Case History

As often happens in groups for seniors, one of the members, Ms. A., was absent for two weeks due to surgery, in her case for cataracts. The surgery did not go well, and for some weeks thereafter, she was unable to drive. She could not reasonably afford cab fare to and from sessions (her fees are paid by state medical assistance) nor did she have available family. The group members frequently asked about her medical progress, and they grew uncomfortable with her extended absence. Why, they asked, could we not bend "Dr. Saiger's rule" this once and allow Ms. B., who lived near Ms. A., to drive her to and from group? Ms. B. promised not to discuss anything of importance during these rides. It seemed like a reasonable request to me, though I was distinctly uncomfortable with this weakening of agreed-upon boundaries. I consulted colleagues, including Ms. A.'s individual therapist, who was unequivocally in favor of the enterprise. Finally, still harboring qualms, I acquiesced. The group members were unanimous that this was the right decision.

At the next group meeting, the group members were pleased indeed to see Ms. A. again. Ms. C. hugged her warmly and enthusiastically. Ms. A. had brought a handmade quilt as a gift for her driver, and Ms. B. insisted that the gift be presented in the group, not in the car. It was, however, not mentioned nor did I notice the hand-off of the shopping bag containing it.

The group had other matters to discuss, of course. Foremost was that a new member, Ms. D,, had made her debut. She introduced herself by complaining about the neglect she felt from the daughter she had moved here to be near. Her story prompted Ms. A. to talk about the neglect and disdain she had experienced earlier in her life from her own husband and mother when she had suffered a miscarriage. This represented a deeper sharing than she had done at any time prior to her absence.

At the next group, Ms. C. reported that, although this group is the social highlight of her week, the one place where she feels a sense of belonging and acceptance, she had left the previous week feeling alone and excluded. She had responded by phoning Ms. B., hoping for some reassurance! I had no idea that the two had ever exchanged numbers.

Ms. B. was not at home; when she heard the phone message she thought that the best thing to do would be to meet Ms. C. for lunch and shopping, but, remembering "Dr. Saiger's rule," she did not call back.

Ms. C. was still upset as she recounted this tale. It seemed to me most likely that the "special" relationship between Ms. A. and Ms. B. which was created by the ride-sharing experience led Ms. C.to feel excluded. I still think that this is true. Ms. C. thought otherwise. She recalled Ms. A.'s story of her miscarriage, and reported, with great emotion, how she had experienced the same constellation when she was a young, frightened, inexperienced bride. Those feelings of aloneness had been reawakened in the here and now.

The group ended with Mr. E. commenting that the whole issue of outside contact was so unimportant that we should not be wasting time on it. Then Ms. D. asked if she could use my phone to call a cab. Ms. B. and Ms. C. quickly said, "Leave Dr. Saiger out of this. He doesn't need to know how we get you home!" And they bustled her out the door. Their sense of proud autonomy was palpable but the group boundary may have been weakened beyond repair.

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