recognized one of her own unresolved issues in a client, she would desperately engage in a defense to protect herself from facing it via the client’s reality.  She would then inadvertently teach the client her own twisted defenses, making them feel that their problems were solved. 

     Elizabeth could only imagine how many of Anna’s former clients snapped years after treatment with her.  Maybe some even returned to see her afterwards based on the logic that she had made them feel better before; not realizing that Anna herself had damned up their issues until the damn broke, and they found themselves even worse than they were before Anna’s therapy. 

     Elizabeth’s only hope for Anna was that she would eventually have a nervous breakdown.  She was getting closer and closer.  In Anna’s case this would be a good thing.  Her defenses were so sophisticated that Elizabeth could not unravel them as quickly as Anna could weave new ones.  A breakdown would force Anna to rebuild from scratch.  Hopefully she would rebuild from the truth.  At this point, it seemed to be her only hope. 

     Anna’s children had reached adolescence and begun to rebel.  This is difficult for any parent, but for Anna it was tearing at the fabric of her reality.  She was so desperate to stop them from changing against her will that she had become psychically abusive.  This actually gave Elizabeth hope that somehow these kids were maintaining their sense of self despite their mother’s narcissistic use of them. 

     Each member of Anna’s family was fighting to save their own reality and truth.  The home was chaotic, however, Anna focused in session on the fact that she was now drinking two glasses of wine a night and this concerned her.  Her drug addicted daughter and marital separation were no fault of her own and beyond her control, and so she felt discussing them would be a waist of time.

     The trick to treating Anna was to remember that each relationship she spoke of was a facet or a conflict within Anna herself.  Elizabeth had no way of knowing what these people were like in real life, but in Anna’s case that really wasn’t relevant. 

     For example, she would describe the facts of her sister’s life; her success and education, but would then contradict herself by adding that the sister was unable to function.  Elizabeth knew it was a projection of Anna’s fear of her own impending breakdown.  In a sense she shared Martin’s defense of narcissism, but was unable to exercise his level of self-control.  Anna was controlling of others as an act of desperate fear, not as a means of maintaining the fortress like Martin, or self protection like Carol.

     Anna’s husband was said by her to be narcissistic and controlling, but also an excellent parent and charitable compassionate man.  Elizabeth felt it was good that Anna’s primary issues were being projected on to the person closest to her.  Anna projecting onto her husband was only one step away from Anna accepting these traits as her own.  Granted it was a large step. 

     Anna even projected onto her cat.  The cat was supposedly angry with the children, afraid of change, plus newly angry and violent.  Elizabeth would have laughed to herself over the cat parable, but the fact that this woman was a therapist kept it from being funny at all.

     Anna always began her sessions by reiterating that this was not therapy but supervision.  Elizabeth was careful to try and help Anna’s clients without threatening Anna so much that she would quit showing up.  In truth, when Anna would report that one of her clients had quit therapy Elizabeth was always relieved for the client’s sake. 

     Anna dressed in ill-fitting clothes as if she were even unaware of the truth of her own form.  The colors usually clashed and she had a repressed matronly quality.  Elizabeth hoped that she presented differently in her client sessions, but knew she probably did not.  Anna had a harsh gnawing voice that made her sound as if she was disapproving of everyone and everything no matter what words she was actually saying.  She could only see the negative traits in others, but none in herself.  She would bring up her most minor issues and pretend to work on those while ignoring the elephant in the room. 

     Elizabeth’s neutrality made Anna nervous that she was being judged.  Elizabeth did not judge her, but did very much judge her professional ethics.  After months of working with her today was the first time Elizabeth could not bear Anna.  As Anna prattled on, Elizabeth began to have fantasies of telling her to get out of psychology or else become an in-patient. 

     Elizabeth imagined how horrible it would be if Brian were referred to someone like Anna.  On her pad Elizabeth wrote that referring Brian was not an option.  Jail was not a deterrent to him.  Then she compared his grasp of reality to Carol’s and drew question marks.  Then she wondered if like Bebe, Brian felt out of control.  He certainly had not presented that way but could it be a compulsion for Brian to abuse his daughter?  Then she drew a picture of Anna jumping off a plank and their time was finally up.

 

5:00 P.M.

 

     Sean came walking into his session brimming with enthusiasm.  He was articulate and motivated.  Elizabeth was immediately glad she had accepted him as a client.  He was clearly brave, and not comparable to Crystal as Elizabeth had expected him to be. 

     Sean’s presenting problem was his concern over the effect his transformation would have on his two small children.  Being primarily psychoanalytic Elizabeth shared this concern.  Castration anxiety was present in all young children, but what would the repercussions of having it acted out by a parent be?  Elizabeth was surprised and challenged already.  She felt a rare surge of joy. 

     As Elizabeth reviewed his history, Sean reported that he had overcompensated for his desire to be female by becoming an exceptionally macho navy seal.  He had also married a woman that he loved, but she had left him when he started the estrogen injections.  Sean explained to Elizabeth that transsexuals are not homosexuals and typically maintain their desire for the “opposite sex” after surgery.  Elizabeth understood Sean’s need to lecture her, but of course she already knew the details of his classification. 

     Sean did not mention however that trans-gender men do seek males to validate them as being in the female role both before and after surgery.  Elizabeth wondered how long male validation would please Sean before it became annoying.  Elizabeth thought of how angry it made her when strange men guided her with waving hands into her parking space.  How they insisted on helping her with simple mechanics that she was perfectly capable of performing.  Then she acknowledged to herself the covert way she had seen other women validate themselves at the expense of men, and decided that it was an even trade.  She again tried to refocus her mind back to Sean’s lecture.

     As Elizabeth slowly probed Sean as to the layers of his motive to have the surgery, he cut to the chase, locked eyes with Elizabeth and said, “Look, its have the surgery or commit suicide”! 

     Elizabeth, not missing a beat asked him if he knew the medical risk.  Sean rattled off every side affect, followed by the statistical probabilities of him suffering each one.  

     “What part of the surgery or suicide didn’t you understand?” 

     Elizabeth took a moment to draw a kribensis fish on her pad, as if she were taking careful notes.  She wanted Sean to know that he was being listened too.  He was, but he needed Elizabeth to indicate it.

     Sean apologized for his outburst.  He explained that he had a lot of resentment built up from years of repression and then ridicule.  Elizabeth noticed him use a darting eye movement which connotes shame.  She had only seen females emote this way.  As their session continued, Elizabeth was struck several times by the subtly feminine movements and expressions he made.  She also noticed that while his voice was still a rich baritone, Sean chose adjectives like a woman might.  His descriptions were less concrete and more social than a typical male’s would be.  Initially, she wasn’t entirely sure if it was true to his nature or an affectation, but she found herself becoming convinced of Sean’s own explanation. 

     Sean truly believed he had a female brain and a male body.  He referred to his current gender as a birth defect.  He also referred to the surgery as a way to finally be complete.  Elizabeth noted that complete was an interesting word choice considering that he was having his male genitalia removed.  It gave Elizabeth faith that Sean was making the right choice for himself.  If he had said repaired, fixed, or altered Elizabeth would have been concerned.  That would be reminiscent of Crystal.  Ridding himself of his masculinity wasn’t the goal.  Sean’s goal seemed to be obtaining a totally feminine self, including the body.

 

Wednesday 3^rd

8:00 Update notes/files

Tell Katie to move Brian to 10:00 A.M. on Mondays and Wednesdays… Gain awareness of unconscious motive???

 

9:00 Emanuel (Bi-Polar)

Passion crashes into obstacles, reason peers around them.

 

10:00 Ross (Panic Attack)

Anxiety is worse than reality.

 

11:00 Peter (Sexual Fetish)

I can’t define it, but I know it when I see it!

 

12:00 Lunch

10 Grams of soy isolate protein.

 

1:00 M (Dysthymic)

Beauty can be feasted upon.

 

2:00 Verna (Major Depression, no features)

Depression is melancholy minus its charms.

 

3:00 Brian (Pedophile)

Evil works through charm.

 

4:00 Martin (Narcissistic Personality Disorder)

A great many people think they are thinking when they are really just rearranging their prejudices.

 

5:00 Dr. Klien (Supervision)

The wise person knows that they do not know.

 

Evening: Check pH balance in tanks #’s 4,7,9

 

 

8:00 A.M.  

 

     Elizabeth had many notes from Tuesday to file.  Katie of course was instructed to never read confidential client files, and so could not assist.  Elizabeth had taken numerous new steps with her clients recently, but could only relate each insight back to Brian.  She found no research, and had no experience that could help her treat him. 

     Elizabeth knew she would have to see Brian at 3:00.  The memory of a dream she had the night before came to her.  It was of a Yeti walking into her office.  She knew it was somehow about Brian not Nathan, but it is always difficult to interpret ones own dreams.

     Katie printed out Elizabeth’s schedule, and then asked her about Brian, “What’s wrong with that guy who’s scheduled for 3:00?” 

     Elizabeth spoke in a cautioning voice and told Katie that she should never ask her about a client again. 

     Katie apologized saying, “Sorry, he just seems so nice and cool.  I was just wondering why someone like that would need help.  I started to wonder about that really hot guy Nathan too, because he was really nice, but then I sneezed while he was waiting, and he jumped out of his chair.” 

     Elizabeth simply walked away from her and waited in her private office for 9:00.

 

9:00 A.M.

 

     Elizabeth was concerned because when she arrived Emanuel wasn’t there.  Elizabeth was shocked.  He was only late when his depression struck.  He should not have begun his downward mood swing yet.  Ten minutes later Emanuel came bounding in exclaiming that he had just met his future wife.  That made perfect sense.  He was still experiencing the hyper-sexuality and grandiosity of his manic phase.  Elizabeth was comforted by his predictability, and by the proof of her accuracy. 

     Emanuel babbled so quickly that Elizabeth could barely follow.  It was time to check his mental competency.  Elizabeth was always so hopeful that he would fail.  If Emanuel’s mind was extremely disorganized then Elizabeth might be able to hospitalize him as incompetent.  She asked Emanuel what season it was, what floor of the building they were on, and his age. When he answered these simple questions, she quickly lost hope.  Emanuel was experiencing auditory distortions, and now believed that his former girlfriend was using voodoo to alter his spinal alignment, but to the delight of Medicaid and Medicare such symptoms, however extreme, come nowhere near the legal criterion for incompetence.

     As Emanuel babbled, Elizabeth realized that as odd as his behavior appeared he was coping really well.  This was bad.  Emanuel’s coping skills were so strong that he would be extremely high functioning during his up coming volatile state.  His self management had improved much more rapidly than had his mood control.  Ironically, the fact that he was better made him more dangerous than ever.  He could potentially maintain his mental clarity well enough to act on his rage with efficiency.  Elizabeth predicted that this cycle would end in jail time.

     Elizabeth let Emanuel ramble on until their time ran out.  She knew that it would not be long before psychotic hostility took hold of him, and then his crash.  Elizabeth still hoped the crash would be followed by Emanuel doing time in a hospital, but the more he rambled, the more she accepted that her hope was rather a wish.  Even when Emanuel had been hospitalized it was always in the forensics unit due to him being a danger to self or others.  Plus, by law he would spent no more than seventy-two hours there. 

     Elizabeth wished that Emanuel had excellent medical insurance that would allow him to stay in hospital care long-term.  It would take months to calibrate his medications and even longer to teach him additional life management skills.  One year or more as an in-patient would save Emanuel years and years of chaos and outpatient treatment. 

     After contemplating Emanuel’s situation, the current laws, and the state of healthcare, Elizabeth felt helpless.  Then she realized that she could at least become a democrat.  Beyond that she was still uncertain as to how she could keep Emanuel safe while accelerating his healing beyond there work together.   

 

10:00 A.M.

 

     Elizabeth’s 10:00 had never seen a therapist before, and even before they met she guessed that this would be his only session.  Ross walked in apologetically and visibly nervous.  He was a construction foreman who commanded over fifty men.  He was large and muscular, but at the moment he reminded Elizabeth of a five-year-old.  He had shown up at the ER believing that he was having a heart attack, but it was in fact an anxiety attack.  Elizabeth did not wait for him to begin.  She knew what he needed to hear. 

     “You are not crazy”, she said.

      Ross laughed hard with relief. 

     Elizabeth told Ross that people frequently show up at doctor’s offices or the ER believing that they have a heart condition, but in reality it’s simply anxiety.  She went on to compare his anxiety attack to an appendectomy, in that they are both sudden and painful, but remarkably easy to treat. 

     “Neither indicates a fundamental health problem.”  She said, “Just an isolated attack not indicative of any over all structural damage.”  Elizabeth chose to say “structural damage” because she thought that phrase might be familiar to him. 

     Elizabeth explained that his body was reacting like a stem valve, releasing his anxiety.  She told him that he needed to allow himself to develop some close relationships so that he could express his concerns before they built up like this again.  She offered to be his therapist, but knew it was too foreign an offer and so also advised him to start chatting more openly with his favorite bartender. 

 

11:00 A.M.

 

     Peter sat quietly avoiding eye contact.  He finally mumbled, “Do you think I am crazy.” 

     Elizabeth initially dodged the word crazy, and began to discuss the elements of subjective distress cause to Peter by his fetish.  To say that his behavior was, or was not, crazy was a judgment Elizabeth didn’t care to make.  She did point out that the fetish was damaging to his primary relationship, whether his wife knew about the cantaloupe or not.  Elizabeth stated that due to his feelings about the behavior, and the fact that it risked his stability he did have a problem.  Then she comforted Peter by saying that she believed that he was in touch with reality and that dealing with this issue was a healthy choice. 

     “What is your goal, what do you want to get out of therapy”, Elizabeth asked. 

     Peter, much like a drug addict, did and did not want to give up his damaging behavior. 

     Elizabeth pointed out to him,

Giving up the fetish does not have to be your goal.  You might choose to accept this behavior and incorporate it into your relationship with your wife rather than risking your marriage and exploiting strange woman.  You also might want to discover the origins of the fetish and understand it on a level that would put into a less distressing context.  Exploring the origins of your fetish might even eliminate your need to act on it, or at least give you more control over what arouses you.

     Elizabeth paused to allow Peter to absorb her words and make his choice.

     Peter nervously tugged at the end of his tie.  He ran his fingers through his thin hair and pulled on his chin.  It was several minutes before he asked if it was, “sick and immoral” to behave this way. 

     Elizabeth understood that he had indeed heard what she just said, but he was edging toward choosing to tell his wife and accepting this behavior.  He needed confirmation that the fetish was potentially acceptable and not depraved.  

     Now Elizabeth had to answer in an objective way, but not so neutral as to injury Peter’s trust.  If she were reflective, Peter would continue his self-loathing perspective.  She had to be truthful enough that he would believe she understood him and was not rejecting him.  

     Elizabeth began by repeating his question, “Is this fetish sick and immoral?  The majority of society would view this behavior as atypical and odd.  The only harm caused is to your relationship with your wife, and the need itself distresses you.” 

     Peter looked blank for a minute and then said, “Well, is it sick and immoral?”  

     Elizabeth tried again by asking Peter to, “Define sick”. 

     He thought for a minute and could only come up with the word “Weird”. 

     Elizabeth repeated the words “odd and atypical”.  Elizabeth then asked, “Peter, define immoral.”    

     Peter stammered out the words, “…evil, bad, unfair”. 

     Elizabeth repeated that he was not harming anyone, but was being unfair to his wife and worsening the prostitute’s inevitable issues which must have lead her to the profession to begin with.  Peter paused for several minutes.  Elizabeth though she should plan for extra sessions if this pausing became habitual.

     Peter slowly began to recount his childhood.  He spoke so slowly that Elizabeth was able to ponder Brian at the same time that she listened to Peter. 

     Elizabeth thought, “This poor fellow thinks that he is sick.  He doesn’t know what sick is.  He doesn’t know what evil is, and he is concerned about being immoral.” 

     This made Elizabeth consider the real difference in an immoral behavior, verses an amoral behavior.  The immoral was so human.  The amoral was just evil.  She could not think of an amoral person she had known who didn’t disturb her on the same unique level as Brian.  Although no one in her life had ever disturbed her as much as Brian.

     Elizabeth had never thought much about the supernatural, religion, or good and evil.  Each client touched on these elements at some point in treatment, but Elizabeth merely reflected their stance back to them and then moved on with what she thought was relevant.  Now the spiritual was becoming relevant to Elizabeth. 

     It struck her as she pondered good and evil that she had judged Peter.  While “Not as bad as he thinks he is”, isn’t too extreme, it was a judgment nonetheless.  Elizabeth was slipping.  She was thinking more and more like a standard human.

 

1:00 P.M.

 

     M came in looking lovely and very well dressed.  She laughed a little and then apologized before explaining why she was apologizing.  She rang her hands a bit and blurted out the question, “Do you like me?” 

      Elizabeth had to go with the classic, “Why do you ask?” 

     M confessed, “I feel that is very important that you like me!” 

     M knew that ethically they could never have a social relationship, but she still felt that she needed to know.  Elizabeth asked M if she was really concerned that Elizabeth may not like her, or if M just couldn’t get a read from her reactions and so wanted an assertion.  M said she feared that Elizabeth didn’t like her, but then she clarified that it was respect that she wanted from Elizabeth more than affection.

     Their session progressed quickly and M had the realization that Elizabeth knew her inner self, and M felt that no one else really did.  M felt that if Elizabeth didn’t respect her then she wasn’t worthy of respect.  Elizabeth asked M if she herself felt worthy of respect.  M had no idea, and said that her mind had gone blank. 

     Elizabeth pointed out that she was well dressed and made up.  She asked M if she had done this in anticipation of their session.  M cried a little and seemed humiliated.  It had been an uncomfortable session, but M had taken another step.

 

2:00 P.M.

 

     Verna had asked for this additional appointment, and then spent the majority of it crying.  When she did speak, her voice was like gurgling water.  It lulled Elizabeth into a trance like state that made concentration impossible.  Elizabeth wondered if this was a device, or an unconscious behavior that Verna used to validate her belief that she was invisible.  That no one heard her, or cared.  Either way it was a classic depressive self-fulfilling prophecy.  Believing no one cared about her Verna behaved in ways that would repel or bore others.  Then her false belief would become true. 

     Verna also had serious social anxiety.  For example, she would become anxious over speaking with the UPS man, and then replay their conversation for days, analyzing how she came across and what he thought.  This wasn’t crazy, but rather a classic symptom of depression.  The snowball effect.  Verna felt that she was weird and unlikable and obsessing over these beliefs made her so.  She also had difficulty thinking and verbalizing simple things.  All this, coupled with no self-esteem had isolated Verna for months.

     Verna’s difficulties with recall and verbal expression were to the point that Elizabeth recommended to Verna that she go on antidepressants to facilitate therapy.  Verna had the usual objections to drugs.  Elizabeth gave the standard rebuttal and Verna finally agreed to see a psychiatrist.  

     Elizabeth then discussed with Verna the possibility that she may need to go on disability.  Verna was terrified by the thought.  Elizabeth eased up on the suggestion for now, but knew Verna would loose her job soon.  Verna worked taking orders for an online florist.  It was not demanding work, but even simple repetitive task had become confusing for her.  Verna had already been warned at work.  Elizabeth also knew that people instinctually avoid depressed people and so the boss would probably be happy to get her out of his life.  Elizabeth felt concerned and hoped that Verna could hang in there for only a couple of weeks longer.  As helpless as Verna felt, she had to fight this.

 

3:00 P.M.

 

     Brian was next.  Elizabeth took a few deep breaths and stared at the door waiting to see his face.  She hated his face, and now vaguely recalled it from yet another dream she had the night before.  Brian came in and greeted her like a friend he was meeting for lunch.  He chatted about his new job managing an accounting firm.  He complained that his coworkers bored him, but said that his office had an excellent view. 

      Brian was killing time with his chatter, but Elizabeth was listening for an opening to make a connection.  He gave her nothing, as if he knew she was fishing.  Finally, Elizabeth asked him about his childhood, but again he gave her nothing. 

     Elizabeth said, “Sounds like a pretty bland upbringing.  Do you think that’s why you’re so impatient with your boring coworkers?” 

     Elizabeth could not have cared less about his office interactions.  She wanted to goad him into elaborating about his past. 

     Brian answered, “Yep, that’s a good point Doc.” 

     It bothered Elizabeth that he called her Doc.  That’s what her friends called her. 

     Elizabeth let him chat some more then struck him quickly with the question, “Are you and your daughter still having sex?” 

     Brian didn’t flinch and answered that he had served his time and understood it was illegal, and so of course would never do it again.  Then he held Elizabeth’s gaze and smiled. 

     Elizabeth kept her face blank and retorted with, “I’m sure that you knew it was illegal before you had charges pressed against you for it.  You did it anyway.  What’s different now, fear of punishment?” 

     Brian noted, “Adding fear of punishment to the end of that sentence is leading Doc.  You are not supposed to suggest answers, that interferes with the process.” 

     Elizabeth stayed calm and said that she was pleased that he was familiar with the process.  She told Brian that she felt his knowledge of the therapeutic process would expedite their work together.  Of course, she was honestly disturbed.  Elizabeth knew that he was not only manipulating her, but had probably researched psychology in order to do so.  More disturbing still was that Elizabeth was her work.  If he knew it, he knew her, and this made her entirely vulnerable. 

     Elizabeth ended the session appropriately and began writing before Brian left the room.  Once the door closed, she dropped her pen and wrapped her arms around herself.  She felt truly afraid, but was unable to pin point exactly why. 

     She talked herself through the facts.  Elizabeth repeated to herself that she had no real reason to fear Brian.  He could not really harm her.  Still, knowing these things did not make the feeling of fear leave.  She then tried visualizing herself as an aspen grove, while focusing on her notes for Martin.

 

4:00 P.M.

 

     Elizabeth wanted to use part of Martin’s session to ask him how he would interpret Brian’s mindset.  Going directly to the narcissistic source as it were.  Elizabeth was fighting her own sense of entitlement.  While she knew this was his time she could not help but struggle with some resentment over all the hours she had spent placating Martin’s ego and tolerating his bigoted rants.  Elizabeth had never realized that she felt this way about Martin until now.  She stopped hearing him, and began to ponder how complicated their relationship really was. 

     Suddenly Elizabeth blurted her question, “Martin, let me interrupt you for a moment and ask for your perspective on pedophilia.” 

     He said he didn’t know what Elizabeth meant by that question, which really meant that he did not know the definition of the word pedophilia.  Martin would never admit it if he didn’t know something, and would certainly never miss an opportunity to share one of his opinions. 

     Elizabeth rephrased the question, “Why do you think that people molest children?”  

     “Well I’ll tell ya”, Martin began, taking his lecture posture. 

     Martin immediately attacked pedophiles at the scum of society (a phrase he used toward many different groups) and ranted for about ten minutes on how they should suffer the death penalty.  As Martin ranted, Elizabeth realized she felt slightly disappointed.  She had hoped Martin would share Brian’s pathologically self-centered opinion, but express it without the fear of legal repercussions.  She had hoped Martin could give her a sliver of information that would help her to stop Brian.  She then realized the fact that in her mind she phrased it as “stop” Brian rather than “help” or “heal” Brian. 

     Martin’s rant was loosing momentum, Elizabeth noticed this by his pace, and so she interrupted again and asks him to share his understanding of the motivation behind pedophilia.  Martin paused before speaking.  He hadn’t paused before speaking since they discussed the cost of his sessions.  Martin began to speak more slowly than usual and with some reverence. 

     He thoughtfully outlined his speech by classifying the types of pedophiles,

Some of them are just angry and want to cause pain to the innocent.  Some want a helpless victim because they are cowards.  Some where probably treated as objects while they were children, and so learned to see children that way, as things not people.      

     Elizabeth stopped her own agenda long enough to acknowledge the significance of this last statement in regards to Martin’s own treatment.  She took a quick note, and told him to go on. 

     “And some of them” he went on, “some of them are evil.  God defines evil as something that destroys without creating.  Maybe evil in and of itself is a motive.”  

     Elizabeth felt her body grow cold.  They were out of time.

 

Wednesday evening:

 

     Elizabeth drove home in the rain that evening.  She usually didn’t care about or notice the weather, but this night it irritated her.  She walked inside and failed to check her tanks.  She looked through the refrigerator, saw nothing appealing, and so decided to make a pizza by hand.  She dug through her cookbooks and found some recipes. 

     While she attempted to mix the dough with her cheap mixer, she realized that she was missing her supervision appointment.  She never forgot anything, and had never so much as been late to supervision before.  She called Dr. Klien to say that she forgot.  Dr. Klien paused suspiciously.  She tried not to wonder what he was thinking which was incredible because as second nature Elizabeth analyzed everyone’s reactions. 

     Something was changing in her, or rather emerging.  Elizabeth had chosen to be neutral for so long that somehow the tiny bit of self she had receded.  She knew it was Brian that was inciting the need to wake up and fight from within her.  Elizabeth was marshaling her anger and power.  She was preparing to stop this man, but she did not know how.  She would have to be both creative and angry.  She hadn’t been either for a long time, if ever. 

     “Could evil in and of its self be a motive?”  She repeated these words to herself aloud as she attempted to cook.

 

THURSDAY 4^th

 

8:00 Archive 1999 files

 

9:00 Kristen (Borderline Personality Disorder)

Neurotics make themselves unhappy.  Personality Disordered people make everyone around them unhappy.

 

10:00 Martha (Adjustment Disorder)

It’s not the size of the dog in the fight, it’s the size of the fight in the dog.

 

11:00 Bebe (Bulimic Eating Disorder)  88%

The mother of excess is not joy, but joylessness.

 

12:00 Lunch

20 Grams of carbohydrate.

 

1:00 Nathan (Post Traumatic Stress Disorder)

Somewhere something incredible is waiting to be known.

 

2:00 Carol  (Personality Disorder, mixed features NOS)

When we remember that we are all mad, the mysteries disappear and life stands explained.

 

3:00 Crystal  (Body Dysmorphic Disorder)

The more you have the more you want.

 

4:00 Anna  (Defenses/denial) -Canceled    

        Bill (Compensating)

Laughter is the shortest distance between two people.

 

Evening: Clagett- TED…