An elderly healthy male, Hispanic origins, presented under pressure by his wife to seek help. He was hesitant, skeptical and avoidant towards Mental Health Services. Self employed, Self Sufficient financially and with married children who were well placed and independent in their living. Had loving Grandchildren.
Individual presented with long history of persistent low mood (called Dysthymia). He was able to maintain all his functionality, communications and social interactions, even expanding his business with his acumen. He had sufficient financial assets which he stated “can sustain 3 further generations of comfortable living by my family.’ The problem he felt is he cannot do small talk with others and he cannot find Emotional Intimacy and Flexibility in his relations with children and grandchildren. His Wife called him, “Rigid, Principled Man.” He was from the Baby boomer Generation, which saw the Great Depression of America.
Treatment:
We started with Talk Therapy sessions weekly once for 40 minutes, along with low dose of antidepressant medication. Over 6 weeks, his depression lifted and some anxiety from old issues surfaced. He carried some Guilt from that falling out with a close friend. As these resolved, he felt better and we started addressing his Social relatedness and Blocks in that aspect of his Personality. Session frequency changed to once in two weeks for next 2 months. During this process, his communication style became more broad in scope and flexibility, first with Therapist then with his Employees. One of his employees commented to him,” You were talking to me Rules and Policies all these years. I thought you cared only about business outcomes. Now, I feel you are interacting with me and my thoughts matter to you.”
After these 10 sessions, frequency was reduced to monthly, with scope for extra sessions if genuinely needed. He experimented with changes at Home front, had anxiety and announced, “It won’t work. My Wife can’t Change and she won’t come with me for Couple Therapy.” The Therapist responded, “Your Wife does not have to change first, if you realize what needs to change.!”
Sessions continued monthly, with some mutually agreed discontinuities. He accompanied his wife, first time in all these years to their periodic Family vacation. His efforts at altering and engaging with children differently was frustrating since he was used to an Authoritarian culture of Parenting and had Perfected the same Style with his children. Diverting to a friendly Style was tough. And with his daughters comment, “You are acting weird”, he aborted the Effort to Re-engage. This temporarily increased his Avoidance to Change.
Therapist motivated him to try again, suggesting that Perfection is a process not just an outcome. He tried being playful with his grandchildren, loosening his attitude from a Directive to Non-Directive approach. Children reacted with Acceptance, surprise and happiness. He felt closeness and Affection with them. His sons and daughter opened up to his efforts of Change and telephonic calls between them became frequent and informal. Emotional connections felt Re-Paired.
Stonewalling between his Persona and his wife’s Personality was the last but important Wall. They talked, but found that Past Hurts cannot be easily forgotten or forgiven. Matters of Mind‘s emotions can become complex, when it is unattended over long time. Denial becomes a necessity rather than a choice. He gathered his Courage to acknowledge his mistake, his regret and made the first move. This time without offering any justifications or excuses beforehand. He felt belittled, bit humiliated since she showed no reaction or immediate response.
Therapist consoled and shared his pain as an Ally. But wondered, if Women who have an Emotion Centered Persona can heal enough to forgive.!
Few weeks later, the Elderly Client returned with a Young Heart beaming with Happiness for one last Session. He said “My Wife spent the whole time talking with me, last few days. We did a lot of things together. She even said, she is not angry or upset with me about the past. She always understood that I had a large extended family of brothers and cousins and I worked hard to care and bring them up. She said that she has always Respected me for my sense of Responsibility for others. We sat on the same sofa, on the same side of the Living room, not the opposite ends.”
On a parting note, while leaving, the Elderly Ally stated to the Therapist, “You changed my Social Relations and Family for me. You changed my View about Psychiatrists.”
The Therapist never met his Wife, but reflected on her statement to her Husband. “I was a young woman seeking some more affection and attention to my feelings for you. I felt Ignored and Rejected by your Sense of Reason. I want us to be Happy, now.” And the Therapist Interpreted; “Fore-Giveness is an approach, a Choice which does not need Words or Fair and Lovely Judgments. One who wants to forgive, somehow Fore-Gives.!”