I Want My Mommy! ~ A Clinical Vignette

by Martha Stark, MD / Faculty, Harvard Medical School



I would like now to present my work with a 30-year-old woman with whom I have been working very intensively for six years now.  Isabella has a very difficult, demanding mother, breathtakingly narcissistic and scathingly critical, and an ineffectual father, loving, gentle, and kind but passive.  The backdrop of our work together has been Isabella’s profound self-hatred and unrelenting despair.


Nonetheless, over the course of the past several years, Isabella has made some rather significant changes in her life.  Once a poorly paid secretary with few friends and a deep distrust of men, she is now a fairly successful therapist with a number of friends and occasional dates.


But as our work has deepened, Isabella has become increasingly aware of the profound loneliness and anguished despair that never let up.  We have also come to understand just how much she despises herself, deprives herself, punishes herself.  She is relentless in the demands she places upon herself.  There is little pleasure in her life, no real joy.  She lives a life of extreme self-denial, every day experienced as something that must simply be lived through and, somehow, survived.


With time, Isabella and I have developed a lovely connection.  I mean the world to her; and, for that matter, she means the world to me.


Periodically, however, she will come to the session and be on a tear, lashing out at everything and everybody around her.  She will beat on herself, rail against the world, berate me and the therapy, and scream out her anguish, her pain, and her outrage.


Over time, I have responded to such tirades in any number of ways.  Most of my efforts have been fairly ineffectual, although eventually, somehow, Isabella does become less tortured and less torturing and we do get to a calmer place.  Sometimes it has taken hours, sometimes days, sometimes weeks, and several times it took months for her to let up.


But one day I did something a little different, something that I think enabled Isabella to relent much sooner than she would have otherwise.


Isabella had come to the session in a rage at herself, her parents, me, and the world.  I had done my usual, mumbling things like: “I think you are wanting me to feel the same kind of helpless and inadequate that you used to feel in relation to your mother,” and “You want me to know just how desperate and unloved you’re feeling,” and “I think you’re showing me what it was like for you to be at the receiving end of your mother’s relentlessness.”  And so on and so forth.  Even I was tired of these interventions, as I’m sure she was too.


But then as I sat there, feeling with her the pain, the despair, the rage, feeling my own pain, some of it a response to her pain, some of it my own pain from way back and stirred up in me now in response to her pain, I suddenly felt an incredible longing to be held by somebody, to be soothed and comforted, so that I wouldn’t have to feel so desperately alone, disconnected, and lonely.


And so I blurted out, “I want my Mommy.”  At that moment, I did want my Mommy.


My sudden outburst stopped Isabella dead in her tracks.  Some of it might have been because of her surprise that I would have said something so unexpected.  But I think that most of it had to do with my having put into words something that, in the moment, Isabella too would have wanted had she but been able to let herself have such yearnings.


I cannot say that Isabella then did a complete about-face, but I can say that, by the end of the session, Isabella had relented and was at last facing, in a way that she had never before done, some of the heartache and devastation she had long felt about just how unavailable, ungiving, and relentlessly hurtful her narcissistic mother had always been.  Isabella was now able to confront – and grieve – intolerably painful realities against which she had spent a lifetime defending herself.


In retrospect, I believe that it was my ability to be with Isabella in her loneliness and her despair and then, in the midst of that barrenness and bleak desolation, to remember a way out, to remember the possibility of connection and engagement with a comforting other – it was this that was transformative.  I think it was my capacity to recover hope, even when I was so deeply immersed in my own loneliness and my own despair, that enabled Isabella ultimately to wend her way out of the quagmire of relentlessness and unrelatedness in which she had thought she was destined to spend the rest of her days.  It was this interaction that stands out for us both as the turning point for the recovery of her own hope and the rekindling of her own desire for connection.