Saturday, April 18, 1998
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Sunday, April 19, 1998
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Monday, April 20, 1998
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2 pm. Second Session with Nicole Ulreich. In my last session with Nicole, she said that she uses recreational drugs occasionally, and then listed quite a laundry list of illegal substances she abuses. This session, she says that she's quit drugs, as if for a long time, and seems outraged by the lack of trust shown by her parents when they don't believe her absolutely. We spent much of the session talking about trust and how it is earned. She thinks that trust should be hers because she's asked for it, and she asked me to intercede with her parents and get them to trust her. Of course, I demurred. Nicole told me that she was in love with a boy named Shawn whom she met in the cafeteria. Shawn apparently doesn't do drugs. Nicole told me the results of her report card. She's doing well at English and Drama, okay at History and Math, and is failing P.E. She's decided to run for a student government position, although her interest seems only to spend more time with a group of friends who are also running. She's doing well in Choir and her group is going to Chicago to compete in some contest there. She's joined the cheerleaders, too. Besides for the drug use, Nicole seems like a perfectly ordinary teenager, although I must admit that I sometimes feel like I have no meaningful frame of reference with which to gauge her behavior.
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Tuesday, April 21, 1998
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4 pm. Third Session with Lisa Benjamin. At the end of the session, Lisa revealed that she is a recreational user of marijuana and amphetamines. I've been surprised at the number of my patients who are taking recreational drugs--and not just marijuana, but amphetamines, cocaine, and even heroin. When I was doing clinical work at Columbia, I treated a number of drug addicts, but their problems usually stemmed directly from their drug use. Now, I'm seeing a lot of patients who perhaps are self medicating to avoid troubling issues in their lives. Lisa told me about Video Free America, a video group where she's working in exchange for equipment and information. She met another stripper there, Gabby, who also desires to create a documentary on the business. Although Lisa didn't say so directly, presumably she'll try to work with her on the project. Two strippers, both novices to the film business, each trying to make separate documentaries simultaneously from the same video facility seems to stretch credibility. It seems like a perfect opportunity to pool resources. Lisa did say that she intends to make Gabby her roommate. Gabby is an ex-prostitute who also was a heroin addict. Now, she's going back to school in Berkeley--whether high school or college, I couldn't tell. Lisa started to tell me a bit about her parents. Her childhood sounds relatively normal--Lisa complained that her parents weren't supportive of her creativity and that they have strong ambitions for her that she doesn't share. Lisa expressed some performance anxiety related to her creative work. She attributes it to her parents' tendency to discourage her creative side as she was growing up. As a child, she expressed interest in being a film director and was told how hard it was and how so many fail. Lisa clearly is somewhat removed from her parents and she hides from them any knowledge about her work as a stripper. I have noticed in myself an interest, perhaps perverse, in Lisa's sexually oriented feelings and experiences. While intellectually I understand the dangerous, unromantic, and degrading aspects to laboring as a sex worker, there's some aspect of it that I find compelling. I'm interested in knowing more about a woman who dances naked on a stage, or performs sex acts with men she's just met for a video camera, or has sex for money. If I'm honest, I have to admit that there's something titillating about women who are both uninhibitated about sex and easy of access. Since sex for men is so often bound up in commitment, I've noticed that a common male fantasy is sex with women who demand no emotional involvement at all--basically, sex that is easy and without consequences. Perhaps it is a prurient interest on my part, perhaps it is akin to gawking at a traffic accident. But I should guard against asking Lisa questions designed merely to fulfill my curiosity as opposed to offering some benefit to my patient.
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Wednesday, April 22, 1998
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4 pm. Forty-Third Session with Katherine Lippard. Katherine has recognized that she has come a long way in therapy and has indicated that she wants to wrap it up. I don't strongly disagree. The original therapeutic issues which Katherine presented initially have been resolved. She is much more confident in herself and her place in the world. She doesn't appear to have the issues of abandonment which she discovered during therapy. She's not a slave to the rigid structures which defined her originally. I suggested that we meet again and I'll prepare an exit interview for her at that time. She did tell me that she was heading towards a casually sexual relationship with Andrew, the professor, when he mentioned that he was married. He maintained that his marriage, however, wasn't an impediment to a sexual rendezvous so long as his wife didn't find out. Katherine didn't go along with his suggestion. Before, with the prospect of a romantic relationship beginning with Andrew, Katherine was much more sanguine about her breakup with Jake. I'm afraid now the separation from Jake will hit her harder than previously. At the beginning of the session, Katherine gave me a curious object. It's a glass pyramid about five inches high, mostly clear but with a slight milky, pinkish-purple hue. Inside is suspended a yin-yang symbol. The odd thing is that it looks the same from every angle. It can't be a sphere or the dividing curve would move as you rotated the pyramid. It can't be a disk, or it would disappear from the side. It's an enigma.
5 pm. Forty-Second Session with Alex Rozzi. Alex's personal relationships have gone right into the toilet. His mother became enraged with him during a dinner where Luke was a guest. By overhearing Alex's mother, Luke found out that Alex had been arrested for shoplifting. Luke, who was already angry at Alex for engaging in S&M experiments with Regina and Camille, decided to tell Alex that he wanted a trial separation. Alex escalated that into a full blown break-up by getting into an argument with Luke about Luke's own uneasiness with his own homosexuality. Alex's mother told him both that she didn't want him to stay with her and that she was unwilling to sign papers which would allow him to graduate early from high school. I find those positions logically inconsistent, but consistent, perhaps, with her desire to wound Alex in any way within her power. Apparently, there was no obvious trigger for her screaming match with Alex--but it was timed to coincide with Luke's visit. After breaking up with Luke, Alex went to Regina's house and, thinking her father was asleep, smoked some of Regina's marijuana with her in the garage. Suddenly, her father was at the top of the stairs, cursing at Alex and telling him that he was corrupting his daughter and banning him from the house. Regina ended up moving out and is now sleeping at Alex's art studio with Ralph's blessing, which surprised me. Alex also described a trip to the Boardwalk in Santa Cruz where he smoked marijuana and then rode many times on the rollercoaster there. Afterwards, he said that he almost passed out--he felt he couldn't take a breath and his visual field went dark. Alex told me that he had suffered a similar experience when he was by himself just after testifying at Benny's trial and he woke up lying on the floor. They sound like anxiety reactions to me, but the marijuana is a confounding factor. We talked about Alex's growing marijuana use. He told me that he smokes before painting and he told me about two incidents this week involving marijuana use. He looked bad. Almost on the verge of tears through much of the session, he also had a glassy, tired look to his eyes; he spoke rapidly at times, almost without taking a breath; and he had a generally disheveled appearance. He told me that he hasn't been sleeping and that he has lost his appetite. I told him that I believed that he was using the marijuana to hide his pain over Benny, the trial, and Joe. Alex reacted strongly to my suggestion--I clearly hit it. He admitted that Benny is constantly on his mind, and Joe is often in the back of his mind. I think we have a lot of work to do.
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Thursday, April 23, 1998
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4 pm. Seventy-Seventh Session with Anna Green. Anna, housesitting for her father's friend, is having difficulty making the house her own. She feels guilty if she moves a chair or rearranges the kitchen gadgets, but she feels resentful if she doesn't. I told her to go ahead and make the home hers--remembering that she can set things back the way they used to be when the owner's come back from Europe. She seemed to be looking for permission to do just that. Anna also has started to have imaginary conversations in her head again. When she first came to see me, it was soon after her breakup with Bill. Then, she was troubled with long-running imaginary conversations where she imagined Bill begging for forgiveness. Now, surprisingly, it isn't Martin who she's internalized in that manner. Rather, it's Kathy. I asked her about the tone of these conversations and Anna said that they are both confrontational and explanatory. Anna feels like she said everything that she had to say to Martin. Now, her relationship with Kathy is the one that doesn't feel like it's resolved. I suggested that Anna is using these imaginary conversations to help resolve this relationship. It is hard to remember that Kathy was a very important friend to Anna, prior to the time that they found themselves competing with each other for Martin's affections. Now that Martin is no longer an obstacle between them, Anna is somehow troubled by the loss of her friend. But Anna seems to be quickly forgetting all the agony that Kathy put her through. And I think it is interesting how little importance Anna really places on the loss of her relationship with Martin. He was always a lightweight in her affections, although the competition with Kathy gave him a great deal more importance than he deserved. Although Anna's sexual experiments with Kathy were disasterous, the emotional relationship with Kathy was really the paramount one in the three-way relationship they shared with Martin.
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Friday, April 24, 1998
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11 am. Fourteenth Session with Sharon Lough at California Pacific Medical Center. Sharon is outwardly bitter over her "incarceration" at the drug rehab facility, but underneath her anger and dark humor, I think she understands that this is what she needed. She threatened to shower me with hideous craft projects if I kept her locked up--she gave me a really awful chartreuse and orange potholder and told me there were more where that came from. I told her that if she sees the program through successfully that I'll be able to reinstate her at SII. I'm not sure that's within my power, but I can write a letter suggesting that she suffered a psychiatric disability and that now she's fine. What with the ADA rules on disabilities, I think that would likely do the trick. Sharon said that she didn't want to return to SII, but really she has no work, no home, and no friends except for Rob. But her relationship with Rob is not healthy--Sharon is in it because of her feeling of financial obligation. If Sharon is going to successfully give up drugs and avoid another suicide attempt, she has to have something positive and stable in her life to return to. I therefore strongly urged her not to give up her job at SII. Although Sharon resisted my advice that she participate in group therapy, I think it would be beneficial for her to interact in that setting and continue seeing me once a week. When she's out of the rehab facility, I'll set her up with the rehab outpatient group therapy. She'll realize that she's not alone. I expect Sharon to be released next week.
3 pm. Eleventh Session with Rachel Tanner. Rachel is clearly responding well to the Fluoxetine, although she has not effected a complete cure. Her rituals are increased by external stressors and she has replaced the initial rituals with other, less intrusive ones. So she has successfully reduced the burden of the rituals without exactly eliminating them. She commented on the changes I made to my office arrangement of chairs, and although she quickly adjusted, she was momentarily discomfited by the violation of her expectations. I asked Rachel about the dinner she was excited about during our last session with her brother and his roommate. She said it went well, although she wasn't invited to accompany them as they went out that night. When they got home that night, they were fairly drunk. Rachel heard them and, intending to get a reaction out of Evan, she decided to dress provocatively and hope to be caught as she went to the bathroom. She got the appreciative reaction she was seeking. She described revealing herself in that manner as very exciting. I feel somewhat protective towards Rachel and I probably overreacted when she told me what she'd done. I was concerned that the move she made on Evan sounded like a repeat of the move she made a couple of years ago when she wanted to lose her virginity and ended up getting raped and I cautioned her accordingly. We talked about OCD in relation to the movie "As Good As It Gets." Rachel thought that the portrayal of OCD was shallow and she didn't believe the reversal of the Jack Nicholson character's obsession with contamination when he was asked to keep a dog in his house. But the movie has done a lot to put OCD on the map, so to speak. Rachel wrote a sex-reversal essay for her writing group where her male character suffered from OCD. This brought up a discussion of the condition which resulted in Rachel "coming out of the closet" with respect to her own OCD. Rachel said that she had been testing the group by putting the behaviors into her character; the group apparently passed. After her session, I read the sex-reversal essay that Rachel wrote. Mostly, it involves a grooming ritual modified to suit a man. Clearly, she's exploring OCD rituals in the context of male behavior. It is interesting that it is easy to tell that it was written by a woman.
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Charles Balis' Personal Diary & Log