1 http://www.anapsid.org/cnd/gender/tendfend.html (accessed January 4, 2017).
2 http://www.health.harvard.edu/newsletter_article/the-health-benefits-of-strong-relationships (accessed January 4, 2017).
Chapter Two
Grappling with Old Demons
Anne
Anne came to see me seeking a referral for her seventeen-year-old son, Justin. She arrived dressed in a crisp white blouse, a navy-blue skirt, and sensible flats. A waft of cigarette smoke trailed her as she entered my office. Her petite physique looked strong, her posture erect and graceful. She looked young for her mid-forties, although I could detect fine lines in her complexion, likely from years of smoking. She spoke in terse, measured sentences, as if reading from a script, and her pale face was frozen into a polite semi-smile. Ill at ease, she squirmed a bit as she sat down on the edge of my couch.
Anne began by telling me that her once easygoing, spontaneous son now isolated himself in his room. His lethargic, sullen demeanor worried her. When she tried to communicate with Justin, he either ignored her or, more typically, exhibited disgust or anger. He complained about her cooking and snarled whenever she asked about his life. “He spends most of his time alone, listening to music or playing video games in his room, and doesn’t seem to have any friends,” said Anne. “He relates to his father, Stephen, and his brother, Matthew, who is away at college, but that’s it.”
Stephen and Anne worked full time, Stephen as a freelance photographer and Anne as a middle school English teacher. “We’re both worried about Justin’s withdrawal and isolation. I’m really concerned that he’s depressed and might be thinking of hurting himself.”
When I asked her to elaborate, Anne, face flushed, said that she didn’t think Justin was in immediate danger, but she wanted me to see him soon. I agreed to meet with Justin a few days later. I also asked Anne to meet with me weekly for a few sessions, so I could learn more about the family dynamics and discuss some effective ways for her to improve her communication with her son.
Although she agreed, Anne made a point of telling me she wanted to keep her own history private. I said I would respect her request. I wondered what had happened in Anne’s own life that she could not allow to be spoken. Perhaps she had suffered some earlier trauma and only now, when her son’s emotional well-being seemed in jeopardy, was she willing to seek help. I hoped that eventually Anne would feel more comfortable sharing her own story.
Meeting Justin
As planned, I met with Justin for an initial assessment. His slouched and rounded shoulders did nothing to diminish a tall, lanky frame that sported a faded T-shirt and baggy jeans that rode precariously below his hips. Without a belt, he might have been in serious trouble! Cell phone in hand, Justin gave me a sideways glance and took a seat, his dirty blond bangs almost completely covering his sad eyes.
Much to my surprise, he began to speak candidly about school, his lack of friends, and his miserable relationship with his mother. He struck me as a warm, intelligent, engaging young man with low self-esteem and mild depression. Justin loathed high school and felt rejected by the other kids. Although he used to get invited to some weekend social activities, the invitations had dwindled and now ceased altogether, so he spent his free time in his room getting lost in music, books, and video games. He was embarrassed that his only real friend was his father, although he loved their shared passion for music and photography. In short order, he let me know what was really bothering him at home.
“I know I have issues, but my mom is the sick one. She is obsessive, weird, and afraid of her shadow. She comes home from work, cooks, cleans, and smokes the night away, reading her books or watching her shows. She holds me back from doing anything fun. I can’t wait to get out of the house. My brother is so happy being away at college. He hardly ever comes home. Now I’m the only one home and the singular target of her craziness.”
Justin seemed perceptive and self-aware. He understood that he was struggling socially, but he didn’t appear to be self-destructive and, paradoxically, was worried about his mother’s well-being. He continued, “I don’t know if my mom told you, but my grandmother died about a year ago. I didn’t really know her, but it’s definitely taken a toll on my mom. It’s made her paranoid and her moods way worse.”
Anne was mourning the loss of her mother, which I suspected was complicated and among the private pieces of personal information she did not want to share. I asked Justin how the loss had affected him. “It’s sad, I guess, but I’m okay. My mom, on the other hand, seems to be getting more negative and stressed. Until my grandmother died, she hadn’t seen or spoken to her sisters in more than a decade. As far as I’m concerned, she needs therapy more than me. The truth is, I worry about both my parents. Neither of them takes good care of themselves. Not only does my mother chain-smoke, but she hardly eats. I don’t know if she has anorexia, but to me she looks scary thin. My father lives on junk food, never works out, has a big gut, and both of them have no friends.” Justin’s worry seemed to have merit. While he was definitely angry at his mother’s intrusiveness, he seemed more concerned about the health of his parents.
Bouts of Loneliness
Occasional bouts of loneliness and depression are common and affect most of us at some point. Usually, these episodes are short-lived and occur around periods of transition, such as the loss of a loved one, losing touch with a friend, moving to a new home, or being downsized from a job. While most people are able to move through the difficult feelings associated with life transitions and emerge successfully, some cannot. This is especially true when the transitions are layered upon previous trauma that is not yet sufficiently resolved. Many people find they can benefit from professional support and coping strategies to overcome their dark periods and learn to live their best possible lives.
In my many years of working with patients, I have repeatedly observed that most emotional suffering comes from worrying about the future or ruminating about something from the past. In Anne’s case, unfounded or not, she was worried that her son’s depression might lead him to harm himself. The more she worried and expressed her concerns, the more she alienated him. Although I still did not know the source of her pain, according to Justin’s clues and her own unusually emphatic request for privacy, she was clearly troubled about something. Anne’s method of self-protection was to isolate from friends and family, just as she planned to keep the therapeutic relationship with me at arm’s length. The question was, “Self-protection from what?”
Justin continued, “I know my mother worries I might be suicidal, but I promise, I’m not. I just want friends. I don’t have anyone to hang with anymore. I’m burned out on the stoners, and the nerdy group is too weird for me. I just need to get out of this provincial little town and find my way, without my mother hovering over me, trying to control my every move. My grades haven’t been great this semester, but I think I’ll get into a decent college. I do want help finding some kind of support group, as dorky as that sounds.” He rolled his eyes and sighed. “The truth is I could definitely use a few friends, but please do what you can to help my mother. She’s the scary one, not me.”
Justin’s assessment of the situation struck me as astute. He knew he needed some specific help with his current social situation, whereas his mother was the one hiding from her own pain. I assured Justin that I would do my best, but his mom needed to make the decision
