Then she smiled and nodded. So what do I do?. So I had anticipated desperation calls like this. If you could plan our time together, what would be the best possible way for me to help?, Saul didnt budge. Thelma arrived twenty minutes early for the session. One dream, in particular, affected him:I saw Susan Jennings. You are someone Id love to have as a friend, but there is no way to do it on an open basis. There is no rear-vision mirror. I almost killed myself once and I believe I will succeed the next time. But why? I knew from our work three years before that this aunt, the one who had brought him up after his parents death, was a bitter, vindictive woman. My real reasons for taking on Thelma lay elsewhere: first, I was fascinated by encountering a love obsession at once deeply rooted and in a vulnerable, exposed state, and I was not to be swayed from digging it out and investigating it; second, I was afflicted by what I now recognize as hubrisI belived that I could help any patient, that no one was beyond my skills. Theres a fair chance, I thought, that hes already sent that money and, if so, hes going to get caught in a tangle of lies with me that will really jeopardize our work. I want to sink into the embrace of some warm daydream. Who or what was he loving? Thelma, who had been apathetically slumped in her chair, suddenly bolted upright. Two weeks ago Thelma had reported an anxiety dreamthe only dream she reported during the entire therapy:I was dancing with a large black man. It was not her doing: it was the work transfer, or the sterile California culture, or the absence of cultural events, or the jock social scene, or societys miserable attitude toward obese people. I moved all over the auditorium to get an unobstructed view, but I could never see the whole slide. GET EXCLUSIVE OFFERS. A total of twelve experienced psychotherapists and psychologists who worked in the sex addiction field participated in conversational, semi-structured interviews. Despite her two hundred and fifty pounds, Betty and I had rarely discussed her eating and her weight. In fact, you were suggesting that last week when you talked about Matthew working out his personal problems in his therapy with me. These are true stories, but I have had to make many changes to protect the identity of the patients. Sooner or later I know that I will do it, its the only way out. To believe that nothing in life is more important than that he think well of you?, I dont really believe hes trying to drive me to suicide. Everything I saw in my first glanceher wrinkled seventy-year-old face with that senile chin tremor, her thinning, bleached, unkempt yellow hair, her emaciated blue-veined handstold me she had to be mistaken, that she could not be in love. Its so busy that it gives me a headache. These feelings never disappeared but during her best times merely receded to the background, awaiting a suitable cue to return. By now Betty was permitted some solid foodone diet TV dinner a daybut found this more difficult to follow than the liquid-only diet. Take a look at this. And another declared, I want to be young forever, as she, an old woman, could not relinquish her obsessive love for a man thirty-five years younger. What difference did it make if she slept next to her daughter? In associating to this dream Betty said that, earlier the day of the dream, she had been thinking that she had shed a whole body: she had lost eighty pounds, and there was a woman in her office who weighed only eighty pounds. The sentiment that one should have done something more reflects, it seems to me, an underlying wish to control the uncontrollable. First, I couldnt get a slide out of the projector to put in another. Soon I received more warnings:Phyllis and I are having dinner in a ramshackle restaurant. Many of them were from his school. Perhaps it was generosity welling out of my relief that it was he, and not I, who was dying. The one goodthe only goodthing about depression is that it always ends.. Her only social contacts were at work, where most of her co-workers resented her supervisory role. I couldnt help smiling: I was pleased that I and Me shared some secrets. Maybe youre right, Doctor. It didnt matter whether I was or not. Of course, his wife tried to obtain information about him. I am at the end of my lifes work. He considers establishing ongoing communication. Daves request for me to keep the letters had to be seen in this context. In a Proustian way, youve packed this creature full of the attributes you so desire. Theres the feeling you just described of being soothed by a physical connection with Phyllis which masquerades as sex but isnt, as you noted, sex at all., So there are two issues. The obsession filled her entire life space. Obviously, it was a fiction that Matthew had any real power over her. Also, she gets a dog, but is forced to put it down as it only holds her back. Betty, whats the danger in letting me matter to you?, Im not sure. But soon I heard my voice offering her another appointment. The drab backdrop of the dozens of hours I had spent with Marge made this engaging phantom stand out with a dazzling clarity. I worked Saturdays and Sundays. If, on the other hand, we explored other themes, even such important issues as her relationship with Harry, she considered the session a waste of time because we had ignored the major problem of Matthew. Nietzsche claimed that a philosophers system of thought always arises from his autobiography, and I believe that to be true for all therapistsin fact, for anyone who thinks about thought. You cant throw a switch on and off, you know!. I really did, but I cannot. You know, Thelma, youve many times asked me questions about my theoretical orientation. When she woke up from the blackout in the drugstore, she had the strongest sense that the graduation card in her hand was not for Chrissie (who would have graduated from high school at this time) but for herself. But Dave had closed down. Then Id daydream about slicing that artery, relieving the pressure, and letting the blood out. No doubt they resented that arrangement while Chrissie was alive, I suggested, but what of their anger now when Penny refused to let them use their sisters room after her death? This question was particularly painful for Betty who, by that time, had visited a gynecologist and been told that she had an endocrine disorder that would make it impossible for her to have children. Suddenly they come upon a carriage, ebony black, cradling a baby girl swaddled in black gauze. it is our own ideas of him which we recognizethese words provide a key to understanding many miscarried relationships. I wasnt certain whether it was to obtain his support or to reassure herself that he could tolerate what she had to say. Our termination session was a high-spirited graduationit lacked only a brass band accompanying his triumphant march out into the world. But all our work had come to a halt four weeks before when Marie was thrown from a cable car in San Francisco and fractured her jaw, suffering extensive facial and dental damage and deep lacerations in her face and neck. Why was the dream a nightmare? Before the invention of the stethoscope, a physician listened to the sounds of life with an ear pressed against a patients rib cage. I dont want to be cut off., Then, Thelma asked, why have you been silent all these years?, Sometimes caring can be best expressed by silence., Thelma shook her head. After all, like Matthew, I know a great deal about you. Just the same, he had my full attention and, as he spoke, I could not help glancing at his large, stranglers hands. Should I, for example, expect a patient, who asked me to be the keeper of his love letters, to deal with the very problems that I, in my own life, have avoided? How would I respond when she asked about my feelings toward her? Then I turned to the dream. There flashed into my mind an interaction with a patient from my first year of residency (these first clinical experiences stay with one, as through an imprinting in ones professional infancy). I had also embarrassed myself professionally. What was important was that he connect or even fuse with you., Thats right. This frustrating, laborious interaction was prototypical. Thelma looked weary. Seriously, Ive been tired and bored with my work for years. Do you feel the same way? Two Smiles Marie is frozed in life since her husband's death. He freely offered the names of hospitals and his treating physicians if I should want to call. The blindfolded man in the room where he and Phyllis were to make love was particularly intriguing. It struck me as wonderfully funny and I started to laugh, and laughed until my eyes filled with tears. I left our treatment contract unclear, aside from saying that having someone with whom to share painful feelings and thoughts always helped. The weeks passed, the campaign continued. So much longing. She wont see any doctor, shes not had a GYN exam in fifteen years. She had never before talked openly about these issues: perhaps the sheer catharsis helped; perhaps it was useful for her to recognize the magical nature of her thinking; perhaps some of her horrifying thoughts were simply desensitized by talking about them in the daylight in a calm, rational manner. That was surprising since the writer seems so youthful, energetic, and often unrestrained and sophomoric. Rather than ninety percent of the time, I spend less than twenty percent of my waking time thinking about Matthew, and even that twenty percent is different. Ive been dreading the publication of this article. I was so preoccupied with these thoughts and with plans for our future work that I missed the first part of Thelmas next commentbut I heard the ending of the sentence all too clearly. Failure had always inflicted terrible wounds, which healed slowly and deeply intensified his feeling of insignificance and loneliness; success offered stupendous but evanescent exhilaration. Do it! I feel little charity for the irresponsible professionals and have urged many patients to report sexually offending therapists to professional ethics boards. He opened them suddenly and checked with me: You asked for this. What I mean is that my attitude about obesity has changed a lot. Not only does a patients confrontation with unanswerable questions expose a therapist to these same questions, but also the therapist must recognize, as I had to in Two Smiles, that the experience of the other is, in the end, unyieldingly private and unknowable. Then two hundred, a fifty-pound loss! 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. Will you open the letters before you mail that letter to Dr. K.? Together these two belief systems constitute a dialectictwo diametrically opposed responses to the human situation. I gave her everything she wanted. Another kind of emergence was taking place. Nothing. Can we spend a minute or two establishing our agenda?. All the bluster was gone. That was the end of it. Penny accepted my offer but said that money was a big problem for her. Now its too late, its too late to live., I sat unblinking through this litany and, for a moment, felt ashamed for being unmoved. He was right in there with me., Thelma was highly animatedshe snapped her words off and pointed down to the earth and up to the clouds as she spoke. It must be scary or liberating to say these things for the first time!, I feel O.K. It was pointless to begin by addressing her weight. At the beginning of therapy, an hour with Elva meant hard work. We did not know, then, that it was to be a permanent farewell. I know this, Dr. K. knows it now, and if you knew something about neurobiology, youd know it, too. The old fool wants his old Thelma back again. Has he been so absent he hasnt noticed that he never had the old Thelma? Id get a pulse of about twenty-six in fifteen seconds. Why did you break off? We know that. I fought to keep my equilibrium. "The wrong one died" -- "I never thought it would happen to me" -- "Do not go gentle" -- Two smiles -- Three unopened letters -- Therapeutic monogamy -- In search of the dreamer Access-restricted-item true Addeddate . There was no time in my schedule, however, and we arranged another session in two days. While we dread death, we generally consider freedom to be unequivocally positive. Keep going., Well, Ive had to keep it under rein all my life because Phyllis has got strong ideas about how much sex we will have. Finally, when I informed him of Thelmas decision to terminate, he seemed relieved and gratified: he had been urging her in this direction for several weeks. Her son? She looked at me with what I imagined to be more respectas though she were impressed with my mind-reading abilities. In fact, everything of importance was elsewhere. The lilt was gone from her voice. For ten years the tumor had responded well to treatment but now had invaded his lungs and was encroaching upon his heart. And it is change that is always the true quarry, however much a therapist may court insight, responsibility assumption, and self-actualization. Nonetheless, we find ourselves under ever-increasing pressure (from hospitals, insurance companies, governmental agencies) to sum up a person with a diagnostic phrase and a numerical category. The wrong one died. Or our work for us. He had consulted a neurologist, who had been unsuccessful in controlling Marvins headaches and then referred him to me. After all, eating was her life. Perhaps on a first meeting, guards are down; perhaps one has not yet determined what persona to don. Then I might really learn something about the function of love. My mother is a crazy, embittered lady, and I grow more like her every day. The fact that much of Pennys therapeutic change was self-generated and self-directed contains an important lesson for therapists, a consoling thought a teacher shared with me early in my training: Remember, you cant do all the work. I was facing a stone wall. I am persuaded that, in these infatuating first meetings, Dan and the woman mistook what they each saw in the other. "Good" therapy, with a "good" patient is at bottom what kind of venture? Youve got to make a place where she can live: thats what fathers dothey build a world for their children. She did not want to stop therapy and asked her company to extend her time in California. Weve been talking more frequently and more honestly than ever before. Whats the big deal? he asked, and then claimed he personally wouldnt mind being raped by an attractive woman. Could I possibly form an honest and a caring relationship with a fat lady whose physical appearance repelled me? Two Smiles: p. 165: Three Unopened Letters: p. 187: Therapeutic Monogamy: p. 215: In Search of the Dreamer: p. 235: Afterword: On Rereading Lope's Executioner at Age Eighty: p. 279: Table of Contents . Has he not learned? It was not hard to understand why Elva clung to the feeling that Albert was still there, out back in the workshop looking out for her, fixing things. Concurrently, a problem on another front had developed. I dont even care if he means it, I just want him to say he cares about me. Maybe they dont sound good, but that happens to be the way were built. Thus, in his meditation sessions, he visualized bears and pigs attacking the armadillos. Youve gotten your meaning out of working. I was moved by the sight of his frail body heaving with sobs as he described his fear that they, too, would abandon him: that their mother would finally succeed in poisoning them against him, or that they would become repelled by his cancer and turn away from him. She had been highly promiscuous in her teens; in fact, she had been the school po white slut (her term), and the father could have been any of ten boys. Thats when I will be truly deadwhen I exist in no ones memory. Thanks to my thoughts, it still lives. Ive very much missed our chats. Everything, Betty replied. Sex is at the root of everything. I promised him that, even though he never asked it, and I kept that promiseuntil now. She presented her true case history so poignantly and convincingly that I was fully persuaded. And then an event occurred which I chose not to tell you about and which caused me to change my mind. Psichologiniai sunkumai vis dar kartu su gdos jausmu iekoti pagalbos. She was right. (The word empty was to arise more and more frequently as therapy proceeded. No one wants to talk about a childs dying. The three-way meeting had been my idea and I had been the one who stripped her of her illusions, I was the disillusioner. The dream (recorded verbatim by a student observer):Death is all around me. . She had a way of putting her finger on vital issues. How do you feel about the role-playing, Thelma? But he never lived up to that early billing. 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. A bag of sourdough starter. Often Dan, his lover, or both, ended up depressed. There had to be some other way. I upped the ante. Together we inspected and discussed each item. That concern gradually evaporated and in its place was left a bitter residuea residue expressed by the phrase I never thought it would happen to me. Along with her purse and her three hundred dollars, an illusion was snatched away from Elvathe illusion of personal specialness. , . At one point I tried to get beneath the forced hale fellow heartiness. But the moment Saul arrived at the Stockholm Research Institute, the moment he was greeted by Dr. K., he felt strangely convinced that his goal was within his grasp, that there was hope for some final peace. During this early phase of therapy, we concentrated on two issues: his marriage and (to a lesser extent, because of his resistance) the implications of his retirement. And yet, time after time, I have seen this group exercise evoke unexpectedly powerful feelings. I did not want Pennys guilt, so recently pried loose, to discover her great neglect of her boys and attach itself to this new object. His parting shot to the group was to say that he would welcome a rape attempt by any woman in the group. She could take care, she said, of not being poor. Moreover, eight years of Thelmas taped phone messages had to be getting to him, and I was confident that he, too, longed for release. Thelma, this feeling that the only thing that matters is for Matthew to think well of youtell me everything you know about it., Its hard to put into words. . Before we begin, this is not a new book. But first, I want to say that I appreciate your recommendation last week. She suffered now, not because she had forgotten the events surrounding Chrissies death, but because of the way she had neglected her two sons. We stood, walked to the door, shook hands, and parted. . It doesnt make sense. One of our main jobs is to sort things out and restore the feelings to where they belong.. Think about your volunteer work with the homeless. They chose that part of the dreamthe theme of secrecythat was most relevant to the way Dave related to them, and they whacked away at it beautifully. There was something patently and privately irrational about the letters ability to ward off aging and deatha dark magic that evaporates when examined under the cold light of rationality. Dammit! I felt, when I was about eight, that she had lost confidence in me and wouldnt have minded if something bad had happened to me.. You'll hear the patient describe vividly a dream they had (yawn), at which point Mr. Yalom goes on to analyze this dream and self-proclaim his genius. I meant it when I said that if rape were legal, Id do it! Yalom mentions it once when describing Marie but no more. Furthermore, Penny had continued to detach herself from Chrissie. In the last two decades, however, groups talk about sex with some ease, and money has become the private subject. It was probably overkill. I really couldnt answer without revealing some of the material Dave had shared with me in our individual session. I had tried not to objectify her, to pity her, or to do anything that created a gulf of inequality between us. From time to time, I had to prod myself to remember that the dreamer was Marvin, that the dreamer provided an open channel to Marvins central nucleusthat whorl of the self which possesses absolute wisdom and self-knowledge. Having persuaded himself that Marie was hysterically overreacting, he refused to prescribe adequate medications for pain relief or sedation. Ive been watching you beat yourself up for months about this. I decided to remain matter-of-fact about it. The creative members of an orthodoxy, any orthodoxy, ultimately outgrow their disciplines. Though I was gradually entering her experiential world and growing accustomed to hyperbolic assessments of Matthew, I was truly staggered by her next comment. During this time, Carlos was particularly helpful. When I went outside, I didnt know what to say to his mother about why we blindfolded him. I said that, But Thelma was not interested in my words and spoke over me. with the problem of obesity I noted Bettys eyes drop with disappointment and silently berated myself for being so impersonal. Indeed, some philosophers claim much more: that the architecture of the human mind makes each of us even responsible for the structure of external reality, for the very form of space and time. There is almost no chance hell say what I hope hell say. By now I was itching with curiosity, yet took a perverse pleasure in not scratching. So I tried to deal with it on my own. At one meeting, however, the tone turned deeply serious.