I
My First Session with Theresa -- Friday Afternoon
I reviewed the patient information sheet for the day's final client. It was her first consultation. She was a thirty-six year old accountant who worked at the local firm that did my taxes. Her health was good; she took no medication other then birth control pills. Her forty-four year old husband was an executive with a local commercial construction company. They had an 18 year old son. She has left the line asking for the reason for the consultation blank. This was not unusual. Many clients were cautious about disclosing their most personal issues in writing to what were effectively strangers. My staff had ensured she had the proper insurance. I buzzed the reception room to send her in.
I greeted Theresa [I have changed her name to preserve confidentiality] at the office door. Anxiety was evident on her face. She wore little make-up and was dressed in a brown pants, sensible flat shoes, and a colorful loose-fitting blouse. Nonetheless, she was a striking woman. She stood about 5 feet 5 inches tall. Her long wavy almost-black hair was pulled behind her head, reaching beyond her shoulder blades. Her dark complexion revealed her Italian ancestry and her slender face featured deep brown eyes, a narrow nose, and thick lips on a relatively small mouth. The blouse, although loose, could not wholly hide her charms. Considering her thin frame her breasts were ample. We shook hands. I directed her to my leather couch. I sat in my chair.
She was nervous. After a brief exchange of pleasantries I decided to open with a question to which I knew she knew the answer. "Theresa, why did you choose me?"
"Well, Dr. Barry, should I call you Dr. Barry?" She asked.
"Sally, will do. Why did you call me? There are many skilled therapists in this community."
"Some friends recommended you. I was also told you have a teenage son."
"That is correct," I replied. Was this about her son? My mind flitted to all the people who come to my office or corner me at parties asking how to bring their son, who is really a good boy but just has a few bad friends, under control. "Call 1 800 ASK-GODD," is an answer no one appreciates.
"And what brought you to my office," I asked as I leaned forward. This was both for effect, I wanted Theresa to know she had my full attention, and because Theresa was soft-spoken, a trait I initially attributed to her obvious anxiety about our meeting but which turned out to be her normal voice tone.
"Well, I'm not sure if I am here looking for permission, or a way out, or to be told I am bad, or good, or simply to make sure I am not crazy, or to see if any damage I am causing can be cured." I waited. Theresa's background and manner confirmed her intelligence. She knew she wasn't saying anything I could use. I was learning that she was confused and worried and looking for me to help. It would take a bit more coaxing before she would tell me why she was here.
I asked if she wanted some water. When she said yes I walked to the back of my office and retrieved the imported bottled-water my clients prefer from a small refrigerator in one of the cabinets. This short interruption was not an accident. Theresa needed a moment to compose herself, something she would do more effectively if I was not staring at her. My mind worked through the usual suspects of issues that would bring a thirty-six year old women with a teen-age boy to my office. I handed Theresa the water and sat down.
"Everything you say in this office stays in this office. All our conversations are confidential. The walls are practically sound-proof. The people out there," I gestured to my office door and staff beyond, "don't know what you and I are talking about. I don't even let them handle my notes."
Theresa considered my words, leaned forward, and said, with her voice tone dropping a level and her eyes on the floor, "Dr. Barry, Sally, my son and I are sexually involved."
My initial thoughts were not exactly clinical. They were, in no particular order, "Omigod, I did not see this coming," and a graphic mental picture of Theresa and her son, who I had never seen but imagined to be as attractive as his mother, making love. I pushed my mind back to professional mode. The look on Theresa's face indicated my face had not betrayed my thoughts.
I had no significant training in incest. Theresa, was troubled, had chosen me to help, and the confession she had just made was tormenting her. She had asked me to be her therapist. Telling her I had to shuffle her off to an expert was not what she needed - it might come later, it would not come now.
I asked her to tell me her story. She said she was not sure how. I asked her to tell me the story in the way she tells it to herself. She seemed reassured.
"I met my husband when I was eighteen. It was the summer before my senior year in high school and I was working in the bookkeeping department of Coliseum Construction [again I have changed the name to preserve confidentiality]. He was eleven years older than me and worked as a job superintendent, running construction projects on a day-to-day basis. He was strong and assertive and tough and I had an instant crush on him."
I took some notes, but mostly paid attention. Her choice to start with her marriage told me that whatever was happening with her son had a lot to do with her marriage.