It was deeply frustrating. Obviously, Thelma was responsible for her own life
predicament. Obviously, it was a fictio...
        The first step in all therapeutic change is responsibility assumption. If one
feels in no way responsible fo...
we had opened up in our therapy- the concealment, the need to entertain, the feeling
she had nothing to offer. Though bett...
Or, perhaps, it was I who had done the maneuvering? It really didn’t matter. I,
too, had profited from our relationship. I...
of power in his presentation, signified that Marie had understood and was affected by
his message.

p. 188
        And so ...
         Driving home that evening I thought more about him, the two Marvins –
Marvin the man, Marvin the idea. It w...
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Yalom love's executioner


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Yalom love's executioner

  1. 1. p.38 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 life. Far from wanting to take back her freedom from Matthew, she had a lust for submission. p.43 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, 70-year- old woman? 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 is difficult with Thelma- it’s not that she wants it, but that she has to have it in order to escape some danger. (shift of thoughts from basic level to superordinate one: I, personal problem we ,oneness) p. 62 “Thelma, what I have to say now is not present, but I think it’s important. Let me try to get my thoughts out clearly. If two people share a moment or share a feeling between them, if they both feel the same thing, then I can see how it might be possible for them, as long as they are alive, to re-establish that precious feeling between the two of them. It would be a delicate procedure – after all, people change, and love will never stays – but still, perhaps, it is within the realm of possibility. They could communicate fully, they could try to achieve authentic relationship which, since authentic love is an absolute state, should approximate what they had before. “But suppose it was never a shared experience! Suppose the two people had widely different experiences. And suppose one of them mistakenly thought her experience was the same as his?” p.66 But Thelma rushed on, not listening to my comments. “He was clear about only one thing – Matthew Jennings is sick and tired of Thelma Hilton. You tell me: What’s the perfect scenario to drive an ex-lover to suicide? Sudden dismissal with no reasons given – that’s exactly what he’s done to me! In fact, it had already begun! Thelma’s surprising outbursts, her sudden eruption of anger towards Matthew was a sign that the old defenses were no longer holding. She was in a fluid state. Every severely obsessional patient has a core of anger, and I was not unprepared for its emergence in Thelma. All in all, I considered her anger, despite its irrational components, an excellent development. p.67 Her response was, in effect, that her losses had been too great – more than she could bear. She had lost her hope for the future(by that she meant she had lost her “1% chance” of reconciliation); she had also lost the best 27 days of her life (if, as I had shown her, they weren’t real,” then she had also lost eight years of sacrifice (if she had been protecting an illusion, then her sacrifice had been meaningless). 1
  2. 2. p.100 The first step in all therapeutic change is responsibility assumption. If one feels in no way responsible for one’s predicament, then how can one change it? That is precisely the situation with Betty: she completely externalised the problem. It was not her doing: it was the work transfer, or the sterile California culture, or the absence of cultural events, or the jock social scene, or society’s miserable attitude towards obese people. Despite my best efforts, Betty denied any personal contribution to her unhappy life situation. (obesity is controllable) p.101 The psychotherapist’s single most valuable practical tool is the ‘process’ focus. Think of process as opposed to content. In a conversation, the content consists of the actual words uttered, the substantive issues discussed; the process, however, is how the content is expressed and especially what this mode of expression reveals about the relationship between the participating individuals. p. 102 I dared not utter the word boring – far too vague and too pejorative. I needed to be precise and constructive. I asked myself what exactly, was boring about betty, and identified two obvious characteristics. First of all, she never revealed anything intimate about herself. Second, there was her damned giggling, her force gaiety, her reluctance to be appropriately serious. p.105 Betty agreed- she could hardly refuse me; and I now had at my disposal an enormously liberating device. I was now permitted to interrupt her instantaneously (reminding her, of course, of our new agreement) whenever she giggled, adopted a silly accent, or attempted to amuse me or to make light of things in any distracting way. p.106 But at the same time she became unaccountably more distressed and reported more sadness and more anxiety. I pounced at the opportunity to understand this development. Whenever the patient begins to develop symptoms in respect to the relationship with the therapist, therapy has really begun, and inquiry into these symptoms will open the path the central issues. p.107 “The problem with that attitude is you end up with an unpeopled life. Maybe that’s part of the reason you feel empty inside. One way or another, every relationship must end. There’s no such thing as a lifetime guarantee. It’s like refusing to enjoy watching the sun rise because you hate to see it set.” p.108 When she had been in therapy for a few months, I decided that her progress would be accelerated if she worked in a therapy group as well as in individual therapy. For one thing, I was certain it would be wise to establish a supportive community to help sustain her in the difficult diet days yet to come. Furthermore, a therapy group would provide Betty an opportunity to explore the interpersonal issues 2
  3. 3. we had opened up in our therapy- the concealment, the need to entertain, the feeling she had nothing to offer. Though betty was very frightened and initially resisted my suggestion, she gamely agreed and entered a therapy group led my two psychiatric residents. p.115 At first it seemed that these flashbacks, as well as the accompanying extreme mood swings, were chaotic, random occurrences; but after a few weeks, Betty realised that they were following coherent pattern: as she lost weight she re-experienced the major traumatic or unresolved events of her life that had occurred when she was at a particular weight. Thus her descent from 250 pounds set her spinning backward in time through the emotionally charged events of her life: leaving Texas for New York (210 lbs), her college graduation (190 lbs), her decision to drop the pre-med curriculum (and her father) (180 lbs), her loneliness at her high school graduation – her envy of other daughters and fathers, her inability to get a date for the senior prom (170 lbs), her junior high graduation and how much she missed her father at that graduation (155 lbs). What a wonderful proof of the unconscious realm! Betty’s body had remembered what her mind had long forgotten. p.119 My hunch was, I told Betty, that when she entered more fully into life, she would lose her terror of death - some, not all of it. (we are all stuck with some anxiousness about death. It’s the price of admission of self-awareness.) p.131 Nothing offers more false security in psychotherapy than a crisp summary, especially a summary containing a list. My own words heartened me: the problem seemed suddenly clearer, more familiar, far more manageable. Though I had never before worked with anyone who had lost a child, I ought to be able to help her since much of her grief was reducible to guilt. Guilt and I were old acquaintances, both personal and professional. p.141 So we changed our focus. We turned away from Penny’s relationship with her sons and ex-husband and began to consider another important characteristic of parental bereavement – the loss of meaning in life. To lose a parent or a lifelong friend is often to lose the past: the person who died may be the only other living witness to golden events of long ago. But to lose a child is to lose the future: what is lost is no less than one’s life project - what one lives for, how one projects oneself into the future, how one may hope to transcend death (indeed, one’s child becomes one’s immortality project). Thus, in professional language, parental loss is “object loss” (the ‘object’ being a figure who has played an instrumental role in the constitution of one’s inner world); whereas child loss is “project loss” (the loss of one’s central organising life principle, providing not only the why but also the how of life). Small wonder that child loss is the hardest loss of all to bear, that many parents are still grieving five years late, that some never recover. p.148 3
  4. 4. Or, perhaps, it was I who had done the maneuvering? It really didn’t matter. I, too, had profited from our relationship. I had wanted to learn about bereavement, and Penny had, in only 12 hours, taken me, layer by layer, to the very nucleus of grief. p.149 Another compelling boundary experience is the death of a significant other – a beloved husband or wife or friend - which shatters the illusion of our own invulnerability. For most people, the greatest loss to bear is the death of a child. Then life seems to be attacking on all fronts: parents feel guilty and frightened at their own inability to act; they are angry at the impotence and apparent insensitivity of medical caregivers; they may rail at the injustice of god or of the universe (many ultimately come to understand that what has seemed injustice is in reality cosmic indifference). Bereaved parents are also, by analogy, confronted with their own death: they have not been able to protect a defenseless child, and as night follows day they comprehend the bitter truth that they, in their turn, will not be protected. “And therefore,” as John Donne wrote, “never send to know for whom the bell tolls; it tolls for thee.” p.150 I used a rational approach to her guilt and her tenacious clinging to the memory of her daughter. I confronted her with the incongruity between her reincarnation beliefs and her behaviour. While often such an appeal to reason is ineffective, Penny was fundamentally a well-integrated and resourceful person who was responsive to persuasive rhetoric. p.159 But when she was robbed, she felt as if she were starting all over again. Most of all, the robbery illuminated her ordinariness, her “I never thought it would happen to me” reflecting the loss of belief in her personal specialness. 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. That’s the rational side of specialness. But we (some more than others) also have an irrational sense of specialness. It is one of our chief methods of denying death, and the part of our mind whose task it is to mollify death terror generates the irrational belief that we are invulnerable – that unpleasant things like ageing and death may be the lot of others but not our log, that we exist beyond law, beyond human and biological destiny. p.165 But there is timing and judgement. Never take away anything if you have nothing better to offer. Beware of stripping a patient who cannot bear the chill of reality. And don’t exhaust yourself by jousting with religious magic: you’re no match for it. The thirst for religion is too strong, its roots too deep, its cultural reinforcement too powerful. p.185 At such times one longs for an umpire of reality or some official sharp-imaged snapshot of the hour. How disquieting to realise that reality is illusion, at best democratization of perception based on participant consensus. I asked him about the two smiles. He remembered them well and was convinced that they signified impact and connection. The smiles, appearing at points 4
  5. 5. of power in his presentation, signified that Marie had understood and was affected by his message. p. 188 And so Marie and Dr. Z were locked in a complex dance, whose steps included a spurned surgeon, a million-dollar lawsuit, a broken jaw, several fractured teeth, and brushed breasts. It was into this extraordinary tangle that Mike – of course, knowing none to this – had dropped his innocent, rational suggestion that Marie seek her doctor’s help in understanding her pain. And then it was that Marie smiled. After approximately one year of psychotherapy, Marie’s depression lifted, and she turned her attention to rebuilding her life. She was convinced that she could attain happiness only through coupling. Everything else was prelude; other types of friendship, all other experiences were simply ways of marking time until her life began anew with a man. p.190 So, from my perspective, Marie’s two smiles had not signified moments of concurrence with Mike but were instead smiles of irony, smiles that said, “if you only know…” When Mike asked her to have a talk with her oral surgeon, I imagined that she must have been thinking, “ Have a long talk with Dr. Z! That’s rich! I’ll talk all right! When I am healed and my lawsuit settled, I’ll talk to his wife and everybody I know. I’ll blow the whistle on that bastard so loud his ear will never stop ringing.” A=> B=> C (ignorance of what lies underneath) p. 197 The unknowability of the other inheres not only in the problems I have described – the deep structures of image and language, the individual’s intentional decision to conceal, the observer’s scotomata – but also in the vast richness and intricacy of each individual being. While vast research programs seek to decipher experience is so complex that it will forever outdistance new eavesdropping technology. p. 234 Though charmed by her ingenuous compliment, I was made uncomfortable by both thoughts: the mysterious “somehow”, and the vision of me as a miracle worker. As long as Marge thought in those terms, she would not get better as the source of help was either outside of herself or beyond comprehension. My task as a therapist (not unlike that of a parent) is to make myself obsolete – to help a patient become his or her own mother and father. I didn’t want to make her better. I wanted to help her take the responsibility of making herself better, and I wanted the process of improvement to be as clear to her as possible. That’s why I felt uncomfortable with her “somehow” and so set about exploring it. “The main thing that turned me around - in fact, the moment the calm set in - was when you told me that your wife and I had similar problems at work. I feel I’m so icky, so creepy and your wife so holy we couldn’t both be mentioned in the same breath. Confiding to me that she and I had some of the same problems proved you had some respect for me.” 5
  6. 6. p.250 Driving home that evening I thought more about him, the two Marvins – Marvin the man, Marvin the idea. It was the flesh-and-blood Marvin who was irritating and uninteresting. But Marvin the project was intriguing. Think of that extraordinary story: for the first time in his life, a stable, if prosaic, previously healthy 64-year-old man who has been having sex with the same woman for 41 years suddenly becomes exquisitely sensitive to his sexual performance. His entire well- being soon becomes hostage to sexual functioning. The event is severe (his migraines are exceptionally diabling); it is unexpected (sex never presented any unusual problems previously); and it is sudden (it erupted in full force precisely six months ago). p.251 We talked past each other, past each other. 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 existence - his sense of finitude, of ageing and decline, his fear of death, his source of life purpose. But we talked past each other. He ignored me, misunderstood me. He seemed pasted to the surface of things. p.254 It was time now to make a recommendation to Marvin about treatment. I did not think that he would be a good candidate for a deep, uncovering type of psychotherapy. There were several reasons. I’ve always found it difficult to treat someone with so little curiosity. Although it is possible to assist in the unfolding of curiosity, the subtle and lengthy process would be incompatible with Marvin’s wish for a brief and efficient treatment. As I thought back over the two hours, I was also aware that he had resisted every one of my invitations to dig deeper into his feelings. He didn’t seem to understand, we talked past each other, he had no interest in the inner meaning of events. He also resisted attempts to engage him more personally and directly: for example, when I had asked him about his wound or pointed out that he ignored any of my attempts to get closer to him. p.256 Nonetheless, it was with regret that I passed up the opportunity of working in depth with him: the dynamics of his situation fascinated me. I was certain that my first impression had been close to the mark: that his impending retirement had stoked up much fundamental anxiety about finitude, ageing and death, and that he was attempting to cope with this anxiety through sexual mastery. So much was riding on the sexual act that it was overtaxed and, ultimately, overwhelmed. Photocopy p.266 and 269 6