Of course, I have my rationalizations. Could that have been true for me? They were distracting and I didnt know how to answer them. Years ago I conducted an experiment in which a patient and I each wrote our own view of each of our therapy hours. I wasnt so sure. He remembered banging his fist on his desk, forcing himself to remember the chill of his mothers forehead when he kissed her as she lay in her casket. I hoped that the establishment of an intimate bond with me might sufficiently attenuate her bond with Matthew so that she could pry herself loose from him. He reassured Phyllis that travel was important to him, but not so important that he couldnt wait until she was ready. So also with those who confront death through a fatal illness: how many people have lamented, What a pity I had to wait till now, when my body is riddled with cancer, to know how to live! Yet Thelma was different. But I cannot descend now into these realms. We were lying on the dance floor having sex. I didnt want to stop seeing Betty. By the time the hour ended, she did not have to tell me how much better she felt: I could see it in her breathing, in her walk, and in her smile as she left the office. But, Carlos, try to put brackets around them for a moment and see if you can get in touch with anything else. What difference does it make what he thinks of you?, I cant tell you why. Now let me answer the personal part of the questionhow do I feel about working with you? Time is valuable in a groupeight patients and only ninety minutesand is not well spent by the patients listening to the therapists problems. Why had he rejected her and cast her out? One of the members asked him to share some more about feeling like a dirty old man. The love was, and is, real. Dave teased and joked about it but adamantly refused to state his age: he would not jeopardize his chances of scoring with one of the women in the group. I told him I would come because I was the only one who could help, but as I started down into the darkness, the stairwell grew more and more narrow and the flimsy banister came off in my hands. If she discovers this relationships, it would be so painful, if for some mistake she finds his love letters. Love's executioner and other tales of psychotherapy . If I worry, even if I keep it completely silent, he senses it and gets upset. I picked up my mail and walked back to the house, flipping through the usual batch of junk advertisements, charity requests. Still another common scenario is for parents to overprotect the surviving children. 3. Books and places are bonded together in my memory. Im available if you want someone to talk tolater today or anytime this week.. Perhaps it is more accurate to describe therapy as treating the patient as an adult. You cant be intimate with me because another therapist, eight years ago, hurt you. But I was to struggle with that question many times before the dnouement of this therapy, and could not have guessed then that, of all the riddles in the case of Thelma, it was the riddle of Matthew I was destined to solve most fully. The Thelma who deceived me? He asked all about me. ! Nor did it escape me that narrative played a vital, if covert, role in my textbooks. Six months ago! And so Marie and Dr. Z. were locked in a complex dance, whose steps included a spurned surgeon, a million-dollar lawsuit, a broken jaw, several fractured teeth, and brushed breasts. She advertised in the newspaper, but even the inducement of free dog food failed to generate a prospect. The author of two definitive psychotherapy textbooks, Dr Yalom has written several books for the general reader, including Momma and the Meaning of Life and Love's Executioner, collections of true and fictionalised tales of therapy; Staring at the Sun; and the novels When Nietzsche Wept; The Schopenhauer Cure, and The Spinoza Problem. Saul was spent and leaned back, exhausted. But they corresponded almost daily. Gone also was my patient. Maybe I was wrong, but I think her eyes said, Are you satisfied now? I did not comment on her gaze. He had always had great difficulty speaking in public: excruciatingly sensitive to any criticism, he had often, he said, made a spectacle of himself by viciously counterattacking anyone who questioned any aspect of his presentation. I really like the light, airy feel of this building, do you?, Thelma put her hand to her breast as though to still her heartbeat and whispered, You see? And yet another dream:I am taking an examination. The search for meaning, much like the search for pleasure, must be conducted obliquely. Probably not one in a million, Carlos said in a sad and weary voice. And, of course, why my letters were loaded for me. While we dread death, we generally consider freedom to be unequivocally positive. To focus on what is actually happening between a patient and himself, rather than the past. She was enlivened by the closeness and the openness of our interaction; but, rather than allow herself the enjoyment of that feeling, she was saddened by the realization that her life heretofore had been so devoid of intimacy. Much as I love to do group therapy, the format has one important drawback for me: it often does not permit the exploration of deeper existential issues. I call to leave taped messages for him on important dates: his birthday, June 19 (our first date), July 17 (our last date), Christmas, and New Years. They had already driven off, but she jumped into her large, souped-up pickup and followed them at high speed down the highway trying to ram them off the road. Good Lord, what had I gotten myself into? He imagined saying his final goodbye to his mother, sitting across from him in her familiar bentwood rocker. And what could be worse for Harry than for his wife to cry last week and share nothing with him? Theres the dream of the two gaunt undertakers and the white-tipped cane. His book Staring at the sun really helped me in my (still ongoing) journey with confronting death anxiety, and I completely agree with you that its so cathartic to hear him admit his own shortcomings, and to relate to his patients case studies so easily. You know, it feels right. Dan, this intense closeness you feel toward Dianemaybe she did allude to the possibility of a relationship some time in the future, but look at the facts. I remember looking forward to each session with more than a little curiosity about the choices that he would make. You showed up time and time again in my office waiting room. There was a certain irony in my use of this intervention: an existential approach and a manipulative paradox ordinarily make bizarre bedfellows. A grandfather who told her stories? Heres what I want you to do. I think it was the best hour of therapy I ever gave. We cant do anything about it! I tried to help her understand that, though the fact of death destroys us, the idea of death can save us. . As you seeshe ran her fingers through her uncombed hairI no longer tend to my appearance.. On a couple of occasions (for example, that time he asked a woman member forty years younger for her phone number), the group had come close, I thought, to calling Dave a dirty old man. I winced for him and was glad that the epithet had not been uttered aloud. It was best to keep the lid of this underworld sealed. The journal informed Saul that their new policy did not permit him to credit anyone without that persons written consent (to avoid spurious use of famous names). They did know that he was growing deeply depressed and seemed to have no one to whom he could turn for support. Nine minutes, Elva reminded me, was all the time required for the GAP to cook dinnerto nuke a slim gourmet TV dinner in the microwave. He had consulted a neurologist, who had been unsuccessful in controlling Marvins headaches and then referred him to me. I had written all my previous books with pencil and paper with the help of my Stanford secretary, who typed them out. Just after our last visit, I received a sad letter from her containing these lines:I always imagined that you might write something about me. And, of course, I was the doctor clad in white who refused to help her and, instead, stamped upon her fingers. Cultural reinforcement is everywhere. I felt bewildered by what had happened. Sex is at the root of everything. I want to know exactly what youve been going through., One of the worst things was that I had no one to talk to, nowhere to turn, no confidant, no trusted friend with whom I could dare talk about this stuff., I dont know if you remember, but it took me fifteen years to make the decision to see you the first time. Or our work for us. Dr Yalom's case histories are more gripping than 98 percent of the fiction published today, and he has gone to amazing lengths of honesty to depict himself as a realistic flesh-and-blood character: funny, flawed, perverse, and, above all, understanding -- Phillip Lopate I loved Love's Executioner. Now quickly, lets pass on to another subject. I need your commitment to hang in there with me., You have it. My life is being lived eight years agoan arresting phrase. I, too, am a therapistin fact I am twenty years more experienced and probably wiser than Matthew. Back to the letters. It made me feel better for a few minutes. But over the years Ive learned that the therapists venture is not to engage the patient in a joint archeological dig. . I colluded with him in the fiction about his back injury. Betty must have felt that the obstructions to losing weight had been sufficiently removed because she gave unmistakable evidence that a major campaign was about to be launched. His amount of self-disclosure was outrageous twenty-five years ago and set most therapists teeth on edge. I thought my question was within the margins of safety: I stayed concretely with the dream material, and Dave could easily demur by failing to have pertinent associations. Two smiles -- 8. Since my diets consist primarily of eliminating ice cream and French fries, I could hardly say to Betty that I was joining hands with her in a sympathy fast. But it was also true that her group was down to five, and she needed new members.) We had worked together very productively for a year and a half. In college she had initially elected a premedical curriculum but gave it up for fear of being in contact with cancer patients. You and I are very much alikein one way, at least. No! I told myself, shaking myself free. She said that, if it were true for me, it was true in spades for herthat she had led a totally self-centered life, that shes never given anything of herself., I reminded her of that. When did you move? He mentions that Carlos had grown up as an only child in Argentina, but never refers back to this again. Would he take the leap? . Another good example, I thought, of the pointlessness of the therapist rushing in with an interpretation, even a good one like this. Furthermore, he was especially kind to Bettyperhaps it was that he knew she was my patient, perhaps that she came along when he was in a generous (everybody has got a heart) state of mind, perhaps simply that he always had a fondness for fat women (which, I am embarassed to say, I had always considered further proof of his perversity). And yet there are so many things I like about this younger self. Other prognostic signs clamored for my attention, but I chose to ignore them. Most of our time together we devoted to Matthew. Her fatty casing began to disintegrate. Ill give you a hint. When the emergency room nurse asked her for the name of her doctor, she moaned, Call Dr. Z. By general consensus he was the most talented and experienced oral surgeon in the area, and Marie felt that too much was at stake to gamble with an unknown surgeon. When years of interpretation have failed to generate change, we may begin to make direct appeals to the will: Effort, too, is needed.
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