Case Study

Case Study

Dancing with the Unconscious

By Rob Fisher

July/August 2011

As I opened the door to my office for our first appointment, Jane said a curt hello before I could greet her, and walked in ahead of me. There was a soldierly rigidness to her gait that immediately left me feeling a bit shut out. She greeted my smile with a slight scowl as she told me, without preamble, what had brought her to therapy: she was tired of being so alone in her life.

“Even when I’m with my husband, I’m alone,” she said. She’d tried talk therapies and appreciated the insight she’d gained, but added, “I just keep doing the same things I’ve always done to push people away from me.”

At 57 and a successful physician in a small town, she found herself returning to her house in the evenings to watch TV alone, while her husband tinkered in the garage. She routinely rebuffed kindly overtures of support from others without really knowing why—which enabled her to say, truthfully, that she got “very little help from anyone.” For instance, before dinner was complete, she’d jump up from the table and wash the dishes, feeling resentful as she preempted her husband’s help. She was almost entirely unconscious of the implicit, but ironclad, rules that dominated her somatic and emotional life.

She spoke with an air of independence, giving me the distinct impression that she suspected that I’d be only marginally useful to her, if at all. Her straight posture, stiff carriage, and severe mouth communicated—more than her words could—that she was struggling to rely…

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