I Hate You--Don't Leave Me - Jerold J. Kreisman [66]
After a few days, Julie was galvanizing the hospital unit with her demands and tirades. Some of the nurses and patients tried to calm and placate her; others bristled when she threw tantrums (and objects) and walked out of group sessions. “Do you know what your patient did this morning, Doctor?” asked one nurse as I stepped onto the floor. The emphasis was clearly on the “your,” as if I were responsible for Julie’s behavior and deserved the staff’s reprimands for not controlling her. “You’re overprotective. She’s manipulating you. She needs to be confronted.”
I immediately came to my own—and Julie’s—defense. “She needs support and caring,” I replied. “She needs to be re-parented. She needs to learn trust.” How dare they question my judgment! Do I dare question it?
Throughout the first few days, Julie complained about the nurses, the other patients, the other doctors. She said I was understanding and caring and I had much greater insight and knowledge than the other therapists she had seen.
After three days, Julie insisted on discharge. The nurses were skeptical; they didn’t know her well enough. She hadn’t talked much about herself either to them or in group therapy. She was talking only to her doctor, but she insisted her suicidal thoughts had dissipated and she needed “to get back to my life.” In the end I authorized the discharge.
The next day she wobbled into the emergency room drunk with cuts on her wrist. I had no choice but to re-admit her to the ward. Though the nurses never actually said, “I told you so,” their haughty looks were unmistakable and insufferable. I began to avoid them even more than I had until that point. I resumed Julie’s therapy on an individual basis and dropped her from group sessions.
Two days later she demanded discharge. When I turned down the request, she exploded. “I thought you trusted me,” she said. “I thought you understood me. All you care about is power. You just love to control people!”
Maybe she’s right, I thought. Perhaps I am too controlling, too insecure. Or was she just attacking my vulnerability, my need to be perceived as caring and trusting? Was she just stoking my guilt and masochism? Was she the victim here, or was I?
“I thought you were different,” she said. “I thought you were special. I thought you really cared.” The problem was, I thought so too.
By the end of the week the insurance company was calling me daily, questioning her continued stay. Nursing notes recorded her insistence that she was no longer self-destructive, and she continued to lobby for discharge. We agreed to dismiss her from the hospital, but have her continue in the day hospital program, in which she could attend the hospital scheduled groups during the day and go home in the afternoon. On her second day in the outpatient program she arrived late, disheveled, and hungover. She tearfully related the previous night’s sleazy encounter with a stranger in a bar. The situation was becoming clearer to me. She was begging for limits and controls and structure but couldn’t acknowledge this dependency. So she acted outrageously to make controls necessary, and then got angry and denied her desire for them.
I could see this, but she couldn’t. Gradually I stopped looking forward to seeing her. At each session, I was reminded of my failure, and I found myself wishing that she would either get well or disappear. When she told me that maybe her old roommate’s doctor would be better for her, I interpreted this as a wish to run away from herself and the real issues she faced. A change at this point would be counterproductive for her I knew, but silently I hoped that she would change doctors for my sake. She still talked of killing herself, and I guiltily fantasized that it would be almost a relief for me if she did. Her changes had changed me—from a masochist to a