Mary's First Session
“I think we ripple on into others, just like a stone puts its ripples into a brook. That, for me, too, is a source of comfort. It kind of, in a sense, negates the sense of total oblivion. Some piece of ourselves, not necessarily our consciousness, but some piece of ourselves gets passed on and on and on.”
- Irvin Yalom
Mary turned 52 just two days before she arrived at my office. She was neatly donned in a peach floral print dress that flowed down to her mid shin. Her hair was pulled back tight into a long single braid directly between her shoulder blades and she forced a thin smile as we made eye contact for the first time since sitting down. I sensed she was either on the verge of tears or seconds away from a panic attack... possibly both. From her paperwork I knew her husband, John, had succumbed to a long battle with cancer three months earlier. Knowing this, I still avoided assuming to know the emotional reasons she wanted to speak with me. I asked Mary the same question I ask all my clients when we first meet, “What brings you in today, Mary?”
“Well… my husband is dead and I am alone.” She choked on these words, her thin smile disappeared, and tears began to fill her eyes. She reached for a tissue and sat up straight with her hands folded over her crossed legs. She continued, “My two children are grown. My daughter, Elizabeth, lives in Ohio with her husband and two children. She remained there after finishing her degree and was hired by the university counseling center, where she shortly thereafter met her husband. My son, Matt, lives in Michigan with his partner. They don’t have children but are in the process of adopting. They moved north to protect their gay relationship from the judgments of southern Christianity. I don’t have any other close family relationships. I've been ostracized from my church because I refuse to denounce my son. That leaves me, here, alone in Chattanooga.” Her posture buckled under the weight of her disclosure. She sunk back into the chair and carefully wiped the tears that had started the journey down her cheeks.
She added “I don’t know why I wore makeup today. I knew I was going to cry.”
I could tell Mary had been thinking about our first meeting. She knew precisely what she wanted to say and aside from her brief emotional pause, she had seamlessly accomplished the tiresome task. In that moment I was grateful I had not assumed her rationale for seeking out the consultation. Feeling alone and feeling grief are not the same. For Mary, at age 52, they may now overlap, but they are still two separate and distinct feelings. Grief was something she had yet to mention, stating only that her husband had died.
“Mary, I can see that sharing these things took a significant amount of energy. I can also tell you put effort into organizing your thoughts for our appointment today. Thank you for taking this seriously… for taking yourself seriously. As for the make-up,” I smiled, “I keep a mirror on the back of my door for mascara touch ups before leaving. ” She gently set the tissue down on her lap and a smile showed on her face.
“I guess counselors are real people too. I didn’t think you would get it. ” she chuckled. Later in the course of our therapy Mary and I talked about my first words to her. She expressed her shock that I had paid attention to her efforts and deliberation. She reflected that the honesty and humor in my mascara comment let her know that I was both considerate and human.
I smiled back with an affirmative nod. We were off to a good start.
“Mary, tell me a little more about this feeling of being alone. I think it may be important to explore that feeling some today. We will have time in future sessions to more fully discover what it means for you, so let’s start slow. When did you first notice that feeling? The feeling of being alone?”
“Well, Josh...can I call you Josh?” she asked.
“Yes, call me Josh. I prefer first names and never cared much for titles.” I replied.
She seemed pleased by this and continued, “Josh, it is hard to say when I first felt alone because I think ‘alone’ has always been present at either a low hum or a loud roar. It may be easier to tell you about the times I felt less alone. Would that be okay?” she asked.
“Please, I’m all ears - feel free to take this where you feel it needs to go today.” I responded. I appreciated her testing the waters and also wanted her to know that she had permission without needing to ask for it.
Mary went on to explain that some of her first memories seemed enveloped in a sense of loneliness. She detailed her first day in middle school and feeling unable to connect with her classmates. She moved on to her lack of friends, playdates, sleepovers, and “cold shouldering” from her mother. This segwayed to her high school years, and a more specific reflection on her parents reaction to her shutout pitching performance at the state softball championship.
“It was like they weren’t there. I remember glancing at my mom while my team hoisted me into the air. She was blank. Nothing. I would have traded all the celebration of that moment for a smile from my mother.”
“And your father?” I asked.
“If he was there, I don’t remember it.” She responded abruptly. “He would have been drunk.”
I could tell Mary was beginning to drift. She was slipping into old reels of loneliness and I was starting to feel disconnected from her.
I interrupted, “You are sharing some difficult memories and I am gaining some understanding as to why you felt alone so early in life. I also get the sense these memories are stealing you from the present moment. You said a bit earlier that it may be easier for you to share some of the moments you felt ‘less alone’.”
Early in therapy it is important to gain understanding in the origins of a client's issue, but it is unwise to fully explore these origins without first establishing trust in the relationship. Plus, she had asked to share about being “less alone” and I was interested in what may be behind that request. I was hopeful that focusing on the “less alone” could bring Mary up for a breath of air and reconnect her with the safety in the room.
“You’re right. I forgot I had mentioned that. I guess when I start down that rabbit hole, I get a bit lost in it. Well, this may seem odd ... Gosh I can’t believe I am going to say this. God forgive me.” She paused briefly, then began again. “The last two days of my husband’s life were atrocious. Hospice had been doing home visits for about three weeks and it was clear that they were just trying to make him comfortable. It was then I accepted that I was going to lose him… two days before he died. There were hoses, tubes, and wires scattered about our living room - it felt like a scene out of a horror movie…” she paused.
“Mary, I can’t imagine how difficult this experience was and is for you. Watching a loved one die is a burden I don’t believe we were intended to bear,” I offered.
“I thought so too, Josh, but I need to be honest with you. Those last two days were the best two days of our marriage. In those last two days I felt the least alone I've felt in my whole life. Those two days felt intimate, yet he was in such bad shape. I don’t know what to do… this is why I came to see you. I feel sick. Am I crazy? God...what's wrong with me?! How could I feel that way?” She began to cry again but continued, “ I sat next to him smiling while I stroked his bald head. I would sing to him and hold his hand, often leaning down and quoting comforting scriptures to him. I told him I loved him over and over.” She continued to detail the two days of careful and thoughtful interactions between her and John. Then she repeated “How could I feel this way? What is wrong with me? I hadn’t showed him that kind of affection in years. Why then?” She began to sob.
The shame was palpable. It often seems that shame emerges in areas of life that we don’t fully understand. Shame serves as an effective yet toxic buffer between our experiences and the insights we can gain from them. I believed that Mary’s main source of stress was an inability to make sense of the connectedness she felt amidst her husband’s sufferings. I also suspected that if we could remove the shame, her connectedness may become a source of healing. My focus became fixed on the shame while remaining aware that this disclosure had tired her. I felt my attention and connection deepen towards Mary.
“Mary, I am here with you and I feel very connected to you. You carry shame for feeling the very connection you have always longed for. Had you felt connection with your husband in a different time of life, that shame may not be present but I believe we can do good work with it. The burden of confusion must be disorienting and overwhelming, but I want to give you a thought - what if suffering is part of the equation of connection? Think on this for a minute. How does this thought impact your sense of shame?” I hoped that these questions would help Mary remain with me and stay with the current emotions she was processing. I also felt it was important for me to convey the connection I was feeling to her.
Mary paused and wiped her tears with little concern for her makeup. She sunk back looking down at the tissue, running it between her fingers… silence. I had just begun to wonder if I had pushed her too far when she suddenly looked up at me, then awkwardly looked down again. She continued to fiddle with her tissue in silence.
Silence in therapy is not unusual. Early in my career I didn’t know what to do with silence, but I have grown to understand that silence is a valuable form of communication and reflection. However in this instance, with our therapy in its infancy, I had no idea what Mary was trying to communicate. We were running out of time in the session and, as is usually the case, I had another client coming in just after her. I decided to take a risk.
“We have gone rather deep for a first session. I wonder if the silence is telling us we have hit a wall today?”
Mary seemed a bit shocked at my question. I quickly realized I had made an error. She responded, “No… you asked me to take a minute to think on your idea about suffering.”
I answered, “Indeed I had. You got me there.” I don’t mind admitting a mistake - counselors are in fact fallible. I waited for Mary’s cue.
She sat up straight again, slightly tilted her head, squinted a bit and said in a voice just above a whisper, “You said you felt connected to me.” With her eyes still mildly squinted, she shifted her head upright, then spoke in a more clear tone “For the life of me, I don’t understand that.”
“Unpack ‘that’ a bit, what don’t you understand?”
“Well, I had just shared something incredibly embarrassing. I don’t understand how you could feel connected to me. You counselors are a strange bunch.” She chuckled, folded the tissue neatly, sat it on her leg, then looked up awaiting my response.
In that moment I sensed Mary and I would work well with each other. She had been through a lot in her 52 years and I was very interested in helping her sort out the issues that were in storage.
I smiled and responded, “I could sense your embarrassment but I suppose that is not what I saw in that moment. I heard your suffering and saw a glimpse of hope in it. It was crowded by shame and embarrassment but I could still see it. Maybe if we can chip through the shame you will find the keys to connecting with others. The same way I found connection to you.”
She nodded several times, clasped her hands together, looked at her watch, and asked, “So, do I schedule with you or….?”
“I can schedule you from our fancy app before you leave. I’m looking forward to working with you, Mary. I have a hunch that we are going to make a good team.”
She responded, “Oh good, I don’t like meeting with receptionist after appointments. I began to resent it about halfway through my husband’s treatments. I’m not sure I could put on a show for anyone right now. Thank you for seeing me today, I think you may have your hands full.” She chuckled nervously after finishing her last words.
“I’m happy you sought this out, Mary. Let’s get you scheduled.”
After we agreed on an appointment time Mary stood up and walked towards the door. I followed her to open it. She briefly looked in the mirror, sighed, then turned to shake my hand. I shook it and she turned and walked out ahead of me.
I was pleased that she wanted to come back. I make it a point to reassure my clients they are not obligated to me if they don’t feel like I'm a good fit. I only ask that they let me know instead of silently firing me. If they let me know, we can process it if necessary and I can help them find a counselor who may be a better fit.
Mary would go on to do a full course of therapy. We met for an hour once a week over the course of the next year and a half. She processed shame, isolation, her marriage, her mother, her father, her relationships with the children, and religious issues within her church. As she worked through these... she grieved. Mary grieved the lack of connection in her life, while also grieving the loss of the intense connection she felt to her husband in his greatest state of vulnerability.... vulnerability she wanted to show in her relationships. The same vulnerability she wished she had seen from her mother and consequently was never able to show - even to her own children. We worked on using the two days of connection with her husband to establish a new path of openness and vulnerability. Suffering showed her the way towards a connected life. It was her husband's parting gift and the gift she became determined to give to those closest to her.
A Counselor’s Note: Mary presented with depression, chronic loneliness, religious disillusionment, a neglectful childhood, separation anxiety, and the traumatic death of her husband. Any of these issues could have taken up the majority of our session had I assumed they were Mary’s primary motivators for seeking counseling. I could have easily jumped to a diagnosis and mapped out a rigid treatment plan… which would have effectively created a barrier between us. She needed connection and she also needed to be heard. I consistently find myself grateful for mentors who encouraged me to see my clients for more than just their presenting stressors. This allows me to form a trusting relationship with my clients and create room for their experiences to play out in session with me.
It is in that space where the healing work takes place.
Disclaimer: The character “Mary” and her unique set of presenting issues are fictional. This story was written in an attempt to convey how a course of counseling may transpire and in no way reveals the identity of any current or past clients.