Tissue Behavior
— Dorothy W. Cantor
For many years, I have observed interesting patterns of patient behavior. I’ve discussed them with colleagues in my Peer Group, and they have encouraged me to write about them. I must have time on my hands these days, because I’ve decided the time is right to further share these observations. I’m not sure at this point how many columns there will be or how often I’ll write them. But I’m glad to have the opportunity to share them with my colleagues in Division 42, and certainly welcome your comments.
My brother-in-law is a physician with a surgical sub-specialty . He often complains to me about his office overhead: staff, equipment, and enormous malpractice costs (as high as ours may seem to some of you, just ask your physician what he or she pays!), “But, Bill,” I reply, “I have to buy tissues!”
There are two boxes of tissues going in my office at all times. For the record, I am careful to purchase unscented tissues without lotion, but suitably soft. One box is on the table between two patient chairs, and the other is on the table between my chair and the couch. The two boxes are about 6 feet from each other. Most individual patients sit directly across from me, with a box of tissues at their elbow. (Another column will have to be about where patients choose to sit!) Every now and then, a relatively new patient who is in tears will stand up and cross the room to the tissues at my elbow, rather than just reaching for those at hand. When I point out the more convenient box, the usual response is, “I never noticed it there.” These patients are so focused on their internal world that they miss some of the obvious things in their environment. The clue their behavior gives me is that they probably miss a lot that is going on around them when they aren’t in my office. That means I have to evaluate what they tell me about their experiences in the light of that narcissistic focus.
Some patients actually bring their own tissues (or occasionally, handkerchiefs).
As distraught as they may be, or as caught in a paroxysm of sneezes, they will search their pockets or pocketbooks for the tissues they have brought with them. With these patients, I wonder silently what taking from me, or anyone, represents. Do they not feel entitled? Do they have a need to be so independent because they fear their dependency needs? I rarely comment but I have stored the observation in my mind to see where it fits in the patient’s personality structure.
Similar to those patients are the ones who will take a tissue, but use and re-use it throughout the session, seldom reaching for a second. They feel, I surmise, somewhat more entitled than the non-users, but cautious about taking too much. Did their parents dole out affection in small doses? Was or is a lack of money an issue in their lives?
At the other extreme are those patients who seem to use a whole box of tissues in a session….a tissue per tear it would seem. They seem insatiable. There is never enough. I become wary of such a patient’s neediness and how it will manifest in the relationship with me. It is not uncommon to see this kind of tissue behavior coupled with frequent between-session phone calls. For me, it’s easier to confront the excessive phone calling than the extravagant use of tissues. The former seems appropriate to deal with as a therapeutic issue. The latter doesn’t, because it makes me feel cheap. I just buy another box of tissues.
Patients show something about themselves in the way in which they treat used tissues as well. Some refold the used tissues. Over the course of a session, a pile of neatly folded, used tissues accumulates on the lap. A trace of OCD? Some crumble them and try to hold the wad in their hand. Now, that could be because the waste basket is not handy and they don’t want to get up during the session and discard them. But perhaps there is some security in holding the soggy ball of paper. Some put their discards into their pockets or purses, rather than throw them in my basket. Are they trying to be good children who don’t make a mess for Mom? Is there some shame in either the crying or the mess it creates that they want to erase by taking the evidence along with them? A few leave the office with tissues in hand, but immediately stop in the lavatory across the hall and deposit them in the basket there. Perhaps the basket next to my desk is perceived as just mine, and using it would feel like encroaching on my space.
Someone has to be the patient who takes the last tissue from the box. Here again, there are differences in the way individuals react. At one end of the spectrum are those who literally apologize for using the last tissue. At the other end are those who are angry with me for not have supplied them, fed them, adequately. Some patients will stand up and go to the other box of tissues, finding a way to take care of themselves. Others will look quizzically at me, as if to ask, “What do I do now?” I invite you to make your own interpretations of the variants of end-of-the-supply behavior.
Tissue behavior, like other non-verbal behavior, has much to tell us about the people who come to see us. And although there is a bit of humor here, there is also something to seriously consider as we look at the whole person whom we are treating..
Dorothy W. Cantor, Psy.D., a former President of APA ,has an independent practice in Westfield, NJ.
