“Sometimes our emotional states can really affect our bodies,” I said, trying to normalize this for John.
“Can we keep my penis out of this? That’s not the point of the story.”
Sex comes up with almost every patient I see, the same way that love does. Earlier on, I’d asked John about his sex life with Margo, given the difficulties in their relationship. It’s a common belief that people’s sex lives reflect their relationships, that a good relationship equals a good sex life and vice versa. But that’s only true sometimes. Just as often, there are people who have extremely problematic relationships and fantastic sex, and there are people who are deeply in love but who don’t click with the same intensity in the bedroom.
John had told me then that their sex life was “okay.” When I’d asked what “okay” meant, he said that he was attracted to Margo and enjoyed sex with her but that they went to bed at different times so it was less frequent than in the past. But often he contradicted himself. At one point he said that he tended to initiate sex but Margo didn’t want it; another time he said that she often initiated “but only if I do what she wants during the day.” Once he said that they’d talked about their sexual desires and needs; another time he said, “We’ve been having sex with each other for over a decade. What’s there to talk about? We know what the other person wants.” Now I got the sense that John was having trouble getting an erection and that he felt humiliated.
“The point of the story,” John went on, “is that there’s a double standard in our house. If Margo’s too tired to have sex one night, I let it go. I don’t corner her with a toothbrush in her mouth the next morning and say”—here he did the Oprah impression again—“‘I’m sorry you weren’t feeling well last night. Maybe we can find some time to connect tonight.’”
John looked up at the ceiling and shook his head.
“Men don’t talk like that. They don’t dissect every little thing and think it has ‘meaning.’” He made air quotes when he said the word meaning.
“It feels like picking a scab instead of letting it be.”
“Exactly!” John nodded. “And now I’m the bad guy unless she gets to make all the decisions! If I have an opinion, I’m not ‘seeing’”—more air quotes—“what Margo’s ‘needs’ are. So then Grace gets into this and says that I’m being unreasonable, that ‘everyone’ has a phone, and that it’s two to one, girls win! She actually said that: ‘Girls win.’”
He lowered his arms now that he was done with the air quotes. “And that’s when I realize that part of what’s driving me nuts and making it hard to sleep is that there’s too much estrogen in the house and nobody understands my perspective! Ruby’s starting elementary school next year but already acts like her older sister. And Gabe’s getting so emotional, like a teenager. I’m outnumbered in my own home and everyone wants something from me every minute and nobody understands that I might need something too—like peace and quiet and some say in what goes on!”
“Gabe?”
John sat up. “What?”
“You said Gabe was getting so emotional. Did you mean Grace?” I did a quick memory check: his four-year-old’s name was Ruby and his older daughter was Grace. Didn’t he just say Grace wanted a phone for her birthday? Or did I have that wrong? Was it Gabriella? Gabby shortened to Gabe, the way some girls named Charlotte are called Charlie nowadays? I’d once confused Ruby with Rosie, their dog, but I was pretty sure I had Grace’s name right.
“I did?” He seemed flustered but recovered quickly. “Well, I meant Grace. Obviously I’m sleep-deprived. Like I told you.”
“But you know a Gabe?” Something about John’s reaction made me suspect that this wasn’t just about insomnia. I wondered if Gabe was somebody significant in his life—one of his brothers, a childhood friend? The name of his father?
“This is an idiotic conversation,” John said, looking away. “I meant Grace. Sometimes a cigar is just a cigar, Dr. Freud.”
We both sat there.
“Who’s Gabe?” I asked gently.
John was quiet for a long while. His face went through a series of expressions in rapid succession, like a time-lapse video of a storm. This was new; he generally had two modes, angry and jokey. Eventually he looked at his shoes—the same checkered sneakers I’d seen on our Skype call—and shifted into the safest gear, neutral.
“Gabe is my son,” John said so quietly that I could barely hear him. “How’s that for a twist in the case, Sherlock?”
Then he grabbed his phone, walked out the door, and shut it behind him.
Now here I am, a week later, standing in the empty waiting room, and I’m not sure what to make of the fact that our lunches have arrived but John hasn’t. I haven’t heard from him since the revelation, but I’ve been thinking about him. Gabe is my son rang through my mind at the most random of moments, especially at bedtime.
This felt like a classic example of projective identification. In projection, a patient attributes his beliefs to another person; in projective identification, he sends them into another person. For instance, a man may feel angry at his boss at work, then come home and say to his spouse, “You seem angry.” He’s projecting, because the spouse isn’t angry. In projective identification, on the other hand, the man may feel angry at his boss, return home, and essentially insert his anger into his partner, actually making the partner feel angry. Projective identification is like tossing a hot potato to the other person. The man no longer has to feel his anger, since it’s now living inside his partner.
I talked about John’s session in my Friday consultation group. Just as he had been lying in bed with a metaphorical circus in his mind, I told the group that now I’d been doing the same thing—and since I was holding all of his anxiety, he was probably sleeping like a baby.
Meanwhile, my mind reeled. What to do with this bomb that John had detonated before walking out the door? John has a son? From his youth? Is he living a double life? Does Margo know? I flashed back to our session after the Lakers game when he’d commented on the handholding with my son. Enjoy it while it lasts.
What John did—the walking-out part, at least—isn’t uncommon. Especially in couples therapy, patients occasionally walk out if they feel besieged by intense feelings. Sometimes that person benefits from a phone call from the therapist, particularly if the reason he or she bolted had to do with feeling misunderstood or injured. Often, though, it’s best to let patients sit with their feelings, get their bearings, and then work through it with them the following session.
My consultation group believed that if John was already feeling cornered by the people around him, a call from me might be too much. Everyone agreed: Back off. Don’t push him. Wait for him to come back.
Except today he’s not here.
I pick up the unmarked takeout bag in the waiting room and look to make sure it’s ours. Inside are two Chinese chicken salads and John’s soda. Did he forget to cancel the order, or is he using the food to communicate with me, making his absence known? Sometimes when people don’t show, they do it to punish the therapist and send a message: You’ve upset me. And sometimes they do it to avoid not just the therapist but themselves, to avoid confronting their shame or pain or the truth they know they need to tell. People communicate through their attendance—whether they’re prompt or late, cancel an hour beforehand, or don’t show up at all.