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From the moment I heard Michael’s voice on my answering machine, I felt intrigued and intimidated.
“Hey, Doc,” he said, though I am neither a doctor nor a character in a Bugs Bunny cartoon. “Word on the street is that you’re a damn good therapist. I might want to set up a meeting, but I’ve got a question. So give me a call and let’s talk.”
I both bristled and chuckled at Michael’s moxie. I thought about Tony Soprano and Dr. Melfi, who, like me, practiced in Montclair, New Jersey, in the famous TV series. When I called Michael back, he pointedly asked me if I was one of those silent “touchy-feely” therapists, or if I would give him the practical tools he needed to solve a problem he was having. He neither explained the problem nor waited for an answer. “I’m willing to give this a shot,” he said, “but I don’t believe in therapy.”
I suggested he come in for a consultation so he could ask questions, see how I work, and tell me about himself. He told me he was amenable, but warned me (or boasted) that his schedule was very busy. We set up an appointment for the following week.
When Michael and I met, his handshake was unusually firm, as if he had something to prove. He looked around my office, with its black leather furniture and bookcases stuffed with books and journals, and said he was impressed. I was surprised by how pleased I was that I had won the approval of a man I assumed was quite narcissistic. After a moment’s reflection, I realized that Michael reminded me of my critical, self-involved father, whose recognition I had always craved. I knew from years of experience with patients that Michael’s bluster most likely was a defense against feeling weak and inadequate.
Michael said he had come to therapy at his wife’s insistence. She had threatened to leave him if he didn’t get help with his explosive anger. Michael recognized that he could be aggressive, but insisted it was only in response to his wife’s nagging. He was here to appease her.
Patients like Michael can be challenging. Psychotherapy requires them to get in touch with their most vulnerable feelings. This is antithetical to the emotionally detached, action-oriented persona that they adopt to protect themselves. In order to feel in control and avoid their pain, they tend to throw their weight around, intimidating the therapist and making sure he or she is kept at a distance.
As I thought about working with Michael, I wondered if he would remain in treatment long enough to be reached. Could he allow himself to risk showing his insecurities? Michael would no doubt test me to see if I could survive his aggression. I understood the fear and shame hidden under his anger, because, on occasion, I utilize a similar defense mechanism — one with roots in my childhood.
I got approval from my father only if I excelled academically. Otherwise, I was forever a disappointment in his eyes. So I became the perfect student, afraid of losing his love. Any lapse caused me shame. Then I became a teenager, and something snapped within me. Without realizing it, I found a way to detach from my fear and shame: by provoking it in my father. I picked fights with him, hoping that it would make him feel like a bad parent. As expected, this made him furious. But at least I was standing up to him and feeling like a tough guy, even if I was still just a frightened kid.
I knew it would be difficult to sit with Michael when he was reminiscent of my father — and of me at my worst. I would have to tolerate the anger and inadequacy that he would no doubt instill in me. This would make engaging him — a man cut off from his sadness and threatened by therapy — all the more delicate. If I wasn’t careful, he might respond like a caged animal.
So we began.
I found Michael challenging from the start. He and I would sometimes get stuck in power struggles around payment, my cancellation policy, and whether something he said had a deeper meaning. It was as if he was saying: “You’re trying to make me dependent upon you? Dependency is for women and weak men. I don’t need you. I will prove it by vanquishing you.”
Surprisingly, I felt empathic toward Michael most of the time. I could sense the pain underneath his bravado. At other times I felt angry and wounded by his attacks. Since Michael wasn’t able to talk about his shame, unconsciously he tried to stir it in me. The only way I could truly understand his experience was to feel it within me.
Thinking this way allowed me to be less defensive around Michael. When he jabbed me for analyzing him, I joined in his aggression. “I’m doing that touchy-feely stuff again, aren’t I?” I would say, using a more colorful word than stuff. “When am I going to learn?”
As we became more comfortable with each other, Michael slowly began to share his vulnerabilities. With great hesitation, he finally addressed his childhood. He told me that his volatile father frequently beat him with a belt. His mother, who was verbally abused by her husband, was unable to protect Michael or herself. Michael was never sure what he did to provoke his father’s wrath or when it would happen again.
I realized that, not surprisingly, the adult Michael had turned into his own abusive father. At the same time, I could still see the 7-year-old Michael — feeling confused, frightened, and betrayed as his father lashed him with the belt. I shared this image with him, knowing that I was taking a risk joining him in a painful place. I was surprised when Michael responded by sitting silently, trying to take in what I had said.
And then something incredible happened. Michael’s eyes welled up. It was only for a moment, and I almost didn’t see it. “Michael, what are you feeling,” I asked.
“Nothing,” he said, angrily. I paused. Should I retreat, or push on?
“I can really understand why you learned to be tough and aggressive,” I said. “It was a survival mechanism, a way of dealing with tremendous fear and anger. Vulnerability would have felt dangerous and weak. But it doesn’t have to. A secure man does have access to his feelings. And I’m impressed and appreciative that you felt safe enough to show me some of yours today.”
Michael’s eyes welled up again, but this time he couldn’t stop the tears. “Damn it,” he said, in a voice that combined anger with sorrow. “I cannot cry. It only makes things worse.”
I asked him how it made things worse.
Michael was silent. He looked at me and then quickly toward the floor. Eventually he continued: “When he hit me with the strap, I would start to cry. Really loud. I was hurt and angry. And that made him hit me again. His face would turn red with anger, and he’d say, ‘I’ll give you something to cry about.’”
“My god, that sounds awful,” I said. My own eyes were welling with tears. “I can certainly understand why you would avoid crying at all costs. Nobody helped you feel safe, to be strong and vulnerable at the same time. No one taught you that you can cry and not feel weak.”
Michael sighed. “I don’t know, Eric, I just don’t know.”
Eric. It was the first time he had called me by my first name. The swagger he used to keep me at bay had faded. A new, softer Michael was emerging, one who could allow himself to cry. There was still work to be done, but for now, Michael had begun to confront his crippling father and his own feelings of inadequacy. In helping him, I had once again come face to face with my own.
Details have been altered to protect patient privacy. A version of this blog post appeared on The New York Times’ Opinionator blog.
