Case Material: “Patricia”

“Patricia”, a 38-year-old female, wanted to understand her anger at others but felt awkward about coming to therapy. She was seven years younger than her three siblings and said that she “knew my mother never wanted me.” A self-described “latch-key” kid from an early age, she related that her mother worked two jobs not out of economic necessity, but out of preference. Early in treatment, I found myself tearing up as Patricia described walking to kindergarten alone on her first day. I offered a comment that I felt was compassionate, to which she responded in a murderous tone, “Don't ever do that again!” In what would become a long-time pattern, she left the session early.

When Patricia was between the ages of five and seven, she was sexually molested by two teenaged brothers at their house where she often played. During this same time period, her father, her closest parent, was ill and dying.

Upon returning to school after the death of her father, nothing was said about her loss. She described how she acted out at her parochial school and was often slapped by the nuns or sent to the principal's office.

Patricia wondered why she returned to the home where she was molested. She reasoned that she “must've liked it” or she would not have returned. “I was stupid for going back.” She blamed herself for the cognition of a six-year-old child. She refused any suggestion that her interpretation was from that limited perspective. She angrily rejected the idea that she was lonely and needed others. She acknowledged that one of the teenaged boys was “nice” to her. The other was mean. They both admonished her not to tell anyone or they would blame her. Patricia connected her “going back” to be molested with the death of her father. She demonstrated the magical thinking of children when blaming herself for this double tragedy in her life.

This is the first dream she brought to treatment:

I am in the old hospital. It has a big, magnificent entrance and I go downstairs where the cafeteri