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. 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. 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. 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. 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. 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