Therapist: “But you know what? You don’t have to be in such a lonely place anymore. You have different choices available to you today. You can reach out for help, and you don’t have to rely only on yourself.”
Alec was moved by that discussion. He was able to develop a new perspective and see that not only does he have capabilities and can get through crises, but also he does not have to rely exclusively on himself. On the heels of that discussion, Alec started expressing greater confidence in himself and therapy and decided to postpone ketamine treatments. He also thought that ketamine treatments would interfere with his ability to tell whether his success had anything to do with his own capabilities as opposed to the ketamine therapy. Thus, he wanted to test himself, learn about his capabilities, and develop self-esteem based on dealing with challenges.
Indeed, as he was no longer living under his parents’ roof, life presented him with several such challenges. First, he discovered the complexity of departmental politics. Reporting to more than one supervisor, he negotiated boundaries as both of his bosses placed high expectations on him. Anxious, he worried about his ability to meet these multiple deadlines, especially when he discovered that one of his supervisors tended to be hypercritical. He talked about his fears, his fluctuating awareness of his capabilities, and a helpless expectation of failure. Gradually, he came up with a few time management strategies and discovered that some of the junior faculty members struggled with similar challenges. He was fearful of being open with them but gradually decided to take that risk, and to his surprise found solace in sharing experiences about work stress and hypercritical coworkers. Due to his reliable productivity, his collaborations within the department strengthened and he developed a solid reputation.
Dating was a different story. Initially, Alec was hesitant about the possibility of being in a romantic relationship. He worried that romantic relationships would require compromises and the acceptance of failures as well as the imperfections of a prospective partner. These were hard for him to imagine, as he anticipated getting annoyed with prospective partners. He imagined that relationships are “too much work and not enough fun”. In sessions, Alec explored these experiences. They reflected a fear of rejection that was all too familiar to him from his disappointing dating experiences in the previous phase of his life. To cope, he hid behind the veil of a pessimistic outlook on his romantic future. Such a defensive retreat into pessimistic certainty was familiar to him as he used to rely on such a maneuver in a different area of his life – his career. By considering dating, he also was stepping outside of the comfort zone of the predictability of his own fantasies and projections. Dealing with real people was far more complex and required acceptance of the uncontrollable and unpredictable nature of their feelings and actions. Pessimistic certainty was more predictable and offered a promise of control, though at a price: missed opportunities. I thought that dating could invite him to explore his fears, wishes, expectations, and personal limits, and also help him accept the unpredictable and uncontrollable complexity of relationships. I thought that life experiences, coupled with exploration of them in our therapy together, could help him start seeing himself and his prospective partners as real people with complex and, at times, contradictory feelings.
After talking about his hesitations, he started dating and discovered that women found him desirable. They thought he was good looking and witty, and his job made him an attractive catch and a viable relationship prospect. And then he met Kate. Kate had a successful career, and he liked her vivacious disposition as well as her caring and patient attitude toward him. He was in love and felt happy to discover that Kate loved him as well. His hesitation about long-term relationships gave way to a dedicated interest in making things work with Kate.
The relationship was progressing and they moved in with each other. That felt like a natural step in their connection as they had also discussed long-term commitment and the possibility of getting married. This brought about more opportunities to deal with disappointments. Kate was traveling for three weeks – first, for purposes of her job and afterward with her girlfriends. She left her three cats with Alec. Alec felt angry at Kate as he did not want to be taking care of three cats. He seethed with anger, feeling that he had become a “glorified cat sitter” while Kate was away. This felt infantilizing and humiliating and brought up memories of his domineering mother who used to make decisions on his behalf. Close to breaking up with Kate, he mustered the courage to speak up. Talking about it in therapy allowed him to entertain the possibility that Kate’s intentions were different from the outcomes of her actions. He respectfully expressed his feelings to her, negotiated with her, and learned that Kate felt overwhelmed with her job and hadn’t thought through her decision. She acknowledged that she was very particular about the cats, trusted Alec with their care, and felt genuinely remorseful that her decision hurt Alec. This was a new experience of effective negotiation, forgiveness, and reconciliation. The breakup was averted as Alec learned that he was not powerless and, Kate, not heartless or controlling. He no longer felt doomed to lose the woman he loved or destroy the relationship through his angry behaviors. He was discovering the ability to negotiate and forgive. Accepting his own imperfections and feeling that he could be accepted despite them allowed him to feel more engaged in the relationship with Kate. He started to feel a sense of agency and ability to choose his own future and make his own choices. He discovered that history does not have to repeat itself.
Alec started contemplating proposing to Kate. He felt that they had good chemistry and was reassured by how well they resolved their disagreements. He shared his plans in therapy and he knew, based on informal discussion of the matter, that Kate would like to marry him, too. Work was stirring up disappointments that he was able to tolerate and learn from. Planning to build his own family, he started exploring the possibility of getting promoted and increasing his income. However, he discovered that this was not an option and felt disappointed. Weighing other courses of action, he started applying for different jobs, hoping to seek more gainful employment. His pragmatic investment in the long-term outcome was different from his past tendency to retreat and give up. He learned from his life and trusted that the future had something good to offer him.