Think of process as opposed to content. But, in milder form, countertransference insinuates itself into every course of psychotherapy. Explain. Did I hate this book. 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. Betty made it clear immediately that she hoped therapy would help her get to the point where she could seriously consider weight reduction, but she was a long way from that at this time. Our web pages use cookiesinformation about how you interact with the site. Of course, she was still special in that she had special qualities and gifts, that she had a unique life history, that no one who had ever lived was just like her. Ive been hurt enough. When we embraced, I was surprised to find that I could get my arms all the way around her. Perhaps I read too much into it, but I imagined that Dr. K. was looking for something from Saul, something just as crucial for him as the affirmation Saul sought from him. Often therapy doesnt work that way. It is when these unattainable wants come to dominate our lives that we turn for help to family, to friends, to religionsometimes to psychotherapists. I am thirty-five years old. To be truly loved, to be remembered, to be fused with another forever, is to be imperishable and to be sheltered from the aloneness at the heart of existence. Translation error is compounded by bias error. Following that, we reviewed her phone conversation once again and planned the next hour. Try to see that. I asked Thelma to project herself into the future and to imagine how she might feel several hours from now. Shes into another life. Isnt that what you fellows always say? I continued. Furthermore, I was convinced he would not profit from individual therapy. They chatted and, to escape the swirl of shoppers, had coffee together in the caf at the St. Francis Hotel. See you Thurs., But though warm spring breezes were wafting through the open window, it was winter in my office. Thelmas words told me clearly that she would not look kindly at any criticism of Matthew. In choosing to enter fully into each patients life, I, the therapist, not only am exposed to the same existential issues as are my patients but must be prepared to examine them with the same rules of inquiry. I had not even managed to establish a solid therapeutic alliance with her: her emotional energy, every dram of it, was riveted to Matthew, and I had found no way to pry it loose. So theres life after all in San Francisco. What are "object loss" and "project loss"? Which is good. In some desperation, I stretched for ways to be helpful to Betty. I didnt know what to say. Poor Bettythank God, thank Godknew none of this as she innocently continued her course toward my chair, slowly lowered her body, arranged her folds and, with her feet not quite reaching the floor, looked up at me expectantly. God knows what had happened to his letters to her!. He suggested that she imagine herself in the dentists chair getting an injection of novocaine. What did it stir up in you?, I felt like an idiot! She was convinced he was going to die soon, though the doctors claimed that his prognosis was not hopeless despite his debilitated physical condition and his advanced age (he was sixty-three). The preparation was finally complete, and the real therapy could now begin. My attempts to generate power were shamefully inelegant and consisted mainly of fumbling, nagging, and repetitively circling her obsession and bashing away at it. It almost never does. For the last few weeks there had been a bounce in her steps, but today she once again resembled the forlorn, plodding woman I had first met eight months ago. The dream is saying that Im not living right., I agree, I think that is what the dream is saying. Only a couple of weeks ago, she had grumbled that she was tired of being hadthat is, being sexually aroused and then left unsatisfied. I floated, I glided, I danced.. Obviously this was much harder to talk about than she pretended. Second, there was her damned giggling, her forced gaiety, her reluctance to be appropriately serious. 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. But as Bettys ordeal continued, I began to feel guilty eatingas though I were acting in bad faith toward her. Patients, like everyone else, profit most from a truth they, themselves, discover. (Not delicious and clandestine but deliciously clandestine, for secrecyand I shall say more about this shortlywas the axis of Daves personality around which all else rotated. Remember, Im in the same group with Carlos and we often chat after the group about you.. Her suicidality, extremely high at the onset, was reduced to the point where she may no longer be considered a suicidal risk. Or mine. I dared not utter the word boringfar too vague and too hurtful. Since patients tend to resist assuming responsibility, therapists must develop techniques to make patients aware of how they themselves create their own problems. Stop expecting to find a wife right now, its too much to ask of yourself. I knew that there was rich material here. There is no alternative. Later when we compared them, it was at times difficult to believe that we described the same hour. She probably would need therapy for many, many years, perhaps always. The author sets out to discover the real Flaubert, the flesh-and-blood man behind the public image. Ignoring my gambit, he responded that Thelma had always been a good wife and that perhaps he had aggravated her problem by being on the go and traveling too much. No, at my first meeting I could find little endearing about Carloss characteror about his physical appearance. 2 These differing visions were later published as Every Day Gets a Little Closer: A Twice-Told Therapy (New York: Basic Books, 1974). Had I grown so stodgy, so old? Obviously something important was up. The best way to do that was to begin to ask the right questions and to discuss her pain in depth with her oral surgeon. The collection of ten absorbing tales by master psychotherapist Irvin D. Yalom uncovers the mysteries, frustrations, pathos, and humor at the heart of the therapeutic encounter. Penny blushed and responded gruffly to my question by muttering, The normal things. I knew I was getting through. But go on. I knew that Thelma would take the rest of the hour spinning obsessional webs. Not only is the past lost forever, but the future, too, is sealed. The ten years of therapy before Matthew? You seem familiar with itId be very interested to know your opinion of it. But I do the same thing with California. And Im going to be open with you: Im almost certain I will eventually commit suicide. After a crash accountancy course, he said goodbye to his students and colleagues and opened an accounting firm, which ultimately proved to be highly lucrative. Ive never known anyone who wasnt. Four major existential concernsdeath, meaning in life, isolation, and freedomplay a crucial role in the inner life of every human being and constitute the thrust of that book. Locked up in a convent? It sounds like your guilt and grief have already broken up your marriage. That means youll be running late all day, doesnt it?. It was as though I wasnt there, or at least the part of me that hurts and pulls me down. He tiptoed in and saw Phyllis kneeling by her bed, praying, chanting the same phrase over and over: The mother of God will protect me. That would not be uncharacteristic of him. I focused on the anxiety. Moreover, Phyllis did not permit Marvin to entertain at home either. She was so scared, sobbing so hard, having so much trouble saying it, that it was incredibly painful. He had wisely decided to bail himself out of trouble by telling the group about his cancer. Even the most liberal system of psychiatric nomenclature does violence to the being of another. Besides, this is me, this is the way I am. Well, nothing has changed in the external world. Would she be left with unasked questions? You tell me that the pain is unbearabletheres a good possibility a one-hour consultation will offer some relief., It may sound simple to you, but I dont want to be made a fool of. The three of us ended the hour with round-robin handshakes and parted. So I, as a child, am dead. Freedom means that one is responsible for ones own choices, actions, ones own life situation. Besides, most of her therapists were young trainees. My children dont need any money. Say some more about being next., Its like my father was no longer there to protect me. Can you remember any of it? A lot of therapists, at this point, would have made an interpretation about the way she was shutting me out. She got the point quickly. It was so hard to talk about this, she said, because she was so ashamed of being ashamed of her own father. No mistaking that message:Marvin senses hes being offered an opportunity by someone undoubtedly you, his therapistto start all over again. Later, children experiment with other ways to attenuate death anxiety: they detoxify death by taunting it, challenge it through daredevilry, or desensitize it by exposing themselves, in the reassuring company of peers and warm buttered popcorn, to ghost stories and horror films. I couldnt help smiling: I was pleased that I and Me shared some secrets. Afraid of what Id say. Why would he not see her or even speak to her on the phone? How could we be when Marge acted so crazy and I patronized her by tolerating her craziness? Ive never believed in dreams.. I have always felt that the way one faces death is greatly determined by the model ones parents set. I drifted back into the landscape of the dream, back into the silent, dark world of the gaunt men, the black meadow, and the black- gauzed baby girl. Now and then, when the receptor site was well prepared, we withdrew some part of Me for transplantation. 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. Alas, however, as Thelma was to teach me before this case was over, much wonderful therapy may be wasted on a patient! Next, I was trying to get into the window of a room where her body might be. Its not too much to askwhen we walked in Golden Gate Park, he almost sprained his ankle trying to avoid disturbing an anthill. I remember times youve walked out of the office feeling much better than when you entered. Number four, this is going to put him in a very compromising and embarrassing position professionally. Though Betty never again heard from George, she often thought about him. Saul, in Three Unopened Letters, knew that any reasonable man would open the letters; yet the fear they invoked paralyzed his will. Couples treatment may illuminate the sources of marital tension and help each partner to recognize and to respect the others mode of grief. And I can ask hard questions. After a decade of study and research, I wrote a textbook, Existential Psychotherapy , intending not to establish a new field but to make all therapists more aware of existential issues. As I thought about the words shed put in Matthews mouth, I could easily understand their appeal and why she had no doubt replayed them so often: they confirmed her view of reality, they absolved Matthew of any responsibility (after all, it was his shrink who advised him to be silent), and they confirmed that there was nothing wrong with her or incongruous about their relationship; it was only that Matthew had a greater obligation to another. I smiled and silently ground my teeth. He insisted that he had asked me to keep the letters at this time for one reason only: his wife was now doing a major housecleaning and working her way steadily and surely toward his study, where the letters lay hidden. Since I doubted very much, after this charming incident, whether Id ever be able to persuade another group therapist to accept him, I persevered. They entered my mind a couple of times right after Chrissie died, but its only been this last couple of weeks that I dwell on them. I had to heed them. She had been robbed. From a feminist point of view, I realise that this book is one of many written by old white men and it shows. 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. To what extent would we agree? Anxious and thoroughly fed up with myself, I entered therapy (yet again), and after several hard months, my mind was my own again and I was able to return to the exciting business of experiencing my life as it was happening. Was it that he was so controlling? Its funny but egg salad sandwiches have always been soothing. Saul, if youre as bad as you say, if, as you insist, you lack all virtues and all discriminating mental faculties, why is it that you think your judgment, especially your judgment of yourself, is impeccable and beyond reproach?. Did he feel rejected? Never had he done a better job. Perhaps the letters might give me additional leverage. But a two-percent or even a one-percent chance is better than no chance at all. And suppose one of them mistakenly thought her experience was the same as his?. I had also embarrassed myself professionally. Perhaps the single most important therapeutic credo that I have is that the unexamined life is not worth living. Getting Matthew into this office might be the key to a true examination and understanding of whats been happening to you these past eight years.. It was ironic, too, that her drive to escape the destiny of poverty and failure was halted only by a deeper destinythe finitude inherent in life. We spent session after session simply reconnoitering the obsession. Though she had reassured me that she would be all right, I had been greatly concerned about her. She cried for the two lost daughters she never knew. One day I have good sex, and everythings all right again. These words were said quickly, but the cadence slowed for the last sentence. In the story Loves Executioner, Thelma would not, for example, relate to me: her energy was completely consumed in her love obsession. I can understand how fury toward a woman could lead to a crime like that.. She could take care, she said, of not being poor. He would, I suspected, be more reasonable in a week or two, and under ordinary circumstances I would simply have been patient. I immediately thought: Not than me; its than I. Your only real crime is using the wrong form of the first-person pronoun. . It is not possible to rebuild your house at nightto change the course you have set, just as you are preparing to enter the sea of death. The impact of death on her sons? But to lose a child is to lose the future: what is lost is no less than ones life projectwhat one lives for, how one projects oneself into the future, how one may hope to transcend death (indeed, ones child becomes ones immortality project). The closer she approached that weight, the more depressed she grew and the more her mind swarmed with feelings and recollections of her father. Within hours and with insufficient planning, Saul put forward a proposal that he and Dr. K. collaborate on a review of the world literature on muscle cell differentiation. Where had they come from? It was not, as I first thought, that she was mercurial and unable to sustain focus. Love's Executioner is a collection of ten true stories (identifying details have been changed to protect anonymity, of course) of patients in psychotherapy with Irvin Yalom and how his work with them progressed. If you feel on the verge, call me. I think a shiver of doubt went through him. Perhaps it was the whimsy in his request: Teach me to hate armadillos.. Marvin put aside his notepad and from memory recited:The two men are tall, pale, and very gaunt. How to start? One of the most irreverent of these was poundage: the heavier the patients clinical chart, the worse the prognosis. I very, very badly wanted to love this book. She waited a couple of minutes for me to read it. None of this is remarkable. How can you stand to be with her? In a dark meadow they glide along in silence. Ive always misrepresented myself, always felt like a fraud, always feared exposure., This was routine stuff, we had been over this material many times, and I didnt bother to challenge his self-reproaches. According to her mother (Betty told me she had no recollection of this), she was reassured by her parents that only old people die, but then she pestered them for weeks by chanting she didnt want to grow old and by repeatedly asking her parents how old they were. Thankfully, times have changed. Is this what you want from your relationships with others?, Doc, I understand completely what youre saying, but theres a bug in your argument. Feed me!. He had so much caring, so much loving. This book gave a lot of insights into the therapeutic process, but I found the guy a total putz--very self-aware of his own reactions to the patients he describes, but not so concerned about their own experience of the process that he wouldn't describe them in great detail to the world at large. I end this retrospective with an observation my younger self would have found surprising: namely, that the view from eighty is better than expected. His parrots perch has a stamp on it Museum of Rouen; and he then shows Barnes a photocopy of a receipt indicating that Flaubert, over a hundred years ago, had rented (and later returned) the municipal museums parrot.