“I don’t really believe he’s trying to drive me to suicide. It’s just a thought I have sometimes. I flip back and forth quickly in my feelings about Matthew. Most of the time what’s important is that he would wish me well.”
“But why is his wish so all-important? You’ve elevated him to a superhuman position. Yet he seems to be a particularly screwed-up person. You yourself mention his significant sexual problems. Look at the whole issue of integrity—at his code of ethics. He’s violated the basic code of any helping profession. Look at the distress he’s caused you. We both know it is simply wrong for a professional therapist, who is sworn to act in the best interests of his patient, to hurt anyone the way he has hurt you.”
But I might as well have been talking to the wind.
“It was only when he started acting professionally, when he went back into a formal role, that he hurt me. When we were simply two human beings in love he gave me the most precious gift in the world.”
It was deeply frustrating. Obviously, Thelma was responsible for her own life predicament. Obviously, it was a fiction that Matthew had any real power over her. Obviously, she gave him that power in an effort to deny her own freedom and her responsibility for the constitution of her own life. Far from wanting to take back her freedom from Matthew, she had a lust for submission.
From the beginning, of course, I had known that the pure forcefulness of my argument would not penetrate deep enough to effect any change. It almost never does. It’s never worked for me when I’ve been in therapy. Only when one feels an insight in one’s bones does one own it. Only then can one act on it and change. Pop psychologists forever talk about “responsibility assumption,” but it’s all words: it is extraordinarily hard, even terrifying, to own the insight that you and only you construct your own life design. Thus, the problem in therapy is always how to move from an ineffectual intellectual appreciation of a truth about oneself to some emotional experience of it. It is only when therapy enlists deep emotions that it becomes a powerful force for change.
And powerlessness was the problem in my therapy with Thelma. My attempts to generate power were shamefully inelegant and consisted mainly of fumbling, nagging, and repetitively circling her obsession and bashing away at it.
How I long at such junctures for the certainty that orthodoxy offers. Psychoanalysis, to take the most catholic of the psychotherapy ideological schools, always posits such strong convictions about the necessary technical procedures—indeed, analysts seem more certain of everything than I am of anything. How comforting it would be to feel, just once, that I know exactly what I’m doing in my psychotherapeutic work—for example, that I am dutifully traversing, in proper sequence, the precise stages of the therapeutic process.
But, of course, it is all illusion. If they are helpful to patients at all, ideological schools with their complex metaphysical edifices succeed because they assuage the therapist’s, not the patient’s, anxiety (and thus permit the therapist to face the anxiety of the therapeutic process). The more the therapist is able to tolerate the anxiety of not knowing, the less need there is for the therapist to embrace orthodoxy. The creative members of an orthodoxy, any orthodoxy, ultimately outgrow their disciplines.
Though there is something reassuring about an omniscient therapist who is always in control of every situation, there can be something powerfully engaging about a fumbling therapist, a therapist willing to flounder with the patient until they, together, stumble upon an enabling discovery. Alas, however, as Thelma was to teach me before this case was over, much wonderful therapy may be wasted on a patient!
In my search for power, I pushed to the limits. I tried to rattle and shock her.
“Suppose, for a moment, that Matthew died! Would that release you?”
“I’ve tried to imagine that. When I imagine him dead, a great sadness descends. I’d be living in an empty world. I never can think past that.”
“How can you release yourself from this? How could you be released? Could Matthew release you? Have you ever imagined a conversation in which he releases you?”
Thelma smiled at this question. She looked at me with what I imagined to be more respect—as though she were impressed with my mind-reading abilities. I had obviously tapped into an important fantasy.
“Often, very often.”
“Share it with me. How would it go?” I don’t rely on role-playing or chair-switching, but this seemed the perfect place for it. “Let’s try role-playing it. Would you move to the other chair, play the role of Matthew, and talk to Thelma here in this chair?”
Since Thelma had opposed everything else I suggested, I was preparing my argument to convince her when, to my surprise, she enthusiastically agreed. Perhaps, in her twenty years of therapy, she had worked with gestalt therapists who had employed these techniques; perhaps it was her stage experience shining through. She almost leaped out of her chair, cleared her voice, pantomimed putting on a necktie and buttoning a suit jacket, assumed a saintly smile and a delightfully exaggerated expression of benevolent magnanimity, cleared her voice, sat down in the other chair, and became Matthew.
“Thelma, I came to you remembering you pleasantly from the work we did together in therapy and wanting you as a friend. I enjoyed the give-and-take. I enjoyed the joking about your shitty habits. I was truthful. I meant the things I said to you, every one of them. And then an event occurred which I chose not to tell you about and which caused me to change my mind. It was nothing that you did—there was nothing about you that was obnoxious, although we didn’t have enough to build a lasting relationship. What happened was that a woman, Sonia——”
Here Thelma broke role for a minute and said in a loud stage whisper, “Dr. Yalom, Sonia was my stage name when I was a dancer.”
She became Matthew again and continued. “This woman, Sonia, entered on the scene, and I realized that a life with her was the proper way for me. I tried to stay away, tried to tell you to quit calling, and—I’ll be honest—it annoyed me that you wouldn’t. After your suicide attempt, I knew I had to be very careful with what I said, and that’s why I became so distant. I saw a shrink, and it was he who advised complete silence. You are someone I’d love to have as a friend, but there is no way to do it on an open basis. There is your Harry, and there is my Sonia.”
She stopped and sank into her chair. Her shoulders slumped, her benevolent smile vanished, and, entirely spent, she became Thelma again.
We sat in silence together. As I thought about the words she’d put in Matthew’s 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. That the other woman was Sonia, herself as a young woman, suggested I needed to spend more time looking at Thelma’s feelings about her age.
I was fascinated with the idea of release. Would those words from Matthew really release her? 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 one’s professional infancy). The patient, who was very paranoid, insisted that I was not Dr. Yalom but an FBI agent, and demanded proof of my identification. When, at the next session, I artlessly presented him with my birth certificate, driver’s license, and passport, he announced that I had proved him correct: only FBI connections could have produced forgeries so quickly. If a system is infinitely expanding, one cannot not be encircled by it.
Not, of course, that Thelma was paranoid, but I wondered whether she, too, would defeat any releasing statements, even ones from Matthew, by infinitely demanding more proof and reassurance. Nonetheless, in looking back over this case, I believe that it was at this moment that I first began to consider seriously whether to involve Matthew in the therapy proces
s—not her idealized Matthew, but the real-life, flesh-and-blood Matthew.
“How do you feel about the role-playing, Thelma? What did it stir up in you?”
“I felt like an idiot! It’s ridiculous for someone of my age to act like a foolish adolescent.”
“Is there a question in there for me? Do you think I feel that way about you?”
“To be honest, that’s another reason (in addition to my promise to Matthew) that I haven’t talked about him to therapists or anyone else. I know they’ll say that it’s an infatuation or a crush or transference. ‘Everybody falls in love with their therapist’—I can hear it now. Or else they’ll talk about it as—what is it called when the therapist transfers something to the patient?”
“Countertransference.”
“Yes, countertransference. In fact, you were suggesting that last week when you talked about Matthew ‘working out’ his personal problems in his therapy with me. I’ll be frank (like you tell me to be in therapy): that grates on me. It’s as though I didn’t matter, as though I were some innocent bystander in something he was playing out with his mother.”
I held my tongue. She was right; those were exactly my thoughts. You and Matthew are both “innocent bystanders.” Neither of you were really relating to the other but to some fantasy of the other. You fell in love with Matthew because of what he represented to you: someone who would love you totally and unconditionally; who would be entirely devoted to your welfare, to your comfort and growth; who would undo your aging and love you as the young, beautiful Sonia; who provided you the opportunity to escape the pain of being separate and offered you the bliss of selfless merger. You may have been “in love,” but one thing’s for sure: you didn’t love Matthew; you have never known Matthew.
And Matthew? Who or what was he loving? I didn’t know yet, but I didn’t think he was either “in love” or loving. He wasn’t loving you, Thelma, he was using you. He had no genuine care for Thelma, for the flesh-and-blood Thelma! Your comment about his playing something out with his mother probably isn’t a bad guess.
As though she were reading my mind, Thelma continued, lifting her chin and projecting her words as to a large audience. “When people think that we really hadn’t loved one another, it belittles the love that we had. It takes away the depth—it makes it into nothing. The love was, and is, real. Nothing has ever been more real to me. Those twenty-seven days were the high point of my life. Those were twenty-seven days of paradise, and I’d give anything to have them back!”
A powerful lady, I thought. She had drawn the line effectively:
“Don’t take away the high point of my life. Don’t take away the only real thing that has ever happened to me.” Who could bear to do that to anyone, much less a depressed, suicidal, seventy-year-old woman?
But I had no intention of being blackmailed in that fashion. To yield to her now would render me absolutely ineffective. So I continued in a matter-of-fact tone. “Tell me about the euphoria, all that you remember.”
“It was an out-of-the-body experience. I had no weight. It was as though I wasn’t there, or at least the part of me that hurts and pulls me down. I just stopped thinking and worrying about me. I became a we.”
The lonely I ecstatically dissolving into the we. How often I’ve heard that! It’s the common denominator of every form of bliss—romantic, sexual, political, religious, mystical. Everyone wants and welcomes this blissful merger. But it’s different with Thelma—it’s not that she wants it, but that she has to have it in order to escape some danger.
“That fits with what you told me about sex with Matthew—that it wasn’t important that he be in you. What was important was that he connect or even fuse with you.”
“That’s right. That’s what I meant when I said you were making too much out of the sexual relationship. Sex, itself, didn’t play too important a role.”
“This helps us understand the dream you had a couple of weeks ago.”
Two weeks ago Thelma had reported an anxiety dream—the only dream she reported during the entire therapy:I was dancing with a large black man. Then he turned into Matthew. We were lying on the dance floor having sex. Just as I started to come, I whispered, “Kill me,” into his ear. He vanished, and I was all alone on the dance floor.
“It’s as though you want to get rid of your separateness, to lose yourself (which the dream symbolizes by ‘Kill me’), and Matthew is to be the instrument by which that happens. Any thoughts about this happening on a dance floor?”
“I said earlier that it was only those twenty-seven days that I ever felt euphoric. That’s not entirely true. I often felt euphoric when I was dancing. Often everything disappeared then, me and everything else, there was just the dance and the moment. When I dance in my dreams, it means I’m trying to make everything that’s bad disappear. I think it also means being young again.”
“We’ve talked very little about your feelings about being seventy. How much do you think about it?”
“I guess I’d have a different slant on therapy if I were forty rather than seventy. I’d have something to look forward to. Wouldn’t psychiatrists rather work with younger people?”
I knew that there was rich material here. I felt strongly that Thelma’s fear of aging and death fueled her obsession. One of the reasons she wanted to merge in love, and be obliterated by it, was to escape the terror of facing obliteration by death. Nietszche said, “The final reward of the dead—to die no more.” Yet here was also a wonderful opportunity to work on our relationship. Although the two themes we had been exploring (the flight from freedom and from the isolation of separateness) constituted, and would continue to constitute, the content of our discourse, I felt that my best chance to help Thelma lay in the development of a meaningful relationship with her. 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. Only then would we turn to the identification and removal of the obstacles that were preventing her from establishing intimate relationships in her social life.
“Thelma, when you ask whether psychiatry doesn’t prefer to work with younger patients, it sounds to me that there is a personal question in there.”
Thelma, as usual, avoided the personal. “It stands to reason that there is more to be gained in working with, say, a young mother with three children. She has her whole life ahead of her, and her improved mental condition would benefit her children and her children’s children.”
I persisted. “What I meant was that I thought there was a question, a personal question, you might be asking me, something involving you and me.”
“Wouldn’t psychiatrists rather treat a thirty-year-old patient than a seventy-year-old patient?”
“Can we focus on you and me rather than on psychiatry, psychiatrists, and patients? Aren’t you asking this question: ‘How do you, Irv’”—Thelma smiled here. She rarely addressed me by name, either given name or surname—“‘feel about treating me, Thelma, a woman who is seventy years old?’”
No answer. She stared out the window. Her head shook ever so slightly. Damn, she was stubborn!
“Am I right? Is that the question?”
“That’s a question, not necessarily the question. But if you had just answered my question the way I first put it, I would have gotten the answer to the question you just asked.”
“You mean you would have learned my opinion about how psychiatry, in general, feels about the treatment of the average elderly patient, and then you would have assumed that that was the way I felt about treating you.”
Thelma nodded.
“But that’s so roundabout. And it may be inaccurate. My general comment may have been a guess about the whole field and not an expression of my personal feelings about you. What stops you from directly asking me the real question?”
“This is the kind of thing I worked on with Matthew. This is exactly what he called my shitty habits.”
That gave
me pause. Did I want to ally myself in any way with Matthew? Yet I was certain this was the correct trail to follow.
“Let me try to answer your questions—the general one you asked and the personal one you didn’t. I’ll start with the more general one. I, personally, like to work with older patients. As you know from all those questionnaires you filled out before we started, I’m in the midst of a research project and work with a lot of patients in their sixties and seventies. I’m learning that they do as well in therapy as younger patients, maybe better, and I get just as much gratification from the work.
“I appreciate your question about the young mother and her potential influence, but I see it differently. You, too, have much influence. All younger people with whom you come into contact will look upon you as a guide or model for their next stages of life. And from your individual standpoint, I believe it is possible at seventy to discover a new perspective that will permit you to flood retroactively, as it were, your whole earlier life with new meaning and significance. I know that that’s difficult to see now—but, trust me, it often happens.
“Now let me answer the personal part of the question—how do I feel about working with you? I want to see you. I think I understand your pain, and I have a lot of empathy for it—I’ve experienced that kind of pain in the past myself. I’m interested in the problem you’re struggling with, and I think I can help you. In fact, I’m committed to helping you. The hardest part for me in our work together is the frustration I have at the amount of distance you put between us. Earlier you said you can find out (or at least make a good guess about) the answer to a personal question by asking an impersonal one. But consider the effect of that on the other person. When you keep asking me impersonal questions, as you did a few minutes ago, I feel pushed away.”