ARI was a patient who was not easy to love, at least not at first and not for me.
Ari was forty when he began to see me. His marriage was falling apart and he had been miserable for years. He felt close to becoming violent with his wife. He was burned out, always angry and always anxious, at home and at work. His daily marijuana smoking for twenty years, along with cigarettes, was literally making him feel sick.
Ari is physically imposing, athletic, muscled like a bull, with a military and soccer background. He wears an expensive watch, a diamond earring, and a leather jacket. He shaves his head close and rides a motorcycle around town and across country. When I first met him, he spoke in a gruff voice, volubly, bitterly, loudly, and without pause for me, even if I did attempt to get a word in edgewise, which I often didn't. He was marvelously articulate about how enraged he felt about everyone and everything in his life. I noticed how often I felt anxious about what I was thinking of saying to him, and realized I feared he would explode with rage and possibly assault me if I said something he didn't like.
Ari spent most of a year splenetically venting, about his wife, his son, his partners, his employees, and so forth. Feeling shut out, I often found myself shuttling between resentment, detachment, and feeling intimidated. Eventually, I understood that I was withdrawing, withholding a necessary confrontation, in retaliation for the narcissistic injury I felt about my perceived lack of effect on him. This understanding helped me
* An earlier draft of this paper received the 2001 Educator's Award for an Outstanding Scholarly Paper from the National Institute for the Psychotherapies, New York City. Another version was presented at the twenty-fourth Annual International Conference on the Psychology of the Self, San Francisco, November 10, 2001, and also at the twenty second Annual Spring Meeting of Division 39 of the American Psychological Association in New York, April 13, 2002. I am grateful to the following for sharing their ideas and their encouragement: Lewis Aron, Carolyn Clement, James Fosshage, Ruth Imber, Peter Kaufman, Peter Lessem, Tamsin Looker, Valerie Oltarsh, Cynthia Shaw, Donnel B. Stern, and Elisabeth Young-Bruehl.
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