He came in to discuss an elevator phobia, but once Ed started talking he described a host of anxiety symptoms. He was so "high strung and perfectionistic" on his job that if one of his employees was doing some menial task that he felt could be done better he would rush in and take over the work, no matter how behind he was in his own work. He knew enough not to fire the employee on the spot -- that is, he knew that it was his perfectionism and not the employee failing that was the cause of his tension -- but he could not control the impulse. He described similar tension at home. As we discussed all this, the phobias began to abate. Within a mere 15 sessions, he was reporting no phobic symptoms. He was, however, paying serious attention for the first time to a whole range of interpersonal situations that caused him great tension and often rage.
One glaring question is why Ed would become so tied up in phobic symptoms and perfectionism instead of just feeling "I hate when people don't do what I need", "I hate having to ask someone for a loan", "I'm really scared my business won't succeed", etc. These feelings are uncomfortable but not impossibly so. They were, we discovered, only the latest in a long history of interpersonal difficulties which began in far more horrific moments of despair, helplessness, and anxiety; and those experiences were too intense to bear. They had therefore been drastically edited or simply forgotten. In the language of the trade, he "resisted" awareness of them.
Ed related one of these original moments in about the eighth session. It was a memory that had always, for no reason he could fathom, stayed with him. But once he told me, he suddenly could make sense of his perplexing symptoms and anxieties; he saw how most of them were reenactments of that awful memory. Most important, those symptoms and anxieties then began to disappear.
When he was about 7 years old at the familyís weekend house in the country, he and his friends did something wrong Ė he doesnít recall what but believes it was minor. His father reacted oddly. First he was disgusted; in Edís memory the manís face was red and he looked as if he were about to hit Ed. Then in an almost smug tone told the boy his punishment would come after dinner that evening. Ed stewed all day over this, increasingly fearful and obsessed. In his room shortly after dinner his mother called for him to come to the top of the stairs so she could ask or tell him something. He vividly recalls the view of his room, his immobility and confusion Ė although interestingly not fear - as his mother called out to him with increasing impatience; he vaguely recalled a queasy dread that this second parent was now disgusted with him as father already was. This memory always stayed with Ed, popping up at odd times in his daily life for no apparent reason -- as it did during one of our early sessions. He could not recall thinking or feeling much, either when it happened or in later recollecting it; he remembered mainly sight of the room, the sound of his motherís voice, and being unable to take any action.
There is no way a seven year old in that situation feels nothing. It is quite safe to assume Ed felt helpless, lost, alone, perhaps utterly useless and disgusting to his parents, and who knows what else. Although the event remained in conscious memory, the awful feelings it caused did not. What we donít feel/remember, we are doomed to act out. Sure enough, the forgotten feelings from this story showed up in every one of Edís troubling symptoms and anxieties, in every present day feeling and behavior he could not understand. His obsessing, impatience, phobias, etc. were incomprehensible as reactions to anything in his current life, but they made complete sense as a seven-year-oldís response to the situation Ed described. (Please note that this story was not an isolated event; Ed always experienced his parents at least to some degree being disappointed and even disgusted with him.)
So Edís problems were a recreation (unconsciously) in adult life of some old business -- the world around him (his father, especially) constantly about to collapse disastrously (reject him in disgust) if he does not remain in complete control of everything including himself. Do you see why he felt compelled to rush in with rage and disgust to take over the less-than-perfect but more-than-adequate work of an employee? This need to be in complete control probably accounts for the panic attacks, too; such attacks almost always involve the fear of losing control. And the phobias are a kind of last resort effort to avoid those horrible old feelings. He avoids them psychologically, by distracting himself from his real fears and instead focusing on elevators. (He even avoids them physically because the phobia prevents his facing his creditors.)
By the way, how do we know that this memory is so critical to Edís life, that it is indeed a source of so much of his troubles? The data point to it. First, Edís symptoms and feelings donít make much sense in his current life; there is nothing going on to account for such reactions. On the other hand they are a reasonable as responses to this old story. Second, Ed had always remembered this story, as clearly as the day it happened. Why should that be unless it has some meaning for him? Third, itís a pretty gross contradiction that he should remember this event so vividly yet claim to have few feelings about it. Furthermore, how could such a story not be painful? Fourth, after the story came out, he frequently found it relevant. It would jump into his head as we explored whatever incident from his daily life he had brought up in session. Fifth, and most important, whenever he made that connection from the present to the past, he felt clearer, more relaxed, more optimistic, and he functioned better. In short, the memory cured him.