Chart Note, Charlotte: Patient, age 25, reports feeling “anxious” for the past few months, though nothing of note has recently occurred. States that she is “bored” at her job. Describes difficulty with parents and a busy social life but no history of significant romantic relationships. Reports that to relax, she drinks “a couple glasses of wine” nightly.
“You’re going to kill me,” Charlotte says as she saunters in and slowly settles herself into the oversize chair diagonally to my right, arranges a pillow on her lap, then tosses the throw blanket over it. She has never sat on the couch, not even at the first session, instead making the chair her throne. As usual, she takes her belongings out of her bag, one by one, unpacking for her fifty-minute stay. On the left arm of the chair, she places her phone and pedometer; on the right, her water bottle and sunglasses.
Today she’s wearing blush and lipstick, and I know what that means: she’s been flirting again with the guy in the waiting room.
Our suite has a large reception area where patients wait to be seen. Leaving their appointments is more private — there’s an exit through an interior corridor that leads to the building’s hallway. Patients generally keep to themselves in the waiting room — but Charlotte has something going on.
The Dude, as Charlotte calls the object of her flirtation (neither of us knows his name), is my colleague Mike’s patient, and he and Charlotte have their sessions at the same time. According to Charlotte, the first time the Dude showed up, they noticed each other immediately, stealing glances over their respective phones. This went on for weeks, and after their sessions, which also ended at the same time, they’d exit through the interior door only to steal more glances at each other in the elevator before going their separate ways.
Finally, one day, Charlotte came in with news.
“The Dude just talked to me!” she whispered, as if the Dude could hear her through the walls.
“What did he say?” I asked.
“He said, ‘So, what’s your issue?’”
Great line, I thought, impressed despite its cheesiness.
“So here’s the part where you’re going to kill me,” she said that day. She took a big breath, but I’d heard this refrain before. If Charlotte drank too much the previous week, she’d open the session with “You’re going to kill me.” If she’d hooked up with a guy and regretted it (as happened often), she’d open with “You’re going to kill me.” I was even going to kill her when she put off researching graduate-school options and missed the application deadlines. We’d talked before about how underneath the projection was a deep sense of shame.
“Okay, you don’t want to kill me,” she conceded. “But, ugh. I didn’t know what to say, so I froze. I completely ignored him and pretended to text. God, I hate myself.”
I imagined the Dude at that very moment sitting in my colleague’s therapy room just a few doors away and recounting the same incident: I finally spoke to that girl in the waiting room, and she completely rejected me. Ugh! I sounded like an idiot. God, I hate myself.
Still, the next week, the flirtation continued. When the Dude walked into the waiting room, Charlotte told me, she opened with a line she’d been rehearsing all week.
“You want to know what my issue is?”Charlotte asked him. “I freeze when strangers in waiting rooms ask me questions.” That made the Dude laugh, and they were both laughing when I opened the door to greet Charlotte.
Upon seeing me, the Dude blushed. Guilty? I wondered.
As we walked toward my office, Charlotte and I passed Mike, who was approaching to collect the Dude. Mike and I met each other’s eyes then immediately looked away. Yup, I thought. The Dude has told him about Charlotte too.
By the following week, the waiting-room banter was in full swing. Charlotte told me that she asked the Dude his name, and he replied, “I can’t tell you.”
“Why not?” she asked.
“Everything in here is confidential,” he said.
“Okay, Confidential,” she shot back. “My name’s Charlotte. I’m going to go talk about you with my therapist now.”
“Hope you get your money’s worth,” he said with a sexy grin.
I’d seen the Dude a few times, and Charlotte was right, he had a killer smile. And while I didn’t know the first thing about him, something in me sensed danger for Charlotte. Given her history with men, I had a feeling the whole thing would end badly — and two weeks later, Charlotte walked in with an update. The Dude had come to his session with a woman.
Of course, I thought. Unavailable. Just Charlotte’s type. Charlotte, in fact, had used that same expression every time she mentioned the Dude. He’s so my type.
Why would people do this to themselves? Because the pull toward that feeling of “home” makes what they want as adults hard to disentangle from what they experienced as children.
What most people mean by type is a sense of attraction — a type of physical appearance or a type of personality turns them on. But what underlies a person’s type, in fact, is a sense of familiarity. It’s no coincidence that people who had angry parents often end up choosing angry partners, that those with alcoholic parents are frequently drawn to partners who drink quite a bit, or that those who had withdrawn or critical parents find themselves married to spouses who are withdrawn or critical.
Why would people do this to themselves? Because the pull toward that feeling of “home” makes what they want as adults hard to disentangle from what they experienced as children. They have an uncanny attraction to people who share the characteristics of a parent who in some way hurt them. In the beginning of a relationship, these characteristics will be barely perceptible, but the unconscious has a finely tuned radar system inaccessible to the conscious mind. It’s not that people want to get hurt again. It’s that they want to master a situation in which they felt helpless as children. Freud called this “repetition compulsion.” Maybe this time, the unconscious imagines, I can go back and heal that wound from long ago by engaging with somebody familiar — but new. The only problem is, by choosing familiar partners, people guarantee the opposite result: they reopen the wounds and feel even more inadequate and unlovable.
This happens completely outside of awareness. Charlotte, for instance, said that she wanted a reliable boyfriend capable of intimacy, but every time she met somebody who was her type, chaos and frustration ensued. Conversely, after a recent date with a guy who seemed to possess many of the qualities she said she wanted in a partner, she came to therapy and re- ported: “It’s too bad, but there just wasn’t any chemistry.” To her unconscious, his emotional stability felt too foreign.
The therapist Terry Real described our well-worn behaviors as “our internalized family of origin. It’s our repertoire of relational themes.” People don’t have to tell you their stories with words because they always act them out for you. Often they project negative expectations onto the therapist, but if the therapist doesn’t meet those negative expectations, this “corrective emotional experience” with a reliable and benevolent person changes the patients; the world, they learn, turns out not to be their family of origin. If Charlotte works through her complicated feelings toward her parents with me, she’ll find herself increasingly attracted to a different type, one that might give her the unfamiliar experience she’s seeking with a compassionate, reliable, and mature partner. Until then, every time she meets an available guy who might love her back, her unconscious rejects his stability as “not interesting.” She still equates feeling loved not with peace or joy but with anxiety.
And so it goes. Same guy, different name, same outcome.
“Did you see her?” Charlotte asked, referring to the woman who came to therapy with the Dude. “She must be his girlfriend.”
In the quick peek I’d gotten of the two of them, they were sitting in adjoining chairs but not interacting in any way. Like the Dude, the young woman was tall with thick dark hair. She could be his sister, I thought, coming with him for family therapy. But Charlotte was probably right; more likely she was the girlfriend.
And now, in today’s session — two months after the Dude’s girlfriend became a fixture in the waiting room — Charlotte has pronounced again that I’m going to kill her. I run through the possibilities in my mind, the first of which is that she slept with the Dude, despite the girlfriend. I imagine the girlfriend and the Dude sitting in the waiting room with Charlotte, the girlfriend unaware that Charlotte has slept with her boyfriend. I imagine the girlfriend gradually getting wise to this and dumping the Dude, leaving Charlotte and the Dude free to become a couple. Then I imagine Charlotte doing what she does in relationships (avoiding intimacy) and the Dude doing whatever he does in relationships (only Mike knows), and the whole thing blowing up in a spectacular fashion.
But I’m wrong. Today Charlotte believes that I’m going to kill her because as she was leaving her finance job last night to head out for her very first Alcoholics Anonymous meeting, some coworkers invited her to join them for drinks and she said yes, because she thought it would be a good networking opportunity. Then she tells me, without a trace of irony, that she drank too much because she was upset with herself for not going to the AA meeting.
“God,” she says. “I hate myself.”
I was once told by a supervisor that every therapist has the experience of seeing a patient with whom the similarities are so striking that this person feels like your doppelgänger. When Charlotte walked into my office, I knew she was that patient — almost. She was the twin of my 20-year-old self.
It wasn’t just that we looked alike and had similar reading habits, mannerisms, and default ways of thinking (over- and negative). Charlotte came to me three years after she had graduated from college, and while everything looked good on the outside — she had friends and a respectable job; she paid her own bills — she was also unsure of her career direction, conflicted about her parents, and generally lost. Granted, I didn’t drink too much or sleep with random people, but I’d moved through that decade just as blindly.
I’ve had to be extra-vigilant in our sessions, making sure that I’m seeing Charlotte as a separate person and not as a younger version of myself that I can go back and fix.
It may seem logical that if you identify with a patient, it will make the work easier because you intuitively understand her, but in many ways, this kind of identification makes things harder. I’ve had to be extra-vigilant in our sessions, making sure that I’m seeing Charlotte as a separate person and not as a younger version of myself that I can go back and fix. More so than with other patients, I’ve had to resist the temptation to jump in and set her straight too quickly when she plops down in her chair, tells a meandering anecdote, and finishes with a demand couched in a question: “Isn’t my manager unreasonable?” “Can you believe my roommate said that?”
At 25, though, Charlotte has pain but not significant regret. Unlike me, she hasn’t had a midlife reckoning. She has the gift of time, if she uses it wisely.
Charlotte didn’t think she had an addiction when she first entered treatment for depression and anxiety. She drank, she insisted, only “a couple of glasses” of wine each night “to relax.” (I immediately applied the standard therapeutic calculation used when somebody seems defensive about drug or alcohol use: whatever the total reported, double it.)
Eventually I learned that Charlotte’s nightly alcohol consumption averaged three-quarters of a bottle of wine, sometimes preceded by a cocktail (or two). She said that she never drank during the day (“except on weekends,” she added, “because hashtag brunch”) and rarely appeared drunk to others, having developed a tolerance over the years — but she did sometimes have trouble recalling events and details the day after drinking.
Still, she believed there was nothing unusual about her “social drinking” and she obsessed about her “real” addiction, the one that increasingly plagued her the longer she stayed in therapy: me. If she could, she said, she’d come to therapy every day.
Each week after I’d indicate that our time was up, Charlotte would sigh dramatically and exclaim with surprise, “Really? Are you serious?” Then, very slowly, while I stood at the open door, she’d gather her scattered belongings one by one — sunglasses, cell phone, water bottle, hair band — frequently leaving behind something that she’d have to come back for later.
“See,” she’d say when I’d suggest that her leaving items behind was her way of not leaving her session. “I’m addicted to therapy.” She’d use the generic term therapy rather than the more personal you.
But as much as she disliked leaving, therapy was the perfect setup for somebody like Charlotte, a person who craved connection but also avoided it. Our relationship was the ideal combination of intimacy and distance; she could get close to me but not too close because at the end of the hour, whether she liked it or not, she went home. During the week, too, she could get close but not too close, emailing me articles she read or one-liners about something that had happened between sessions (My mom called and acted crazy, and I didn’t yell at her), or photos of various things she found amusing (a license plate that read 4evJUNG — not taken, I hoped, while she was inebriated behind the wheel).
If I tried to talk about these things during our sessions, Charlotte would brush them off. “Oh, I just thought it was funny,” she said about the license plate. When she sent an article on an epidemic of loneliness among her age group, I asked about its resonance for her. “Nothing, re- ally,” she replied with a perplexed look on her face. “I just thought it was culturally interesting.”
Of course, patients think about their therapists between sessions all the time, but for Charlotte, keeping me in mind felt less like a stable connection and more like a loss of control. What if she relied on me too much?
To deal with that fear, she’d already left our therapy and returned twice, always struggling to stay away from what she called her fix. Each time, she quit without notice.
The first time, she announced in session that she “needed to quit and the only way I’ll do it is if I leave quickly.” Then she literally got up and bolted from the room. (I’d known something was up when she hadn’t unpacked the contents of her bag onto the armrests and left the blanket draped over the chair.) Two months later, she asked if she could come back “for one session” to discuss an issue with her cousin, but when she arrived, it was apparent that her depression had returned, so she stayed for three months. Just as she started feeling better and began to make some positive changes, an hour before her session, she sent me an email explaining that once and for all, she needed to quit.
Therapy, that is. The drinking continued.
Then one night Charlotte was driving home from a birthday party and crashed into a pole. She called me the next morning, after the police had issued her a DUI.
“I didn’t see it at all,” she told me after she arrived wearing a cast. “And I don’t just mean the pole.” Her car had been totaled but, miraculously, she’d ended up with just a broken arm.
“Maybe,” she said, for the first time, “I have a drinking problem, not a therapist problem.”
But she was still drinking a year later, when she met the Dude.
This is an excerpt from the new book Maybe You Should Talk To Someone: A Therapist, Her Therapist, And Our Lives Revealed by Lori Gottlieb. Published with permission from Houghton Mifflin Harcourt.