– Notes and Quotes –
Irvin D. Yalom (1931-Present)
“Love’s Executioner” –
An older woman, Thelma, recounts one of her previous therapists, Matthew, with whom she had a 27 day long affair. Thelma developed an intense love for Matthew but he decided that their intimacy wasn’t right and stopped returning Thelma’s calls. Thelma obsessed over the event and even tried to commit suicide by overdosing on medication prescribed to her for insomnia. Thelma felt, “My life is being lived eight years ago.” (23).
It is revealed that, after eight years of therapy, Thelma has never mentioned Matthew to any of her therapists. The “good ‘last ditch’ therapist” narrator interweaves a memory for his days in school before inquiring of Thelma as to how she came to see him as she explains that she was referred by her previous therapists who were also students of the narrator’s. The narrator agrees to work with Thelma. At that moment, Thelma’s experience with therapy is revealed, “I see that my fifteen minutes are up and, if nothing else, I’ve learned not to overstay my welcome in therapy.” (25).
Upon Thelma’s departure, the narrator immediately shows his own emotions towards Thelma’s situation and Matthew’s place in it, “He infuriated me.” (25). The narrator then considers the patient’s need for affirmation of their sexuality and the way in which that boundary is seldom crossed by therapists with patient’s who might be considered physically less-attractive. The narrator speculates that Matthew may himself have been working out psychosexual issues.
In their second session, Thelma explains that her husband, Harry, may suspect that Matthew had something to do with her suicide attempt. Harry was in the military and may exhibit violent tendencies. Harry had given up sex twenty-one years earlier and now the two are rarely if ever intimate. This is interesting in that, by this point in the story, neither the narrator nor Thelma have discussed the original reason Thelma began seeking therapy to begin with, before Matthew. Thelma and Harry’s childless marriage and Thelma having to stop being a ballerina because of gout both contribute to her initial decision to seek therapy before she ever met Matthew. Despite the narrator’s lack of background details of Thelma’s past, the narrator allows himself to become at least slightly emotionally involved with his judgments of Matthew. Perhaps Matthew’s story does not run exactly parallel to Thelma’s story.
Eight years of therapy and Thelma broods of Matthew’s absence, “His silence is killing me.” (29), but perhaps there was not an actual affair. The natural aging is what is killing Thelma. Matthew’s silence is merely her distraction, her fixation, her captivation, an answer to her questioning desire, but never the answer. Thelma of Matthew, “He trying to drive me to suicide.” (29), or perhaps in the eight years of silence since their fling Matthew changed his phone number and profession, Matthew moved on, Matthew was imprisoned, Matthew suffered an amnesia inducing blow to the head, or maybe Matthew died.
Thelma makes the statement, “I don’t expect Matthew to love me again, I just want him to care about my being on this planet.” (30). Thelma just wants Matthew to care, however, she requires his personal attention to gratify her simple desire. Thelma doesn’t expect Matthew to love her again though she is interpreting his emotions to have registered as “love” to begin with. The narrator explains his surprise at Thelma’s comment that if Matthew called her once a year then she could “live happily.” (30). Here again Thelma is requiring the attention of another to achieve personal gratification. Comfort through codependency, “Is that too much to ask?” (30).
On page 31, the narrator finally writes of his concern for Thelma’s history before Matthew when considering Thelma’s ten years of therapy previous to her sessions with Matthew. Here the narrator also reveals his reasons for choosing to help Thelma which perhaps double as his weaknesses: a fascination with love-obsession, and a hubris affliction. On page 34, the narrator reveals his own experience with obsession and how he sought therapy to overcome it. By page 36, the narrator reminds the reader of the unhealthiness of a therapist becoming emotionally involved with a patient but follows up with, “My anger toward Matthew grew.” (36), which displays the narrator’s own emotional involvement with the patient. The narrator’s own emotions are directed at Matthew but these emotions remain the narrator’s perception of the patient’s world. The narrator is allowing himself to become emotionally involved with the patient by commiserating with the patient’s experiences while shaming Matthew for becoming “emotionally” involved with Thelma, though, by this point, there has yet to be any proof of Matthew being emotionally rather than sexually involved. Although it is explained that sexual intimacy between Thelma and Matthew only occurred on the first night, it was over the span of the twenty-seven days that Matthew perhaps came to realize that his involvement with Thelma was not right while Thelma couldn’t think of anything more right.
Emotionally charged toward Matthew, the narrator again admits to “vindictive feelings” and a desire for “striking back” at Matthew for Thelma (37). The narrator expresses his perception of Matthew, “He seems to be a particularly screwed up person” and of Thelma, “She had a lust for submission.” (38). The narrator and Thelma engage in a moment of role reversal where the narrator brings Thelma to the realization that Matthew’s silence may have been at the suggestion of Matthew’s own therapist (if Matthew did in fact seek therapy) (41). The narrator and Thelma eventually come to the possible determination, “Don’t get close,” or risk getting hurt (48).
By the fourth and fifth months, Thelma doesn’t feel as though therapy is helping while the narrator becomes discouraged at his own inability to help Thelma within their brief six-month period of sessions despite the decades of psychology and psychologists Thelma has collected. Then the narrator decided that the time had come to play his cliché “final card” of radical intervention, to invite Matthew to a session with Thelma. This got Thelma’s attention but perhaps for the wrong reasons, particularly with his admitting that, “I had not fully thought through my proposal,” (49). The narrator is presumptuous of Matthew, of Matthew’s having the same phone number, and of his own reputation to produce results. The narrator confirms the reader’s suspicions of a lack of professional concern with the comments, “couldn’t summon the energy,” (couldn’t or wouldn’t?) and, “I was definitely growing irritated,” to the point of mentally referring to the patient as, “you ninny.” It is unclear how this portion of the narrator’s perception of the patient is relevant to the treatment, particularly when the narrator has previously admitted to having experienced obsession. Not to mention that, judging from the author’s smug picture on the back cover of the book, Thelma must be at least twenty to thirty years older than the narrator, perhaps received less schooling than the narrator, and at the very least deserves a nuance of the narrator’s respect for keeping their deal of her not committing suicide. Of course, the narrator would never say such things to Thelma aloud for she may resort to suicide and then the narrator would have that blight on his record and regret in his memory. It remains to be seen how the pseudo-cynical narrator and his reputation surpass that of Matthew’s.
Thelma makes the call to Matthew’s number for the narrator. She pitches the idea of the three-way session to Matthew’s answering machine and he answers for the first time in eight years. They converse for twenty minutes and Matthew agrees to participate in the session. Thelma can’t quite recall what they talked about, only what they didn’t talk about; why he broke of the affair, and how he feels about her now (53).
The day of the three-way session with Matthew finally arrives. The narrator cruelly applies the term “preamble” to describe Thelma’s nervous and lengthy way of roundabout explaining herself in the awkwardness of the situation (55). This is an interesting word choice considering the irrelevant moments of the writing itself thus far (i.e. raw hamburger). Remarkable how entirely fragmented these characters’ realities are. 27 days, 8 years, 6 months, etc, and the narrator expects to somehow boil it all down in one magical hour of unpredictable therapy. So Thelma asked Matthew why and what happened. He explains that she “asked for more and more until it reached the point that I couldn’t find a way to give anymore.” And that he and his own therapist actually did both agree that, “the best thing to do was to cut it off completely.” (56). Perhaps “best” here is a bit of an overstatement since Thelma still wishes to commit suicide over Matthew’s cold shoulder. Matthew reveals that just before he and Thelma had run into each other at Union Square he had cracked-up a bit and split to India to get his head straight. He didn’t find was he was looking for in India and his brother came and took him home (57). When Thelma began her obsession with Matthew, the excessive phone calls were enough for him to check himself into a hospital. So for the preservation of personal sanity, Matthew and his psychiatrist determined that the “best” thing to do was to sever contact. By that rationale, Matthew’s sanity was only affected by talking with Thelma and not actually by the ignoring of eight incessant years of voice messages Thelma leaves. It is unclear if Matthew’s psychiatrist suggested that Matthew simply change his number.
The narrator then explains his perception of Matthew as derived from Thelma’s perception as “a charmer” and “smooth.” It is with Thelma’s perception of Matthew that the narrator feels qualified to judge Matthew. The narrator soon admits, “Over the last several months, I had constructed a vision – or, rather, several alternative visions – of him.” (59). Acceptance is the first step. And only in addressing his own perception of the matter does the narrator finally ask that question it’s taken some six months to ask, “In this relationship, who had exploited whom?” (59). Matthew comes clean about his divorce, his religious conversion, the end of his being a therapist, etc, and admits that he cares about Thelma but, during Thelma’s next session with the narrator, Thelma explains that she doesn’t feel that Matthew was genuine. It is in that same session that the narrator decides to finally set Thelma straight, that the love shared with Matthew “was never there in the first place.” (63). The narrator then laments, “I don’t think I’ve ever said a crueler thing.” (63). For the narrator, apparently referring to a patient as a ninny is somehow less cruel than expressing truer, more relevant perceptions. The truth hurts and, if things do not end badly, then things do not end. With this expression of truth comes another misconception on Thelma’s part, “He still hasn’t told me why he cut me off!” The narrator is lost in the clouds as Thelma snaps him back to reality, “and that’s why I have to stop therapy!” (67). Thelma and Harry leave the narrator’s office as the narrator goes on to refer to Harry with the strangling hands as “the old fool” for wanting the “old Thelma” back (70). This is perhaps because the narrator impetuously takes “old Thelma” to mean the Thelma before the reunion with Matthew, not the Thelma before ever receiving therapy from Matthew or therapy in general. So Thelma quits therapy for good as the narrator reflects, “But she apparently never again developed an appetite for my type of treatment, and I did not hear from her again.” (72), that is, until the day he requested consent from her to publish their tale of psychotherapy.
“If Rape Were Legal” –
Sarah is a group therapy leader working for the narrator. Carlos is a terminal cancer patient put into Sarah’s group by the narrator. One of the members reveals that she had been raped. To comfort the woman, Sarah reveals that she, too, had been raped. This was something that the narrator was unaware of. Carlos began asking specific details of the women and their separate rape encounters, to which Sarah perceived to be him “getting off” (74), and to which Carlos counters callously of the act of rape.
The narrator listens to Sarah’s complaints before recounting Carlos’ back story for the reader. The narrator debates on whether to take on Carlos as a patient for treatment, “What sense does it make to talk about “ambitious” treatment with someone whose anticipated lifespan may be, at best, a matter of months?” (78). Again, the narrator determines that if he chooses to help then he must somehow muster the “energy” and time to be invested in the case. Some would attribute this “lack” of physical “energy” to various factors other than the patient’s situation, such as fatigue, imbalanced diet, or negative self-talkng.
As Carlos continues going to groups and picking people for insight, the other group members remain uncomfortable with his presence. The narrator explains to Carlos that he should try to better integrate himself into the group without making the others feel uncomfortable. The narrator denounces that real people are not the place to find information, “These were real people – they’re not sources of information.” (81). Of course real people are sources of information. Otherwise what might be the purpose of attending group therapy if there is an absence of information being exchanged?
When Carlos entertains the idea of a world where rape would be legal, the narrator cleverly questions of Carlos’ daughter’s place in a world of legal rape (85). This is not an easy subject for Carlos. The narrator breaks down his perception of Carlos’ reality for Carlos, “Concentrate on having a good conversation. Try deepening a friendship with the people you already know.” (89).
During the next group session and every one subsequent, Carlos exhibits a reformation of character. Carlos developed and explained his two insights: “Everybody’s got heart” and “I am not my shoes.” (90). Although his cancer kills him in the end, Carlos thanks the narrator for “saving his life.” (92).
“Fat Lady” –
Interesting the narrator’s pattern thus far of his own disagreeable of each of his client or remembrances of previous persons…………???
It’s as if the narrator is fixated on sharing his mis/perceptions of others, borderline gossiping, perhaps deriving some sort of satisfaction from comparing/contrasting himself with others.
The narrator attempts to hash out exactly what it is about obese women that he dislikes without mentioning a dislike for obese men. At the very least, obese people have obesity in common. The narrator’s refined view of what physical “beauty” is likely does not include “beautiful” women being intimate with obese men. “Beauty’s where you find it” (Madonna – “Vogue”), and not always on the outside. But if the individual craves an intimate relationship, the longer the individual goes without the intimate relationship the more likely that the individual may reevaluate/lower their standards of what equates “beauty” and what/who will satisfy their needs. Obese people need some loving and some action once in a while, too.
The narrator on his childhood in Washington D.C. and being the odd man out between the black kids, the white kids, and the fat kids, “I needed someone to hate, too.” (94). But just two paragraphs earlier the narrator explained that obesity was “endemic” in his family. This leads the reader to think that the narrator perhaps harbors unresolved feelings toward his family. If hating fat kids because they are fat is OK, best come full-circle and hate your own family for being fat. But surely the narrator doesn’t hate himself for being of fat folk. Surely the narrator doesn’t hate himself for his low tolerance and generalization of the obese and others.
On and on, the narrator expresses this dissatisfaction until, finally, he shows his soft side by referring to his present client, obese, Betty, as “Poor Betty” because she hasn’t a shred of an idea about the narrator’s ill thoughts toward her physique (95). It is after this lengthy display of mental and literary irresponsibility in which the narrator remembers his place in Betty’s world, “After all, this person had come to seek help from me.” (95). The narrator then lapses back into his brooding tolerance for the obese by comparing Betty to cartoon characters.
When the narrator finally gets down to brass tacks, he uses a whole paragraph to really express how serious he takes his work and clients, “I always take seriously the business of . . . to relate to the patient in an intimate, authentic manner.” (97). It is unclear why the narrator doesn’t take this attitude before accepting an individual as a client. The caring shows when to payment flows.
“She revolted me,” (97), and the reader ever wonders if the narrator can, for a moment, focus on business. “By the end of the first hour, I felt irritated and bored.” (97), the narrator admits without considering how his patient and readers might feel. Because of the narrator’s own difficulties with obese, not the client herself, the narrator selfishly decides to give Betty therapy.
“It was hard to remember that less than a year before, it had been difficult for me to even look at Betty. Today I felt positively tender toward her.” (119-20). It is unclear if the narrator’s “positive tenderness” toward Betty is influenced by her physicality or her entirety of change. Were Betty’s “change” all but physical, would the narrator still have attained “positively tender” feelings, or would the narrator’s revolting perception persist? Only the narrator can say.
Betty eventually reveals that she was ashamed of her father, the one man who ever held her. It is further revealed that Betty was aware of the narrator’s difficulties with looking at her and never even tried to shake her hand so long as payment is made. The two come to terms on the awkwardness of their relationship and it ends with a heartfelt hug and the narrator ruining the moment as might have been expected.
“The Wrong One Died” –
In this story, Penny is four years bereaved by her daughter’s death from leukemia. She seeks the narrator out for therapy. Because Penny spoke right up, the narrator employs his keen detection skills to determine that Penny is hard of character, “I like hard women, and I liked her style.” (128). This is the narrator, again, allowing his impression of the client to affect his treatment of the client, “I noticed that and began to speak a little tougher.” The presumptions made by the narrator have proved to be a dangerous of interacting with patients in the previous, yet the narrator persists on making these sorts of haphazard rationales.
Penny was eager for therapy and, as the narrator explains it, by “sheer chance,” the first question asked is one that sets off Penny’s emotional time-bomb (128). Here it can be seen that perhaps the narrator’s first impression of “hard” Penny was incorrect as she so readily breaks down. The narrator notices that this client may perhaps be as challenging as another client and decides to use his head, “I saw that, to work with Penny, I would need to lash myself to the mast of reason.” (131). Reason, logic, compassion, etc, the narrator likes to take things one rhetorical nautical reference at a time.
Penny’s guilt rises from her not helping her daughter talk about dying and from not letting go of the daughter sooner (131). The narrator admits to his then naiveté when dealing with the bereaved and their sometimes unusual rituals for remembering their dead. The narrator determines that Penny is unknowingly in contradiction between her beliefs in death and in reincarnation (132). This is not uncommon given that an individual may apply their own perceptions of a concept or philosophy, such as reincarnation, rather than seeking more detailed explanations of the concept. Permanent death and reincarnation may become incorporated in the believer’s mind particularly that any afterlife involving a heaven or hell may be taken as its own form of reincarnation. Perhaps for Penny the idea of reincarnation is equivalent to transcendence to heaven for earthly reincarnation holds no guarantee that the next time around will be free of pain and illness as narrator partially recounted Penny’s interpretation of reincarnation, “Penny knew that the next time around she would be luckier – perhaps richer. She also knew that Chrissie was going on to another, healthier, happier life.”(130).
With continued sessions, the narrator discovers that there is more than the death of her daughter afflicting Penny, “Her plans and her family were shattered: her daughter was dead, her husband gone, one son was in jail, the other in hiding.” (137). Penny describes her children as the daughter having been an angel, one son in jail, and the other a drug addict, “I had three children – and the wrong one died.” (137), and feels “inhuman” for saying as such. The narrator reassures Penny that, though unsettling for her, it is quite human to have such feelings.
Penny and the narrator “work through” these feelings to determine what may have happened for her sons to proceed down the paths they are on, what her relationship with her parents was like, and what her intimate relationships have been like (139). By the last few sessions, the narrator personally divulges his soap-opera fascinations, “I might as well be honest – I was transfixed on the unfolding drama, as each week offered a new, exciting and unpredictable episode.” (143). Penny’s need to escape poverty and find stability in the world leads back to her desire not to be destined to repeat the life of her mother, the life of a “poor-crazy-old-lady,” (144). In the end, the narrator appropriately recaps the case by offering professional insights rather than making snide, off-the-cuff remarks about the client’s physical state.
“I Never Thought It Would Happen to Me” –
Elderly Elva experienced a purse-snatching which re-framed her reality. Elva was surprised at society’s betrayal because society causally strings people along into accepting and expecting life to play out like a Disney cartoon. Fortunately, and something perhaps Elva is overlooked at the time, the crime of theft didn’t escalate to something more severe such as assault, rape, and/or murder. Elva is further fortunate that the incident happened in a public place rather than suffering a home invasion. As with other clients, regardless of Elva’s physical and mental state, the narrator expresses with brutal honesty yet another disinterested physical first impression, “Upon first meeting Elva eight months before, I could find little to love in her,” but admits to being transfixed on and amused by her “facial plasticity,” (156). The narrator, patient as ever, explains of their sessions, “All I could do with Elva was to hold on, hear her out, somehow endure the hour, and . . . find something supportive to say – usually some vapid comment about . . . her . . . anger.” (157). Upon their final session and emptying the unusual contents of Elva’s purse, the narrator realizes, “I think it was the best hour of therapy I ever gave.” (162).
“Do Not Go Gentle” –
Dave is an elderly man, married, who, thirty years earlier, had an affair with a woman, Soraya, and has been keeping this secret as well as Soraya’s letters from his wide for these thirty years. Dave asks the narrator to hold onto the letters. The narrator accepts under the initial idea that holding on to the letters would be a positive factor for Dave to maintain therapy, but dismisses the thought as “an angle, one of my dumb, harebrained, manipulative ploys that always backfire.” (168). Always backfire, yet always within reach and loaded. In digression, the narrator wisely opts for more “straight-forward, honest behavior,” (168). The narrator ponders of Dave’s death, “What would I do with the letters then?” (169).
The narrator does not take the letters. Dave begins to attend group therapy, but for the wrong reasons as Dave begins using the therapy group as a dating pool. When the group arrives to discussing “secrecy,” Dave finally begins to open up to the group and has a breakthrough. Seemingly satisfied, Dave never returns to single or group therapy which leaves the narrator concerned as to what might have transpired, something done or said by the narrator or others, that would make Dave decide never to return. The answer is on only Dave can give.
Dave, 64yrs, Caucasian, male, divorced 3 times, married 4 times
Self-referred, seeing Yalom for erectile dysfunction
Issues with trust, intimacy, secrecy, and obsession
Pining over an affair he had 30 yrs ago
No intimacy with women
Considers his current wife to be the “warden” in his own marriage-prison
Dave asked Yalom to hold the letters
(review the 8 steps of the ethical dilemma)
Pros: trust/bond, holding the letters is collateral to maintain client participation in therapy
Cons: taking the letters reinforces Dave’s pathology of avoiding responsibility.
Yalom’s countertransferrence – he has his own letters
Yalom decides to take the letters as long as Dave talked about them with the group
Build trust/avoid pathology
- Barrier within each of us and how we express – inaccurately
- Impression manage & selective sharing
- Say/Negotiate – need others to understand, but the interpretations vary
“Two Smiles” –
Marie is seven years bereaved over her husband’s death. Despite Marie’s cultural differences as a Mexican immigrant, the narrator perhaps overlooks this with the comment, “For several months I had attempted to challenge her belief that life, real life, can only be lived if one is loved by a man.” (181). Aside from the male/female dominance/subordination of Latin American cultures, Marie’s husband, Charles, was an accomplished surgeon who was tragically killed in an automobile collision on his way to the hospital. When the collision happened, it likely turned Marie’s life upside-down, particularly because now she would have to support herself monetarily, perhaps seeking employment, that is, unless she was reimbursed with a large settlement from the auto insurance company, provided that the other party in the collision was carrying current insurance. Being forced to start over like this may be enough to throw the even most stable of psychologies into a state of disarray. But, according to Marie’s later recounted history with Dr. Z, her oral surgeon, he worked at the hospital where her husband was brought at the time of the collision (186). This eludes that the collision occurred in the U.S., rather than Mexico, and hopefully the other party in the accident complied with mandatory insurance regulations.
When Marie is seriously injured by falling from a cable car and must undergo many surgeries, it is explained that medication does not relieve her pain. The narrator encourages Marie to try an alternate form of therapy, “For weeks I had urged her to see a hypnotherapist in consultation.” (181). Marie accepts on the condition that the narrator is present for the session. The narrator admits his ulterior motive, “I also wanted support from a colleague.” (182). This is an important crack in the armor of the narrator’s hubris as he seeks assistance from his pool of resources, however, he explains that he is actually trying to satiate a “needy part” within him for someone to commiserate on his difficulties with counseling Marie.
The hypnotist’s most excellent moment of insight comes as, “Marie’s first step…was to learn more about her pain: to differentiate between functional and unnecessary pain.” (183). This is invaluable information for the individual who has never explored or experimented their own sensory perceptions. There exist different kinds of pains and pleasures. Contemplating the levels of the sensory experience, may prove effectual in channeling the sensation and emotion into motivation.
With the narrator’s line about the hypnotist’s productivity, “…he could not have guessed how difficult a patient Marie had been and what a herculean job I had done with her.” (184), Marie becomes like a tightly sealed pickle jar that the narrator had struggled with to open until the hypnotist came along simply outdid the narrator with a single, two-handed twist. Besides, Hercules’ strength and power stemmed from his beautiful and uncut hair. Perhaps the narrator’s receded hairline was an attributable factor of impediment in opening the jar, Marie, in her earlier treatments.
Enter Dr. Z. When the relationship between Marie and her anti-hero, Dr. Z., is explained, so much more depth to Marie’s pain is revealed. “And so Marie and Dr. Z. were locked in a complex dance…” (188), which, without rehashing Dr. Z.’s lesser qualities, involves numerous complicated elements, and into this “extraordinary tangle” the hypnotist unknowingly braves as the narrator omits the crucial details of Marie and Dr. Z.’s awkward relationship from the hypnotist’s awareness. It is suggested that Marie include Dr. Z in her exploration and understanding of pain, and Marie agrees revealing her first of “two smiles”. The second smile came with the hypnotist’s analogy for Marie to quit smoking that she would not poison a dog’s food, so she should not poison herself with tobacco use. The smile likely grew out of the memory of her husband’s dog, Elmer (188). Elmer happened to be very defensive of Marie and the house. The narrator explains his dispassion for dogs. It is later revealed that Marie’s smiles are smiles of irony and that she felt ashamed, embarrassed, and concerned if the narrator had to the hypnotist of her relationship with Dr. Z. (191-2).
Marie decided to quit therapy with the narrator on the grounds that she feels he overstepped his role as a doctor in reference to his own father and his own dispassion for dogs. As the narrator later explains, “Translation error is compounded by bias error.” (195), but also that he, “helped Marie explore her self-contempt for the way she had compromised herself with Dr. Z.” and, “she never smoked another cigarette again.” (193).
At the top of the menu of a Las Vegas drive-thru wedding chapel, “People who feel empty never heal by merging with another incomplete person.” (197).
“Even the most liberal system of psychiatric nomenclature does violence to the being of another.” (199).
Yalom, Two Smiles
Marie: 40 years old, Hispanic, educated, immigrant, widowed
Four years of therapy, depression, self-referred
Grief for lost husband 7 years prior
Surgeon traffic collision
Her view of therapists is influenced by her experience with her dentist and other doctors
She had a traumatic cable car accident
Needed severe face body teeth reconstruction, sexually harassed by her dentist
Potential accident lawsuit very likely to go to court & subpoena of medical records
This makes a difficult case for Yalom
Hypnosis – repressed memories
You can never really know anyone
Not a good relationship with her father
One of the reasons for leaving Mexico
Her husband’s dog, Elmer
Two Smiles – talk to doctor about pain
First smile – misinterpreted by the hypnotist
Marie – embarrassed, uncomfortable
Yalom – wanted validation from Mike “If he could only know what she was like…”
Second smile – Elmer, put to sleep because he was mean and angry
Mike – “would you feed your dog poison?” “connected” thought of
Marie – felt need to protect Yalom for overstepping his boundaries and didn’t want him to look bad.
Yalom – “if he could only know what she was like…”
Marie – not an easy client, would not accept suggestions, impression management focused, and difficulty with meeting men.
Yalom experienced counter-transference for Marie’s beauty
Remember to consider culture – Mexico
Her demeanor may be culturally influenced
Stoic, aggressive, intimidating, needs a man to feel complete
Machismo vs. marianismo
Must not pathologize cultural differences
Hypnosis – for chronic pain, meds not helping
Marie’s dentist would not prescribe meds, sexual harassment
Hypnotherapy with Mike went well; she stopped smoking, and better manage her pain.
“Three Unopened Letters” –
Saul had a premonition and began suffering a panic attack during a session with the narrator. It had been three years since Saul had seen the narrator. The narrator wanted to hear all of the details, “Details are wonderful. 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.” (201). He had received a dreadfully expected oversized envelope from the Stockholm Research Institute about a potential fellowship and a fifty-thousand-dollar stipend for Saul to pursue his career in neurobiology. Saul did not open the letter immediately because he was sure the news was bad. He instead put the unopened letter into a drawer. The narrator interpreted as a sign of naturally paced maturity. When an identical letter arrived eight days later, Saul did not open it either and put in the drawer on top of the first letter.
Saul explained to the narrator that he had been having daydreams and the narrator naturally wants to hear about the dreams. One daydream was of a stellar performance Saul gave at a trial with members of the institute. Another daydream was of an imaginary heart attack and the paranoia of not being able to accurately apply his pulse rate to determine if the experience was really happening. Another daydream was similar to suicide contemplation, “Then I’d daydream about slicing that artery, relieving the pressure and letting the blood out. At one hundred and four beats a minute, how long would it take to enter darkness?” (203). The daydreams digress from suicide to exercise on a stationary bicycle to filling a paper cup with blood and counting how many spurts it takes to fill. Saul’s daydreams continue to fixate on suicide by cutting his wrists with a kitchen knife or razor blade. Saul admitted, “One of the worst things was that I had no one to talk to, nowhere to turn, no confidant, no trusted friend with whom I could dare talk about this stuff.” (204). Enter the role of the therapist. Saul further admitted that he had not seen the narrator for three years because he felt a sense of disgrace and shame. So Saul handled the letters as best he could, “…they were my final judgment, my personal apocalypse.” (205). When the third letter arrived, ten days after the second, Saul finally made an appointment with the narrator.
Saul was an admirer of Dr. K. and the two began to collaborate at Saul’s suggestion. Because the collaboration did not produce the desired results, Dr. K. wanted to disassociate himself from the project (a project Saul did 95% of the work on). When Saul eventually made the project produce the desired results and published the paper, it was without Dr. K.’s expressed permission and credit. Thus Saul’s desperation and reluctance led him to see the narrator. Saul’s laundry list of ailments included, “…his willingness to pay fifty thousand dollars; his morbid, suicidal ruminations…; his anorexia; his insomnia; his request to see me sooner…blood pressure…nearly fatal coronary.” (210).
“Poor Saul” (206) came looking for help at just the right/wrong moment when the narrator had his hands full with three other cases from this collection, “it was unfortunate for Saul that he consulted me at a stage in my professional career when I was impatient and managerial, and insisted that patients promptly and fully confront their feelings about everything, including death,” (211). Unfortunate, yes, however, if we look at the narrator’s history of working toward something like simply opening three letters, rather than urging, “Go home and read those goddamn letters!” (210), there may be a shortcut to satiating the narrator’s impatience and quickly seeing results. Perhaps the most obvious way to relieve this confusion and suspicion of the envelopes’ contents would be for the narrator to offer to open the letters and read them to Saul.
After the narrator realizes that he’s lost in Saul’s “illogical scenario,” the narrator addresses Saul as he might have from the beginning were it not for Saul’s three year absence from treatment, “Saul, what kind of timetable are you on? Put yourself in the future. One month from now – will you have opened the three letters?” The narrator tried to nail down to Saul’s goal orientation, “…what would be the best possible way for me to help?” to Saul’s reply of, “I absolutely do not know.” (213). Although Saul resisted, the options were clear; open the letters; destroy the letters. “Somehow Saul had found the power to take a stand against me.” (215).
Since his parents died, Saul has sought stability, affection, and approval. Saul’s aunt never adopted Saul and said that he was lucky she would take care of him rather leaving him in an orphanage. This expression of fortune at the mercy of luck as the result of a life-altering event likely compounded Saul’s confused and lonely feelings. As the narrator explained, Saul downplayed his achievements. This was done not out of modesty, but as a benchmark for not having met greater levels of achievement, “My crime is misrepresentation. I’ve done nothing of substance in my field. (219). When Saul’s youth is explained, a need to accumulate money/wealth became paired with a restriction of food intake as Saul would only permit himself to eat portions of his meals if he did not meet his expectations for the money he made each day.
The letters “…not only represented some current professional misfortune but symbolized a lifetime’s search for acceptance and approval.” (221). It’s not until Saul hears the news of Dr. K.’s death sometime before Saul received the letters that Saul finally opens the letters because Dr. K would never discover that Saul had left off credit to Dr. K. The third letter contained a personal note from Dr. K. explaining similar feelings toward Saul’s reputation as Saul held for Dr. K.’s reputation, “…the tone of the letter was unmistakably accepting, even affectionate and respectful.” (226). What bitter irony that could have been forged into productivity if only Saul and Dr. K. had had a more effective openness in communication.
The narrator, like Saul, like so many, “…continued to work compulsively and to impose a professional schedule…” (210-1), that makes simple things like taking an afternoon walk an impossibility.
Saul was willingly taken advantage of by his wives and students and for his professional consultative services.
“ego-alien and bizarre” behavior
Saul – age 63
Saul cringed at the sound of his own Brooklyn accent.
“Therapeutic Monogamy” –
Marge White, age 35, Caucasian, a lab-technician, a smoker, a stutterer, sexually inhibited, self-hatred, self-destructive comparisons to others, started therapy at age twelve after a lifetime of mental “illness,” never been loved, never will bear children, never had a long-term intimate of social relationship, and, “I will always be poor and will always spend most of my salary on psychiatric care.” (230).
“The one good–the only good–thing about depression is that it always ends.” (232).
Depression is like poverty or jealousy in that the individual may rise out of depression but depression will always exist somewhere in society as depression may be a byproduct of oppression.
After twenty-three years of therapy the narrator describes Marge as “borderline” based on her tendencies toward depression, anxiety, multiple suicide attempts, eating disorders, early sexual abuse by her father, episodic psychotic thinking, and desperately alone.
The fact that Marge could make late-night telephone calls to the narrator made this story unique from the others though similar to the narrator’s house-calls to Saul. Although the narrator seemingly exudes dissatisfaction for non-office therapy sessions, some may consider these exceptions to be important for the narrator’s own creative use of his abilities. Perhaps a therapist’s abilities may grow stale from working with too much inside-office therapy and thus out of balanced from too little outside-office therapy. Like the walks the narrator wished he could have taken with Saul, and could have if it were used as a therapy session.
Despite Marge’s insecurities and the narrator’s profession, he admits, “God I hated those calls.” (227). Marge had made twenty or so in a year’s time but the narrator never felt as though he helped her the way she needed.
The narrator’s “first impulse was to get the hell away, far away…” (228), but decided to accept Marge as a client to quell his feeling of “shame” for not accepting clients who needed him the most.
“The very word treat implies non-equality. To “treat” someone as an equal implies an equality which the therapist must overcome or conceal by behaving as though the other were an equal.” (236).
Marge “split” personalities and began to criticize the narrator’s office furnishings. When this personality begins to gloat of its power over Marge, the narrator effectively enlightens, “What do you get out of this? If she loses, you lose.” (237).
One thought about Dissociative Identity Disorder (DID) is that seemingly those who experience the disorder apparently assume that they are unique in experiencing such mentality and that it is assumed that the psychologists themselves never experience such variations in identity.
Interesting that the narrator actually had to restrict his personal interest in Marge’s “Me” personality which he found to be more intriguing that Marge’s “Marge” personality. “Me,” “…had avenged herself by burning herself into my memory.” (244). Beware…counter-transferences can last a lifetime.
“In Search of the Dreamer” –
Marvin was a sixty-four year old, short, chubby, bald, large-eyed accountant with graphic skills. He was married with no children and his own parents were separated.
Marvin referred himself to therapy after six months of experiencing severe migraines and erectile dysfunction which he recorded and found that the two coincided sexually. He was also experiencing a fluctuation in mood from feeling good to feeling anxiety and depression.
When the narrator first saw Marvin’s chart of activities, the reaction is perhaps one of overwhelmed and repelled interest in Marvin’s sex-life and an undeniable creativity with graphics. The narrator revealed that he was distracted after having just counseled Elva from, “I Never Thought It Would Happen to Me,” “To compound the problem, I had just had a poignant but exhausting session with an elderly, distraught widow whose purse had recently been stolen.” (246). It seems the narrator will write a tale of psychotherapy about any one of his clients.
Marvin had an interest in spectacles. He complimented the narrator and inquired of the maker, and the farsighted narrator experienced a perceptual stretch, “I removed my glasses to read the brand name on the stem and found that, without my glasses, I could not read it.” (246). With that kind of vision it’s even hard to tell if the lenses are clear or smudgy.
Neurologists tried to tread Marvin for manic-depression with lithium and damaged his kidneys. When Marvin spills the words “docs” and “get sued,” the narrator reflects, “I didn’t want to get involved with that.” (247).
The narrator expressed his impatience and irritation with Marvin’s directness and his chart, “I thought tearing that chart to shreds and enjoying every moment of it.” (249). Were the narrator to follow this impulse and still help Marvin, would it be more appropriate to tear the chart up in private or do it in front of Marvin? Meanwhile, the tapestry that Marge’s “Me” personality hated probably remains upon the narrator’s office wall.
The second session was focused on what had happened to Marvin six months previous when his ailments began. Marvin had retired and had not considered that the event might have some sort of negative effect on his life.
Marvin’s dream-world was, “…a world seething with death, murder, suicide, anger towards Phyllis, fears of dirty and menacing phantoms erupting from within.” (254-6): 1) Marvin’s wife, Phyllis, was stuck in a castle. He tried to save her but he could not. He tried to turn back but could not. He was afraid to fall and to jump from a ledge. 2). Marvin and Phyllis were about to be intimate but an associate of Marvin’s was in the room and the man’s mother was outside the room. They blindfolded the man and continued being intimate. Afterwards, Marvin did not know how to explain the blindfold to the mother. 3). A camp of “filthy dirty” gypsies were conspiring against Marvin. He was perplexed why the law did not run them off. 4) The earth under Marvin’s house began to liquefy (groundlessness) and he would have to drill sixty-five feet down to save the house (perhaps one foot for every year Marvin has lived, plus one), but hit solid rock and awoke.
The narrator suggested that Marvin and Phyllis seek behavior oriented couples therapy and felt that Marvin’s retirement may have been the catalyst for Yalom’s givens, “fundamental anxiety about finitude, aging, and death….attempting to cope…through sexual mastery” (256). Marvin was creating meaning in a retired world where death is imminent and loneliness will haunt the surviving marital partner after the passing of either Marvin or Phyllis. Phyllis refuses to see a therapist.
Another session, another migraine, another dream, and the narrator employs “the old Fritz Perls device” of starting from the beginning and describing the dream in the present tense (258). 5) Two men in black, like Victorian undertakers, find a black carriage with a baby inside wrapped in black gauze. One of the men pushed the carriage until the tip of his black cane began to glow white. The man then inserted the glowing tip into the baby’s vagina.
The narrator’s mid was effectively blown by Marvin’s dream and largely from the disbelief that Marvin was even capable of such a dream, “How could I, I wondered, meet the dreamer…” (258), “a dreamer tapping out an urgent existential message.” (261). Luckily existentialism is the narrator’s specialty.
It is later revealed that Phyllis will not see any kind of doctor in general. She is “set in her ways” (259), which may be considered another way of saying that she is “set in her psychology.”
Agoraphobic, does not like to entertain people at home, hates to spend money
“She rarely leaves the house for any reason unless…it’s to escape another fear.” (259).
“’There are other reasons for making love than to get rid of tension.’” (262).
Although Marvin was the one who usually initiated sexual intimacy in their marriage, Phyllis had always limited how regular their sexual activity at twice a week with exceptions.
Marvin explains that he felt disloyal by simply talking about his and Phyllis’ sex life and that she may find out what he has said. The narrator hinted to Marvin of his psychotherapeutic future, “You give her a lot of power. Sooner or later we’re going to have to find out all about that.” (264).
Over time, Marvin’s migraines ceased but his moodiness remained.
Many more dreams…(265-7, 269, 271, 273-4).
Marvin’s mother had banished his father for being either a cheater or gambler.
Marvin’s friends teased him that he was dating his mother (268).
Marvin’s “…wife, like his father’s wife, wielded control by cutting off sexual favors.” (269).
The narrator explained the article from Psychology Today that and the idea of creating a final and meaningful conversation with each of the people with whom the individual needed closure. When Marvin tried this, he uncovered his real emotional detachment by addressing his mother’s death, “I will never see you again!” (272) and he still did not really feel anything, the narrator considered Marvin to have deadened himself. With the realization of this deadness, Marvin then begins to feel.
Marvin had the dream about a female god on a pedestal and understood it to mean that he had been turning women into goddesses to be appeases for his own safety (278), and was revealed to be the source of Marvin’s impotency.
When Marvin explains that he witnessed Phyllis praying, “The mother of God will protect me.” (278), he and the narrator determine that this was Marvin’s realization that Phyllis was just as mortal as he was.
Phyllis was actually self-conscious of her own inadequacies and regrets. She didn’t like to meet new people because she didn’t want to expose her lack of education and appear intellectually inferior (280-1). This explains Marvin’s perception of her as an agoraphobic.
What Marvin’s meant to Phyllis was more free time to travel, Marvin’s presence ‘taking over’ the house and remodeling, and that he would lose respect for her because she felt that she did not do much in a day.