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A little effort, a little ingenuity should suffice to yank the whole weed out. Between swimming, tennis, and walking, I exercise a minimum of two hours a day. The last thing I wanted to do was enter into that discourse with him. But he did join the group and attended the first several meetings faithfully. Furthermore, she insisted that they have unnecessarily frequent medical checkups to screen for cancer. He has become aware of too much, too fast. Today was a therapy holiday. She said there was something pathetic, maybe sad, about the way they were dressedshoes on the wrong feet, dirty inside-out clothes. She was six years younger, equally shy and equally inexperienced with the opposite sex. Or this very moment? She smoked furiously during the session, often taking two or three drags before angrily snuffing out the cigarette, only minutes later to light up another. Betty experienced emotional flashbacks and would spend much of a therapy hour tearfully discussing startlingly vivid memories, such as the day she left Texas to move to New York, or her college graduation, or her anger at her mother for being too timid and fearful to attend her high school graduation. What payoff did Dave get from a belief that he was imprisoned by a woman? It was the first time he had seen Thelma in eight years, and if he was in any way startled by the physical aging she had undergone, his boyish, good-natured smile gave no evidence of it. Hypnosis works for stupid people or people with weak wills. Saul had in mind one edited by a former student who often solicited articles from him. Phyllis enjoys sex. But the problem is that sex is turned into something medicinalno, thats not strong enoughsex becomes a life or death proposition, and your survival depends on merging with this woman. Again and again I invited Marvin to look within, to adopt, even for a moment, a cosmic perspective, to identify the deeper concerns of his existencehis sense of finitude, of aging and decline, his fear of death, his source of life purpose. On the negative side, I can think of several possibilities. She went on a liquid Optifast diet, ate no solid food, bicycled forty minutes every morning, walked three miles every afternoon, and bowled and square-danced once a week. Psychological emptiness is a common concept in the treatment of those with eating disorders.). I refused to stop dancing to have children, but I was forced to stop thirty-one years ago because I got gout in my large toenot a good disease for a ballerina. If a system is infinitely expanding, one cannot not be encircled by it. The more she thought about her family, her dead daughter and her two sons, the more she began to think: What am I living for? She mollified me: Its not you. (Yalom's professional rosary). Im still on antidepressants. It was apparent that both he and I had reservations. There is no way I can promise you this. I answered her calls at first, but they kept coming. Over the next several months of therapy, I continued faithful to Marge. As a result of her discontent, our time together became ungratifying for me as well. Saul, nothings going to happen to you. Phyllis and I were undressing to make love. In a way no patient had ever done before, she showed me everything. And there with her face in spasm, like Quasimodos, horribly distorted, barely able to talk. What did Penny's work with Yalom start and end as? and thats why I have to stop therapy!, I scrambled to respond. I should have written Dr. K. immediately. It was not that Marie could not be decisive. He seemed upset. What about my countertransference? What would happen if (I smiled at my if) I died and they were found? Otherwise, he was much as Thelma had described himslender, mustached, well tanned. Inhuman., No, its the opposite. I wasnt able to have children, Im afraid of people, Ive never worked outside the home, I have no talents or skills. She paused, wiped her eyes and said to Marvin, See, I can cry if I put my mind to it., She turned back to me. To focus on what is actually happening between a patient and himself, rather than the past. It was true that Betty offered an opportunity to improve my personal skills as a therapist. Visits to a pet psychologist and trainer were equally fruitless. Many thingsa simple group exercise, a few minutes of deep reflection, a work of art, a sermon, a personal crisis, a lossremind us that our deepest wants can never be fulfilled: our wants for youth, for a halt to aging, for the return of vanished ones, for eternal love, protection, significance, for immortality itself. More than I had expected. So we changed our focus. I clasped his shoulder as he sobbed. Matthew was amused that nothing had changed; there was no need to explain anything to himafter all, he knew everything about her. Thirty years! He saw my next sentence coming: And what better place to start than in the group?. She rarely leaves the house for any reason unlessMarvins voice grew hushed and conspiratorialits to escape another fear.. His fantasy about Ruth allowed him to feel that he could still be touched and cared for by another human. I began to relinquish my ideas of striking back at Matthew. These were real people therenot sources of information. Thus, Thelma clung to the infinitesimal chance that she might once again revive her relationship with her lover, renunciation of that possibility signifying diminishment and death. Saul suggested they offer a creative synthesis and identify the most promising directions for future research. Our discussion about the smiles opened up such rich material for therapy that I put aside my musings about differing views of reality and helped Marie explore her self-contempt for the way she had compromised herself with Dr. Z. Table of Contents: Acknowledgments Prologue 1. I next saw Marvin one year later: I always schedule patients for a one-year follow-up session both for their benefit and for my own edification. Marie was brittle, irritable, and despite her avowed gratitude to me, often sarcastic or provocative. More than anything else, I resolved to be present with her, and I immediately called her back whenever she started to leave my presence by slipping away into another age or another role. We got up to leave, and I offered her my hand, both hands. Although Penny did not ask for more time, it was obvious we had to meet again. But I got little solace from pointing my finger at Thelma and Harry or from lamenting the weakness of the human spiritthat feeble wraith unable to survive without illusion, without enchantment or pipe dreams or vital lies. Should I ask harsh existential questions of a dying man, a widow, a bereaved mother, and an anxious retiree with transcendent dreamsquestions for which I have no answers? (As a general rule, the less ones sense of life fulfillment, the greater ones death anxiety.) According to Marvin, their sex life had been wonderful until six months ago: despite forty-one years, it seemed to have retained luster and passion. Why then? Far better that he forget what we talked about than the opposite possibility (a more popular choice for patients) to remember precisely what was talked about but to remain unchanged. Both refused, offering the ingenious dodge that they didnt want to be age- typed. . To make matters worse, that evening Marge had gone to a public lecture given by an extremely articulate and attractive young woman philosopher. And those shots of the California coast. Carlos was indeed isolated. I had tried to maintain complete objectivity but she must have noticed some evidence of disbelief, some small cue, perhaps a minuscule widening of my eyes. Dr. K. was a great presence: speaking in an impeccable Oxonian dialect, he refused to be bowed by seven and a half decades and employed every one of his seventy-six inches in the construction of one of the worlds great postures. Thats goddamn good, isnt it to forget it, to be free of it, to be able to live a normal life for a while?. The course and the exam is over. I wondered what position I should take about the fifty thousand dollars? I provided sentences to complete: for example; Irv, when you say that, I feel __________ toward you.. In other words, even though his body was imperiled, he himself, his vital essence, was intact. Though it is understood that therapists embrace other relationships, that there is another patient waiting in the wings for the hour to end, there is often a tacit agreement not to address that in therapy. I flip back and forth quickly in my feelings about Matthew. My one basic ruleTreat Marge as an equalwas no longer sufficient. She was empty. Plunge into that feeling, explore it. But I could not. It was necessary to modify my basic rule, Treat the patient as an equal, to Be faithful to the patient. Above all, I must not permit myself to be seduced by that other Marge. " " . Dave scarcely wondered about the ultimate meaning of his clutch of letters and now, tight and brittle, he would not be receptive to such an inquiry. The dream, I continued, was a dream about death. Good question! I think I just collapsed in a kitchen chair and sat there. I could see she liked talking about Matthew. Marvins change initiated an adaptive spiral: liberated from a restricting role, Phyllis underwent enormous change in the space of a few weeks and continued and solidified that improvement in individual therapy with another therapist over the next year. He began to breathe rapidly, taking short, staccato, shallow breaths. It had rear windows with a kind of filter that slid up and down but it was stuck. Dave had responded well to this approach and made impressive attempts to share with his wife more of his life and internal experience. Hes the one person who has ever known everything about me. From there it was an easy step for Marie to transfer her numbness to all the painful areas of her face and neck. I dont know why, but I suddenly saw them in a different way! I tried to help Thelma talk. Our web pages use cookiesinformation about how you interact with the site. He hadnt anticipated this. She was a multiple personality whose two personae (whom I shall call Blush and Brazen) waged a deceitful war against each other. How could it be otherwise? Not that I blame youafter all, you guys are running a business and gotta earn a living. I want to travel. I was sorry I had to see him again. She lived in a furnished suburban apartment doing nothing, she said, but working and eating and chalking off the days till her eighteen months were up. He reassured Phyllis that travel was important to him, but not so important that he couldnt wait until she was ready. You, too, have much influence. Despite such behavior, I am nonetheless proud of his putting nothing in the way of forging a true therapy encounter; I would do exactly the same today. And something else totally unexpected had happened. He proceeded, and now reproach entered his voice, to describe how Thelma had gotten progressively worse since she and I had started working together. How could Chrissie talk about dying to a mother who continued to pretend it wasnt happening? She was incapable, or unwilling, to reveal herself in the immediate present that we two were sharing. Just mashed egg, salt, pepper, mayonnaise served on very fluffy white bread., Did it work? I wouldnt have made it without you. Would he find a way, once more, to pull the comforter of self-deception over his head? Nietzsche carries a lot of weight with me, and that citation gave me pause. Could we take another walk across the Golden Gate Bridge? The very word treat implies non-equality. But when I see a fat lady eat, I move down a couple of rungs on the ladder of human understanding. Im only asking for time, Saul. He had kept Sorayas letters (numbering in the hundreds) well hidden. Id like your permission to phone Matthew and invite him to join us. As long as he continued to believe that he was tantalizingly close to being desired and loved by an attractive woman, he could buttress his belief that he was no different from anyone else, that there was nothing seriously wrong with him, that he was not disfigured, not mortally ill. As I searched for a reply, I remembered something my first analyst, Olive Smith, said to me over thirty years before. Voted #1 site for Buying Textbooks. Some patients are easy. Then two hundred, a fifty-pound loss! Horrible thing! Volunteers who are willing to be interviewed, please call 555-6352. Over forty years ago, she had made a contract with life whose explicit genesis and terms had been eroded by time but whose basic nature was clear: Albert would take care of Elva forever. Actually, that was helpful. Turns out it's no fun reading about peoples mental afflictions or a creepy psychoanalyst therapy session. Every person who knew about the situation had advised her to get rid of Elmer. When one person, the therapist, treats another, the patient, it is understood from the beginning that the treatment pair, the two who have formed a therapeutic alliance, are not equals or full allies; one is distressed and often bewildered, while the other is expected to use professional skills to disentangle and examine objectively issues that lie behind that distress and bewilderment. For those who look inward, retirement is a time of life review, of summing up, a time of proliferating awareness of finitude and approaching death. She had heard nothing from him since. Throughout my year of work with Marge, I had only a single real rule in my worktreat her as an equal. Whats the point of it all? I knew he was entirely capable of such gross behaviorand worse. I care a great deal. Marge is a creep. He was going to kill it soon anyway, with drugs, with AIDS. Thanks also to many, many colleagues and friends who did not bolt when they saw me approaching, a new story in hand, and offered criticism, encouragement, or consolation. Sometimes so little effort is required of me that I invent work, posing a question or offering an interpretation simply to reassure myself, and the patient, that I am a necessary character in this transaction. That notion rains true in the book "Love's Executioner," by Irvin Yalom. But, Thelma, go back to what I was saying earlier. Her facial expression was frozen, as well as her imagination, her body, her sexualitythe whole flow of her life. The blackout consisted of her waking up in a drugstore (the same store where she had once before awakened holding a stuffed animal) weeping and clasping a high school graduation card. Marvin gave much weight to Phylliss feelings and was deeply troubled when he thought he had displeased her. In reality, they had had a strictly professional relationship which had in no way splashed over the formal patient-therapist boundary. , , , . The concept of sexual identification has been around at least since De Beauvoirs seminal work The Second Sex, but Yalom fails to mention or even notice that he might be objectifying his clients. I think he ought to know that Im talking about him to you. Surely my patience that day was a sign of having arrived at some degree of maturity. Though I had known her for less than an hour, I had been charmed by her. Needless to say, Marvins new family assignment did not increase his popularity with his father, who became a thin presence in the family, then a mere shadow, and soon evaporated forever. Members wondered about Daves hiddenness; some could understand his wish to keep the letters secret from his wife, but none could understand his excesses of secrecy. I cannot alter the future because I am being overtaken by the past.. We spoke on the phone several times a day and saw one another fourteen times. They turn my stomach. First, we became acquainted with Japanese culture, as I taught for two weeks in Tokyo; then, two weeks of travel in China where my wife, a feminist scholar, lectured to university students and teachers. That one, Thelma informed me when she saw me turning to the second photo, of a sixty-year-old handsome but stolid woman, was taken about eight years ago. In a dark meadow they glide along in silence. I followed her into her every nook and crevice, awed that one old womans purse could serve as a vehicle for both isolation and intimacy: the absolute isolation that is integral to existence and the intimacy that dispels the dread, if not the fact, of isolation. 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. The dreamer soon gave me a series of messages about Marvins reaction to our historical forays:I saw a car with a curious shape, like a large, long box on wheels. To illustrate, Mike suggested, Think of your dog or, if you dont have one now, imagine a much-loved dog. But they didnt help. What do you make of the fact that the only kind of car you could get was a green Honda Civic?, I hate green and I hate Honda Civics. The first was of a young beautiful dancer wearing a sleek black leotard. 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. They are informative, they are calming, and they penetrate the anxiety of isolation: the patient feels that, once you have the details, you have entered into his life. Their shoes were on the wrong feet. Lets see, how does it work? Im not asking for any longer commitment, but I wont start without this. I dont have any more hope, Ill never have any more satisfaction. Any failure to meet these goals was punished by denying himself part or all of his dinner. Its just a thought I have sometimes. He put his head between his knees and held his breath, but without avail. 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. I had known Carlos to close up completely like this on other occasions. For most people, the greatest loss to bear is the death of a child. She was fiercely determined to evolve and to succeed in the genteel world. [Hats off to you, my dear dreamer friend! I havent forgiven you for preventing me from dating her. When he had first started the group six weeks ago, he talked at great length about his infatuation with Sarahor rather with her breastsand was convinced she would be willing to go out with him. He cried for all that he had missed, for all the years of deadness in his life. That last question on the exam, what was it? If I have good sex with my wife, the world seems bright. I tried to rattle and shock her. And that other Marge? Lets try to turn this into a learning experience for him. When Saul was seven his parents had died in an automobile accident, and he had been raised by an aunt and uncle. How could we be when Marge acted so crazy and I patronized her by tolerating her craziness? It seeps into your dreams. One innocent question and its answer. I suggested several options: to see the two of them myself; to refer them to someone else; or to refer Phyllis to a female therapist for a couple of sessions and then for the four of usPhyllis, Marvin, I, and her therapistto meet in conjoint sessions. Most of this book was written during a well-traveled sabbatical year.