JASON STARR - Panic Attack

When the session ended, Adam felt guilty for charging David. Normally Adam was extremely attentive and used his instincts to anticipate where a session was headed and find the right openings to challenge his patients’ behavior, but he felt like he hadn’t helped David as much as he could’ve. For example, instead of letting David go on with his self- loathing, Adam should have been tougher and said something like “It sounds like you’re ready to leave your marriage.” Adam knew that David had no desire to get a divorce, but this could have helped David begin to acknowledge his reasons for philandering. But today Adam had been so distracted with his own thoughts and self- doubt that he’d felt off, out of sync, like he’d missed all of the obvious openings.

He had two more morning sessions and, as with David, Adam felt out of sorts, off his game. He had no doubt that the shooting and related issues were seriously affecting his performance at work. If this continued and he couldn’t work through it, he’d have to take some time off to clear his head, maybe go down to Florida after all.

During a break in his schedule, he went around the corner to the deli to get a cup of coffee and a muffin, and on his way back he checked his voice mail and saw that he had three messages and four missed calls from Dana. She had called and left a message on his work voice mail as well. Jesus Christ, what was going on now?

He called her, and she picked up during the first ring and said, “I’ve been calling you.”

“I’ve been with patients all morning, what’s going on?”

“She’s HIV positive.”

He thought she was talking about Marissa. Feeling like he might pass out, he managed to say, “What the hell’re you talking about?”

“Detective Clements just called and told me they found out Gabriela had HIV. They found her medicine or whatever in her apartment.”

“Jesus,”he said, catching his breath.“I thought you meant…”

“What?” Dana said.

“Never mind,” Adam said, still light- headed.

“Can you believe it?” Dana continued. “Clements said even her sister didn’t know. She might’ve been infected for years.”

Adam didn’t understand why Dana was calling him so urgently to tell him about this. “So is that it?” he asked.

“Aren’t you shocked?” Dana asked.

Actually Adam wasn’t shocked. Her boyfriend had had HIV, so why was it out of the realm of possibility that Gabriela had been infected?

“Oh, and that’s not all,” Dana went on. “They found out she was a drug addict, too, heroin, just like her boyfriend. Can you believe it? She was a junkie and had AIDS while she was working for us.”

“Let’s not start with that again,” Adam said. “That’s not how AIDS, HIV, is transmitted.”

“I’m talking about the deceit,” Dana said. “That woman lied to our fucking faces for years. I can’t tell you how furious I am.”

“You have a right to be furious,” Adam said.

“Aren’t you furious?”

“Of course I’m furious.”

“You don’t sound furious.”

“I’m standing on the corner of Fifty- eighth and Madison,” Adam said. “Sorry, but there’s a limit to the amount of furiousness I can express right now.”

Dana didn’t seem amused and said, “Well, it was nice talking to you too,” and hung up.

Several minutes later, as he rode in the elevator back up to his office, he decided that although hanging up on him had been melodramatic and childish, Dana had made a good point. Being so wrapped up in what was going on with the police and the media, and then, on top of everything, receiving that threatening note, maybe he hadn’t been expressing his anger very effectively lately, and this was likely contributing to all the symptoms of anxiety and self- doubt he’d been experiencing.

His one o’clock appointment, Helen, didn’t show up. Helen had never missed an appointment before, and Adam assumed that it was related to the shooting and that he had permanently lost another patient. His two o’clock, Patricia, a banker with panic disorder, showed up, but Adam felt he was as ineffec tive and off the mark as he’d been with his earlier patients. Patricia didn’t seem pleased at the end of the session either, and when Adam asked her if she wanted to make an appointment for her next session now, she said in a somewhat distant tone, “I’ll call you,” even though she normally made her appointments in person. Adam knew that something had to change fast, because at this rate either all his patients were going to stop coming to see him on their own or he was going to drive them away.

At four o’clock, Adam went down the hallway to Carol’s office for his session with her, and he felt like he seriously needed it. Carol, waiting in her chair, didn’t say hello, just “Come in.”

She was slim, in her late fifties, always wore her gray hair in a neat bun. She’d been a mentor to Adam and also a confidant. He often discussed patients with her, and she always had sound, rational advice. He was eager to talk to her about everything he’d been going though lately, but first he felt like he needed to express his feelings about her and his other coworkers, so he said, “Before we start, I just want you to know that I feel incredibly attacked and judged by all of you.”

Carol, holding her pad, was sitting calmly across from him. “Attacked?” she asked as if surprised. “Why do you feel attacked?”

The problem with being in therapy as a therapist was that Adam always felt one step ahead of Carol. He always knew exactly where she was going with her questioning, what types of feelings she was trying to elicit from him. It was like being a football coach who had access to the other team’s playbook. It was still worthwhile for him to see her- expressing how he felt was important in itself, and simply talking about his problems always helped him understand himself better- but he felt like he’d never be able to make true progress in therapy because he’d always be slightly guarded and would never open up fully. Right now, for instance, he knew that she knew exactly why he felt attacked, but she was asking the rhetorical question to get him to express his anger more fully. He knew what she was doing because it was the same tactic he would take with his own patients.

Going along with it, just to express himself for the sake of expressing himself, he said, “I just felt incredibly judged by everyone, like I was guilty till proven innocent. I felt uncomfortable just being here yesterday.”

“Do you feel uncomfortable today?”

“Yes, I do. To a slightly lesser extent, but I feel like I’m… I don’t know… an outcast.”

Adam knew that probably sounded very whiney- like his own patients sometimes sounded- but he already felt better, just from verbalizing how he was feeling.

“Well, I’m sorry if I made you uncomfortable,” Carol said. “That certainly wasn’t my intention.”

She was backing off, giving him space to continue to vent. She also wanted to reestablish trust in the therapist- patient relationship, to make him feel safe and relaxed.

“As you can imagine, this hasn’t been an easy situation for me to be in,” he said.

“I’ll bet,” she said. “It’s probably bringing up a lot of issues for you.”

He was surprised she was taking the session in this direction so quickly.

“What kind of issues?” he asked.

“Issues of control or lack of control,” she said. “Issues with your family- your current family and your parents. You grew up in the same house you live in now, didn’t you?”

“You’re right.” He hadn’t thought much about this connection to his past that now seemed so obvious. “It is bringing up issues with my parents. It’s a very familiar feeling of being blamed, of being judged.”