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Session 01

My name is Suzette Cole, M.D. I’ve been practicing psychiatry in Forrestburg, Mississippi since the late Seventies. Few women applied to medical school back then, particularly in the Deep South, and I was an anomaly. At first, my patients were a mixture of men and women, but I doubt if I helped any of the men. It’s not my fault that men who like their women dark and petite found me sexually attractive. I never encouraged such attention. I’ve always dressed conservatively. Dresses, mostly, with full skirts, a minimum of jewelry and cosmetics, closed toe shoes, glasses, never contact lenses, and no nail polish. For the work day, I wear my hair pulled back into a ponytail. The overall impression I try to create is neat, clean, and efficient, but definitely not sexy. So why in hell did so many of my male patients make a play for me? I asked my own therapist, Bill. His real name is Guillime and, like me, he has a Creole heritage. We went to med school together and I trusted him, still do.

He actually smirked and said, “Shit, Sue, have you ever looked in a mirror?”

Flabbergasted, I answered, “What the hell does that mean?”

He shook his head. “It means that no matter how quietly you dress, you can’t hide the fact that you’re beautiful. For therapy to work, we have to build trust with the patient so he’ll reveal enough for us to help him. Combine that with any man’s natural response to beauty, well …” He shrugged. “Close emotional bonds form all the time. You know this.”

It was my turn to shrug. “So I have to keep dropping my patients and refer them to someone else? How can I build a practice doing that? Soon I’ll be broke enough to look for a government job.” I shivered. “Can you imagine? Working in the hopelessness of the state hospital in Whitfield? Christ, it’s too grim to contemplate.”

Bill patted my hand. It wasn’t professional, but he had been my friend long before he became my therapist. “Have you considered limiting your practice to women?”

I shook my head. “I don’t get that many. Maybe they don’t feel comfortable with me.”

He nodded. “Maybe they feel intimidated by your looks?”

I bristled and raised my voice. “And the men pick me BECAUSE of my looks?”

He smiled and patted my hand again, obviously trying to calm me. “We’re all only human and it’s very hard to control our physical reactions. We’re drawn to beauty, women as well as men. Don’t you feel this when you see a handsome man? Aren’t you more likely to engage with him instead of someone less attractive? You know this to be true. You also know that the trick is to find the beautiful in all things in all ways, and a large part of helping a patient in a troubled relationship is to get him or her to understand this. This can be easier to achieve with women because they’re wired to find the best mate and BEST includes security and kindness, but even that search begins with physical appearance.

“The trouble with men is that the search often ends there. A man finds beauty, or his version of it, and, if he obtains it, well, ‘job done’ so to speak. He doesn’t want his newly found beauty to change, ever. A woman will find a suitable candidate and obtain him, but her search for the BEST never ends. She continues to search, at least subconsciously, and this often results in a permanent feeling of discontent. And this discontent can lead her to try to hone her choice, urge him to achieve more, earn more, buy more for her, etc. There’s a saying. A woman marries a man hoping he’ll change and he doesn’t. A man marries a woman hoping she’ll stay the same and she doesn’t. Meanwhile God sits in heaven laughing his ass off.’ Understand?”

Of course I already knew most of this. But in my studies, it came in dribs and pieces. I’d never heard anybody put these ideas together so succinctly or lightheartedly before. I smiled despite my discomfiture. “So tell me, oh swami, can I limit my practice to women? I mean, wouldn’t that be like refusing to treat somebody just because he’s black?”

Bill shook his head. “I don’t think so. More women than men seek psychiatric treatment anyway so you’ll have a larger pool. A typical man is more reluctant to admit that he needs help. And I know that ‘men and women are equal in all ways’ is one of the new mantras, but you and I both know that’s bullshit. The sexes tend to have distinct differences in their responses to the world, differences that are now being quantified by scientific studies. The distaste that the mantra reflects is based on the assumption that the female response is ipso facto inferior. You don’t feel that way and you’re a woman, so, isn’t it logical to conclude that you may have a better chance to help women than a man has?”

I frowned. “Maybe, maybe not, but I’m tired of things as they are. I guess I’ll try your way.”

And it worked. I had a few women patients already. I began using the insights that Bill had articulated with them and achieved mostly good results. And whenever I kocaeli escort bayan had to drop a male patient, I made sure to let him know that I was now concentrating on women. Soon word spread and my practice grew, helped by the fact that I also kept late hours for my patients who worked or had to wait for their husbands to get home and watch the children. For the past thirty years I’ve treated only women and developed an emphasis in helping them with the two most common complaints, depression and sexual problems, two closely related issues.

During the early years I had three patients who really stood out to me and I decided to chronicle their cases. Of course, I’ve changed all the people and place names to protect their identities. They might recognize themselves, but nobody else could. And, for the two who are still alive, I got their permission before starting. One has been gone from us for decades, the dear lady, and I got permission from her next of kin.

I call the three women Genivieve, Nanette, and Vanessa. I already wrote the stories of Gen and Nan in the form of novels from the third person omniscient point of view. But I am first and foremost a doctor and writing fictionalized accounts in that way presented difficulties. My second attempt is better than the first, but still not entirely satisfactory.

My presentation of Vanessa’s story will be a straight forward report, except that I will add details as needed in the form of dialogue that may not have happened as written but will state all the essential facts. Also, I’ll have to compress the action, like they do in movies. This will make it seem as if Vanessa progressed through her therapy in a unrealistically short period of time, but I assure you that wasn’t the case. I’m no psychiatric “Mary Sue” and it actually took many months of intense therapy for Vanessa to make progress and eventually reach a resolution acceptable to her. So, please don’t take the chapter titles “Session 01” and “02”, etc., literally. They’re simply narrative breaks to avoid too much boring exposition. If I like the results of this literary technique, I’ll probably re-work the first two. Whether I take the trouble to do that will depend upon your reactions to Vanessa’s story and, more importantly, your comments.

It was a Tuesday afternoon at two o’clock when Vanessa appeared for her first appointment. I found her extremely interesting the moment she walked through the door. She looked pretty and sexy. Neither term necessarily includes the other, but she was both. She wore her naturally blond hair (you could tell from her blond eyebrows) down to her shoulders and parted it on the right side. Her medium brown eyes shone like a light whenever she smiled. Her plump lips invited kisses and her genuine smile could certainly melt a receptive heart. A severe critic might think that her disproportionately long front incisors spoiled her otherwise perfect teeth. To me, this slight defect only made her more attractive; it showed she was real, not manufactured on some doctor or dentist’s operating table. Her skin was smooth and tan and showed that she liked outdoor activities. The trimmed nails at the end of her fingers and toes sparkled like diamonds from the clear polish on them, unlike the silly green, blue, black, and God only knows what color some women currently wear or that damnably garish red they used in former years so exclusively. In summary, her prettiness stemmed from her healthy and wholesome “All American Girl Next Door” appearance.

Her sexiness came from her body and the way she moved. At the start of her initial session, I took her height and weight. She stood 64 inches tall and weighed 135 pounds, so, by the books, she was near to the limit of the optimum weight, and nowadays, might even be considered fat. But back then, in the late 70’s, she was curvy and feminine. She moved with a sensuous and fluid grace. Her breasts were impressive, at least DD cup. In my life I’ve had lovers of both sexes and whenever I’ve chosen a woman, she’s been large-breasted. Vanessa’s bosom made my mouth water. The rest of her was impressive as well. Her bottom looked full, round, and firm, like her bosom. Her legs contributed more than half of her 64 inches of height. Her hands and feet were well-shaped, even dainty.

For that first session she wore a dress more form-fitting than mine but not what one would call tight. Indeed, she looked more as if she were going out on a date than seeing her doctor. Her legs were encased in high-quality flesh-toned hose. When she lay down on the couch the hem of her dress rode up and I could see that instead of pantyhose she wore a garter belt. She didn’t bother pulling the hem down. Either she was so nervous she didn’t realize it or she didn’t mind showing me a small bit of her sexy lingerie. I struggled for an instant to get my mind back on my job.

I have a pat speech that I use at the beginning of my first session with any “abnormal sexual activity” patient. The goal is to relax izmit escort bayan her, build up the trust between us, and develop her confidence in me. Most people fear the judgment of others. I alleviate that fear by undermining the very concept of a STRICT definition of NORMAL. I tell them, “What’s ‘normal’ anyway? Truth be told, ‘normal’ is often an amalgamation of ideas imposed on us by a variety of sources, mainly religion, family, and societal expectations. But nobody measures up to ALL those criteria and therefore NONE of us have much right to JUDGE others so long as they’re not hurting anybody. So, Vanessa, what would you like to talk about?”

I offer all my patients the opportunity to lie on a small and slightly inclined couch. Most do and when they do I encourage them to remove their shoes while I dim the light so that they can relax better. The more they relax, the easier they find it to talk freely. Sometimes I use hypnosis.

Her smile had been genuine but faded quickly. There she lay, all pretty and sexy, but troubled. I sat at a right angle at the head of the couch so I wasn’t facing her unless I turned. And she couldn’t see me unless she sat up and turned. When she didn’t respond to my prompt, I stretched my neck to get a look at her face. She opened her mouth to speak and closed it before saying a word. She did this several times. Obviously, either she didn’t know where to start or couldn’t bring herself to say what was on her mind.

I decided to help the process along. “I see from your patient information that you’re 25 years old, single, have a B.A. in English Literature, are certified to teach in Mississippi, live in Beauchamp on the coast, and you’re not employed. You’re paying for your treatment with a credit card in the name of Aaron Wilson, I assume with his permission?” I said this last with a light tone so that she could tell that I was joking.

She responded in the grand old Southern fashion, “Yes ma’am.”

I tried to put warmth into my voice. “You may call me ‘doctor’, ‘Dr. Cole’, ‘Suzette’, or just plain old ‘Sue.’ ‘Ma’am’ is appreciated but, in your case, unnecessary. I’m only a few years older than you.”

“Okay, Sue.”

“Good. Now, you indicated on your patient info form that you’re seeking treatment for ‘abnormal sexual activity.’ Well, I’ve just said that I probably won’t consider anything you’ve done as ‘abnormal’ and I absolutely won’t judge you no matter what. I am your doctor and I have sworn to help you and to keep everything you tell me confidential. I am on your side. It will be you and me against the world if it comes to that. You have my word.”

She choked and began sobbing. I hadn’t expected such a strong reaction so soon. It usually takes several sessions to get that kind of a response. I got up, grabbed a box of tissues, walked over and sat on a chair next to the couch facing her.

I tried to sooth her and quietly, just above a whisper, I said, “That’s it. Just let it all go. You’re safe in here, nowhere safer. Cry it out. Get rid of it.”

She snatched a tissue and grabbed my free hand. Had she been sitting up, she surely would have thrown an arm around my neck and hugged me tight, like a drowning person trying to be pulled to safety. That much contact with such a sexy woman might have caused me to compromise my professional integrity, so I was glad she remained lying down.

Her sobbing stopped but her voice cracked when she spoke. “I’m so sorry. I just don’t know what to do. I’ve made a mess of my life and I don’t have anyone I can talk to, that is, that I can trust to give me good advice and not tell others.”

I patted her hand. “Now you do. Lie there for a minute and let me take a few guesses. If I’m right, maybe you’ll feel better about starting. Okay?”

The way she nodded her head and looked at me, eyes wide and red from crying, face wet with tears, and more tears appearing to be on the way, reminded me of a little girl in distress. It smote my heart. I never felt so protective of another patient, not even Genevieve. Now there’s a woman who made a mess of her life. Thinking about Gen for a moment, I patted Vanessa’s hand again and said, “I can promise you, Vanessa, you can’t possibly have made more of a mess of your life than some of my patients.”

I remained seated in front of her. I dropped her hand gently so I could pick up my pen and pad. They weren’t really necessary because I make an audio recording of all my sessions, but the pad and paper convey authority and competence and patients need these in order to have confidence in their doctor.

When she remained silent, I said, “Let me start for you. You’re single but you don’t work. Twenty-five years old and already graduated from college means you probably don’t live with your parents. You dress well and obviously visit a high quality salon to have your skin, hair and nails treated at least every other week. You’re here with a man’s credit card. And you’re wearing earrings, a necklace, gebze escort and a fairly large ring. All the pieces match, are formed with a golden clove hitch in the center, and are set with a good-sized diamond within the knot. Clearly custom made and expensive. And a clove hitch is one of the primary sailing knots. I don’t know what kind of car you drive, but I’ll bet it’s expensive.

“Obviously you have a relationship, maybe even live, with a man named Aaron Wilson. He’s rich enough to support you in a lavish fashion, and he owns a yacht, on which the two of you spend a great deal of time unless your tan comes from the salon. He may have been born a rich kid, but there really aren’t many of those around. More likely he’s a lot older than you and has worked years to achieve his success. And despite this seeming good fortune, you’re HERE, distressed enough to weep and sob heavily.

“Based on these assumptions, I can see two possibilities, one or both of which may be true. First, despite his apparent generosity, you now think Mr. Wilson an inferior companion. I would have to guess the reasons. Abuse? Forcing you into sexual practices that you find distasteful? You’ve decided he’s too old? Too fat? Too crude? Second, or perhaps more accurately, a direct corollary to the first, you’ve embarked on an affair. Perhaps you’re in love with this new sexual partner? Or, possibly, you have some kind of urge, maybe you’ve had the urge for a long time, that this new partner satisfies. Either way, you feel in imminent danger of losing Mr. Wilson’s financial support, perhaps? I don’t intend to paint you in mercenary colors, but we all have to eat and I suspect that having lived large you would find it difficult to merely survive alone and on a teacher’s salary. In any case, either your fear or your guilt or both has created, or more likely raised, anxiety within you to an intolerable level. Am I in the ballpark?”

Vanessa’s eyes weren’t exceptionally large, but they opened wider and wider as I spoke. When I stopped, she answered. “Dead on about the man and money. But wrong about most of the rest of the stuff. I don’t find Aaron inferior. He’s twice my age, but for an older guy he’s pretty fit. And he’s kind and generous and spends time with me. I’d probably marry him if he asked me. But he’s already been married once and it turned out really bad, so he’s done with that.”

She paused and hung her head. “But you were kinda right about me having an affair, I think.”

That perplexed me and I frowned. “How would you define having an affair?”

She shrugged. “If I had sex with another man, that’d be having an affair.”

I sat back. “I think I see. You’ve had sex with another woman, not a man, so you think it might not ‘count’ as having an affair. Is that right?”

She nodded. I continued. “Well, let’s say you performed oral sex on another man. Would you call that an affair?”

She cringed and her voice trembled. “I don’t know.”

I tried to sound cold and clinical. I had to cut through this delusional and pedantic bullshit if I was going to help her, and I wanted to help her very much. “So, to be clear, you think that in order to call having any form of sex with another person an affair, that other person has to be a man and then only if he sticks his penis inside your vagina. What about your anus? Would that count?”

Vanessa sat up. “Are you making fun of me?”

I remained calm. “By no means. I’m simply trying to understand how YOU define terms. And while we’re on the subject, how do you think Mr. Wilson would define the phrase ‘having an affair’?”

She cast her eyes down again and wouldn’t meet my gaze. I continued. “Then don’t let’s quibble about definitions. It is commonly accepted that the phrase ‘having an affair’ means performing any sexual act with anybody else other than your spouse or current committed partner. Probably kissing and groping doesn’t actually meet this definition, but the other party would still feel betrayed and believe that you had broken trust and that’s really what it’s all about, isn’t it. Do you feel as if you’ve broken Aaron Wilson’s trust? Of course, if you don’t, then you don’t really have a problem and you can go home from here and tell him all about it.”

The way she shrunk back from me told me the answer I already knew, so I continued. “Honesty and trust. It’s hard to separate the two. But if you’re honest with yourself, you can admit that you’ve broken Aaron’s trust and now you fear the consequences of him discovering that. Yes?”

She whimpered and reached for another tissue. She lay back down and the tears began again. I continued. “So let’s examine why you had an affair. There’s always a reason. You say that you would marry Aaron if he asked you. Nevertheless, you felt it necessary to have sex with another woman. Yes?”

She gave me a weak, “Yes.”

“You know, when telling a story, most people like to proceed in chronological order. Why don’t you start at the beginning? Close your eyes, relax, and tell me about your childhood.”

She sighed and did what I said. “We weren’t poor. We had a house and a car that didn’t break down often. My dad was never out of work. But mom always bitched and complained about money. Nothing was ever good enough.”

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