63 pages • 2 hours read
Content Warning: This section contains references to child abuse, substance misuse, verbal and physical abuse, sexual assault including rape, suicide, and suicide ideation.
Dr. Catherine Gildiner narrates the book, conveying the experience of providing therapy from her own point of view. As a Clinical Psychologist, Gildiner is trained and licensed to provide treatment and maintains a high level of professionalism in her interaction with patients, and this gives credibility to her voice in the book and its narrative. She is attuned to her patients’ needs and fears and proceeds with caution when she senses that a patient is unwilling to speak on certain topics. She notes that this skill has been honed with years of experience and that it is this coupled with her knowledge, training, and observation of other psychologists through mentoring, that she has become a successful therapist.
The book provides readers a glimpse into Gildiner’s progress as a therapist by profiling both her very first patient (Laura) and her very last patient (Madeline), and three in between in chronological order. In reflecting on her career over time, Gildiner is able to identify the ways her techniques have evolved. She charts the ways that, over time, she departs from doing things “by the book” when she senses that the patient is resistant. For instance, Gildiner has been taught that therapy should begin by taking down the patient’s family history. When Laura is resistant to talking about her childhood in early sessions, Gildiner must adapt and depart from this “rule” to find other ways to establish trust. Indeed, developing a rapport with her patients is essential for Gildiner—she wants them to recognize that she feels empathy and desires to help them. At the same time, she must maintain professional boundaries, keeping her personal life separate and remaining objective. Her narrative demonstrates the way in which successful therapy is a balance of providing empathy, but not judging or interfering. Likewise, Gildiner frequently reiterates the importance of a patient coming to their own conclusions, discovering truth on their own (in keeping with the book’s key theme).
Gildiner deliberately and self-consciously reveals her mistakes and those times when she is professionally unsure, which occur in all of the case studies. In the narrative, she is able to reflect on these missteps and examine the flaws in herself that led her to make them and this demonstrates her humanity, humility, and her ability to grow, as her patients do. Often, it is identifying too closely with a patient’s experience that causes Gildiner to lose her objectivity momentarily. At the end of the book, she reflects on this, noting that all of the female patients she chose to profile—though Gildiner did not have a physically traumatic childhood as they did—face similar challenges to herself as a child and adolescent. It is notable that Gildiner ends the book with a critique of herself, drawing a parallel between herself and her patients and showing that, she too, is learning as she lives. In this way, Gildiner presents herself as an example to the reader, rather than separating herself from the examples of her patients.
Laura Wilkes is the first patient of Gildiner’s book and, as such, her story serves to introduce many of the themes and issues of the book. She is also Gildiner’s first ever patient and, as such, serves to introduce Gildiner and her career to the reader. Laura is an assertive and straightforward person, who initially approaches therapy and the aspects of her life that bring her to it quite bluntly. Gildiner emphasizes Laura’s “Type A” personality, meaning that she is accustomed to being proactive to remedy a problem or complete a task effectively and efficiently. This mentality has served Laura, thus far, but her recurrent herpes outbreaks reveal a high level of stress beneath.
Although Laura carries an attitude of anger and negativity into many of her initial sessions with Gildiner, she is a dedicated “student,” always completing the “homework” Gildiner assigns. For instance, she reads numerous books on subjects Gildiner points her to, such as stress and alcohol use disorder, then goes further by developing charts and graphs to deepen her understanding of the material. As Laura’s childhood trauma is uncovered, it becomes clear that this hardworking approach to life is Laura’s survival mode but is also fueling her stress. As a child, she had no adult to rely on and, quite literally, was left to feed, clothe, and care for herself and her siblings. In this survival mode, Laura had no time for emotions, and she has carried this approach into her adult life. Likewise, Laura is deeply impacted by her relationship with her father. Although he neglected her, when present he singled Laura out from her siblings. This attention, although often negative, created a complicated dynamic in which Laura tends to defend her father’s aberrant behavior. Laura’s story, as the first of the five, introduces subject matter, much of which is difficult in nature, which will be explored in a variety of different ways as the book progresses.
As Laura discovers the way her relationships with men, such as her boyfriend and boss, are shaped by the way she learned to “fix” the problems caused by her father, she begins to learn to establish boundaries. In showing Laura creating and maintaining boundaries successfully, Gildiner lays the foundations for the importance of boundaries, which are essential throughout her book.
Peter Chang is a polite and softspoken Chinese American man. Although he is tender and caring with those around him, Gildiner uncovers an abusive past that prevents Peter from connecting in an intimate way with others. The defense mechanisms and coping strategies Peter developed at a young age now prevent him from being sexually intimate with a woman and from forming emotional attachments more generally. Importantly, Peter at the start of therapy doesn’t recognize his mother’s behavior as abusive, insisting—as his mother has told him—that the ill treatment he received was both done to keep him safe and because he deserved such treatment.
Peter’s story is important in the book as a key example of reframing, as Gildiner is gradually able to shift Peter’s perspective. This helps him to recognize not only the ways he has been mistreated but the ways this mistreatment continues to affect the relationships he attempts to maintain, He learns to be self-assertive in a way that both protects himself but also fairly prevents his mother from doing further damage to his psyche. Uncovering details of his mother’s past that explain her abusive behavior helps Peter to understand that he has been impacted by generational trauma.
For Gildiner, Peter’s courageous spirit is evidenced by his inability to give up on his goal, despite how emotionally and mentally difficult it proves. In the end, both his musical career and personal relationships improve because of the work he does in therapy. Peter remains dedicated and determined. Peter, like Laura, insists that he would not change his past, if given the opportunity, because it has shaped him in important ways. He, like other figures in the book, has been able to grow and improve both because of and in spite of adversity.
Danny Morrison, a member of the Cree nation, attends therapy reluctantly after being advised to do so by his boss. His boss stresses his excellent qualities: As an employee he is dependable, hardworking, and skilled. His boss—who operates a trucking company—entrusts Danny with tasks that would prove difficult for other employees. Gildiner finds Danny to be quiet and reserved—courteous but determined not to reveal any personal details. As with other figures in the book, the initial issue that brings Danny to therapy—the untimely death of his wife and daughter—proves to be merely the tip of the iceberg.
Danny has developed a coping mechanism of depersonalization—numbing himself so that he experiences no feelings and thus preventing himself from experiencing further sadness or hurt. The abuse Danny survived as a child, coupled with the ways he has been taught that his heritage and identity as an Indigenous person is wrong, makes him resistant to trusting Gildiner and months go by before Gildiner is able to gain Danny’s trust in a manner that allows him to share his past. Like Laura, Danny is an example of how therapy is a long and difficult process for both therapists and patients, and that the very trauma that makes therapy necessary can lead to a patient’s resistance.
Many aspects of Danny’s personality and identity are presented as the result of his Cree heritage and his story develops the theme, introduced by Peter, of how trauma can intersect in complex ways with culture, race, and identity. Gildiner shows this intersectionality as a strand through Danny’s character and his role in the book: It is a cause of his trauma, an exacerbating factor for his loss of identity, and an initial barrier to communication between the two of them.
When Danny hones the tools needed to process his emotions, he begins the painful healing process. In time, he reconnects with his Indigenous heritage in a way that proves meaningful to his identity, providing enrichment in his life that has since been absent. The positive influence Danny goes on to have in the lives of Indigenous youth is evidence, in Gildiner’s view, of his heroic character, the key message of the book.
Alana X is a 35-year-old lesbian. Alana strikes Gildiner as mild-mannered and witty, and also intelligent and highly functioning. Yet, Alana immediately informs Gildiner of the physical symptoms of her troubled mind, which include reflexive gagging and retching along with uncontrollable vomiting. These physical symptoms are the manifestation of the years of trauma Alana endured. They most often occur when Alana “hears” the voice of her extremely abusive father in her head.
Alana represents the most extreme case of psychological disorder in the book and, as Gildiner says, was one of the most significant of Gildiner’s career. Alana also reaches crisis during her treatment, attempting suicide. The seriousness of Alana’s condition, according to Gildiner, is demonstrated by her exhibiting of several distinct personalities. The three alter egos—Chloé, Roger, and Amos—are initially described by Alana as different computer programs she “runs” to deal with the intrusive voice of her father. Each one is able to respond to and handle Alana’s trauma in ways that Alana herself cannot. Alana does not remember the actions of her other personalities. Gildiner is uncertain whether a diagnosis of multiple personality disorder or dissociative identity disorder is most appropriate for Alana but helps Alana to realize that the functions of the personalities need to be assimilated into Alana’s primary personality.
Gildiner frequently points to Alana’s immense intelligence. Though she was consistently gaslighted by Art into believing she was “dumb,” the opposite is actually true. Her intelligence has garnered her a successful career, although Alana has had to learn ways to accommodate her physical ailments so they do not interfere with her work. Indeed, she speaks of being so valuable to the company that others have learned to “just leave [her] alone” (209). Gildiner’s assistance encourages Alana to have more faith in herself and her career, and to explore what will fulfill her in her personal and romantic relationships. In many ways, the seriousness of Alana’s condition is, for Gildiner, proof of her resilience and Heroism. Gildiner displays no hint of stigma around Alana’s multiple personalities; rather, she presents these as an ingenious way for Alana’s psyche to survive her trauma prior to therapy.
Madeline Arlington is a successful business owner and the descendant of a wealthy family. Gildiner stresses the confident outward demeanor that Madeline conveys. She wears expensive clothes that are carefully chosen, has impeccable makeup, and appears professional and full of good health. Inwardly, however, Madeline’s battle with anxiety and obsessive compulsive disorder completely contradicts her outward appearance. She differs from the other patients profiled in that she has made all of her employees fully aware of the problem that initially leads her to seek therapy: her fear of flying in planes.
Madeline is a self-described “workaholic,” and her employees support this claim, as do Gildiner’s observations. She works at a relentless pace, logging in hours at the antique dealership she owns at a number that exceeds what is expected of a full-time job. Though she complains relentlessly of her employees and criticizes them for being “weak” when they express a need, Madeline does not recognize (according to Gildiner) her role in this for having hired people who exhibit the same behaviors and traits as she does. Through therapy, however, Gildiner uncovers that the trauma Madeline has endured as a result of her mother’s verbal and emotional abuse is the true blame for her anxiety. Being shaped to believe she is a “monster” who never performs well enough, Madeline has spent her life chasing an unattainable perfection in hopes of finally achieving her mother’s love. Madeline has internalized the belief that she is indeed a terrible person and her constant thoughts of dying in a plane crash are the result of believing she is not worthy of the success she has achieved.
It is through understanding how her mother has shaped her—and, learning that her mother’s narcissism and own lack of mothering prevent her from knowing how to love others—that Madeline can begin to remedy the symptoms that initially brought her to therapy.
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