Mary — Hello? Are You Listening?

Is it reasonable to expect therapists to recall unique crises?

My friend Marlene, age 68, underwent a transitory creepy experience 50 years ago that threw her into a state of terror from which she’s never fully recovered.

Marlene contends with an undercurrent of unease. When her recall of the event is triggered, as it is intermittently, her baseline anxiety devolves into full-fledged panic.

Given that the bizarre event in itself would not be expected to cause ongoing preoccupation as to its significance, Marlene doesn’t merit a diagnosis of PTSD. (The criteria for which are limited to trauma consequent to combat, torture, rape, etc.)

Marlene receives ongoing psychiatric care; her tenuous stability is maintained by medication and counseling. The facility which provides her treatment obliges patients to see a therapist monthly in order to receive prescriptions from a nurse practitioner.

Over the course of seven years, Marlene was assigned to five rotating therapists of various approaches, all of whom she was comfortable with. For the past six years, she’s been working with Mary, who, though supportive, tends to impose her values and to interject unsolicited opinions (e.g., “your husband is a dick”).

Nonetheless, they have established a rapport over the years. (I suspect that Marlene is secretly validated by Mary’s assessment of her husband.)

This past summer, Marlene’s ruminations were reactivated, and her obsessive thoughts persist. Over the course of six sessions, she’s told Mary of her escalating preoccupation. (They’ve been conducting sessions by phone these past four years in the wake of corona.)

In the first two sessions, Marlene maintained a calm demeanor whilst introducing, and subsequently repeating, the subject of concern.

When it became apparent that Mary wasn’t picking up on her anxiety, nor even recalled the topic of discussion, Marlene ramped up her expression of distress in session three, figuring that it would register.

In session four, Marlene had to prompt Mary once again, and reiterated her profound torment over the matter. Surely it would sink in.

Ditto session five.

Session six was two days ago. Marlene began by asking Mary if she recalled the content of their previous session.

Mary offered to consult her notes, at which Marlene told her not to bother. She made clear her resentment, chiding Mary for her inattention.

Mary’s response was that she has lots of patients and can’t be expected to remember details of sundry conversations from one month to the next.

Marlene dismissed Mary’s excuse. Given that a half-century’s worth of disturbance was wildly disproportionate to the event — and that the nature of what triggered the trauma response was “one-of-a-kind-weird” (true!) — her tormented revelations should have stood out.

Mary chided Marlene for being hard on her.

Marlene didn’t back down. She said, “This isn’t working.”

Silence.

… During which Marlene wondered whether Mary would hang up.

Mary finally spoke. She calmly asked if Marlene felt that their relationship was irreparably damaged.

Marlene, relieved that Mary’s tone wasn’t defensive, responded in kind.

She conceded that their sessions were otherwise worthwhile and suggested confining discussions to her (many) other concerns. She acknowledged Mary’s hurt feelings and apologized.

Weigh in if you will.