Overview

Sabina is a single woman of African American descent in her late 40s with some college education who works for a law firm as an executive secretary. She has a 23-year-old son who lives with her on and off. Sabina’s father left when she was 3 and died when she was 21. She had no contact with him after he left. Her son’s father and she separated when her son, David, was 2. David’s father has had minimal contact with him or Sabina since leaving. Her mother and sister live near each other and about 45 minutes away from Sabina.

I have seen Sabina in individual psychotherapy on a weekly, bi-weekly, or monthly basis for 3 years (with two breaks of about 6 months) and a total of 49 sessions to date. The concerns that brought her to therapy were persistent depression, anxiety attacks, unresolved conflicts with her mother and sister, and concerns about her son who has periodically spent brief periods of time in prison. Sabina has a number of health problems, including asthma, arthritis, recurring abdominal pain of unknown origin, and difficulty sleeping. She takes medication for depression, anxiety, asthma, and severe cramps.

A major concern is her lifelong conflicted relationship with her mother. Sabina’s mother, who is in her mid-70s, left her and her sister with an aunt when Sabina was 3, something that troubled Sabina deeply because she could not comprehend why her mother would leave her at such a young age. Coming to terms with her feelings of being abandoned has been a major focus of therapy. Sabina’s relationship with her mother is further complicated by her belief that her mother favors her older sister, who is in her late 40s.

Sabina identified a number of goals during the course of her therapy. However, for the purposes of the therapeutic illustration here, I will focus only on the primary goals of her therapy, including: (a) coming to terms with her strained relationships with her mother and family; (b) improving her health; (c) becoming an entrepreneur/businesswoman and real estate owner; (d) improving her organizational skills; (e) developing a more satisfying social life; (f) learning to accept and deal with being alone and single; and (g) losing weight.

Sabina is a bright, personable, attractive, outgoing, open, and straight-forward woman with a ready smile and friendly demeanor. She is a client always looked forward to seeing and who uses her therapy sessions very effectively.

Initial Phase of Therapy First Session

In the first minute of the first session Sabina said, “My mother writes (me) nasty letters. She likes the other daughter but not me.” She indicated that after nine nasty letters, “it really shut me down. She always feels that she has to tell us off. Instead of talking personally, she writes nasty letters.” Sabina acknowledged that she felt hurt, angry, and immobilized and withdrew from contact for a while. She began seeing a psychiatrist for medication for depression and anxiety and, soon after, sought psychotherapy. As she focused on the story of her relationship with her mother, Sabina said that her mother left her to live with her aunt for most of her childhood and adolescence while her mother moved to another state. She then stated simply, “I was abandoned.” Later she commented, “I don’t think my mother approves of me and who I am.”

When I inquired about what she hoped for in therapy, Sabina said she hoped to come to terms with the rift she believes her mother has caused and that her mother would take steps to repair their relationship. She then added that she didn’t expect that to happen and she needed to “stay out of the path of abuse.” When she did visit her mother, she coped by “keeping it shallow.” Sabina mentioned that her mother wants her and her sister, who is a nurse, to pay her mother’s rent and generally do whatever her mother wishes (e.g., take her shopping, give her money, clean her house, buy things for her), something Sabina resents because she feels that her mother rarely reciprocates such kindnesses.

After listening to Sabina’s pained feelings of rejection and disapproval from her mother, I commented, “You’ve been a bad daughter” to which she responded, “I’ve been a very bad daughter.” A little later I asked her what kept her in the relationship. She replied, “She’s my mother. You only get one. I feel a duty to honor my mother,” in part because of her Christian religious beliefs. In short, Sabina continues to contend with enormous ambivalence toward her mother, detesting her mother’s criticism and lack of interest, yet still hoping her mother will accept and value her.

Later in the first session, as Sabina was talking further about her mother and the hurt she experienced, she began to pull the sweater she was wearing around her. I commented on this seeming symbolic behavior, “You need to protect yourself,” and she replied, “It’s not safe.” Sabina was attempting to cope with her pained relationship with her mother and her depression by sleeping up to 17 hours a day. She added, “I’m not living. I’m sleeping my life away.” She did, however, go to work daily and functioned well in her job. Her life consisted mostly of working and sleeping to withdraw from her unhappy world.

Sabina mentioned that she had an on-and-off relationship with a man who was “the first person I dated in 13 years.” She hoped to marry some day but was frustrated with the men she met over the years, including this relationship, and tended to avoid relationships. At the end of our first session I asked what, if anything, she might take from our first meeting. Sabina replied, “I need to look at my days and plan things and regulate my sleep.” As I reflected on our first session, I was aware of liking Sabina, finding her endearing and appreciating her courage in being so vulnerable in sharing her pain and frustration. I felt compassion for her and hoped that she could come to terms with her despair about her relationship with her mother and get her life on track. Sabina’s motivation to improve her life was evident. I had a sense that there was a resilient woman residing in the wounded soul I had met. By the session’s end I had a good “feel” for who Sabina was and had a sense that she felt heard and supported. I was optimistic that the resilience I sensed in her would prevail.