In Therapy: The Patient stops Flirting

What had me thinking about this patient's flirting at all was when it stopped.  It is so strange that while it was going on, I did not feel like talking about it or writing about it.  Isn't it interesting how secrecy can be part of attraction and desire, even when I never consciously meant to keep it secret?

I saw a flirty patient again after a 2 month hiatus.  This is a long break between appointments and it was our first since we started.  I had gone away on vacation and then he went away for a conference.  Even though it was a virtual appointment, immediately I could tell something was different. 

"Hello Doctor", he says formally.

"Hello", I reply.

He tells me how things are going really well for him and he is surprised.  He is feeling more motivation and his mood is better.  For the first time in many months, he does not complain about his girlfriend.  He does not talk about their problems.

He tells me about something he is proud of, something no one else knows about him.  I register how privileged I feel that he would share this with me.  No matter how long I have been seeing a patient, I never feel entitled to the information shared.  A person is allowed his secrets.

He ends with "I don't need anyone to be proud of me." I pick up that this is something he has not had, and that maybe he does want this, but can not ask.  He doesn't dare.

So I do.  "What would it be like if someone were proud of you?" I ask.  I considered saying, "I am proud of you," but could feel how off the mark it would sound, a little too cliche.  I worry it would be more painful for him to hear, because he wouldn't believe it.

He shuts me down, "What is the point?" He says.  "Why would I care what others think, especially when they have no power over me.  No one thinks about me, not even one instant Dr. Chan.  Why waste my time thinking about them?"

He is not wrong.  I want to ask him what the cost is to him to care, to be in touch with the part of him that wants to make his parents proud.  But before I can, he answers this question for me, "You just get disappointed with people you know?  I am going to start doing things for me now and not for others."  There is a defiant edge to his voice and I hear a small child trying to pick up his boot straps and be strong.

I do not know if I should see if there is room for vulnerability and compassion, or help dust him off and pretend he is ok.  I believe that if he could access the part of him that is wounded and rejected, that he would feel better overall.  You can only start addressing a need once you register you are in need in the first place.  But it is a process, and the person has to feel safe.   What do I say to someone who is telling me, with no ambiguity that he is fine, doing great in fact?  And that he wants, or perhaps needs me to agree with him?

The banter that was in the previous sessions is completely gone.  His eye contact is more distant and hard.  Have I lost some ground by being away?  Has it threatened the trust between us?

Another possibility enters my mind.  Perhaps he is putting me in my rightful place.  Perhaps he has mended things with his girlfriend and it is with her he now flirts and has banter with.  And rightfully so.  If this is the case, then isn't it my job to respect the boundary?  To not push for vulnerability when it might over-step into his romantic relationship?

I notice the inner conflict.  I was confused about my want for vulnerability, because I did not know if this was for the patient and deepening his self-awareness, or for me, so I could feel more secure in the relationship.  I have to tread very carefully.

I was taught that if I am ever unsure, it is best to do and say nothing.  What is certain is that something is happening and it will declare itself with time.  Today he is telling me he is feeling happier and I want that for him.  I will also listen to my intuition that something else is amiss, and the only thing for me to do is stay tuned.