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My therapeutic relationship with Ms. W. has been limited to ten minutes a month for the past seven years. Ms. W. has a primary psychotherapist. I am the psychopharmacologist.
Ms. W. who has been in and out of therapy for over twenty years, has witnessed the styles of diverse therapists, men and women, marital and pastoral. Ms. W. hasn't worked or socialized for ten years. She doesn't feel able to deal with job demands or with the interpersonal aspects of the work environment. She has never related any personal contacts with anyone except her daughter, of whom she is most critical. Her daughter always lets her down. She doesn't meet Ms. W.'s expectations, which include phoning once a week, visiting on Mother's day and birthdays.
In our once a month visits Ms. W. relates an anecdote, usually voicing a complaint, finding her therapist lacking in one way or another. I listen and nod my head, generally remaining silent or asking if she has discussed this with her therapist. She knows that I know simply by looking at her how she is doing. On the days or months during which she is drinking, she appears discouraged and disheveled. When she takes her medication, antidepressants and major tranquilizers, she appears composed and generally resigned. She frequently comments on my appearance, something like, “You always look so nice.”
Today Ms. W. was glowing. She attributed the improvement to the change in medication.
“I think there has to be another change in your life besides the medication,” I challenged.
“Well my daughter hasn't contacted me yet,” she added in a down note. “I think she's still taking drugs. You know a priest here told me many years ago, that he thought I wanted my daughter to be on drugs. Do you think that's possible?”
“What do you think?” I asked.