Amy: Here’s a case from my office which reveals how a partner’s emotional withdrawal can act as a powerful anxiety-producer: ( As usual, identifying data/details  are disguised.)

I first met Kim, a s vivacious 32-year old fashion designer, when she was referred to me by her primary care doc for severe anxiety. Pale, slim, and elegant in her avant-guarde clothes, Kim felt “desperate” to find out what was wrong with her. She bounced from doctor to doctor, seeking both relief from, and understanding of, her symptoms.

images-7She had panic attacks in restaurants, crying spells that came on suddenly, heart palpitations, dizziness, and a host of other symptoms. Her fragility stemmed in part from the stress of her impending break-up with her boyfriend of six years, Leo.  Kim talked about how Leo emigrated from England  eight years before, and had worked hard to establish himself as a musician in an indie rock band. She described him as increasingly “cold” toward her on the past year, withdrawn and unresponsive to her needs. She realized she had to “kick him out” to save herself and her sanity.

I managed to get Leo  to come in for one session with Kim. I got my first glimpse of their duet. This young, handsome British  hipster looked scared of Kim. He approached her cautiously, like he was afraid she would fall apart, that if he uttered the wrong word, she would break. When I asked him about his “take” on the relationship, he talked about Kim’s anxiety, and how nothing he did seemed to help. He seemed fixated on her needs, and on his failure to help her. When I hazarded a guess that he might have some needs of his own, he said he didn’t feel she could handle this weight. This sent tears cascading down Kim’s face. He said “See what I mean?” Leo then exhorted her to “get help”, his voice soaked in frustration and anger. I also detected a toxic mixture of fear and guilt. This pattern mostly likely got established awhile ago in their relationship, and ended up polarizing them to the point of separation.

images-5I shared my observations with them, but at this point Luc had more than one foot out the door. They decided not to come for therapy. I continued to see Kim intermittently to help her work through the break-up, and all the turmoil that preceded it. During this time, Kim and Leo  frequently ran into each other since they travelled in the same artistic circles. Kim often broke down in tears after their meetings. She was having a hard time getting over him, and felt anguished over the lack of resolution to the relationship. The break-up–and the relationship–felt like “unfinished business.” I suggested she bring Leo in for a session.

We framed this session as a kind of “post-mortem”, a relationship autopsy that might bring some relief. KIm’s symptoms of anxiety had almost completely diminished, but she remained haunted by Leo’s lack of responsiveness to her. Had he ever cared? Even though it was her idea to break up, why did he let the relationship go so easily?

The duet that I glimpsed in our first meeting played itself out at our second meeting. When Kim questioned Leo about his distance toward her, he talked about feeling “pushed away” and dismissed, particularly at the break-up. Leo’s feelings of powerlessness and anger rose to the surface. He felt Kim was never pleased with him, that nothing he did was ever “enough”–he didn’t make enough money, he didn’t do enough for her, that HE wasn’t enough. He felt inadequate to comfort her, and lived with his own anxiety about her moods. He worried daily about “how she would be when she returned home from work.” The intensity of her moods paralyzed him.

Kim studied Leo as he sat next to her on my office couch, probably wondering who the heck this guy was. Behind his earlier haughty, cool facade lurked a frustrated lover who felt thwarted in his role as boyfriend and protector.

images-6As they revisited their duet, the dynamic emerged: Kim attacked and criticized Leo for abandoning/not caring about her, as Luc alternately defended himself and/or withdrew. Or, Leo  withdrew from Kim in anger/helplessness and Kim attacked him for not caring. Pick one. Or both. That’s how these two decent people ended up in alone, in their separate corners, Kim overwhelmed by anxiety at the disconnect and relegated to doctor-hopping.

Kim and Leo came to see me once more after this session. I think these meetings acted as a myth-buster– with neither partner as a victim of the other, each one identified as a powerful player in the duet.

We sculpted a story together that is the most common one I see in couples. Two people, one couple, trapped in a circular pattern and cannot escape. Kim had no idea how powerful her emotionality affected Leo, how he felt both controlled by her intensity and crippled by it. And he had no idea how powerfully his disconnection affected Kim. His emotional withdrawal felt like a blow more powerful than any slap.

Two well-meaning people with emotional blinders on, caught in the whirlwind of their own experience, each inadvertently creating the other.


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