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    Not Getting Better? Insist Upon The Biopsychosocial Model (Part 4)

    The Conclusion of Sandra’s Story

    Sandra began to reveal her deep feelings of guilt over attending school in a distant city while her mother’s health was rapidly declining, and rage over her mother’s progressive debilitation and over feeling abandoned upon her death. Sandra was filled with self-hate over her belief that she should have dropped out of college and medical school to move home and be at her mother’s side during her decline. She had these feelings despite that fact that at the time her mother had told her father that her greatest pleasure in life, one that sustained her each day, was the feeling of immense pride that Sandra was on her way to becoming a doctor.

    She also felt rage at her father, believing that he hastened her mother’s death through prematurely involving hospice and providing excess narcotic pain relievers that “put her to sleep for good,” and over the fact that six months later her father married a much younger woman that he’d met online. As these feelings and memories surfaced, the sessions were punctuated with Sandra’s sobbing and raging, and I did my best to empathize with her emotional pain, which at times seemed boundless.

    She felt so horribly guilty over not being there, and I pointed out, “Sandra, your emotional pain feels overwhelming at times. You are feeling so horribly, thinking that you let your mother down in such a profound way, and believing that without your being at her bedside she felt more alone and isolated as she declined. Yet it is really important to remember what your mother told you on several occasions. Please look me in the eye as I tell you this.” I could barely keep from crying as I told her, “Sandra, your mother spoke of how comforting it was to her that you were continuing your studies, excelling at school, and moving on with your life. She felt so enormously proud of your accomplishments and that sustained her throughout the long decline, and she would have felt greater emotional pain had you dropped out of school to be at her bedside. Had you acted against her fervent wishes that you stay in school, it would have disrespected her, and made her feel even more powerless. This was at a time where your mother was being progressively robbed of control over her life by her debilitating disease, and it would have been far less compassionate and supportive if you had dropped out of school to be at her bedside, as opposed to staying in school.”

    As we explored these issues in her therapy, it became apparent that the emotional barriers to Sandra fully grieving her mother’s death led her to putting up obstacles toward a more intimate emotional relationship with Sam. She talked about how frightened she was to truly love Sam – to deeply depend upon him – to open up and share her deepest feelings and dreams about their life together – for fear of losing him as she had lost her mother. As I gave her empathy, support, and clarification about the relationship between the loss of her mother and her difficulties with emotional intimacy, Sandra gave up her extramarital affairs and began to feel a bit closer to Sam. She stopped going out with friends to drink and use drugs, and focused more on trying to build a relationship with him.

    He in turn began to focus more on Sandra and less on work, and entered individual therapy to address his own issues that confounded the development of emotional intimacy with Sandra. While we have a great deal more work to do together, her mood has become brighter and she has given up her impulsive use of alcohol, cocaine, and other men to distract her from her deep emotional pain. She is feeling more love for Sam, and is trying really hard not to sabotage the turnaround in their relationship. The combination of several different medications to address dysfunctional circuits[vii][viii] in her brain, combined with intensive psychoanalytic therapy, began to bring her the possibility of healing her fractured heart, and a future filled with more light and less darkness. Sandra’s sun is set to rise.

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