I had tried not to objectify her, to pity her, or to do anything that created a gulf of inequality between us. I was impressed by two things: you were clearI could understand your writingand you were willing to speak openly about death. Concentrate on having a good conversation. But Marvin the project was intriguing. The verdict was mixed: in some areas he had maintained his changes; in others he had done some backsliding. At sixteen? From both my personal and my professional experience, I had come to believe that the fear of death is always greatest in those who feel that they have not lived their life fully. The smiles, appearing at points of power in his presentation, signified that Marie had understood and was affected by his message. 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. She also examined her feelings toward me with more honesty than before: her fears of dependency, her gratitude, her anger. One night he couldnt sleep and heard some whispering from her room. Object Loss - the loss of a figure who has played an instrumental role in constitution of one's inner world. I had obviously tapped into an important fantasy. She realized that whenever she got really close to someone, she managed, in one way or another, to break off the relationship. Good question! I got turned on, I admit it. I phoned again and left a message irresistible to patients: to call me because I had something very important to tell him. Go! I moved all over the auditorium to get an unobstructed view, but I could never see the whole slide. And now it was apparent that the center could not hold. He said he had orders to paint everything, inside and out. He gamely proceeded, but not without his usual coyness. Instead, she was courageously unfolding her multilayered grief. The first, he called (glancing at his notes), Everybody has got a heart. The second was I am not my shoes.. He imagined saying his final goodbye to his mother, sitting across from him in her familiar bentwood rocker. They were soon all over the house. Almost like shell find out about it., You give her a lot of power. Tears were streaming down her face and onto her denim skirt. What does this do for you?, I dont know what youre talking about., Yes, you do! . Good try, Doc! It had been one hell of an hours work. No part of this book may be reproduced in any manner whatsoever without written permission except in the case of brief quotations embodied in critical articles and reviews. I still cant get it out of my mind.. She had joined a womens therapy group and was working on her fear of attending social functions. Self-esteem improved and there was corresponding significant improvement on several other scales: anxiety, hypochondriacal, psychoticism, and obsessionalism. In this instance, for example, if he hadnt been desperate for Dr. K.s approval, he would have avoided the whole problem by doing what any collaborator doessimply keep ones co-author informed about all developments in their joint work. I knew a way. I sighed even more deeply. This is exactly what he called my shitty habits.. Yet here the sequence seemed natural. On the contrary, two broken-winged birds coupled into one make for clumsy flight. . Marge, Me said, should write her autobiography and entitle it (here she began to chuckle) Born to Be Pathetic.. Every session was an ordeal, and Betty often left my office badly shaken. When Betty told me about going to a western bar where two rednecks sidled up behind her and mocked her by mooing like a cow, I felt outraged for her and told her so. I knew we were entering an area where once I would never have dared to go. We were talkingthat was the important thing. A life sentence?. Ive been in therapy once removed. In fact, just asking the question, What helped in the past? was helpful because it assured me that there was a way I could get better. Weary of traveling alone on these little subterranean excursions, I decided to stay closer to Marvins concerns. I believed that Marvin was entirely wrong when he said that sex was at the root of his problems; far from it, sex was just an ineffective means of trying to drain off surges of anxiety springing from more fundamental sources. She had often claimed, As long as a person has eyes, ears, and a mouth, I can cultivate their friendship. But no longer. Just time enough for his letter to reach me in California., Saul stopped here. My next few days were filled with self-recrimination and worry about Thelma. I thought she had finished, but it was hard to tell since she spoke like a simulacrumwith uncanny stillness, with nothing moving but her lips, not her breath, or her hands, or her eyes, or even her cheeks. It was as though he, too, sensed that she could be released only by information, that her illusions could not endure the beam of truth. In the next hour she tried several times to come to me again. She had always been a talented photographer and now, for the first time in years, had picked up her camera and was once again enjoying this form of creative expression. What is Yalom's primary clinical assumption? First, she responded in a teasing way (I told you all along thats what I needed). It was the worst thing that had ever happened to me. Why was the dream a nightmare? Your comment about his playing something out with his mother probably isnt a bad guess. This all happened so insidiously that there was a time lag before the group began to catch on that he was getting off on it. It was the same quest, she and I were the same. Then I started asking questions. She and her dog stopped from time to time and listened for danger. If youre going to pretend to be a Jewish intellectual, why not furnish your office like one?. She had occasional brief periods of pride and exhilaration (especially when she went shopping for slimmer clothing), but mainly she experienced such deep despondency that it was all she could do to get herself to work each morning. Shes into another life. Maybe Im a slow learner.. 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. (Ive clearly not been looking in the right places). Maybe when I tried to commit suicide, I really wanted to kill Matthew? Wary though I am always of generalizations, in this instance male-female stereotypes often hold true. Its not too much to askwhen we walked in Golden Gate Park, he almost sprained his ankle trying to avoid disturbing an anthill. Other doctors have told me that I am in a vicious circle. I think its important for you to know exactly what happened eight years ago. I absolutely do not know. They werent certain how honest he was willing to be with himself. It reminds me of the strong feeling youve often expressed of never belonging anywhere. Of course, I didnt reach him, but I told his telephone-answering tape about your proposal, and I said for him to phone me or you andand. Beware of stripping a patient who cant bear the chill of reality. In addition, he effectively employed a systems approach and introduced, into the therapy process, both her husband and a lifelong friend (from whom she had been long estranged). Our discussions about sexual practice and her sexual identity generated so much anxiety and such an agonizing sense of emptiness that, on several occasions, she binged on cookies and doughnuts. I see the past only filtered through the eyes of the presentnot as I knew and experienced it at the time, but as I experience it now. She did lack the capacity to be close to others. She had told me she was thirty-five, a lab technician; that she had been in therapy for ten years with a psychiatrist who had just relocated to another city; that she was desperately alone; and that sooner or later, it was just a matter of time, she would kill herself. Without them I might run wild., That was a curious comment. I was walking in the fields behind the house. (Sociopaths often present themselves well, I thought.) She stared out the window. Was there any moment when we began to enjoy it? I am now my mothers age when she died. Imagine two minds pressed tight together and, like paramecia exchanging micronuclei, directly transferring thought images: that would be union nonpareil. Oh, yes, he told me he had been married and divorced and that he had gone through a lot of turmoil about the divorce. His mother was outside. I ended the session by establishing a contract. I want to go about it in an adult manner.. Psichologiniai sunkumai vis dar kartu su gdos jausmu iekoti pagalbos. My self-pity for being stuck with Marie? I can understand how fury toward a woman could lead to a crime like that.. Be content to help a patient realize what must be done and then trust his or her own desire for growth and change.. She hated even more those who offered false hope. But she hadnt proved to be a slow learner. My first impulse was to get the hell away, far awayand not see her again. I reassured her that there would be no fee: since we had started to meet as part of a research venture, at this point I could not, in good conscience, suddenly change our contract and charge her. There was considerable internal preparation as well, which Betty found difficult to describe other than to say she was gathering inner resolve and waiting for the right moment to commence the diet. Marvins dysfunction was acute and would respond, I thought, to a brief cognitive-behavioral approach. Marvin continued to be refreshingly open during the first several weeks of therapy. By the third week I was hallucinating and thought that I could see through walls and had total access to both my past and future lives. I had persuaded him, with difficulty, that a sexual approach to Sarah would be both futile and unseemly. Im good at it. One day when he was alone, he tried it. Deliver me from both of them! These are true stories, but I have had to make many changes to protect the identity of the patients. I felt one with Thelma. I agreed to speak to him for the last ten minutes of Thelmas hour and also made it clear that I would feel free to report back to her the entirety of our discussion. The head in the slidemy head, my vision, my memorygets in the way. I hear those angry and judgmental feelings, and I know you really feel them. So much wanting. He organized a cancer self-help group (not without some humorous crack about this being the last stop pickup joint) and also was the group leader for some interpersonal skills groups at one of his churches. For the last forty years hes run the office and Ive run the house. She could not sit for the session but three times stood and paced up and down. The ten years of therapy before Matthew? Sarah, by now one of his greatest boosters, was invited as a guest speaker to one of his groups and attested to his responsible and competent leadership. Weve known two couples with marital problems who saw psychiatrists, and both ended up in the divorce court. If she could play all those roles, she must be the concealed, guiding intelligence behind them all. What comes to mind?, I can see her faceround, pudgy, large glasses., No, but I know what youd saythat she looks like me: the round face and oversized spectacles., Oh, theres something there, all right. He majored in mathematics at a small city college and briefly considered graduate school. What sort of resolutions? No real need for my question, since Thelma had been on the verge of describing the resolutions, but I had to have some exchange with her. The next session, two days later, proceeded along similar lines. It was her depression speaking, and I was foolish enough to be persuaded by it. I doubted that I would find the answers to these questions. Besides, this is me, this is the way I am. In fact, he became more offensive and accused Martha and me (and all rape victims) of making too much of it. He knows it. I think we need some help to move along further. Dr. K. had work of far higher priority, and Saul was certain that he would prefer simply to wash his hands of this whole pestilence. Should I keep Daves letters? Your patient is a dumb shit and I told him so in the group last nightin just those words. Sarah, a young psychiatric resident, paused here and glared, daring me to criticize her. Ive always found it difficult to treat someone with so little curiosity. Last night, Marthashes a really fragile borderline young woman, who has been almost mute in the group started to talk about having been raped last year. Ive very much missed our chats. At one level the dream related to Chrissie. Bereaved parents are also, by analogy, confronted with their own death: they have not been able to protect a defenseless child, and as night follows day they comprehend the bitter truth that they, in their turn, will not be protected. Carlos, with his incurable cancer, was so isolated and felt so shunned that I had decided to support him by going out of my way to touch him. Yet freedom from an existential perspective is bonded to anxiety in asserting that, contrary to everyday experience, we do not enter into, and ultimately leave, a well-structured universe with an eternal grand design. If I really think about it (which I dont), I guess it boils down to an exchange of goodsI humor Dr. Z. and let him have his disgusting little feels in exchange for his help in my lawsuit., My smile saidWhy are you so interested in my smile?, I guess my smile said, Please, Dr. C., go on to something else. Without question she had neglected the boys for the past eight years. Pleased with his progress, he had realized, as he put it, a good yield on his investment. My last physical exam was over fifteen years ago., Another group member: You look like youre in great shape, Dave, whatever your age., Thank you. 2. New friends only mean more farewells to say and more people to hurt.. I tried often to focus on our relationship, but aside from some barbs in the first couple of sessions (of the you fellows think sex is at the root of everything genre), he made no reference to me whatsoever. They think theyre swimming when theyre on a dry stage, or that theyre rowing a boat when sitting in a chair. 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. It is trueor, rather, was truethat, when we first began to meet, I was put off by your body., Tell me, Betty, knowing thisseeing that I didnt look at you or was uncomfortable with you why did you stay? But now it was his turn to be shocked. Reincarnation is a case in point: though I personally consider it a form of death denial, the belief served Carlos (as it does much of the worlds population) very well; in fact, rather than undermine it, I had always supported it and in this session buttressed it by urging that he be consistent in heeding all the implications of reincarnation.