Chapter 14
Rob and Mary Williams walked along Main Street in the historic section of Bethlehem, Pennsylvania. They had just finished lunch and were on their way to the office of Steven Cooper, Ph.D., a marriage and family therapist. The cream-colored bell tower of Central Moravian Church, just off the Hill-to-Hill Bridge, loomed up ahead of them gracefully, like a silent music concert to God. The bright and sunny afternoon stood in stark contrast with the stormy inner feelings of this young married couple. Rob and Mary had recently lost a young child, their first and only one. Doctor Johnson-Angelo did everything medically possible for the little boy but sometimes that is still not enough to save a life. Their marriage was clearly in danger after that. Mary appeared apathetic to just about everything in life. Rob seemed to be working harder at living but was feeling depleted by the lack of response from his wife.
Abbot Francis de Sales, who had treated Rob individually for a brief period of time, made the professional referral to the outstanding marriage and family therapist they were on their way to see for the very first time. Dr. Steve Cooper and Abbot Francis had attended Moravian College as undergraduates, right there in Bethlehem. Both of them were a little older than the college population of those days. Steve had been in the service and Francis had been through postulancy, novitiate, and the early years of vowed monastic life. The first course they took together was called “Behavior Disorders” and the friends sometimes joked about that course setting the tone for their relationship of nearly thirty years. Steve’s wife was instantly a part of the relationship, though she was working while hubby went to school early on. Later the roles of the married couple reversed but the three always remained good friends, many other people becoming part of the enlarging circle of friends over the years.
The historic red brick building, beautifully refurbished by Steve and his wife, stood just a few blocks off of Main Street. Several other health care professionals in various specialties shared office space in this building as well. The nervous man and woman found their way to the waiting room in the building and had a seat. Soft music filled the high-ceilinged room and coffee simmered on a warmer. Mary flipped through the pages of an old magazine without comprehending what she was looking at; she sat there as if in a trance. Rob filled a cup full of spring water from the water cooler in the corner and never drank the water. Before long, happy voices wafted out of Dr. Cooper’s office as he opened his door into the waiting room. An older couple walked out, the man with his right arm in a sling and a cane in the opposite hand, the woman with dark over-sized glasses on. The stresses of their medical problems were causing some marital conflict. The doctor focused on helping them to come up with creative ways to lighten their load of daily tasks, keep perspective, watch their “self-talk,” and not take their frustrations out on one another.
Dr. Cooper gave the seated younger couple a little nod, which non-verbally seemed to say “I’ll be with you in just a few moments.” Back in his office, the marriage and family therapist made some sketchy notes on what happened during his last session, then pulled out some client information intake forms and placed them on his desk. He believed that this would be a challenging case so he took a few moments to do some deep breathing and get himself centered and focused. His Hungarian and Slovak genes prompted him to say a little prayer, which he did. Then he opened his office door with a smile.
“Please come in, Mr. & Mrs. Williams. I am happy to meet you. May I call you Rob and Mary?”
“Please do, Dr. Cooper,” responded Rob with genuine enthusiasm. Mary gave a weak smile, wishing she had stuck with her resolve not to go to this session.
The couple got settled on a couch and Steve sat behind his desk for a few moments taking name, address, birth dates, social security, health insurance information, et cetera. The young man and woman looked around at the office. Its muted colors provided a feeling of comfort and warmth. The certificate from the American Association of Marriage and Family Therapists indicated that their doctor was not only a member of that prestigious specialty organization, but that he was an approved supervisor—certified to train others in his field.
After the initial intake information had been gathered and recorded, Steve walked around in front of the desk and sat in a comfortable chair to one end of the couch and facing toward the couple. The chair was angled so that he was not directly facing the couple and could glance at them and away easily. This was one of the first things he learned in his psychotherapy training, just a few blocks away at Moravian College. At the time he felt the class on the placement of furniture in an office, complete with drawings on a blackboard, was silly. Now he saw it as eminently practical. The furniture placement created ease and freedom in what can sometimes be a frightening and intimidating situation, but which typically became comfortable, insightful, and challenging before very long in Steve’s presence.
“Abbot Francis gave me just the briefest sketch of your situation, but I’d really like to hear from each of you what you perceive as happening right now, and how you think I might be of some help to you both, and to your marriage.”
Typical of Western patients, both parties were rather passive in the presence of the doctor. They much preferred to be given a pill or being told what to do. It was clear to Steve that neither of those approaches would even begin to fix this situation. Again, Rob spoke up first: “Our marriage has just about a flicker of life left in it, Doctor Cooper. We wanted a child for the first years of our marriage but it didn’t appear like that was going to happen. Then, unexpectedly, we did become pregnant. After having our little baby for not quite a year, he was taken away from us in death. I believe in faith that he is still with us but something inside of me feels very differently.
Mary and I barely talk to one another. If I start a conversation, it doesn’t seem to go anywhere. We don’t, for that matter, go anywhere either. Life has become going to work and taking care of the house and that’s about it. We don’t dislike one another but there doesn’t seem to be much passion in our relationship.”
Before Rob could continue on or Dr. Cooper respond, Mary broke in: “You might as well tell it like it is, Rob. I don’t have anything to say to you or anyone else these days. I go through the motions of my day. I manage to get to work, take care of the house, and get lost in TV or books most evenings and weekends. I don’t feel like relating to anyone ever again. It makes coming to a session like this exquisitely painful for me. I’m sorry, Doctor.” A mix of sorrow, anger, and frustration washed out of the young woman and into the room.
“I’m sorry, too, Mary. I also understand—at least as best I can. I have not been through exactly what you’re going through but know that it is one of the most painful life experiences a person can endure. You both may know that when a couple loses a child, and I am sorry to say this, it greatly increases the probability of that marriage not surviving.”
This piece of information made Rob’s heart race even faster, and Mary’s head bowed down a little further yet toward her lap. The intake interview continued for about another half hour. Steve got as much information about the “family of origin” as he could out of both parties. Marital conflict was often related to attitudes developed in the “family of origin” and then brought to the new relationship. When healthy, these attitudes could be very helpful to the marriage in some cases; in other cases the family of origin attitudes could cause expectations or distortions that were not helpful but perhaps even harmful. In either event, the people in therapy needed to be guided into an attitude of personal responsibility, not excusing themselves or blaming others from their pasts.
Steve’s preliminary assessment was that the couple was experiencing reactive depression due to the loss of their child. Rob appeared to manifest a very controlled anger while Mary exhibited an apathetic depression. The marriage had a less than a fifty per cent chance of survival, in Dr.Cooper’s estimation, without therapy. With it, the odds were slightly more in favor of the marriage remaining intact.
“I think it would be very appropriate for the two of you to see me for a course of marital therapy. I would suggest several months of treatment and then we can reevaluate the situation. My experience of progress in therapy is that when couples do their ‘homework,’ things move along much more quickly.”
Rob was the responsive one yet again. “What kind of homework do you have in mind, Dr. Cooper?”
“I would like you both to join a gym, you know, a health club.”
“A gym!” shouted a startled and angry Mary. This was the most emotion Rob had seen in his wife in several months, and he liked seeing it there.
It seemed as if the doctor was expecting such a reaction. “That’s right, your body is a sounding board for your mind, and is also influencing it very powerfully. In your case, Mary, the tempo of your being is much too slow for a healthy body, mind, or spirit. Your depression is dragging you down and slowing life down to a dull and listless existence. Rob, your smoldering anger is eating you up inside. You need some ventilation. The old ‘ventilationist’ model of anger is not substantiated in the research. It is only a symptomatic and partial treatment, but it can be very helpful on occasion. Expressing or ventilating anger whenever you feel it can actually raise the anger level in many people. You’ve probably seen folks who seem to be angry all the time. They bought into the sixties and seventies pop psychology notion that you need to get all angry feelings out in the open all of the time.
“The research on anger is clear. You need to sort out what is an important issue, or a recurrent issue, and respond to that with appropriate and constructive anger. Put the less important or lighter material in another category. These would be events and experiences that would probably fade away in an hour or a day anyway. Try not to bother with them. I’m being very direct because you people have been through enough and I want to move this process along as quickly as possible. You seem like bright and healthy people who can cope with this type of directness.
“Inside yourselves, you are probably thinking that Mary is the problem because she is so apathetic and that you, Rob, are doing all you can to make things work. There’s a little truth in that but the greater truth, the more complete truth, is that your anger, Rob, is part of what is shutting Mary down. She just doesn’t have the strength to deal with direct or indirect anger from you right now. You both have your work cut out for you, and therefore, so do I. Please take a little time to consider what I have offered here today. I’ll see you in about two weeks. My schedule doesn’t permit more frequent visits than that, and you do have some things to think about and also exercising to do. Is it a deal?”
This time Mary responded first. “Some unfathomable voice inside of me says that there is some wisdom in what you have said. I really don’t mean to be offensive, Doctor, and I respect your years of study and experience.”
“That’s quite all right,” Steve said. I respect the two of you as well. Respect is one of the ‘core conditions’ that are foundational to a positive outcome in clinical treatment. If the doctor does not have that for the patient, not much can happen. Respect from a clinical research point of view means that I believe you have within you what it takes to deal successfully with your situation. And I honestly do believe that to be the case.”
The three people made their goodbyes in a more somber way than the previous older couple did. The bumps and bruises on the younger couple were not as obvious either, but just as surely present. When Steve opened the door from his office into the waiting room to show Rob and Mary out, there was a teenage girl with pink and green spiked hair sitting on the couch. She had enough metal through the piercings in her body to require a ground wire if she were out in an electric storm. Dr. Cooper gave that same non-verbal “I’ll be with you in a few moments” nod to the young girl. She responded by smiling, revealing even more metal--this time on her teeth.
The preoccupied couple left the office and walked out back to Main Street looking at their situation a little differently. Neither was sure how he or she felt about the session yet but something had shifted inside both of them, and that type of shift is an essential ingredient for positive change in therapy.