Every Day Gets a Little Closer

Every Day Gets a Little Closer

A Twice-Told Therapy

Irvin D. Yalom, M.D.

and

Grinny Elkin

Copyright © 1974 by Basic Books, A Member of the Perseus Books

Group Library of Congress Catalog Card Number: 74–78308

ISBN: 465-02119-0 (cloth)

ISBN-10: 0-465-02118-2

ISBN-13: 978-0-465-02118-5

eBook ISBN: 9780786723171

Manufactured in the United States of America

DESIGNED BY VINCENT TORRE

Every Day Gets a Little Closer

Editor’s Foreword

IT IS TRUE that the literature of psychotherapy already numbers many works

which recount the saga of recovery. Since the turn of the century, psychiatrists
have increasingly elected to publish illustrative and exceptional case
histories, and, not to be outdone, patients have increasingly presented their
own retrospective versions. This book is unique in that it simultaneously
traces the course of treatment from the vantage points of both patient and
doctor, as they evolve a delicate and difficult relationship which has
personal meaning for both of them.

The book is an outgrowth of an experiment undertaken by my husband, Dr.

Irvin Yalom of Stanford University, and one of his patients, henceforth known
as Ginny. In the fall of 1970 my husband decided that it would be inadvisable
for Ginny to continue with him and a co-therapist in group therapy, since she
had made virtually no progress in that format for a year and a half, and he
suggested that they subsequently meet in individual therapy. Because Ginny’s
problems included that of a “writer’s block” (a serious complaint for an
aspiring novelist), Dr. Yalom stipulated that she pay for treatment in the form
of post-session reports, which would provide an obvious stimulus to her
writing. At the same time Dr. Yalom decided that he too would prepare a
separate account of their weekly meetings, with the understanding that he and
Ginny would exchange these reports at six months’ intervals, in the hope of
therapeutic benefit. For two years thereafter doctor and patient recorded his
and her recollections of the hour they had shared together, frequently adding
afterthoughts, interpretations, emotions and associations which hadn’t been
voiced during the session.

Although my husband almost never discusses his patients with me, I was
privy to some of his reflections on Ginny as he considered this method of
encouraging her writing. Since I am a professor of literature, he knew this
project would be of real interest to me. I suggested that he carefully preserve
both sets of reports until the end of therapy and then decide whether they
merited a wider audience. Privately I wondered if the post-session reports
might not constitute a publishable piece of literature, with two distinct
characters and two recognizable literary styles, not unlike an epistolary
novel.

It was, thus, with an especial interest that I read the manuscript for the first
time two years later. My enthusiastic evaluation, and that of less biased
judges, succeeded in persuading the authors to publish it. Although changes
were necessary to conceal the identity of the patient and to adapt the doctor’s
tapescripts for a reading public, the words are essentially those of the
original texts. No supplemental thoughts or fictive events have been added to
the symbiotic drama of psychotherapy. In the case of the doctor’s accounts,
not one significant reflection has been added or omitted—except for a few
tapes which were, unfortunately, mislaid and lost for good. Aside from very
minor stylistic corrections, Ginny’s reports are virtually unaltered.

At the suggestion of several readers who found the manuscript difficult to

approach without some explanatory material, and others who were eager to
know what became of Ginny after therapy, Dr. Yalom and Ginny each wrote a
Foreword and an Afterword composed a year and a half after their last
therapeutic meeting together. These do add considerable information and
clarification of both a personal and theoretical nature. Still, it is my belief
that the central portion can be read like a novel, as the story of two human
beings who met in the intimacy of the psychiatric tête-á-tête and now permit
you to know them as they knew each other.

Marilyn Yalom

February 20, 1974

Doctor Yalom’s Foreword

IT ALWAYS wrenches me to find old appointment books filled with the half
forgotten names of patients with whom I have had the most tender
experiences.

So many people, so many fine moments. What has happened to them? My

many-tiered file cabinets, my mounds of tape recordings often remind me of
some vast cemetery: lives pressed into clinical folders, voices trapped on
electromagnetic bands mutely and eternally playing out their dramas. Living
with these monuments imbues me with a keen sense of transience. Even as I
find myself immersed in the present I sense the specter of decay watching and
waiting—a decay which will ultimately vanquish lived experience and yet,
by its very inexorability, bestows a poignancy and beauty. The desire to
relate my experience with Ginny is a very compelling one; I am intrigued by
the opportunity to stave off decay, to prolong the span of our brief life
together.
How much better to know that it will exist in the mind of the reader rather
than in the abandoned warehouse of unread clinical notes and unheard
electromagnetic tapes.

The story begins with a phone call. A thready voice told me that her name
was Ginny, that she had just arrived in California, that she had been in
therapy for several months with a colleague of mine in the East who had
referred her to me. Having recently returned from a year’s sabbatical in
London, I had still much free time and scheduled a meeting with Ginny two
days later.

I met her in the waiting room and ushered her down the hall into my office.

I could not walk slowly enough; like an Oriental wife she followed a few
noiseless steps behind. She did not belong to herself, nothing went with
anything else—her hair, her grin, her voice, her walk, her sweater, her shoes,
everything had been flung together by chance, and there was the immediate
possibility of all—hair, walk, limbs, tattered jeans, G.I. socks, everything—

flying asunder. Leaving what? I wondered. Perhaps just the grin. Not pretty,
no matter how one arranged the parts! Yet curiously appealing. Somehow, in
only minutes, she managed to let me know that I could do everything and that
she completely delivered herself up into my hands. I did not mind. At the
time it did not seem a heavy burden.

She spoke, and I learned that she was twenty-three years old, the daughter of
a one-time opera singer and a Philadelphia businessman. She had a sister
four years younger and a gift for creative writing. She had come to California
because she had been accepted, on the basis of some short stories, into a one-
year creative writing program at a nearby college.

Why was she now seeking help? She said that she needed to continue the
therapy she had begun last year, and, in a confusing unsystematic fashion,
gradually recounted her major difficulties in living. In addition to her explicit
complaints, I recognized during the course of the interview several other
major problem areas.
First, her self-portrait—related quickly and breathlessly with occasional
fetching metaphors punctuating the litany of self-hatred. She is masochistic in
all things. All her life she has neglected her own needs and pleasures. She
has no respect for herself. She feels she is a disembodied spirit—a chirping
canary hopping back and forth from shoulder to shoulder, as she and her
friends walk down the street. She imagines that only as an ethereal wisp is
she of interest to others.

She has no sense of herself. She says, “I have to prepare myself to be with
people. I plan what I am going to say. I have no spontaneous feelings—I do,
but within some little cage. Whenever I go outside I feel fearful and must
prepare myself.” She does not recognize or express her anger. “I am full of
pity for people. I am that walking cliche: If you can’t say anything nice about
people, don’t say anything at all’” She remembers getting angry only once in
her adult life: years ago she yelled at a coworker who was insolently
ordering her around. She trembled for hours afterward. She has no rights. It
doesn’t occur to her to be angry. She is so totally absorbed with making
others like her that she never thinks of asking herself whether she likes
others.

She is consumed with self-contempt. A small voice inside endlessly taunts

her. Should she forget herself for a moment and engage life spontaneously, the
pleasure-stripping voice brings her back sharply to her casket of self-
consciousness. In the interview she could not permit herself a single prideful
sentiment. No sooner had she mentioned her creative writing program than
she rushed to remind me that she had come by it through sloth; hearing about
this program through gossip, she had applied for it only because it required
no formal application other than sending in some stories she had written two
years previously. Of course, she did not comment on the presumably high
quality of

the stories. Her literary output had gradually waned and she was now in the
midst of a severe writing block.

All of her problems in living were reflected in her relationships with men.

Though she desperately wanted a lasting relationship with a man, she had
never been able to sustain one. At the age of twenty-one she leapt from nubile
sexual innocence to sexual intercourse with several men (she had no right to
say “no!”) and lamented that she had hurled herself through the bedroom
window without even entering the adolescent antechamber of dating and
petting. She enjoys being physically close to a man but cannot release herself
sexually. She has experienced orgasm through masturbation, but the internal
taunting voice makes quite certain that she rarely approaches orgasm in
sexual intercourse.

Ginny rarely mentioned her father but her mother’s presence was very large.
“I am my mother’s pale reflection,” she put it. They have always been
unusually close. Ginny told her mother everything. She remembers how she
and mother used to read and chuckle over Ginny’s love letters. Ginny was
always thin, had many food aversions and for over a year in her early teens
vomited so regularly before breakfast that her family grew to consider it as
part of her routine morning toilet. She always ate a great deal, but when she
was very young she could swallow only with much difficulty. “I would eat a
whole meal and at the end still have it all in my mouth. I would try then to
swallow it all at once.”

She has horrible nightmares in which she is sexually violated, usually by a

woman, but sometimes by a man. Also a recurrent dream in which either she
is a large breast with clusters of people clinging to her or she herself clings
to some mammoth breast. About three years ago she began having frightening
dreams where it was difficult for her to ascertain if she were asleep or
awake.

She senses people staring at her through the window and touching her; as
soon as she starts to experience pleasure from the touching, it turns to pain as
though her breasts are being tugged off. Throughout all of these dreams there
is a far away voice reminding her that none of this is really happening.

By the end of the hour I felt considerable alarm about Ginny. Despite many
strengths—a soft charm, deep sensitivity, wit, a highly developed comic
sense, a remarkable gift for verbal imagery—I found pathology wherever I
turned: too much primitive material, dreams which obscured the reality-
fantasy border, but above all a strange diffuseness, a blurring of “ego
boundaries.” She seemed incompletely differentiated from her mother, and
her feeding problems suggested a feeble and pathetic attempt at liberation. I
experienced her as

feeling trapped between the terrors of an infantile dependency which

required a relinquishment of selfhood—a permanent stagnation—and, on the
other hand, an assumption of an autonomy which, without a deep sense of
self, seemed stark and unbearably lonely.

I rarely trouble myself excessively with diagnosis. But I know that because
of her ego boundary blurring, her autism, her dream life, the inaccessibility
of affect, most clinicians would affix to her a label of “schizoid” or, perhaps,

“borderline.” I knew that she was seriously troubled and that therapy would
be long and chancy. It seemed to me that she had too much familiarity already
with her unconscious and that I must guide her to reality rather than escort her
more deeply into her underworld. I was at that moment hurriedly forming a
therapy group which my students were to observe as part of their training
program, and since my experience in group therapy with individuals who
have problems similar to Ginny’s has been good, I decided to offer her a
place in the group.

She accepted the recommendation a bit reluctantly; she liked the idea of
being with others but feared that she would become a child in the group and
never be able to express her intimate thoughts. This is a typical expectation
of a new patient in group therapy, and I reassured her that, as her trust in the
group developed, she would be able to share her feelings with the others.

Unfortunately, as we shall see, her prediction of her behavior proved all too
accurate.

Aside from the practical consideration of my forming a group and searching

for patients, I had reservations about treating Ginny individually. In
particular I felt some disquiet at the depth of her admiration for me, which,
like some ready-made mantle, was thrust over me as soon as she entered my
office. Consider her dream dreamt the night before our first meeting. “I had
severe diarrhea and a man was going to buy me some medicine that had Rx’s
written on it. I kept thinking I should have Kaopectate because it was
cheaper, but he wanted to buy me the most expensive medicine possible.”
Some of the positive feelings for me stemmed from her previous therapist’s
high praise of me, some from my professorial title, the rest from parts
unknown. But the overevaluation was so extreme that I suspected it would
prove an impediment in individual therapy.

Participation in group therapy, I reasoned, would allow Ginny the

opportunity to view me through the eyes of many individuals. Furthermore,
the presence of a co-therapist in the group should allow her to obtain a more
balanced view of me.

During the first month of the group Ginny did very poorly. Terrifying
nightmares interrupted her sleep nightly. For example, she dreamt that her
teeth were glass and her mouth had turned to blood. Another dream reflected
some of her feelings about sharing me with the group. “I was lying prostrate
on the beach, and was picked up and carried away to a doctor who was to
perform an operation on my brain. The doctor’s hands were held and so
guided by two of the group members that he accidently cut a part of the brain
he hadn’t intended to.” Another dream involved her going to a party with me
and our rolling on the grass together in sexual play.

After the first month my co-therapist and I both felt that a once-a-week group
was not enough for Ginny and that some supportive individual therapy was
necessary, both to prevent Ginny from decompensating even further and to
help her pass through the difficult early stage of the group. She expressed a
wish to see me individually, but I felt that it would be more complicating than
helpful to see her both individually and in a group and thus referred her to
another psychiatrist in our clinic. She saw him individually twice a week for
approximately nine months and continued to attend the group therapy
meetings for approximately eighteen months. Her individual therapist noted
that Ginny was “beleaguered by frightening masochistic sexual fantasies and
manifestly borderline schizophrenic thought processes.” He attempted in his
therapy to be

“ego-supportive and to focus on reality testing and distortions in her

interpersonal relationships.”

Ginny attended the group religiously, rarely missing a meeting even when
after one year she moved to San Francisco which necessitated a long
inconvenient commute via public transportation. Though Ginny received
enough support from the group to hold her own during this time, she made no
real progress. In fact, few patients would have shown the perseverance to
continue so long in the group with so little benefit. There was reason to
believe that Ginny continued in the group primarily to continue her contact
with me.

She persisted in her conviction that I, and perhaps only I, had the power to
help her. Repeatedly the therapists and the group members made this
observation; repeatedly they noted that Ginny was fearful of changing since
improvement would mean that she would lose me. Only by remaining fixed in
her helpless state could she insure my presence. But there was no movement.
She remained tense, withdrawn and often noncommunicative in the group.
The other members were intrigued by her; when she did speak, she was often
perceptive and helpful to others. One of the men in the group fell deeply in
love with her,

and others vied for her attention. But the thaw never came, she remained
frozen with terror and never was able to express her feelings freely or to
interact with the others.

During the eighteen months Ginny was in the group I had two co-therapists,
each male, each remaining with the group for approximately nine months.
Their observations about Ginny closely parallel my own: “ethereal . . .
wistful . . . a haughty but self-conscious amusement at the whole proceedings
. . . reality would never fully engage her energies. . . . A ‘presence’ in the
group . . . a tortured transference to Dr. Yalom which withstood all
interpretative efforts . . .

everything she did in the group was considered in the light of his approval or
disapproval . . . alternated between being someone who was extraordinarily
sensitive and reactive to others, to someone who simply was not there at all .
..

a mystery in the group . . . a borderline schizophrenic yet she never came

close to the border of psychosis . . . schizoid . . . too much awareness of
primary process . . .”
During the period of her group therapy, Ginny searched for other methods to
escape from the dungeon of self-consciousness she had constructed for
herself. She frequently attended Esalen and other local growth centers. The
leaders of these programs designed a number of crash-program
confrontational techniques to change Ginny instantaneously: nude marathons
to overcome her reserve and hidden-ness, psychodrama techniques and
psychological karate to alter her meekness and unassertiveness, and vaginal
stimulation with an electric vibrator to awake her slumbering orgasm. All to
no avail! She was an excellent actress and could easily assume another role
on stage. Unfortunately, when the performance was over she shed her new
role quickly and left the theater clad as she had entered it.

Ginny’s fellowship at college ended, her savings dwindled and she had to
find work. Finally, a part-time job provided an irreconcilable scheduling
conflict, and Ginny, after agonized weeks of deliberation, served notice that
she would have to leave the group. At approximately the same time my co-
therapist and I had concluded that there was little likelihood of her benefiting
from the group. I met with her to discuss future plans. It was apparent that she
required continued therapy; though her grasp on reality was more firm, the
monstrous night and waking dreams had abated, she was living with a young
man, Karl (of whom we shall hear more later), and had formed a small group
of friends, she enjoyed life still with only a small fraction of her energies.
Her internal demon, a pleasure-stripping small voice, tormented her
relentlessly and she

continued to live her life against a horizon of dread and self-consciousness.

The relationship to Karl, the closest she had ever experienced, was a
particular source of agony. Though she cared deeply for him, she was
convinced that his feelings toward her were so conditional that any foolish
word or false move would tip the balance against her. Consequently, she
derived little pleasure from the creature comforts she shared with Karl.

I considered referring Ginny for individual therapy to a public clinic in San

Francisco (she could not afford to see a therapist in private practice), but
many doubts nagged me. The waiting lists were long, the therapists
sometimes inexperienced. But the compelling factor was that Ginny’s great
faith in me colluded with my rescuer fantasy to convince me that only I could
save her.

Besides all this I have a very stubborn streak; I hate to give up and admit that
I cannot help a patient.

So I did not surprise myself when I offered to continue treating Ginny. I

wanted, however, to break the set. A number of therapists had failed to help
her and I looked for an approach which would not repeat the errors of the
others and at the same time permit me to capitalize, for therapeutic benefit,
on Ginny’s powerful positive transference to me. I describe in some detail
my therapeutic plan and the theoretical rationale underlying my approach in
the Afterword. For now, I need only comment on one aspect of the approach,
a bold procedural ploy which has resulted in the following pages. I asked
Ginny, in lieu of financial payment, to write an honest summary of each
session, containing not only her reactions to what transpired, but also a
depiction of the subterranean life of the hour, a note from the underground—
all the thoughts and fantasies that never emerged into the daylight of verbal
intercourse. I thought the idea, innovative to the best of my knowledge in
psychotherapeutic practice, was a happy one; Ginny was then so inert that
any technique demanding effort and motion seemed worth trying. Ginny’s
total writing block which deprived her of an important source of positive
self-regard made a procedure requiring mandatory writing even more
appealing. (Incidentally, this plan entailed no personal financial sacrifice
since I was on a full-time salary status with Stanford University and any
money I earned from clinical work was turned over to the University.)

Because of my wife’s interest in literature and the creative process, I

mentioned this plan to her and she suggested that I, too, write an
impressionistic nonclinical note following each session. I thought this idea
was an inspired one, though for an entirely different reason from that of my
wife: she was interested

in the literary aspect of the endeavor; I, on the other hand, was intrigued by a
potentially powerful exercise in self-disclosure. Ginny could not disclose
herself to me, or anyone, in a face-to-face encounter. She regarded me as
infallible, omniscient, untroubled, perfectly integrated. I imagined her
sending me, in a letter if you will, her unspoken wishes and feelings toward
me. I imagined her reading my own personal and deeply fallible messages to
her. I could not know the precise effects of the exercise, but I felt certain that
the plan would release something powerful.

I knew that our writing would be inhibited if we were conscious of the

other’s immediate perusal; so we agreed not to read the other’s reports for
several months and my secretary would store them for us. Artificial?
Contrived?

We would see. I knew that the arena of therapy and of change would be the
relationship existing between us. I believed that if we could, one day, replace
the letters with words immediately spoken to one another, that if we could
relate in an honest, human fashion, then all other desired changes would
follow.

Ginny’s Foreword

I WAS an A student in high school in New York. Even though I was creative,
that was just a sideline to being mostly stunned, as though I had been hit on
the head by a monster shyness. I went through puberty with my eyes shut and
my head migrained. Fairly early in my college life I put myself out to pasture
academically. Although I did occasional “great” work, I liked nothing better
than to be a human sundial, a curled up outdoor nap. I was scared of boys and
didn’t have any. My few later affairs were all surprises. As part of my
college education, I spent some time in Europe working and studying and
compiling a dramatic résumé that was really all anecdotes and friends, not
progress. What passed for bravery was a form of nervous energy and inertia.
I was scared to come home.

After I graduated from college, I returned to New York. I couldn’t find a job,
in fact had no direction. My qualifications dripped like Dali’s watch, as I
was tempted toward everything and nothing. By chance, I got a job teaching
small children. Actually none of the children (and there were only about
eight) were pupils; they were kindred spirits and what we did was play for a
year.

While in New York I took classes in acting on how to howl and breathe and
read lines so they sounded like they were hooked up to a real blood stream.
There was a stillness to my life though, no matter how much I rushed through
classes and friends.

Even when I didn’t know what I was doing, I smiled a great deal. One friend,
feeling himself pressed up against Pollyanna, said, “What have you got to be
so happy about?” In fact, with my few great friends (I’ve always had them), I
could be happy; my faults seemed only minor distractions compared to how
natural and easy life was. However, my grin was stifling. My mind was filled
with a jangling carousel of words that rotated constantly around moods and
aromas, only occasionally dropping out into my voice or onto paper. I was
not too good when it came to facts.

I lived alone in New York. My contact with the outside world, except for
classes and letters, was minimal. I began to masturbate for the first time, and
found it frightening, just because it was something private happening in my
life.

The transparent quality of my fears and happiness had always made me feel

light and silly. A friend said, “I can read you like a book.” I was someone
like Puck, who didn’t need any responsibility; who never did anything more
serious than vomit. And suddenly I was starting to act differently. Quickly I
began to immerse myself in therapy.

The therapist was a woman and in the five months I was with her, twice a
week, she tried to make my grin go away. She was convinced that my whole
objective in therapy was to get her to like me. In the sessions she pounded
away at my relationship with my parents. It had always been ridiculously
loving and open and ironic.

I was afraid in therapy because I was sure there was some horrible secret
that my mind was withholding from me. Some explanation of why my life felt
like one of those children’s drawing boards: when you lift up the paper, the
easy funny faces, the squiggly lines, are all erased, leaving no traces. At that
time no matter how much I did, how many best friends I loved, I was
dependent on others to give me my setting and pulse. I was both vibrant and
dead. I needed their push; I could never be self-starting. And my memory was
mostly deadly and derogatory.
I was progressing in therapy to the point where both me and my feelings were
sitting in the same leather chair. Then an unusual circumstance changed my
life, or at least my location. I had applied on a whim to a writing program in
California and was accepted. My therapist in New York was not happy with
the news; in fact, was against my going. She said I was stuck, took no
responsibility for my life, and no amount of fellowship was going to get me
out.

However, I could not act adult about it and write to the grant people saying,

“Please postpone my miraculous stipend while I try to find my emotions and

feel confident and human.” No, like everything else, I waded into the new
environment, even though I was afraid that my therapist’s words were correct
and that I was just leaving at the beginning, risking my life for a guaranteed
year of sun. But I could not refuse experience, since that was my alibi, my
backdrop for feeling, my way of thinking, of moving. Always the scenic view
rather than the serious, thoughtful route.

My therapist in the end gave me her blessing, convinced that I could get
excellent help from a psychiatrist she knew in California. I left New York,
and as always there was something thrilling about leaving. No matter how
many valuables you have left behind, you still have your energy and your
eyes, and right before I left, my grin, like a permanent logo, came back, with
the exhilaration of getting out. I gambled that the psychological pot would
still be

waiting for me when I arrived in California, and I wouldn’t have to start from
scratch as a child star.

Because of the intensive and heroic work I had done in New York with
acting, therapy and loneliness, I made it to California with all my limited,
padded feelings still intact. It was a great time in my life because I had a
guaranteed future, plus no men whom I had to try and stretch myself for and
be judged by. I hadn’t had any boyfriend since college. I found a small
cottage with an orange tree in front; I never even thought of picking the
oranges off the tree till a friend said I could. I substituted tennis for acting.
And made my usual quota of one great girlfriend. At the college I did okay,
though I acted like an ingenue.
I went from one therapist to another in coming from New York to Mountain
View.

In a teetering frame of mind, teething on Chekhov and Jacques Brel and other
sweet and sour sadnesses, I first went to see Dr. Yalom. Expectations, which
are an important part of my lot, were great since he had been recommended
by my New York therapist. As I went into his room vulnerable and warm,
maybe even Bela Lugosi could have done the trick, but I doubt it.

Dr. Yalom was special.

That first interview with him, my soul became infatuated. I could talk
straight; I could cry, I could ask for help and not be ashamed. There were no
recriminations waiting to escort me home. All his questions seemed to
penetrate past the mush of my brain. Coming into his room I seemed to have
license to be myself. I trusted Dr. Yalom. He was Jewish—and that day, I
was too. He seemed familiar and natural without being a Santa Claus
psychiatrist type.

Dr. Yalom suggested I join his group therapy that he conducted with another
doctor. It was like signing up for the wrong course—I wanted Poetry and
Religion on a one-to-one visitation and instead I got beginning bridge (and
with no good chocolate mix either). He sent me to the co-leader of the group.
In my preliminary interview with the other doctor there were no tears, no
truths, just the subtext of an impersonal tape recorder breathing.

Group therapy is really hard. Especially if the table is stacked with inertia as
ours was. The group of about seven patients plus two doctors met at a round
table with a microphone dangling from the ceiling; on one side there was a
wall of mirrors like a glassy web where my face would get caught every
once in awhile looking at itself. A group of resident doctors sat on the other
side and looked in the window mirror. It really didn’t bother me. Although I
am shy, I

am also a little exhibitionist, and I removed myself accordingly and “acted”

like a stuffed Ophelia. The table and chair put you in a posture where it was
difficult to get going.
Many of us had the same problems—an inability to feel, un-jelled anger, love
troubles. There were a few miraculous days when one or the other of us
caught fire and something would happen. But the time boundaries on either
side of the hour and a half usually doused any big breakthroughs. And by the
next week we had subsided into our usual psychological rigor mortis. (I
should speak for myself. Others did get helped a lot.) In the group it was fun
to share problems but we rarely shared solutions. We became friends; we
never touched (which is practically a given in California). Toward the end
we went out for pizzas with everything on them. I enjoyed Dr. Yalom as a
group leader even as I became more distant and lop-sided, hardly ever
interacting with him, except visually. Part of my problem was that as usual I
wasn’t making decisions in my personal life, but drifting by on presence and
friends. I couldn’t really hold my head up. (I had a few months of private
therapy concurrent with group therapy.

It was with a young doctor. I’d been having horrible dreams and Dr. Yalom
had suggested it.)

I was beginning to feel lifeless again and pretentious, so I sought artificial

respiration from encounter groups, which were indigenous to the area. They
were held in people’s lush forest homes—on rugs, on straw mats, in
Japanese baths, at midnight. I enjoyed the milieu even more than the content.
Physicists, dancers, middle-aged people, boxers would show up with their
skills and problems. There would be stage lights and Bob Dylan coaching
from the corner of a hi-fi, you know something is happening, but you don’t
know what it is.

This form of theater with your soul auditioning appealed to me. There were
tears and screaming and laughter and silence—all energizing. Fear, real hits
on the back and friendships staggered up out of the midnight slime. Marriages
dissolved before your eyes; white collar jobs were slashed. I gladly signed
up for these judgment days and resurrections since I’d had nothing like it in
my life.

Sometimes you would only be brought down though, without any upward
sweep and salvation. You were supposed to be able to follow a certain ritual
rhythm and beat, from fear and panic to howling insight, confession and
acclamation. And if that failed you were supposed to be able to say, “Well,
I’m a schmuck, I’m hopeless, so what? I’m going to go on from there,” and
dance out your stomach cramps.

Eventually though I realized I was straddling two opposite salvations—the

impacted, solid, sluggish, constant, patient group therapy which was just like
my life; and the medieval carnivals of the mind and heart of the
psychodramas.

I knew Dr. Yalom disapproved of my encounters, especially one particular

group leader who was inspired and brilliant but with no credentials other
than magic. I never really chose my side but continued both forms of therapy,
diminishing all the while. Finally in group therapy I got to feel as though I
dragged my cocoon in, fastened it onto the chair each week, held on for an
hour and a half and left. Refusing to be born.

I was bloated from the many months of group therapy, but was making no
move to get out of the situation. My life was happy and yet as usual I felt
somewhat submerged and foggy. Through friends I’d met a boyfriend named
Karl who was intelligent and dynamic. He had his own book business, which
I helped him with, learning no skills but managing to ply him with my jokes
and getting stirred up inside. I was at first, however, not naturally attracted to
him, which worried me. There was something about his eyes that seemed a
little fierce and alien. But I enjoyed being with him even though I had some
doubts, because unlike my few other loves, Karl was not an immediate crush,
not someone I would have chosen from afar.

After a few terrific weeks of dalliance, we settled into a livable

nonchalance. One day, almost as an aside, he told me there was an apartment
he knew of where we could live together, and I moved from Mountain View
into the city. Karl once said, holding me, that I brought humanity into his life,
but he wasn’t given to many love declarations.

We began living together easily and enjoying ourselves. It was the beginning
of our life together and there were plenty of new green shoots—

movies, books, walks, talks, embraces, meals, making our friends mutual and
giving up some. I remember I had a physical around then at a free clinic and
they wrote: “A twenty-five-year-old, white female in excellent health.”
I had left psychodrama by then, and the group therapy was just a habit that I
dared not give up. I was waiting as usual to see what would happen in
therapy rather than choose my own fate. One day Dr. Yalom called and asked
if I would like to have private, free therapy with him on condition that we
would both write about it afterward. It was one of those wonderful calls
from out of the blue that I am susceptible to. I said yes, overjoyed.

When I began therapy as a private patient with Dr. Yalom, two years had
gone by since my first fertile interview with him. I had replaced acting with

tennis, looking for someone with being with someone, experiencing

loneliness to trying to recall it. Inside I had a feeling that I had skipped out on
my problems and that they would all be waiting for me at the ambush of night,
some night. The critics, such as my New York therapist, and loves, whom I
carried around with me would have said that there was hard work to be
done.

That I had succeeded too easily without deserving it, and that Karl, who had
started calling me “babe,” really didn’t know my name. I tried to get him to
call me by my name—Ginny—and whenever he did my life flowed.
Sometimes, though, in deference to my blond hair and nerves, he called me
the Golden Worrier.

Eighteen months of hibernation in group therapy had left me groggy and

soiled. I began private therapy with only vague anxieties.

The First Fall

(October 9–December 9)

October 9

DR. YALOM

GINNY appeared today in, what is for her, relatively good shape. Her
clothes have no patches on them, her hair has possibly been brushed, her face
seems less broken out and far more in focus. With some awkwardness, she
described how my suggestion to pay for sessions with write-ups rather than
money had given her a new lease on life. At first she had felt elated, but then
managed to undercut her optimism by making sarcastic jokes about herself to
other people.

When asked what kind of sarcastic jokes they were, she said I would
probably publish our write-ups under the title of “interviews with an
ambulatory catatonic patient” Wanting to clarify our arrangement, I assured
her that whatever we wrote would be joint property and if we published
anything, we would do it together. I told her it was premature and something
that I hadn’t really considered (a lie, since I have had flitting fantasies of
publishing this material some day).

Then I tried to focus things a bit, lest we wander endlessly in the haze so
characteristic of time with Ginny. What did she want to work on in therapy
with me? Where did she hope to “go”? She responded by describing her life
now as generally empty and meaningless; the most pressing problem is her
difficulty with sex. I urged her to be more explicit and she described how she
could never allow herself to let go just when she sensed she was at the point
of orgasm. The more she talked, the more she struck up chords within me of
some conversations I have recently had with Viktor Frankl (a prominent
existential analyst). She spends so much time thinking about sex when she is
in the midst of it, asking herself what she can do to bring herself off, that she
inhibits any possible spontaneity. I thought of ways I might help de-reflect her
and finally came out quite artlessly with, “if only there were some way you
could de-reflect yourself.” She reminded me of the centipede in a children’s
book who, when asked to watch the way he walks, can no longer manage his
hundred pairs of legs.

When I asked her what her day was like, Ginny talked about how empty time
was for her, beginning with the emptiness of writing in the morning, which

led into the emptiness of the rest of the day. I wondered with her why the
writing was so empty and what there was that gave her meaning in life. More
shades of Viktor Frankl! So often now recent readings or conversations with
other therapists creep into my therapy, which makes me feel like a chameleon
with no color of my own.
Later it happened again. I commented to her that her whole life was played
out against soft background music of self-abnegation. There was an echo of
what a Kleinian * analyst once told me years ago when I considered entering
analysis with him: that the analysis would be carried out against the
background music of my skepticism of his theoretic position.

In a thread-like voice Ginny continued to present herself as a person lacking

both propulsion and direction. She is drawn to emptiness like a magnet and
sucks it up and spits it out in front of me. One would think that nothing in her
life exists except nothingness. For example, she described sending some
stories to Mademoiselle and receiving an encouraging letter from the editor.
When I asked her when she had gotten the letter, she told me that it was only
a few days ago; I remarked that it could have happened years ago from the
apathetic tone of her voice. It’s the same when she speaks about Eve, a very
good friend, or Karl, her boyfriend with whom she lives. There is this little
demon within Ginny stealing the meaning and pleasure from everything she
does. At the same time she tends to observe herself and romanticize her
plight in a tragic way. She flirts, I think, with the vision of herself as a
Virginia Woolf who one day will fill her pockets with rocks and walk into
the ocean.

Her expectations from me are so unrealistic, she sees me in such an idealized

way that I feel discouraged, sometimes hopeless, of ever really making
contact with her. I wonder if I’m not exploiting her by asking her to write
these reports. Maybe I am. I rationalize it by saying that at least it forces her
to write, and I do feel strongly that after six months, when we exchange these
notes, something good will come of it. If nothing else, Ginny will have to
begin to see me in a different way.

October 9

GINNY

THERE must be a way to tell about the session other than repeating exactly
what happened and mesmerizing myself and you. I had built up expectations,

but I concentrated mostly on thinking of the change in time schedule. I started

and ended the session with that busy thought. Fussing and not feeling.
I felt like a dilettante in your office, at first. You were asking me what was on
the agenda, what I wanted to happen. I have a long history of not answering
or taking questions seriously. I never use my mind or cast it out further than
the present, except when I use it to fantasize. I don’t let it change or shape
reality, just comment on its passing. Your insistence, though, when you kept
repeating the question, “Well, what does it mean—your writing not going
anywhere?”

finally annoyed me. It was like a countdown in a fight. I knew I had to get up
at that point, and say something or it was all over. After three or four repeats
of that question, I said: “What I guess I feel is that it’s not the writing, it’s the
judgment thing in me that doesn’t go anywhere, that stays pointing to zero,
fluctuating slightly in either direction when there is applause or criticism.” I
never let on, when I was talking about Karl and me in such a grey voice, that
Sunday and Monday mornings had been lovely, with great tenderness and
playfulness. Why did I misrepresent myself? (My father’s favorite criticism:

“All your life you’ve downgraded yourself, Ginny.”) But why couldn’t I
come in and tell you some good things, especially since I know you like to
hear them?

When I was talking to you I was conscious of trying to remember what I had
said the time before. I wanted to be sure I didn’t repeat myself in this
session. At the end, though, I thought I had.

I didn’t want to go in and talk about sex since that always sounds so Ann
Landers and mature and impersonal. And besides, the importance of sex
happens with me not in the sometimes good, sometimes bad, act but the
reprisal the moment after. The occasion to hate myself and fear punishment
and recognition from someone else and try to cope with the full-length
darkness and conscience.

When you used the word “de-reflect” so calmly I liked that a lot.

(Afterwards I used the word in three jokes that day.) I took it to heart and
was glad you wanted more from me than descriptions and appearance.
Toward the end of the session, when I talked about Sandy, my old friend who
committed suicide, and my anger against parents who don’t listen to
psychiatrists unless something specific is prescribed, I was feeling anger
without being aware of it. When it was over I felt I was getting sad and quiet
and open. I felt a mild sensation, like pleasant nerves in a child dreaming of
sex.

Then you commented that the session was over. Whenever I sense that cue, I
begin to feel tentative again. The light that has been shining on me is about to
go out. The psychiatrist’s clumsy parliamentary procedure to get the patient
gone. “And would two o’clock be all right?” you asked, which it wasn’t, but
I couldn’t think firsthand. Only while going home did I have time to gnaw at
that problem and make it into a big production number of possibilities.

At the time I decided I wouldn’t try hard to write up these sessions, that I
would let the style develop as my perceptions and experiences did. I gave up
before I started writing this. I felt at the session like an exhausted person who
has been reading and reading because of habit, who has stared only at the
hard structure of print and not at the flight of words. Yesterday, like almost
always, I was so self-conscious, glued to my surface, superficial structure of
what I must say, what I must be. Reciting into a mirror. One mirror that
wouldn’t be bad luck if it were broken. (But those aren’t fighting words. Just
more yap.) You said you wanted to hear only what happened in our sessions.
At first that seemed limiting and then refreshing, because that cuts away the
overhang of dense foliage. And you wouldn’t read It for six months, which
means that the sessions won’t be a writing critique and there’ll be no
redeeming through words. And then later it dawned on me you had said “six”
months, which was a comforting six months’ guarantee.

October 14

DR. YALOM

THE SESSION was scheduled for 12:30. I saw Ginny in the waiting room at
12:25. I had something in my hand I wanted to give to my secretary, but it
really wasn’t important and I could have seen Ginny at 12:25. As things
worked out, I screwed around with something relatively unnecessary and
ended up taking her three minutes late. I can’t understand why I do this with
patients. Sometimes, no doubt, it is a measure of my own countertransference
and resistance. But not with Ginny, I enjoy seeing her.

She looked well today, with a neat skirt, blouse and tights, and her hair
almost brushed, but she was clearly very shaky and tremulous. For the first
twenty to twenty-five minutes of the session we floundered without my
knowing where the main thrust of the hour should go. It turned out that she
had an extremely bad time of it last night, with waves of anxiety coming
every ten

to fifteen minutes, and these tightly bound to past terrible feelings and
experiences, which seem to be the only things that give her a sense of
continuity and time.

I first fiddled around with the timing of her night anxiety spells, wondering
whether they were related to our sessions. There were three last week—one
occurred the night before and one after our last hour, but the third one was
somewhere in the middle of the week: so that didn’t take us very far. Dealing
with the ideational content of her anxiety spell was like walking on
quicksand. I stepped in too deeply, was sucked down, and spent most of the
hour trying to scramble out again, because it’s all primitive, early, boundless
material.

The next thing I tried was a happier choice. I simply became concrete and
precise. I said, “Let’s start from the beginning and really track down your day
yesterday and what happened last night.” I do this often with patients and
advise my students to try out this approach, since it rarely fails to provide
some foothold out of the mire of confusion. Well, Ginny went over her day—
she had gotten up feeling pretty good and wrote for an hour or two. Although
she tried to minimize her writing, she admitted that she had been more active
than usual, working presently on a novel. This makes me feel good; I take
special pride, too much pride, in her being able to work at writing. Then she
lay on her bed reading a book about female impotence written by a woman
psychiatrist, whom I don’t know, and becoming inundated with sexual
feelings, she masturbated.

And that was the beginning of her downfall for the day. Shortly afterwards
she went out to the post office, accidentally meeting Karl, and was overcome
with bad shameful, guilt feelings. Here she began to reproach herself in
characteristic fashion; if she hadn’t masturbated she could have saved it for
Karl that night or maybe she could have gotten him sexually right then, etc.,
etc. Things went from bad to worse—the meal she cooked was a failure; at
night when she was full of energy and wanted to go out, Karl was tired and
went to bed; she wanted him to make love to her, but he fell asleep; she
worried that maybe he was really rejecting her since he hasn’t made love for
two or three nights. She can’t bring herself to try and approach him.

She also talked about last Saturday when Karl had been busy with people all
morning and had walked by himself the rest of the day, not coming home until
8:30 at night, at which point she couldn’t even say that she would like to
walk with him sometimes. She just cried every time he came near her. I
began to wonder about her ambivalent feelings towards him especially when
she described her recurring fantasy that he would leave her and that she
would go

to Italy with her friend Eve, and write and drink chocolate. Well, all these
things together made me think that despite her pledges of selfless allegiance
to Karl, there’s a part of Ginny that wants to tear loose from him. But it
wasn’t easy to pursue this; perhaps this is something Ginny is unable to deal
with right now.

Maybe not—I must not let her “fragile flower” pose control me to a point of
impotent gentleness.

What I did do was to flood the room with Viktor Frankl. Now it happens that
I had been reading one of his books last night and thinking about him. It
always makes me disgusted with myself to read someone and then find
myself using his techniques in my next therapy session. Be that as it may, I
approached her as I think Frankl might have approached her, and I think I did
rather well.

The first thing I suggested to Ginny is the notion that she was born with
anxiety, that her mother and father are anxious, and that it is not
inconceivable to think she actually has a genetic source of anxiety, and
perhaps even of sexual tension.
I had a couple of things in mind. If Ginny has enough faith in me by now, I
could help remove some of her guilt about masturbation, and on several
occasions during the interview I went back again to the subject of
masturbation, wondering what on earth she felt so guilty about. When she
said things like,

“it’s weird” and “it’s dirty” and that she should be “saving it for Karl,” I told
her that what was really weird was her vomiting every morning because
some bio-energetic psychiatrist in the East had told her to do this as a means
of relieving tension! I told her I saw nothing wrong with masturbating; if she
has an excess of sexual tension, why not masturbate every day? This will not
necessarily take away something from her sex relations with Karl, but might
actually add to them, since she won’t be so anxious. I was actually trying to
do two things: symptom prescribing and relieving anxiety. I think it’s going to
be quite helpful, although I’m sure she’ll go on to another type of symptom
and concern.

The next thing I did was to point out to her that an inborn excess of anxiety
and sexual tension (which I described in rather specific terms, i.e., an
inability to metabolize adrenalin properly) is really not her core. She, Ginny,
is something much more than these extrinsic factors. I guess I was getting into
an examination of basic values. I asked her what it is in life that is really
important to her, what she really values, what she can stand for. I was
tempted to ask what types of things she would be willing to die for, but
fortunately refrained.

Well, she said some of the “right” things, to my point of view. She said she
really wanted to get “into the light,” “into the mainstream;” she deeply
treasures

her experience with Karl, and she ended by saying that her writing is very
important. Naturally, like a reflex, I pounced on this, at which point she
immediately called her writing “frivolous,” adding that she knew I would say
it wasn’t. I followed suit and said, “It isn’t frivolous.” She laughed. I
continued with the comments that no one else can do her writing for her, that
it is something she alone can do, and that it’s important, even if no one else
ever reads it. She seemed to buy that, and that was about the end of the hour. I
was being somewhat authoritarian, but I think that I’ve got to be with Ginny. I
like her very much. I want to help her very badly. It’s hard to believe
sometimes that a poor tragic lilting little soul like this really exists and
suffers so much.

October 14

GINNY

THE SESSION was very important for me. I think I managed to talk and think
and feel through my tears. Not just cry and be done with it. I could keep more
to the point, and not let sarcasm or charm get the upper hand. I reached a kind
of balance.

I didn’t use the therapy to take away my feelings. I felt less strained at the
end. I still appreciate that you talk and tell me things. I don’t feel like I’m in
the room alone. If I were, I’d get confused and wander. When you said that
all people masturbate, I burnt with shame because I thought you might be
telling me something about yourself. I couldn’t look at you. I pretend that
everyone is structured and you can’t see people’s lives in private, only mine,
which is transparent.

I think the session helped me use the tension I had and have to some good use
and understanding.

I wonder why I always seem to place my men in a bad light, though. In

retelling incidents, I know you get a one-sided view. It troubles me that I’m
unfair and somehow I’ll be punished.

I make it seem that Karl and I are like a frog and its insect in a school
aquarium—so tight; when actually there’s a lot more loose, good time
between us than I let on. I guess I concentrate on the bad times because they
are so annihilating.

As far as abstaining goes, I live by that. “I won’t do this and maybe that will
happen.” I sort of have a checking account in my head, where I always have
to

be in debt to come out ahead.

After the session I felt centered; less awkward. I could give in to at least
three impulses—to eat, to sit in the cactus grove near Stanford’s grave, and to
take deep breaths of the plants and trees.

When you told me I looked better, I felt bad that I didn’t tell you how nice
you looked in your landscape conglomeration of russet suit and various
colored stripes coming from everywhere like rain. I withhold things.

Now whether I’ll try the things you told me, I don’t know. ! know they’ll
depress me at first and punish me temporarily. And they’ll depress me
because they are happening in my life, with me privately. That’s the reason
abandonment scares me so much. I’m afraid of being abandoned by other
people, since I long ago abandoned myself. So there’s no one there when I’m
alone. I am so camouflaged by my experience and you are asking me to
accept some part of myself (nervousness) and go on from there.

October 21

DR. YALOM

BETTER TODAY. What was better? I was better. In fact I was very good
today. It’s almost as though I am performing in front of an audience. The
audience that will read this. No, I guess that isn’t completely true—now I’m
doing the very thing I accuse Ginny of doing, which is to negate the positive
aspects of myself. I was being good for Ginny today. I worked hard and I
helped her get at some things, although I wonder if I wasn’t just trying to
impress her, trying to make her fall in love with me. Good Lord! Will I never
be free of that? No it’s still there, I have to keep an eye on it—the third eye,
the third ear. What do I want her to love me for? It’s not sexual —Ginny
doesn’t stir sexual feelings in me—no that’s not completely true—she does,
but that’s not really important. Is it that I want to be known by Ginny as the
person who cultivated her talent? There is some of that. At one point I caught
myself hoping that she would notice that some of the books in my bookcases
were nonpsychiatric ones, O’Neill plays, Dostoevsky. Christ, what a cross to
bear!

The ludicrousness of it. Here I am trying to help Ginny with survival

problems and I’m still burdened down with my own petty vanities.
Think of Ginny—how was she? Pretty sloppy today. Her hair uncombed, not
even a straight part, worn-out jeans, shirt patched in a couple of places. She

started off by telling me what a bad night she had had last week when she
was unable to achieve orgasm, and then couldn’t sleep the entire night
because she feared rejection from Karl. And then she started to go back to the
image of herself as the same body of a little girl who used to lie awake all
night when she was in junior high school, hearing the same bird crying at
three in the morning, and suddenly there I was again with Ginny, back in a
hazy, clouded, mystical magical world. How fetching it all is, how much I
would like to stroll around in that pleasant mist for awhile, but . . .
contraindicated. That would really be selfish of me. So, I tackled the
problem. We went back to the sexual act with her boyfriend and talked about
some obvious factors that prevent her from reaching orgasm. For example,
there are some clear things that Karl could do to help arouse her to reach
climax, but she is unable to ask him, and then we went into her inability to
ask. It was all so obvious that I almost feel Ginny was doing it on purpose to
allow me to demonstrate how perceptive and helpful I can be.

So, too, with the next problem. She described how she had met two friends
on the street and how she had made, as usual, a fool of herself. I analyzed that
with her, and we got into some areas that perhaps Ginny hadn’t quite
expected.

She behaved with them in a chance meeting on the street in such a way, she
says, as to leave them walking away saying, “Poor pathetic Ginny.” So I
asked,

“What could you have said that would have made them feel you were rather
hearty?” In fact, I proved to her there were some constructive things she
could have mentioned. She’s trying out for an improvisational acting group,
she has done some writing, she has a boyfriend, she spent an interesting
summer in the country, but she can never say anything positive about herself
since it would, not call forth the response, “Poor pathetic Ginny,” and there
is a strong part of her that wants just that reaction.

She does the same thing with me in the session, as I pointed out to her. For
example, she had never really conveyed to me the fact that she is good
enough to work with a professional acting troupe. Her self-effacing behavior
is a pretty pervasive theme, going back to her behavior in the group. I
shocked her a bit by telling her that she looked intentionally like a slob, that
some day I’d like to see her looking nice, even to the extent of putting a comb
through her hair. I tried to de-reflect her self-indulgent inner gaze by
suggesting that maybe her core isn’t in the midst of her vast inner emptiness,
that maybe her core is as much outside of herself, even with other people. I
also pointed out to her that although it is necessary for her to look inside to
write, sheer introspection without writing or some other form of creation is
often a barren exercise. She did say that she has

done considerably more writing during the last week. That makes me very
happy. It may be that she is just giving me a gift, something to keep me
anticipating improvement.

I tried to get her to discuss her notion of my expectations for her, since this is
a genuine blind spot for me. I suspect I have great expectations for Ginny; am
I really exploiting her writing talent so that she will produce something for
me?

How much of my asking her to write instead of paying is sheer altruism?

How much is selfish? I want to keep urging her to talk about what she thinks
I’m expecting of her; I must keep this in focus—the Almighty God

“Countertransference”—the more I worship it the less I give to Ginny. What I

must not do is try to fill her sense of inner void with my own Pygmalion
expectations.

She’s a fetching, likeable soul, Ginny is. Though a doctor’s dilemma. The
more I like her as she is, the harder it will be for her to change; yet for
change to occur, I have to show her that I like her, and at the same time
convey the message that I also want her to change.

October 21

GINNY

(handed in three weeks later)

SOMETHING might happen if I were more natural looking. So I left my
glasses on. Something might not happen though.

I spoke about that bad Tuesday night which turned out to have had a bad
Tuesday beginning. The idea of a hearty, robust me, which you suggested and
asked for, was very encouraging. My usual register of “success” is how much
I have been released and done difficult things, like crying or thinking straight
without fantasizing. And you pushed me in that direction.

I had fun at the session and before that could disturb me I enjoyed the
sensation, the buoyancy. I seemed to see alternatives to my way of acting.
This lasted even when I went on the campus afterwards. Though during the
session and later I was obviously questioning this optimistic feeling. Surely
happiness must be harder? Could I end it as a hearty wench?

I was looking at your way of treating me, like an adult. I wonder if you think I
am pathetic or, if not, a hypocrite, or just an old magazine that you read

in a doctor’s office. Your methods are very comforting and absurd. You still
seem to think that you can ask me questions that I will answer helpfully or
with insight. You treat me with interest.

I think during the session that I am bragging, trying to show myself off good. I
am dropping little self-indulgent hints and facts, like me being pretty (a real
static fact), like the acting group, like the good sentence I wrote (treading
water in front of your face). I know these are a waste of time since they don’t
do me any good and are things that go through my head every day with or
without you. Even when you say, “I don’t quite understand,” that is a kind of
flattery to my worst old habits of being elusive in word and deed. And inside
me I don’t understand either. God knows I know the difference between the
things I say and the things I feel. And my sayings are not satisfying most
times.

The few times in therapy when I react in a fashion not predestined by my

mind, I feel alive in an eternal way.

So yesterday’s experience was strange. I usually distrust the things that are
said. Parent pep talk. I give it to myself regularly.
But I didn’t feel down when the session was over, or let down. It was funny
to hear you talk about my hair and dress. Kind of like my father but not quite.

Of course maybe you think Franny * dressed good. To me she looked

attractive but always seemed an arm’s length away. I look like a badly bent
hanger with the clothes slipping off. I like to look heroic, like I’ve just done
something.

Though I wish I didn’t have such an uncanny burlesque instinct in dressing.

Sometimes I try and still look schleppy.

The night after the session I couldn’t sleep at all. There was such a rush of
blood in my chest and stomach and I could feel my heart beating all night.
Was it because there was no release in the session or that I couldn’t wait for
a new day to begin? I was raring to go. I am saying this now cause I don’t
want to say it in the next session.

I think it is wrong in therapy for me to be too self-conscious, to say things

like, “I am feeling something in my leg.” Those are probably cheap asides
left over from sensory awareness afternoons, that stop the direction you are
heading me in. You must get sick of them, infliction, indulgence.

It was funny when you said I couldn’t make a career out of schizophrenia.

(I still think catatonia is right up my sleeve.) In a sense this takes away a lot
of the romance I have been flirting with. I feel awkward and lacking and
can’t connect in social situations. There must be another way. With Dr. M.
——* I think he thought the things I said were “far-out,” weird, and that they
should be

recorded for their nuances. I think you know they’re shit. I was always
watching him write down things. I’m not aware of your face too much except
that it seems to be sitting over there waiting for something. And you seem to
have a lot of patience. I don’t like to look at your face cause I know I haven’t
said anything. If it did light up at the wrong places, I’d begin to distrust you.
In these first few sessions I think I can be as bad as I want, so later the
transition will seem lovely.

November 4

DR. YALOM

A FAINT metallic taste in my mouth after the interview. Not totally satisfied.

Subdued, that’s the word for it. Ginny came in apologizing for not having her
description of the previous week’s meeting. She said that she had written it
but hadn’t typed it up the night before. When I questioned her more
specifically, she said she was going to type it, but it had so many
embarrassing things concerning masturbation that she didn’t want to type it
around Karl. I asked her whether she usually waits so long to type up what
she’s written. She said no, she usually does it the next day or two, but she
knew she wasn’t going to see me for two weeks. All the while, of course, I’m
wondering what it meant to her not to have seen me last week, how much
resentment or disappointment there was. It does seem odd that she has had a
two-week interval and brings in no write-up, whereas previously she never
failed to prepare her report. I am sure that at some level she is pouting and
attempting to punish me.

Then the next thing she says tends to confirm my suspicions. She had seen me
on Union Street in San Francisco with a woman. I said that was my wife,
which she seems to have taken for granted; she added that the woman looked
so young and pretty and that we seemed so happy together and that she
(Ginny) had a good feeling about it. She also wondered whether that was the
reason I hadn’t seen her last week—whether I had just simply decided to
spend the week with my wife. How did she feel about that? “Very good.” I
had my doubts!

I asked her whether or not she changes what she writes when she types it up.
She states that she does sometimes. For example, the previous week she took
out something that sounded like active flirtation with me because she was
subsequently embarrassed at having written it. So the whole first part of the
session was a subdued, even embarrassed interchange. I asked her at one
point quite frankly whether or not she could discuss the subterranean part of
the session, thinking that we could get at her unstated feelings. But she
refused to nibble, and instead insisted that there really was nothing else she
hadn’t talked about. Things have gone so well, relatively speaking, that she
can’t specify a single problem.

And indeed they seem to have gone well; the waking up at night with terror
seems to have subsided; she took the pill I gave her after the last session,
which broke the cycle, although she was careful to let me know the pill
wasn’t entirely successful, since she had a real drowsy depressed hangover
following it. To tell the truth, I forgot to write down exactly what medication
I had given her: I remember only that it was a very mild tranquilizer, which
should not have produced such strong sedative effects. But she has been
writing, she has been active. She started to reel off a list of activities:
German lessons twice a week, yoga, giving several dinner parties, dancing
class. It does seem that she has been making some real strides. She is also
grateful to me for having talked to her about masturbation; since that
discussion she had had a sense of liberation and masturbated without feeling
guilty or without fixating on the subject the rest of the day.

I was really impressed with how pretty she looked today. I have the chairs at
a Sullivanian ninety degree angle and was looking at her more in profile.
There have been times before, especially in the group, when I considered
Ginny rather homely, and yet today I saw her as quite lovely.

Almost desperately attempting to provide me with an offering, she

volunteered a couple of dreams. We languished in them for a few minutes,
one of them presenting some pretty clear Oedipal components: a dream in
which she was lying in bed and a man came in with a silver cigar for a penis.
The associations to this had to do with her lying awake at night when she was
young, listening to the sounds of a mattress squeaking which meant that her
parents were having intercourse, and then an episode when she was twenty-
one when she hurt her father by saying that her mother had once told her that
sex wasn’t always everything in life. There is abundant evidence of a desire
to split her parents, to get between them, but it’s folly for me to get into this
with Ginny. Reconstruction of the past, interpretations, clarifications of this
sort are not going to be helpful for Ginny. Visiting the past with her is a
beguiling, charming voyage; but she knows the terrain far too well—it never
fails to transport her away from today and from the benefit which I know will
come

from our understanding everything that happens between the two of us. So I
switched the subject to the present.

She has been preoccupied with the fantasy that Karl will leave her,
whereupon she’ll go into a cabin in the woods and gradually become more
mature. She exclaimed that this is horrible because it must mean that she
wants Karl to leave her, but I pointed out that the fantasy has some redeeming
features in that it is life-oriented and does offer the hope that she won’t be
extinguished if Karl were to leave. I used some paradoxical intention by
suggesting that she deliberately force this fantasy to appear whenever Karl
comes home late, and give it at least five minutes’ trial. The same thing with
sexual relations: she states that she hears this little voice inside of her telling
her that she’s not really there, that she’s separate, not really joined to Karl,
that “this really isn’t it,” and then at the end of the act, it chastizes her for not
having experienced enough. I suggested that she actively take the part of this
voice, call it up as it were, in order to control it so that it doesn’t control her.
I do this in the hope that she will eventually see that it’s nothing that happens
to her, but it’s something that she causes to happen.

Toward the end of the session she quoted something from Alexander Pope
about a woman who seems similar to herself and she doesn’t want to be like
that. Having not read Pope for fifteen or twenty years, I found myself wishing
that she would mention writers I’m more familiar with so I could have
responded with more savvy and more ease. I think this also reflects some
feelings of tension that I have about tomorrow’s presentation at the Modern
Thought seminar where my interest in literature is vastly exceeded by glaring
gaps in knowledge.

November 4

GINNY
I WAS pretty nervous yesterday. I just grabbed at straws, thinking of
something to say, that’s how seeing you that day with your wife came up. I
was inside the car with Eve discussing The Freedom of Sexual Surrender, a
book which discredits clitoral orgasm as something that doesn’t happen in a
mature woman’s body. So in the middle of this sexual talk, you and your wife
crossed the crosswalk in front of us, like a stunt in a T.V. comedy.

I saw that what I do is pretend that some part of me is doing what actually I
am doing. For instance, the last five minutes, that “part of me” happened to
look at your open pants and imagine that I saw something. I was immediately
embarrassed,, and started talking about something different. You immediately
crossed your legs. And I had divided myself because I had done something
that

“I,” as I am known, don’t do. And I goad myself into it because I know it
breaks my concentration and progress. It’s like doodling with your mind.

I always like it when you give me directives. I become much more aware of
my behavior, not as something magical, but just as behavior. Last night I
became aware of how the fear starts. I think of something, I hold my breath to
listen, that hurts my stomach, makes me feel like I’m in an elevator and can’t
get off. And before I know it, I’m on an unlucky floor.

The session made me very nervous, more nervous than when I went in.

November 12

DR. YALOM

AN ODD sort of session. I didn’t think I’d be much good for anything since I
had only two hours sleep last night. I stayed at a friend’s home on the ocean,
and the strangeness of sleeping outside and the pounding of the waves had
kept me up all night. I thought then how ironic it was that I should be seeing
Ginny the next day since she has often come in with complaints of being
unable to sleep. My being awake last night was different in that it was a
comfortable state of wakefulness and I enjoyed watching and hearing the
ocean and reading Kazantzakis, but I’ve had those other kinds of night too.
Never do I feel more like a fraud than when after a sleepless, anxious night I
counsel some poor insomniac who in truth slept more hours than I. But who
would follow a general who on the eve of battle walked around wringing his
hands? I didn’t cancel the hour because I felt functional today and during the
session was hardly aware of my state of fatigue.

I was approximately ten minutes late, though, and to help stay awake brought
a cup of coffee into my office, which is unusual. I did offer her one, which
she refused with embarrassment. She began by talking about her envy of her
younger sister, who is now visiting. She sees her sister as so much more
decisive, more “committed” than she, for example, in choosing to live with
someone. I tried to help her understand the fact that this is only an attitudinal

posture; I asked her whether or not it meant that her sister really did have
more of a sense of commitment and wondered with her whether it meant only
that her sister could overlook some of the negative feelings she had about a
situation, or perhaps even engage in self-deception about some of her
conflicting feelings.

What’s to be envied about such “positiveness"? She heartily agreed that this
was so.

I then went on to talk with her about the little imp inside that strips all
pleasure from every one of her endeavors, stops her from enjoying sex,
enjoying her trip to Europe, from enjoying life. This is it, her one and only
life.

No rainchecks, no replays when she is feeling better. “Ginny, you’re going

through life right now and can’t postpone it till another time.” I’m not sure
how helpful that tact was. Wasn’t I being overly pedantic?

The other major theme was her anger or rather her lack of anger in infuriating
situations. For example, she talked about her relationship to her landlady
who is so maddening, so flighty that she drives everyone crazy.

Ginny’s response to this woman is only to “feel more dead inside” and to
make a greater effort to be nice to her. We worked on how a feeling of anger
or annoyance toward the other person can somehow get converted into a
sense of personal deadness. Later in the discussion I was afraid that she
interpreted my comments as a suggestion not to be nice to people and to let
all her angry feelings out, whereupon I reassured her that she shouldn’t feel
ashamed of being “nice” or generous—these are genuine traits which don’t
have to be reduced to something else, but it is necessary for her to understand
her true feelings in these situations. She went on to say that when she engages
in generous or altruistic acts, she always manages somehow to turn them into
vices, and I in effect told her to stop this Freudian reductionism and accept
generosity or gentleness as positive and important truths about herself which
stand by themselves and don’t require further analysis.

She doesn’t talk much about her feelings toward me. She felt tense today and
uneasy. Whenever I asked what she was feeling at a specific moment, she
always came up with an abstract generalization about the course of her life,
without dipping into the vast subterra nean pool of emotions underlying each
of our interviews. When I asked specifically about this, she said much that is
unstated emerges when she reflects back upon the sessions while writing her
reports. She mentioned several times in an offhand fashion that it takes much
of the day to prepare herself for the meeting with me. She had a two-hour
wait for a bus to get back to San Francisco so that it’s really an entire day’s
affair, and

she is very anxious lest she not use the time constructively. At the same time I
think that the relationship between us is a very solid one. I find myself very
peaceful and warm when I’m with Ginny. She’s a remarkable person,
remarkable not only in her capacity for anguish, but in her sensitivity and
beauty.

November 19

DR. YALOM

GINNY dressed in patched jeans and appearing particularly Ginny-gentle

and Ginny-fragile. Speaking softly, she confessed that she didn’t have her
write-up of last week—she hadn’t written it till five days after our last
session, hadn’t typed it up yet, and there is even a possibility that she had lost
it. I felt this was terribly important and that we were going to have to spend a
great deal of time on the subject. She dug in her heels and wouldn’t budge.
She had no ideas or associations to the issue when I brought it up. I got a bit
stronger each time around, stating, that, for example, it is highly unlikely that
she should suddenly forget her assignment; why is it now that five days pass
between her session and her review of it, whereas previously she wrote it
the day after? When she responded that she is lazy, I pushed her further and
asked why she is lazy now.

But nothing came of my question. I felt strongly she wasn’t going to be able to
talk about anything else and so it was. She stumbled about trying to find some
other issues, without success. At the very beginning of the session she had
mentioned that she had gotten into a quarrel with Karl about psychiatrists,
since he thinks psychiatrists are really unnecessary and unhelpful. I
wondered aloud whether or not she was feeling that she had to choose
between Karl and me.

This too got nowhere. A bit impatient with her, I let her wallow in her
helplessness for awhile.

Perhaps the turning point, as I look back on it, appeared when I said
cryptically, “There is no magic after all.” Ginny asked what I meant, but I
knew she knew, and she agreed that she knew even after she asked the
question. I meant that there was no magic after all in my taking her out of the
group and seeing her individually, that nothing was really going to happen
until she made something happen. She felt a little alarmed at that and
wondered whether I took her out of the group on purpose in order to show
her that there was no hope for

her outside of herself. I assured her, of course, that this wasn’t the case, but
that there is indeed no hope for her unless she moves from within.

For the rest of the interview I tried to push her more and more into a
discussion of her and me. At one point she said that I looked something like a
man she had recently seen in a film who was an old letch. When I asked
about sexual feelings she may have had toward me, I received no leads. I
then began asking her how she wanted me to see her, how much she had to
screen her statements because of what she expected I would feel about them.
She stated that she only wanted me to know she was trying to get well. But
wasn’t she nonetheless deceiving both of us, since she admitted that she
wasn’t trying much of the time?
Only later on in the interview was she able to talk about wanting to be a
woman in front of me (as she sat there like a child), that she wanted to appear
attractive to me, yet nevertheless she wore these dungarees today because
she wasn’t feeling well last night and wanted to sleep on the bus. (She had a
migraine headache last night, the second migraine immediately prior to a
visit with me). I was quite rough with her today. For example, I made it clear
that although she says she wants to please me, she deliberately did something
designed to displease me, i.e., not bringing in the written material. I again
pointed out, and this time it finally seemed to take, that there was something
behind her not writing which was probably connected to her feelings toward
me; it was striking that at the same time she stopped writing, she also stopped
talking in the sessions. I also decided to help her test reality by pointing out
that writing a summary of the previous interview is not optional—that’s part
of an adult (thought I didn’t use this word) contract she has made. What was
unstated was the implicit threat, which I am perfectly serious about, that I
will not see her without her keeping this part of the contract. She seemed a
bit subdued by this, said she felt like a young student in front of a substitute
teacher.

Later when discussing her attractiveness as a woman, she expressed some

bad feelings about her body, especially about her elongated labia, which
makes her feel ugly and unlike a woman. I suspect this is the analogue of men
feeling they have penises which are small. Since she has never, in fact,
compared this area of her body with anyone else’s and secretly uses this to
feed her negative image of herself, I jestingly asked her who she’s ever
checked it out with.

Then I asked if she felt she was now pleasing me more. She said that she
was. I asked her when it began. She started to cry, uttering through the tears
that it was as though she had to talk about unpleasant parts of herself to
please me

and herself. That wasn’t the way I felt and told her so. I am pleased when she
is simply more honest with her feelings and stops resisting and denying
issues. It makes little difference to me whether or not these are intrinsically
unpleasant or pleasant subjects as long as she’s being honest. She seemed to
hear that, and we ended up on a closer and more harmonious note, I think,
though the hour was an unsettling one for her. I tried to reassure her
somewhat by reminding her that next Wednesday is the day before
Thanksgiving, but that I will be here if she is planning to come. I guess what I
was really saying is, “I do care about you and I’ll be here, even though it’s
practically a holiday.”

November 19

GINNY

AS I was coming up on the bus I said “unfocused” and that became the cue
word for the morning. Three-fourths of the session that’s how I felt. So as not
to appear stupid or boring I had to concentrate on what I was doing. Even
though you are seeing it simultaneously I have to say things like “I’m talking
into my nails, mumbling.” I have to say things inside me first. Kind of sharing
the observation with you so as not to leave you out completely. The part I
brought you of me doesn’t really touch deeply, even though I can mumble
about it for forty minutes. It is like going to the zoo and looking at an animal
but really only focusing on the cage. You can’t see the animal for the cage.

As for telling you that you looked like Don Lopez of Tristana, I said that to
Karl first as a kind of crack joke about you. Having fun at your expense. But
it really wasn’t a bad thing in my eyes. I would like to be able to induce such
a dream where you could take an active role.

I first started feeling real in the session when I said I felt sad because I knew
I was disappointing you. I never felt like 1 was disappointing you in the
group since I didn’t think you were expecting anything in particular. There
were so many other mute faces. You seemed more imaginary than you do
now. Then I started talking, saying things that could either be put in the
“sexual category” or the “bad things.” But as I was saying them I saw that I
was bundled up inside this wrapping, these leggings, this smile of a little
girl. I think it’s always when I feel this presence inside me that I start to cry. I
feel like I have to drag this pitiful, but real, kid around in me. And the most
important question was when you asked me, “Do you think of yourself as a
woman?” I knew, “No, no.”
That’s why there’s always a certain amount of gameiness and flirtation, but it
is more me flirting with a woman’s identity. I can’t really be violated. Not a
woman seduced by a man. The landlady and I in our fights are not two
women.

It’s a crank and a little girl who has done something wrong and wants to get
on the good side of life.

Then you said, “Have you pleased me?” I knew I had but when we started
analyzing it, that brought the other part of me back, that unreal equal I feel I
have to be. I just want to be bundled up and rocked by you. I think I got off
the track. That’s when I agreed with the categories. I hate to look back over
my shoulder like that and I always do. You ask for it. You prompt me into
analyzing sensations, whereas I just want to have them. But before, while I
was talking, I had pleasurable feelings. A relief to talk, not to have to keep
up such a face. Of course my melodramatic, sarcastic agent was booking me
up on the sideline, with the title “Queer.” Kind of to taunt me out of my
feelings and to change the subject.

So then I said, “It will be so awful, the thoughts that will come out.” I didn’t
mean that I was trying to pacify and agree with the sarcastic part. Actually I
felt grateful. It didn’t seem like facts I was telling, just feelings.

I also felt a progression. Like I didn’t want to start from nothing next session.
Didn’t want to end the session, either.

That dream of the pulled flesh was one of the rare sexual dreams where flesh
is actually involved. The people around me who were pulling my flesh down
were doctors. I concentrated on the session for the forty minutes after, when I
sat on the grass and wrote this. But after that I did practical things that I
thought might help me. I was aware of pleasurable thoughts this week,
moments with Karl that seemed real without tears. Also, I was aware of that
feeling that is not a feeling, but a suspension. Like before I know I have to
write and don’t, before I know I have to type this and don’t, before I know I
should be thinking of this and don’t. That a great part of my time is spent in
holding back. Just like I do in the session, an imperfect replica of life.

November 25
DR. YALOM

A FLUID and close encounter with Ginny today. It should have been bad but I
worked hard and well, and Ginny was willing to stretch herself. A migraine

headache, she says; it started yesterday. Another one, I said. I think that’s
several occurring the day before seeing me, and also those night panics the
day before our sessions. I inquire about this, gently of course. She plays
dumb. I ask again, in fact I ask several times. She plays very elusive, she
doesn’t know what I mean. She answers each of my questions concerning her
feeling about seeing me without using the pronoun “you.” This makes me
even more convinced that she’s avoiding me. I’m surprised. We know each
other so well, now, it’s been two years, and it surprises me to rediscover that
she still can’t talk about me and even has to evade thinking about me. She
comes up with the reason that if she talks about me, this will make it even
harder for her to relate to Karl. That’s magic, I think, and say so, as if giving
voice to thoughts makes them a reality.

She nods and talks a bit more. I bluntly comment upon her inability to
address me as “you” and wonder about my role in her fantasies. There, she
stretches a bit and gently opens the door. She reveals that she has had a
fantasy of writing a story, earning $300 for it and buying me a gift. I try to
push her into the fantasy, asking what the gift was. She can’t remember. I ask
her why she wanted to give me a gift. She says, to repay my faith in her.
Therefore, it had to be in writing a story. I wonder what else it means to her
to give me a gift.

At this point I am coyly inviting her to say something loving. She can’t. She
says it reminds her of having given a gift to a teacher, but you usually give a
teacher a present only at the end of term. I become braver and wonder aloud,

“Isn’t it possible to give a teacher a gift because you like him?” At this point
she makes the connection and says disarmingly, “Well, you know I like you.”
I maintain my composure: “You say that so easily now!” I remind her that she
has eschewed that admission ever since we have known each other.
Moreover, liking is not undimensional—liking me must have a considerable
number of facets, and yet she cannot express any of them. She listens. She
opens up a bit more and talks about how she liked me last year when I was
leading the group and how she would silently cheer for me, if I were to say
something that would help some of the other patients, only this year it’s
different because she is the patient and it’s hard to be subject and observer at
the same time. Silence. I ask her where her thoughts are. She flits away and
says she had started to think about her old boyfriend, Pete. I let her go.

We talked about Pete and she tells me how he had just called her minutes
before Karl walked through the door, how she told Pete she had to hang up
and then felt guilty for it and called him back in twenty minutes and was
obsessed with all the bad things that she had done. I went over each of the
bad things, as

I have in the past with other events, indicating to her on each occassion how
she hyper-analyzes. Why can’t she stop sometimes with a sheer good feeling
or sense of altruism without always turning it into a vice? In fact she did care
about Pete, she gave him what she could, she was happy the next day when
she learned that he had made a new girlfriend. In each case she turns it
against herself by saying that she didn’t care enough or that she didn’t give
enough, or it was for her own interest that she tried to do something fine for
him. The self-destructive alchemist inside of her changes everything from
good to evil. I tried to underscore this by pointing out that she has been rather
magnanimous in her feelings toward him, and, of course, I stumbled, as I
always do, over the word

“magnanimous!” She responded by stumbling over the word “fecund,” which

was the last thing she said: “It will be a fecund week.” We moved today, as
we usually do, when I can open her up about her feelings toward me.

November 25

GINNY

THE THING about a migraine is you can’t have anything ruffle your balance.

That is the posture I’ve taken in sessions. Inside I think I want myself to be
changed radically—no vestige or shred or smile to remain. So when you try
to salvage some of my ways of doing things, showing they’re not all bad, it’s
sort of comforting. But the remnant doesn’t mean too much. I feel sarcastic
about your praise.

When I used to be religious, God was a kind of catalyst between me and my

relations with the world. I would give up so much for things to go good in the
outside world. In this way I bargained off years of life, said I wouldn’t care
if I never had a boyfriend and never got married, so long as my parents
would stay alive. I, on my part, was never as good as I promised, but in the
sloppy interchange between me and God, things worked out on His part, even
though I fell short.

I would do anything just to keep myself in a relationship. Even though I might

be totally camouflaged, so the other person doesn’t know I’m there.

That’s what I do with you, I think. Try to measure up, but I don’t want to
disturb you or myself. And I know I’m not supposed to entertain you—so
somewhere in between I sit. I am sort of sustaining the exhibit, not smashing
it or finishing it.

When I talked about Pete and you said, “Why do you have to get to the bad
side?” That’s like saying that a person would be pretty if her nose hadn’t
grown that extra inch. If I try deliberately stopping after a single thought
before it becomes fetid and heavy, I’d be aware that I was doing it. Vicious
circles are my natural train of thought.

I know I want too much attention, undivided attention. But just a physical
proximity, not too much in-depth attention.

I am very on guard in session now. I know you want me to probe my feelings

toward you, and because they are not just bubbling out of my mind and face, I
feel silly digging for them. I have always been honest, I thought, in saying
what I am thinking, but all I’ve really been is the top part of the flower, and
never crawled under the dirt and exposed roots. My sincerity is pretty and
probably superficial.

I feel in everything I must hold back, and when I do it, as my emotions and
me are receding from view (it inevitably leads to that) I am the first to
censure.
And there are so many words of censure, I watch my actions, justify them. I
see that I am not rewarded. And that is right.

These words don’t pertain to any particular incident. They are just a view
that I am stuck with. It’s why I sometimes can’t concentrate on particular
incidents.

December 2

DR. YALOM

I FELT very alert, eager to see Ginny, eager to make contact with her today.
She came in and handed me what she had written from last week. As I put it
down on the desk, I saw her eyes watching me. She looked as though she
were feeling something, and I said to her, “Go ahead and say it.” She
couldn’t say it.

She said there was nothing. Then she said that she had just rewritten the
report this morning because it was all in scraps of paper. I asked her how
long she had taken to write it. She said she had spent about a half hour on it,
but then hastily added, “That’s all I spend on anything.” I wondered whether
this was an apology. She denied that, saying she never spends more time
writing anything, that she never thinks about what she writes, but that the
words just flow from her.

The official start of the hour. A complaint. Things aren’t good with Karl,
sexually. Then she combined this grievance with another —it had been like
this ever since I had given her those pills. She couldn’t elaborate. I got the
feeling that there was a not-so-hidden accusation against me in her statement,
but no further traces of that were visible during the hour.

She had written well the day before: two good solid hours of work producing
ten pages, but then she felt so sloppy and bad inside the rest of the day. I
spent a while trying to investigate that statement, wondering if we could
rationally reexamine her feelings. She could immediately see the fallacy of
her value judgment. I asked her what she meant by “sloppy?” My theory was
that she at least spends the rest of the day generating ideas for the next
morning’s writing, so that anything she did the rest of the day could be
construed as useful. She wouldn’t accept that, insisting that mornings and
afternoons are completely compartmentalized—nothing feeds into the
morning after except an occasional dream. Oh yes, there was a dream of a
big woman with big breasts and a big penis, she was lying on top of this
woman and that scared her a good bit. She mentioned the dream a couple of
times. She wanted to work on it, I didn’t. If I fall into Ginny’s
phantasmagorical dream world, I lose touch with the flesh and blood person,
and we both lose touch with what’s happening between the two of us, and it’s
on the thread of what’s passing between us that I think everything depends.
So I didn’t bite at the dream-bait and instead returned to her feelings of
sloppiness. From there we went into an endless cycle of her feeling sad, of
her feeling that she lets everyone down, that nothing she has is worthwhile. It
soon became clear, as I have said to her many times before, that all of her
experiences are filtered through that background music of self-deprecation
with the constant refrain, “I’m not worth anything, I don’t deserve anything,
I’m bad.”

I tried another reasonable tact. How come, I wonder with her, many people
like you, many people find something of value in you? Could it be that their
judgment of you is better than yours? She doesn’t answer, but I know what
she is thinking. “They don’t really know me; nobody can perceive the
emptiness inside of me.” She talks of her inability to continue anything. For
example, she went through the motions of coming to the group, but was
passive within it for a whole year. She only pretends to live and to give. She
does the same with Karl. I wonder aloud why Karl chooses to spend his life
with her. She undercuts herself again by claiming that she puts on a show for
him.

Then I give her the loaded question. “Why do I see you? Why do I continue to
see you?” She seems flustered and says she doesn’t know, and is near tears.

She talks about not being able to give me anything, that she desperately wants
to be able to walk out of here improved, no longer desperate and hopeless.
She doesn’t know how to do it. I want to say to her that obviously I’m
continuing to see her because I see something of value in her. I don’t say that
explicitly but it comes out implicitly. She says she can’t even look at me. I
ask her to look at me and she does and suddenly I become aware of the fact
that she hasn’t really looked at me for any length of time before. So we look
at each other’s eyes for awhile in the session today.

She says she suddenly feels dizzy and nauseated and very tense and then
begins to weep. I try to find out what’s behind the weeping. She can say only
that she doesn’t deserve to get any kind of warmth from me, and yet feels
herself on the edge of receiving this warmth. She must do something first to
deserve it. What has she got to give me? If I wanted her to clean up my
office, she’d do it. (I recall how eagerly she told me about a series of novels
written by Anthony Powell, an English writer, and how timidly she tried to
suggest that I, she is sure, would enjoy these.) I commented again on her
feelings of blackness and unworthiness. I label it a myth and wonder where
the myth arose. She says it’s not so much blackness or evil as emptiness. I
tell her that she can’t even look in my eyes without being filled with feeling,
so that emptiness too is a myth. I hope that’s true. Perhaps I’m not giving her
profound feeling of schizoid emptiness its due. And yet I don’t want to pay
attention to that right now because she is filled with feeling, and I’d rather
work on that level. She weeps when I say that. I reassure her that we are
together through thick and thin and I’m going to see this out with her. She tries
to trip off and starts to talk about the dream. I bring her back by saying that I
think the dream must be of me, that I am the big person with breasts and a
penis. She then ties me together with her female therapist in the East, who has
big breasts.

Toward the end of the hour she feels the onset of a migraine. She states she
was so proud of not having a headache before coming to see me this week,
but the danger period is not over. I spend the last three minutes giving her
some relaxation procedures, starting from the toes up, with the major
suggestion that her eyeballs sink back into her head, since she complains that
they are practically bulging out of her skull. The relaxation exercises seem to
be helpful.

Ginny leaves feeling much better, and, ironically, it has stopped raining.

Water had been flowing for much of the hour on both sides of the window.

Ginny says it’s as if she had been drinking something fattening and is
suddenly filled up. Maybe that’s true. I think of Madame Sechahaye * and
symbolic realization. That’s O.K. I can work with that too.

December 2

GINNY

WHEN I came in after a week that was fecund in the wrong direction I didn’t
expect anything, probably just to confess that much.

When I first started crying it was out of tension and frustration. But for once
it didn’t stay there. It didn’t even jump immediately to release, as it
sometimes does. Yesterday you broke the circle. You sort of guided me out. I
felt that if ever I came in again, non-seeing and waiting and on-looking,
pretending that there is nothing on my mind but drizzle, I’ll just be acting coy.

Things seemed to change. I took new steps. I had been refusing to answer
your repeated question, “What do I mean to you?” because I could only have
answered with words. Because I insisted on limiting myself to words. Kind
of like a short-answer quiz.

Even at the end when you told me to close my eyes and relax, other times I
would have been impatient that time was going by, and that it wouldn’t work.

But something was happening. I didn’t get a migraine, then or all day.

When I went to leave and the sun really had broken through, as though we
were in a Hollywood psychological thriller, I said “Well, it will rain again.”
A soggy answer, I realized, a flip answer, but I didn’t have to flaggelate
myself for having given the wrong answer and failed somehow. I took it for
the sarcastic habit it is. But because I felt different inside, I could quiet the
mumbling. I didn’t feel like a warehouse of echoes as I usually do.

All through the session it seemed I was trying to go back on my old track, to
involve us in the old habits of dangling sentences. And you kept bringing me
back.

Also, I was mostly aware, except at the end, that it’s just me there and you.
Not worrying that what I was doing would detract from other people—Karl,
my parents, my friends.

When I felt dizzy and nauseous I tolerated it. I didn’t immediately think of
drinking three glasses of warm salted water and making myself vomit with
my

thumb. I try to feel some of the sensation on the other side of the nausea
which is not mere fear, but actually pleasurable feelings.

I feel a little dizzy, aware now when I talk to people, how I do not make
contact. With everyone I probably don’t have to go through a procedure like
yesterday’s, but I wonder why with some people I choose to hide.

When you said I was tingling with emotions, flooded with them, it was so
nice. The rest of the day I was aware of more feeling and sadnesses. But
things were easier. I was not plugged with indecision. I felt clearer. Though
the rest of the week I regressed and plummeted.

December 9

DR. YALOM

GINNY ebullient today. She used that word to describe something she wrote
—

a word I haven’t used for years—it was right for her today. She was high-
spirited, optimistic, somehow changed by last week’s session. She came in
saying she really wished we weren’t meeting for a few more days because
she is not “ready.” That meant that she had such high hopes for today’s
session, but didn’t see how she could get herself into the proper frame. She
wasn’t sure that she could do it today. I had to ask her what “it” was. So
much has been happening to me this week, the last meeting was still a little
sketchy. However, within a minute or two it suddenly burst into my mind, and
I remembered everything that had happened. She said “it” was expressing her
feelings clearly.
Unimaginatively but doggedly I suggested that “it” was especially expressing
feelings to me and about me.

She said her reason for not being ready was that she had had to prepare a
surprise birthday party for Karl, which used up a lot of energy. That
explanation made me more convinced than ever that, at some level, she was
pitting me against Karl, that she could give only to either him or me. It was as
though she had only a permanently limited supply of love and affection and
what she gave to one was taken from the other. When I expressed this to her,
she remarked that when she came back from last week’s session, she told
Karl that I had said she was tingling with feeling. He scoffed at that and
hugged her in a playful, mocking fashion. That was a curious business
because I don’t think I used the word “tingling”— it’s not one of my words.
She, too, was a bit confused and then changed the subject to sex and her
present inability to have an orgasm with

Karl. Suddenly she stopped and said that I wasn’t interested in what she was
saying any more. This is an entirely new kind of comment from Ginny. She
has rarely, in fact probably never, said something like that in the past. I
wanted to encourage her for criticizing me and dealing with me so directly,
but at the same time I had to tell her that she was wrong, because as a matter
of fact I was listening with much interest. In fact, I had been on the verge of
asking her what Karl could do to help her have an orgasm and what
prevented her from telling him. Specifically I was wondering why she
couldn’t allow him to masturbate her. So I said both things: I assured her that
she misread me and also implied that I was glad she raised the question.
Later in the session I said so more explicitly.

Did I enter into her sexual life in some way? She replied she had been so
optimistic the day after our last session, but the feeling had gradually
disappeared and she had a migraine the following evening. I commented on
her end-run around my question and repeated it. She then told me a recent
dream in which she and Mr. Light were looking at each other for a long
period of time.

Mr. Light was a former teacher who had encouraged her writing and had
apparently fallen in love with her. At their very last meeting he had put his
hand under her tiny brassiere. A month later he visited her and her family and
she spent a day with him at the beach, but had not made love with him,
mainly because of lack of a suitable opportunity. Later he wrote her that he
had been considering leaving his wife for her. I asked for associations to Mr.
Light and she produced only, ‘Til show you the light.” I thought it was clear
that Mr.

Light in some way represented me—not only in my showing her the light but
also in the fact that she and I had looked into each other’s eyes last session
much more than before. She then recalled another dream fragment of a rough
cowboy, not Karl, but a boyfriend who reminds her of Karl, pulling her by
the arms to get her away. She was obviously embarrassed while telling this
story about Mr. Light and I asked her why. She said it was because she was
handling something that was once very serious in a flippant, light-hearted
way. My suspicion was that she was embarrassed because she was indirectly
talking about me. I asked her whether or not the relaxation exercise I gave her
at the end of the session was a type of sexual experience. She said it wasn’t,
but that it really made her feel good and she was glad for it. After the session
she had gone to the ladies room and lay down on the couch and relaxed some
more.

She said she has tried various relaxing exercises in encounter groups, always

with little success, so she had a negative feeling when I started. It was
successful for it did thwart the migraine that day.

I pursued Mr. Light and asked her whether the idea of my leaving my wife
had occurred to her. She said that she has seen my wife and that my wife
appeared not too unlike herself, only a more integrated woman. My wife and
I seem right for each other and she suspects a separation would not be likely.
Mr.

Light’s wife, however, was a different kind of woman, fat and unintellectual,
so that Ginny represented something really different to him.

I remarked that I was saying many unusual things today. She wondered
whether they were genuine—or was I just testing her in some fashion? I told
her the truth—I was saying things in a much more uncensored fashion than is
usual for me. I could say almost the first thing that came to my mind, such as
the questions about how I fit into her sexual life and what she thinks of me
and my wife, because I felt her to be much more open and receptive and
unafraid to look at me. (We did continue today to look at each other far more
than we have in the past.)

During the session she recited a few lines of her poetry, especially from a
satirical poem written in response to a speech by a woman’s liberationist. I
was much amused by some of the clever lines, e.g., “Do you want us to walk
with breasts unfurled?” But then she began to chastise herself for having
written this, calling it small and frivolous. I asked her if there’s not a more
generous descriptive word and she used ironic or witty. Irony comes hard for
her; she finds it almost impossible to express feelings of disagreement or
anger without subsequent self-castigation. She thinks she doesn’t have the
right to criticize; in fact she doesn’t allow herself any rights at all, and that’s
still a big part of her being a little girl and having to keep the lid on any part
of her not inconsiderable reservoir of anger.

She left the session, I think, somewhat disappointed because of

unrealistically high expectations. Toward the end of the hour I felt a different
kind of feeling settling in, and my hunch is that the high optimism will be
dampened and she will be somewhat depressed as she recognizes some of
her unrealistic feelings about me. That’s not to say that I don’t feel good
about Ginny and that we aren’t moving along together, but I’m aware that an
extra, rather powerful bit of feeling has been placed on me, that has nothing
to do with me and nothing to do with our relationship but rather with ghosts
from the past.

December 9

GINNY

I THINK I was trying to entertain you. I wanted to go deeper than last week
but when I came in I didn’t feel in the mood. I just wanted to enjoy us.

All of last week didn’t wear off, however, since I was more aware of you-
me looking, at least. I pulled myself in that direction.
If you had scolded or said “What’s this game you’re playing this week?” I
would have changed. Instead you didn’t seem to mind (that I was a waitress
and you were a client).

We did a good job of analyzing someone whose motives were there but not
emotions.

I don’t feel bad. I told most everything that happened to me that was
important, but without a compelling center of a need to change.

I didn’t see any of the parallels with Mr. Light until you made me see them.

In a way that dream was showing and experiencing the meaningfulness and
pleasure in my small relationship with him, and my telling it to you
emphasized the absurd side. Maybe I told you the dream to show you the
absurd ironic side to my looking you in the eyes. To put the last session in its
ridiculous perspective (with the cement of sarcasm).

Actually the session was me in the purest, as I am every day. All the things I
want to change. The sarcastic, giddy, anecdotal time-passing images. I feel
angry in perspective that I carried on and enjoyed so this superficial side.
The revenge is there’s nothing to write in this write-up because there were no
revelations. (Except maybe the intellectual idea that there’s a parallel
between you and Mr. Light and then the perennial loss that I did not explore
that in the session; only named it and went over old stories out of my
compulsive past.) Because I was talking very outside any emotional senses.
No aftermath.

* A London-based analytic school founded upon the teachings of Melanie

Klein.

* Group member.

* Group co-therapist.

* Sechahaye, M., Symbolic Realization (N.Y.: International Press, 1951.)

II
A Long Spring

(January 6–May 18)

January

DR. YALOM

REVISITING. We turn to the past. Three weeks ago Ginny called to tell me
she had suddenly decided to go home for Christmas, since Karl and all of her
friends were leaving and she couldn’t bear the thought of being here alone.
As she described her visit East, it sounded like a journey into guilt. She
introduced it by saying that she should have stayed longer, that she was there
only thirteen days, that she hadn’t been fair to her mother or her father, that
she spent only three days with them and the rest of the time with her friends
and she hadn’t been sensitive enough to her parents’ needs. On Christmas day
Mother had picked up and gone to the beach for three hours by herself
because she was upset. Ginny came down, asked her father where Mother
was, and said,

“What’s the matter with Mother—is she crazy, going out to the beach today?”

Immediately Ginny’s sister bombed her for her thoughtlessness in saying such
a thing.

In a period of five to ten minutes, as Ginny was describing her home, I

suddenly had an entirely new perspective on the making of Ginny. In so many
ways I envisioned her mother as a guilt-inducing machine. When I expressed
some of these thoughts to Ginny, which I did fairly openly, Ginny quickly
rushed to her mother’s defense: for example, Mother had gone to the beach
“to experience some of her more stormy emotions” She then tried to shift the
onus of blame to her domineering and matriarchal grandmother. I agreed that
it wasn’t her mother’s intention to create guilt, but, nevertheless, that’s what
happened. Ginny continued by considering how awful it is for her mother
because her two daughters are leaving her. I suggested that a mother’s job is
to prepare her children to be able to leave home, but Ginny brushed this
aside almost impatiently.
Then she talked (in my language) about her inability to differentiate her ego
boundaries from those of her mother. She said that her psychotherapist in
New York was always shocked that she and her mother would use the
bathroom at the same time. She wanted Mother to see her bras, she wanted to
show her figure to Mother and tell her how she too was growing fat and
having the same type of body as her mother. She defended Mother by saying
that she had made it possible for Ginny to transfer to a first-rate college,
instead of staying on safe home ground. I reminded her, although I’m sure
without effect, that things are

much more subtle than that, that Mother probably has very mixed feelings
about her living away and gives her two conflicting messages at the same
time (ye old doublebind—classical form).

And so we talked about these things, though I suspect without much benefit
for Ginny. (I persisted because it was illuminating to me; I gained a much
clearer view of Ginny within her family context.) She wants so much for
things to be different, had such hopes of going home and really breaking
through. But what does she really want? She wants to return to a warm,
loving idyllic childhood that never in fact existed. Or, at least I think it never
existed. It’s remarkable how little Ginny and I have talked about her
childhood. I’m very wary of getting sucked into a Proustian recircling of the
past. Stay in the future with Ginny. She’ll have a different past soon.

She told me a dream, prefacing it and concluding it at least a half dozen times
with the commentary that it was a silly dream that didn’t mean anything.

Naturally I see this as secondary revision and can only conclude that the
dream was in fact very important. The dream was that I was having dinner
with a number of gurus, who were obviously incompetent, and yet I was
saying that they were O.K. The dream was unsettling because in it she said
she ought to have someone new to work with. However, in her waking state
she knew this wasn’t so and thus decided to hide the dream from me, lest I
take it seriously.

Her associations to this were newspaper articles she had read about me
(which had misquoted me somewhat), in which I criticized Esalen and other
kinds of encounter groups, especially an encounter group leader who led a
group that she had been in.

She talked about her new job as a traffic guard. She finds it very humiliating
and then joked with me saying that I thought I was working with a writer and
now I’m working with a policewoman. I became very uncomfortable at that
and felt that I was in a sense, at least in her mind, doing the same thing her
mother had been doing, making great demands on her for production, and she
sensed that she had to be a writer and produce for me rather than for herself.
I said as much to her, but with little effect. No doubt there is more than a little
truth therein. I do want Ginny to be able to write. And no doubt in my fantasy
I would be very pleased were she to become an exceedingly able writer.
Yes, I can’t deny that. However, it shouldn’t make that much difference to me
if that were never to occur, and if Ginny were to come out of her work with
me having grown and having found some peace with herself and were never
to write another word, that would be O.K. too. I hope the truth really is that I
am

seriously interested in Ginny as a person, and I’m having only a mild

flirtation with Ginny, the writer.

January 6

GINNY

IF I WERE accused of a crime I would be my own best witness. Whenever I

talk about people I love, I always make them seem guilty and I do this with a
smile. Because if I’m guilty, they’re guilty, guiltier in your eyes. I was giving
you information, though I don’t know why, because you’re not going to make
any evaluation or come up with an answer or plan. Anything good that
happens in this therapy happens simultaneously.

I knew I was giving you ammunition against my parents. That made me feel
worse. Especially since that day I was mailing a letter to them—“Dear
Mommy and Daddy” and giving them lots of real love. I feel if you talk to
someone else about people, you are betraying them. I probably betray myself
most of all since I am always telling things about myself.
During the session though I didn’t feel bad. I was much too hot—I felt like I
was in leggings, a bundled up baby—and maybe I should have said
something.

But then I adapted myself to the heat, and the heat was a cozy pastime. I am a
lazy boy fishing off a bank. If I put the right kind of mother bait on, you will
always bite.

No, I know what you were trying to do. To tell me to believe in what I say.

To accept the limitations and faults of my parents. But every time I do think
about those things, I seem to diminish. As I take away from them, I am taking
away from myself. And also I realize I have not changed or wrestled with my
parents at all.

I have told them almost everything in my life. But my life is not there, in all
those facts and stories. It still feels buried. The only vital agitation I have
with these facts is dreams. And then my parents and I are much more active
and ghastly.

Comfort I have been trying to get is by digging down, burrowing back to the
nest, surrounding myself with calm. I really think I must be still burrowed in
the cave, like Plato’s cave, since I write and think only with analogies.

Everything is like something else. Even this write-up is so veiled, it is not

direct.

Maybe you wouldn’t understand it. Here’s another translation. “Yeck!” That’s

how my mouth and eyes and face and mind feel after I have revelled (pun—I
meant to say but misspelled “revealed”) just enough to keep me floundering
but not drowning.

January 13

DR. YALOM

A RATHER distant hour. I felt distant from Ginny and think she probably felt
distant, though not so much as I. In fact, it is only with considerable effort that
I can bring myself to dictate this. There was a five-minute lag between the
first and second sentence. She started off by saying she has been outside
herself the past few days, and feels nervous and tense. I couldn’t find any
convenient way of involving her or involving myself in what was going on. I
tried to get into last week, but she remembered very little from that session.
She then talked about her feeling that she doesn’t change. She gets to a certain
point in her sexual relations with Karl but can’t go any further. She’s done the
same in therapy with me. I tried to pry up some examples of changes that she
has made, in fact, even suggested that we get out one of the old tape
recordings we made a couple of years ago. She wasn’t too happy about that
and managed to come up with a few ways in which she felt some changes had
occurred. I think I try to help Ginny find ways of discussing her progress
more for my sake than for her own.

Following this she returned to her relationship with Karl. Her current plight
is that she is merely marking time, waiting around to be told when it will all
be over. A few days ago he gave up his business and took another job. She
knows this change means something and what it may mean is that he will
begin saving money to go to Mexico and then she will, one day, learn from
him whether or not he intends to take her with him. If not, the relationship is
over. I was rather overwhelmed with the helplessness she expressed. At the
same time I realized that she takes pride in her helpless tragic pose. I even
tried to bait her by referring to her as the little match girl, and then followed
quickly with the suggestion that she decide, adult-like, what she wants from
the relationship. Is there no decision she has to make? Is there anything in the
relationship that might make her move to terminate it? For example, if Karl
refused to support her, or if he would never permit her to have children. It
was very difficult to prod her into saying that she could make a decision. In
fact, it’s even impossible

for her to ask Karl whether he intends to take her to Mexico; she feels she has
to wait in silence until he tells her. I ended up the session rather despairing
and baffled about how I could infuse her with any respect for her own rights.
At one point she said she tried to ask me a couple of weeks ago about my
vacation and she couldn’t pull it off; it would be the same thing with Karl. I
suggested she try again with me. Could she now ask about my vacation or
about anything else? She asked how I felt the sessions were going, but since
it was already after the hour was over, we passively agreed to pick up from
there next time.

January 13

GINNY

AT THE END of the session, things began when you asked me to ask you a
question. It’s kind of like kids miming throwing stones, and then one kid
throws a real stone. At first when you said, “Ask me about the vacation,” I
thought I had inadvertently come up with a real piece of information that you
were leaving on a big vacation. I always feel great when I am so dense and
not intuitively knowing all. But that was the realest part of the session. I did
ask you vis-a-vis with my eyes a few weeks ago but my talking is kind of like
me alone in a rain barrel. Or a limp actress on stage talking to the audience.
She can’t see them because of the lights, she knows they’re out there and that
she must give the appearance of reaching out and making contact and looking
directly in their eyes. If she needs help she must imagine them. I still haven’t
really spoken to you as though you are as near as you are.

And with Karl I try to be all good, simultaneously storing my mistakes in my

brain. With you I try to be all bad. I say all the worst things about my
situation. And neither way is realistic. I realized that last week.

I would like to flow with my moods and take from you. But instead, before I
come in, I have a theme song—“I am nervous.” And the overture keeps
playing until in the last minute when the curtain’s about to come up with your
line, “Ask me a question,” I notice that it’s intermission for another week.

I go outside and make the air smell like popcorn for me. And I think I’m
hungry and this at least is a real sensation, so I go buy a lunch with black and
white soda, with expectation stretching back to when I was five years old,
and a hamburger, and when I don’t enjoy either, I am still paying $1.79. It
strikes me like a wave—that here I am paying this money for this crap, and I
have just not

given you anything. (I don’t mean money which I don’t want to pay. I mean
real feelings.)
Probably the horrible things I say in session make me feel guilty. You were
right about word magic. Although when you said it, I thought you meant all
the bad metaphors I used to cover up real statements.

This whole write-up for sessions is word magic which I hide. Which I
wouldn’t want anyone to see.

But the biggest magic that has ever entered my life is not words but real
emotions and actions, like tears and thrashings. I get lost talking. I have no
subtext.

I have been able to appreciate the good things that happen to me.

January 20

DR. YALOM
A RATHER important meeting. I had the feeling, it may be an illusionary one,
that we broke new ground today. But then I think of the old story back at
Johns Hopkins of the patients who would come in for years and almost every
week the chart would say-patient better, patient better—and then at the end of
several years, one sees that there really has been no change. Nevertheless,
even taking this into consideration, somehow I feel that we moved into new
and fertile territory today.

Things started with Ginny complaining of a very severe migraine headache.

I uged her to see an internist, whereupon she quickly changed the subject and
launched into a discussion she had had with a good friend, which merely
reinforced some things we had talked about at our last meeting: namely, that
this friend and her husband would like Ginny to visit them sometimes alone,
the reason being that nobody sees much of Ginny when Karl is around. She
gives herself up when he is present, becoming little more than a mute and
featureless shadow. In the midst of this I tried to state very clearly, and more
than once, that I thought the relationship with Karl was a limited one in which
she was not herself, and, what’s more, that changing might not be a way of
losing the relationship but strengthening it, since I suspect that Karl, or any
man, would relate more to a full woman. I also mentioned the opposite
possibility; it may be that Karl has a good deal invested in her being just the
way she is and any change would drive him away, in which case, I said, I’m
not sure that would be

particularly calamitous, since an involvement with a person who doesn’t let

one grow is hardly a healthy situation for either party.

She went on then to engage in some more self-derogatory sentiments. For

example, she had been feeling depressed all day and rather “than staying with
the feeling last night” she got dressed up very pretty and went to play
pinochle at a friend’s house. She called herself frivolous for that. I indicated
that labelling herself as “frivolous” is another example of her semantic self-
flagellation. Why not “plucky” or “resilient"?

She blocked for awhile. Then I began to prod her for her feelings toward me.
She stated that she hardly ever writes about me in the post meeting write-ups,
and she knows she never presents me to her friends as a real person, in fact
pretends to have little allegiance to me. She added that her friends are
curious about me, for example, they want to know my age. I asked her what
she told them and she said “thirty-eight,” and I said that was very close, that I
was thirty-nine. She admitted having cleverly manipulated me into telling her
my age without asking me directly. We went back to last week, when at the
end of the hour I suggested she ask me something and I asked her again to do
so. Then she asked how I really felt about the hours, were they O.K.? I told
her that she could probably find out a lot more when she reads what I’ve
written; basically I had mixed feelings—occasionally I felt impatient or
pessimistic and often I felt good about them. She wondered how she would
feel later about my saying that I was pessimistic or discouraged. I pointed out
that I don’t often have that feeling, and that I felt reluctant about saying that
openly to her because she always presents herself as such a fragile flower,
that I am afraid such a comment would leave her crushed and defenseless.

I asked her what else she wanted to ask me, and then she asked whether or
not I thought of her between the sessions. I tried to rephrase that by asking if
she meant whether or not I care about her. That was difficult for both of us
for awhile, and she seemed on the verge of tears. Abruptly she said she
doesn’t really care if I care about her “in that way,” but then she started to
cry and confessed that she thinks about me, about parts of my body and my
hair, and wondered how she’s allowed me to become such an important part
of her life.

Also we got into a discussion of the fact that she can’t really get well
because if she gets well, she’ll lose me, for it is unlikely that we shall
continue our relationship as two equal adults. At the same time, however, she
wants me to treat her like an adult, and I said to her, fearing very much that I
was being a scolding parent, that to be treated like an adult, one has to act
like an adult. It

really came out sounding disgustingly pedantic but I didn’t know quite else
how to put it. I think this tact of helping her to relate to me more as a grown-
up person and helping her to inquire more about my personal life is going to
be useful and I’ll encourage her to continue.

January 20
GINNY

OH GOD. Yesterday’s session was the first that I began to feel my own
methods. And why I defeat myself. I play the children’s game that says “take
five steps,” but unless I say “may I?” I get put back or put myself back. After
the session in little ways I tested my power. And that kind of extended the
session further. For Instance, at night when Karl wanted to read instead of
going to bed, although not coming right out with it, I did tell him that there
was something between reading and deep sleep.

In that one bramble bush toward the end where I said “I don’t want you to
like me like that but (big pause) to care for me,” I started half crying. It was
more like I cried because here I was back to my old cliché, “Do you like me,
care for me?” I start to cry and get ashamed because I have travelled so little.

Like a child who says “ma ma” up to five years old, crying in frustration
because though he means “ma ma” he means a whole lot more.

When I was home I saw how my parents must have done everything for me
when I was young. Comforting me even before I needed it, feeding me,
buying me wonderful things. So somehow I feel like I’ve never made a needy
gesture.

Everything was just all around me in abundance. And that’s the way I place
myself around other people now—like a delicious fruit bowl waiting at a
table, and the fruit already a little spoiled.

As with everything I seem to have gotten stuck on the sentence, “I need,” or

“Do you like me?” Three years ago that was revolutionary for me. Just like
the abundant sexual feeling and awakening I have now. But I don’t extend
them or draw them out any further.

What follows close behind me is my catatonic shadow that convinces me I do

not move.

I do not stagger on.

I don’t progress.

I only pose, a model for my shadow,

a shadow for my silhouette.

February 8

DR. YALOM

A RATHER unsatisfying feel for this hour. I think I’ve been too intrusive in
forcing my values upon Ginny. I was too authoritarian today, too directive,
and engaged in too much exhorting and preaching. But it was hard for me to
do anything else. She began the hour by talking about her many fantasies of
leaving Karl and somehow starting life anew. Over and over again, when I
hear these fantasies, I can only think that there is obviously a strong part of
her that wants to leave him, that is highly dissatisfied with the relationship,
or that perceives the relationship as a stifling one. Then she described an
incident in which Karl suggested to her that she share the gasoline money
with him. He is now earning approximately $90 a week, she only $30. She
does the cooking, grocery shopping, and the cleaning, and though she feels
it’s unfair for her to have to pay gasoline money as well, she made only a
feeble protest to his request and ended up by consenting.

I tried to make her see that giving in to something she considers unfair stems
from a refusal to recognize her own rights. I feel that in the long run this is
self-destructive; she’s almost insuring that Karl, if he’s a well-integrated
person, will soon tire of their relationship. If, on the other hand, he’s the kind
of person who really needs such a selfless, disenfranchised friend, then he’s
going to stay permanently. But either way it’s self-destructive. She said that
she would not like to continue this relationship permanently, but that it’s very
sweet in some ways. Without him, life would be an abyss; without him, she’d
fall apart. I told her I thought that was bullshit and she agreed, although the
abysmal feeling is very real. I then asked her what she would have to do to
change things and she went over, in a rather effective fashion, the types of
things she would say to him and his response, which would generally end up
with his lowering the boom on her and concluding that they should break up.
Unfortunately, however, the treatment hour took on the aura of a pep talk, in
which I was urging her to do things she may not be ready to do; yet somehow
I want to impart to her the knowledge and the feeling that is really her

responsibility to change her life. It may be that Karl is such a limited person
that they will break up, and I guess I feel in the long run that’s just as well.
On the other hand, I could imagine that Karl or any man would be really
impressed at her gradually growing up and becoming a “mensch” and if that’s
too much for him to handle, so be it. I’m sure Ginny in the long run will find
plenty of other men who can appreciate her as a more integrated person.

February 8

GINNY

IT’S HARD for me to remember what happened. It all seemed pretty direct
and straightforward (a cliche, that sentence like “How are you?”). When I go
in to the session like that—full of grievances that have been aching all day—I
feel like I have a deficiency, like a vitamin one, and you have to supply the
stuff that gets my complaints out, that stops the cracked record from
repeating.

I think you probably got to see more of me as others see me, or as I function,
in that session. I don’t really try to interact with people, I intuit or imagine
what their behavior and circumstances will be, and improvise my responses
out of nervous energy. No thought process anywhere. Like for instance when I
was sure that you would only have the 1-2 hour slot free, and built a labyrinth
of arguments around it. I kind of evolve all convoluted.

It was the first time in therapy you didn’t side with me—you know how you
said, “Well any man would leave a woman who only showed the surface.”

I liked that.

I think Karl really is a good strong person. And he is only stingy because he
is not in love. If he did love me, things would come naturally—the gasoline
would flow without me having to make a federal case out of it. I guess I am
really hurt because in putting down petty rules for Karl and me, I know I am
asking them to take the place of love and generosity.

When I finally told Karl, it was anti-dramatic. He said he didn’t like the
martyr quality in me. “Behind every martyr is a shrew.” He says he only
wants to be told things and that’s true. When I tell him something
immediately, he’s very pliable, acquiesces, doesn’t put up a fight, provided
my voice comes out deep and resonant. However, as soon as I delay the
emotion, and then replay it, if he detects the slightest screechy timbre to my
voice, he turns on me, and whatever point I’ve won, I’ve also lost.

And the dialogue never got as deep as I had planned. But it was still better to
get it out.

February 17

DR. YALOM

I HAD a patient immediately after Ginny and some unusual scheduling

difficulties which didn’t permit me to dictate a note on her. Now it’s been
several days and the interview has begun to blur in my mind. The most
striking thing was that she came in and immediately said, “Well, don’t you
want to hear what happened?” and then went on to tell me that she had talked
to Karl about the things we had discussed last time. It hadn’t worked out too
well, because Karl got a little upset with her acting like a martyr all the time,
but, in fact, I think in many ways it did work out, because she doesn’t have to
pay for the gasoline and has been able to assert herself, if only minimally. I
was a bit surprised that she came in that strong because I hadn’t really sensed
she was going to go ahead and literally do some of the things we had
discussed last time.

At some point in the interview I wondered what she wanted to work on next.
She talked about making love and wanting to be able to ask for things for
herself. I wondered what she wanted to be able to ask for. What Ginny said
then was so benign that she couldn’t help laughing at herself: she merely
wanted to ask Karl to do something a little longer because it felt good. I
asked her to say this aloud a couple of times, so that she could take some
distance from it and see the absurdity of her inability to say this, and she
could not repeat her statement without mimicking herself or saying it with a
funny accent.

She also expressed the feeling that what she has with Karl is very precious
and I am going to take it away from her somehow. When she was lying in his
arms in the morning, she realized how much this means to her and that nothing
else is really as important. Ginny also felt rather proud of herself because
she had had a migraine the night before, hadn’t taken any strong drug for it,
and somehow managed to triumph over the headache without being all
drugged up today.

It’s remarkable how four days later I can’t go back and really recapture what
my feelings were to her during the hour. They all blur into a generalized good
feeling, and I know that she was happy and bouncy during the session. Of

course, I always like to see her like that. Now I do remember that we talked
about how young she felt. She does manifest herself to me often like a very
young girl. I also remember that, as usual, she shouldered all the blame for
therapy sessions which she considers unsatisfactory. Obviously there must be
times when she is dissatisfied with what I give her, and she rather tenuously
got into the area by admitting she sometimes wishes I could show her more of
myself. I asked her what kinds of things she wanted to know, but we didn’t
get very far with that question.

February 17

GINNY

WHEN I came yesterday I was expecting a surprise. Something that would

make the session a little different. An emotional assignment. The expectation
of going cured a migraine. My fantasy and release kept step with my walking
as I rounded the long path to the hospital. I am always “cured” and jubilant
on the walk in, and feel about as heavy as a piece of duck down.

I say things in therapy that are not true. Even as I’m saying them, I know I
don’t believe them, that they will confuse you. Like when I said, “you’re
sitting across from me and seeing nothing.” Many times you’ve told me you
don’t think of me as nothing. If only I could catch myself when I’m saying
things like that, contradict myself, say “No that’s not what I mean,” maybe
then I could take myself seriously when I speak. I don’t fight for my words.
They just come.

That’s why I tend to disbelieve them. And you diminish in my eyes when I
see you going after my words too seriously—some of my words.

You said one thing yesterday that I had never thought of before and therefore
came as a revelation—that if I am so scared to say “such benign things, they
must be substitutes for angrier things hiding.” I don’t know if they are angrier
things or just stronger things. Like not saying “I love you” to K, when I
sometimes feel it.

Anyway all the energy I have, even yesterday, seems to be wasted on

observation. And yet it’s not observation of a present moment, but big
memory observation, years of experience that I can tally with one sarcasm.
And when good things come up they hardly penetrate my way of looking. I am
what I see, not what others see in me, but what I see. I feel very removed.
Maybe that’s why I can’t get close to you with words. Cause I can’t get close
enough to

myself with words. If these write-ups were intellectual, that’d be one thing.
But I don’t even think in them. They’re automatic. They’re like not carrying a
problem into therapy and waiting for your surprise agenda to save the day.

Lately you’ve been putting slight pressure on me to do things. Like thinking

about the gasoline. I appreciate this. Because every small thing I do gives me
more to work with, more exposure, and disappointment, cause it is still one
removed, not originating with me. Coming from you.

February 24

DR. YALOM

THE MEETING started off in black despair. Ginny said she had been up
almost all night, because of a terribly upsetting incident which centered
around Karl’s saying to her that she was, in effect, “a sexual lump.” I
remember Nietzsche’s statement that the very first time you meet someone
you know all about him, and from that point on you gradually erase these
correct impressions.

My first response to her description of the incident was that it corroborated

my first impressions of Karl; it was a horridly callous remark and should
have called forth some anger in Ginny. She went on describing it in some
detail, I got sucked up into her pathos, and considered with her ways to break
through the impasse that had developed between them. It seems that she had,
earlier in the evening, perhaps unwittingly rejected his advances, and thus
felt responsible for his reaction and, in fact, totally accepted his definition of
her as a lump. She began feeling like a lump in all aspects of her being
despite the fact that Ginny is anything but a lump. She is alive, imaginative,
deeply creative, and very bouncy. Indeed, earlier that day she had gotten
dressed in some outlandish spoof costume just to amuse Karl and later had
gotten into a long giggling spree in a German class they had attended together.
All this stands out in marked contrast to seeing herself as a lump.

All I could do at this point was to question her willingness to accept another
person’s definition of her. She lives in constant terror that suddenly Karl will
announce the news that he is through with her. She was so afraid that Karl
was thinking about the relationship last night, because, if he thought about it,
then that would be curtains for her; so she partially felt that she wanted to
interrupt his thought processes. Once again no recognition that she has any
rights or any choice in the relationship.

Gradually, however, I returned to my feelings about her anger. In her

fantasies during that night she once again imagined leaving Karl and even
committing suicide. In a dream she and Karl were being pursued, and Karl
was killed. I commented that, although she claims to feel no anger toward
Karl, she killed him off in the dream. She pointed out that they were together
and that she begged for his life to be spared, but I think that was irrelevant.
The important thing is that she expresses some of her anger in her fantasies
and dreams, but is absolutely unable to do so consciously. As we talked, she
remembered a fleeting feeling, a whispered hope that Karl might apologize to
her in the morning, and I tried to make her recognize that hidden part of
herself which felt offended and expected an apology. But there was no way in
which I could help her overtly experience any of her anger toward Karl, even
in play acting. As a rehearsal exercise, I suggested she try to express some of
her disappointment with me. This was quite hard for her to do. We ended the
hour with her feeling that she had failed once again. I tried to reassure her
with the explanation that we had gotten into a really crucial area for her—
one which well have to work on for a long period of time: her inability to
express any anger, or aggression, and her inability to assert herself and
demand her rights all fit together in this gestalt. What stops her from feeling
anger, let alone expressing it, is something we haven’t even begun to explore.
I’ve got a hunch she has a brimming, but hidden reservoir of anger, but is
fearful of tapping it lest she be unable to turn off the spigot. At one point I
even taunted her with the question, “Could it be that sweet little Ginny wants
to murder somebody?” But I got no response.

February 24

GINNY

DURING the session, a part of me was really getting excited, but it was
surrounded by the therapy character who sits on the leather chair and listens
and thinks “maybe.” And on cue concludes tamely that nothing really
happened, though there is still a possibility.

When you kept wanting me to go after anger and I couldn’t, I felt miserable
inside but I also felt “very adult” sitting there on the outside. It was almost
like you were interviewing the parent and the child.

I would listen to the little thing inside and then I would tell you about it once
removed. Inside I was boundless, saying things like—“Fuck you. Fuck

him. Fuck him.” But it would just sit there. Never really talking itself because
if it would, it couldn’t use the same kinds of words I do or the dubbed
conversational tone.

I pose as heavier and “stronger” and “more conventional” than the small
anger or sadness inside. Which would dribble out, wet my eyes, be mostly
incoherent, attack the things that go round in my memory. It’s like when you
say, “Maybe Ginny’s so angry she wants to kill.” I agree with you—we’re
like two women at a park and one has the child on a leash and there are so
many things—swings, jungle jims—the child could get into, and we discuss
abstractly those things. I feel a slight tugging on the leash, like a man who
goes fishing to sleep on the shore with the sun and some beer. He feels a pull,
smiles, dozes and lets the fish nibble and go. I always feel the little pull in
our sessions.

Sometimes, like that night before, I feel desperate and tired. But I never
really catch what has been biting and gnawing at the line. I just get calm
again and it is gone, the terrifying feelings, the helplessness.

You gave me a great deal of hope and confidence when you said that you had
started to see me and my problems more clearly and that we were just at the
beginning and would have a lot more chances. That is the leather chair
persona thanking you while the squirt inside me is still ranting: Fuck you.
Fuck him.

March 3

DR. YALOM

A WORKDAY, bread and butter session. Ginny started by telling me that she
had been thinking about the content of our last meeting, especially about her
inability to express anger, which she recognizes as very true indeed. Not only
is she unable to voice her anger, but she is terribly uncomfortable around
other people who can and do. She then described a conversation with Karl
following our last session, in which he, as he often does, asked her what we
talked about, and wondered whether it had been about the previous night.
This surprised me somewhat because it seems as though Karl is much more
closely attuned to their relationship than she sometimes implies. He was
giving her a perfect opportunity to talk about her anguish, which she did to
some extent, saying that she didn’t like being called a lump, but he pointed
out that when he said this, she didn’t do anything—just lay there and became
even more like a lump. This, to me, tended to confirm what I’ve been
suggesting to Ginny for some time—

that her fear of expressing anger because it might endanger her relationship
with Karl (or someone else) does in fact bring about the very thing she
dreads, i.e., a stunted or severely damaged human relationship. By not giving
vent to her anger and other profound emotions, by remaining a one-
dimensional person, she prevents people from relating to her with the kind of
depth and egalitarianism she would prefer. If Karl leaves her, it will not be
because she has driven him away with her anger, but with her lack of anger. I
wondered whether she has always been like that. Ginny said “yes” and gave
a couple of examples when she did express some anger but shook with terror
during the act. She pointed out that during her childhood her mother usually
expressed her anger for her.

I said that perhaps one of the things she could do would be to start talking
about her feelings toward me, which might be easier than with Karl. She
nodded, as though that were very logical, but when I asked her to talk about
some of the things that she disliked most in me, it was extraordinarily
difficult for her to say anything, although we’ve been through this several
times already.

The criticisms she selected were thinly veiled virtues. For example, one of
my problems is patience; I am too patient with her. Most of the things she
said were based on the premise of my omniscience. She stated that I really
knew everything that was going on but there were times in the therapy group
when she wished I had acted in such a way as to satisfy the needs of certain
members, even though that may not have been what they needed in the long
run. I pointed out that she attributed more omniscience to me than I possessed
and that there were times, in fact, when I really didn’t know what the hell
was going on with some of the group members or with Ginny, for that matter.
She reacted as though that were really news to her.

Next she mentioned a couple of other things; she wished that I could reveal
more of my feelings, that I could show more annoyance with her, but she’s not
sure whether I wouldn’t just be like her mother at that point. She talked again
about how upset she feels when Karl is not sleeping because she thinks he is
contemplating leaving her. I felt frustrated, caught again in a vicious circle,
and could only comment that her worrying about Karl’s leaving her causes
her to be tense and anxious, which in turn will promote the very thing she
fears. I wondered whether the same pattern occurred in her conversations
with me: that she was so worried about my leaving her that she has to be
careful about what she says. She denied that, but later asked, in a whisper,
what was going to happen to our sessions after the summer. I pretended that I
didn’t hear her so as

to make her phrase the question a little more clearly; in other words what I
wanted her to do was get some experience in asking a straightforward
question, which is entirely her right to ask. So what she did was to ask me,
“Will you continue seeing me after June?” I answered that I would. I asked
whether there was anything else she wanted to ask me and she said “no.” She
talked about the lack of personal feeling she’s had toward me, unlike her
strong interest in other people in her life, such as some of her teachers. When
she discusses her therapy with one of her friends, she usually describes me in
impersonal terms.

Somehow we began to speak again of her sexual feelings toward Karl and
her inability to initiate any sexual activity, although Karl had recently “given
her permission” to make sexual demands on him. She talked about her sexual
tensions during the day and her ability to deal with them rather quickly by
masturbation, since I had assured her it was okay. It seems as though my
attempts to take some of her guilt and anxiety out of the masturbatory act
were successful.

I had planned to see her next week, even though I couldn’t make it on our
normal Wednesday, but as she wasn’t necessarily expecting it and had made
some other plans, I finally decided that, since next week is so hectic, we’ll
skip the session.

March 3

GINNY

OF COURSE I have waited too long to write this. (It’s Monday morning,
nearly a week gone by.) I remember we talked about honesty, anger, speaking
up.

The next night Karl was restless which was a contagious condition. I
couldn’t calm him or sleep myself. The anxiety and sense that I should be
doing something was too much to allow for sleep.
So while I hear things in therapy, and am kind of buoyed up by the hope it
gives me, when the time comes for applying them, I stay with my old patterns.

They are already there, in remote control.

When you asked me to tell you my bad feelings and opinions of you, I sort of
did it more intellectually than emotionally.

I know all the ways to describe my fiascoes. Describing anything else would
be a new experience.

While I appear to go about with a selfless face, I am really more selfish than
Karl. I don’t even think that what I am doing can have some effect on him,
good or bad. And so I hold back energy and keep us both as static as myself.
I do it with you too, lots of times. I give you nothing but run-down sentences
to work with. And then lead you on by saying I am going to try harder next
time, to take it more seriously. So while I asked you if you would continue
therapy with me, I sort of knew you would, and that if you didn’t, only I could
be hurt and I would know how to take that hurt and make it something I could
bear (bare). And this kind of maneuvering of experiences, so they all get
absorbed by my great fiasco digestive tract, leaves me babbling along to
people who are never as real as they really are, and my self is only half
realized and not going forward.

I will try to do better in the therapy reports. I think the reason they are so
hard is that I’m not on multi-levels (fear is the great leveler) so that when I
comment on things in the reports, I think they must be obvious or already
said.

March 17

DR. YALOM

WE DID NOT meet last week. Ginny started off the session by saying that
she had spent last Wednesday (our usual meeting day) with friends. Her
friend, who had just finished a long workshop for changing her own
behavior, spent about five hours working on Ginny. Ginny felt she was being
strangled by this girl. I felt that she was implying that she had already been
strangled by me. We returned to familiar ground, i.e., Ginny’s inability to
express anger. It’s becoming clearer and clearer, I think, to Ginny and to me
that this seems to be a major conflict area. It’s also becoming clear that
whenever she gets close to expressing any anger she bursts into tears. She’s
done this on several occasions during the week. I told her that I thought her
behavior was perfectly explicable if we accepted the assumption that she is
harboring a murderous degree of rage and has to be terribly careful not to let
any of it leak out. This didn’t seem to mean much to her but she started to talk
a bit about “petty grudges, petty rages, bits and pieces of anger” that she had
toward people. She expresses them very reluctantly and in a pathetically
ineffective manner. For example, she got angry at the girl who spent five
hours working on her and Ginny punished her by withholding the news that
she had gotten a post card from a mutual friend.

Ordinarily she would have told the girl right away but this time conveyed the
message twenty-four hours later. Then she confessed a sense of hopelessness
and wondered if she can ever change. I questioned her definition of
“change.”

She sees change as looming so large and issuing such radical proclamations
that she must become an entirely different kind of person, and this, of course,
scares her.

At this point she said she feels guilty about the lousy write-ups she’s been
handing in to me. I told her if she really wants to stop feeling guilty, she
should write better reports. She knows this, of course, but really wants to
hear me punish her for it. I wondered about the subterranean world she says
she writes in; what does she hear? What happens there? What does she not
say in my office? She went on talking about her sexual feelings, that she felt
somewhat sexually stimulated coming in here now and it was a kind of a
different feeling than usual, an adult sexual feeling. Somehow it involved me
but she couldn’t quite bring herself to say so, nor could she admit having any
sexual fantasies about me, since that embarrasses her so much. I imagine it is
awfully unfair for me to expect her to talk about her sexual fantasies toward
me when I would not be willing to talk about my sexual fantasies toward me.
In fact, I don’t have any overt sexual fantasies about her, but I can easily push
myself into feeling quite pleasant about touching Ginny or holding Ginny,
although I guess the professional role is so deeply ingrained in me that I have
difficulty extending the fantasy to sexual intercourse with her. However, I
think that part of the shame she feels results from the inequality of a
relationship, where I’m expecting her to talk about fantasies, yet not sharing
in them; so in a sense the shame is to be expected and I was being unfair in
urging her to talk about them.

Ginny keeps insinuating that somehow or other I should be pressing her

harder, that I should do something more dramatic. Sometimes I get the notion
that a really good therapist would, at this point, tell Ginny she has three
months to make some change or end therapy; I wonder whether it’s because I
like Ginny so much and enjoy working with her that I refuse to use our
relationship as a fulcrum for demanding change. Am I impeding her progress
by not being harsh or “therapeutic”?

March 17

GINNY

I HAVE an impression that I talked a lot. I came in with a wild nervous

energy.

In my dreams I had been a loved woman having affairs, and this made me
happy, satisfied and aggressive as soon as I got up. When you were five
minutes late for the session, I started to get angry, because I wanted to see
you, didn’t want to be sent home. And I fantasized that you had left for lunch
partially forgetting me, and later leaving word for me to come back
tomorrow.

And I said (knowing I shouldn’t be angry since you were doing me the favor
and not vice versa) to forget it, that I would just come the next week. See I’m
getting emotions but they’re all evolving from fantasies or turning into
fantasies.

Anyway I’m glad I at least talked in your office. A lot of times you say “I
don’t follow you,” and usually those times are when I’m not making real
sense
—bull shitting, and reminiscing, using my fantasies as the experience. Like
when I said I felt like a forty-five year old woman, and that everything was
over for me.

When I told you about Eve’s coaching me on bringing out more of my feelings
and self in conversation rather than just relying on impressions and punch
lines, I didn’t equal the feelings that I had had that day. (You see I thought that
the closed trap I was in was just with you, that with you and sometimes Karl
I withheld things. But then I found I was doing it with my best friend too and
being put down for. it.) I couldn’t recapture for you the anxiety it gave me.
But maybe that is my mistake in therapy —to think that I must produce
everything I’ve experienced or feel I should have experienced. To keep going
over experiences verbatim with no relief. Most times I think I’m not giving
you the real thing and not giving it to myself. I have this precious museum of
emotions and I relegate all my feelings to the few sparse exhibits, rather than
letting them flow or change.

That first time I ever spoke to you, three years ago, was the perfect time. (I
was ripe from intense therapy and awakening.) All my emotions since then
seem to be dwindling away from that vibrant moment, when I felt I spoke to
you in truth and vulnerability. After being mirrored * in group therapy for two
years, I’m always self-conscious in there with you now. I have an image of
me, rather than just experiencing myself. I feel generally stagnant, all
damned up.

Whenever I say something it is usually very premeditated or fluff. Either way

I feel I am not digging down into any new sources. I don’t surprise myself
most times and I’m sure I don’t surprise you. This makes me angry at you, but
angrier at me. I’m the one who has blocked up the current, only allowing a
small seepage of feeling to escape. And when it does, I stare at it till it dries
up

or you do. I don’t know what has made me so self-conscious. Maybe part of
it is seeing myself through Karl’s strong severe eyes.

I’m released from this self-consciousness—when I’m having fun with Karl or
friends or you ask a question that is right. When I become involved and am
not worrying about every response and what I must do. Then I miss a lot, but
I feel more and usually have less memory. I get off clean. The moment and
experiences seem finally over, without any bad echoes.

In therapy I can’t marvel at your reactions to my controlled givings. I don’t

give you a live person to work with. At least this is the way I perceive it
today.

Even when I feel other things, this other critical image of myself is
superimposed and locked in place. When I’m as nervous as I was today, it’s
like a television picture jumping up and down. It’s the same old soap opera
but it wouldn’t stand still.

Maybe that fantasy about making love and talking at the same time is a
fantasy about therapy too. That you would talk me into giving way, freeing my
feelings, giving liberty to other feelings besides defeat. Usually when you
say,

“What do you feel for me?” I go through this quick hard thought process—Oh
there he is again trying to get me to admit I have sexual feelings toward him.

Well I don’t (quick answer). But today when you said it, I thought about it
and allowed myself to fantasize and I did have such feelings. Though they
were a free flow exercise and not something that is strongly lodged in my
mind.

I seem to be more on my guard in therapy than anywhere else. Even though I

know it would make you happy for me to act a little different. I don’t.

Part of the defeat I feel is being able to deceive you and not get booed. I
acted on the stage and somehow my face and body are superficially there
whenever I want them. They put in an appearance, they understudy for
emotion and strength. This gives me no good feelings though. However after
therapy I am usually more able to act out my aggressions which are a
retaliation against my posing.

April 14

DR. YALOM
I HAVE NOT seen Ginny for three weeks. The last two weeks I have been in
Boston. The week before that I was supposed to meet Ginny at 11:00 and
catch a 2:00 o’clock plane to the East Coast. I planned to do this until
Tuesday when

I really began to see that it was impossible for me to get everything done in
time to catch that last flight out for Boston. I worked all day Tuesday and late
into Tuesday evening and finally after a great deal of hesitation I decided that
I had to call Ginny up Tuesday night and cancel the appointment. I still gave
her the option on the phone of letting her know that if it were an absolute
emergency, I would still try to swing some time to see her. Her response at
that point on the phone was that it was too bad she wasn’t going to meet with
me because she had a good report to give me. I felt badly at missing this,
frankly because I was curious to see what had happened, but at any rate that’s
the background for this meeting today, which I can aptly entitle ‘The Two-
Day High.”

Essentially what Ginny told me was that for a couple of days she had felt
extremely well—that it seemed to have begun perhaps on Sunday evening
with Karl again calling her a lump, accusing her of going right to sleep every
night and not really caring for him, and she apparently retorted directly,
returning anger for anger. The following morning she was able to be angry at
a schoolboy who had been disobedient and taunted her on her job. No matter
that she scolded the wrong boy, she was still able to find the right one and
scold him, and no matter that he still didn’t pay any attention to her. She
began to feel very strong and potent and take herself very seriously. It sounds
as if Ginny had a glimpse of her inner strength and form, and then suddenly
my cancelling the interview took everything away from her. She said that she
had a feeling that somehow she was going to be able to come in and get some
renewal from me that would keep the current going and that my going away in
a sense put an end to the circuit. She couldn’t fully express these things to me
on the phone because when I called she was just a couple of feet away from
Karl with whom she was playing liar dice. This placed her in a rather
difficult position between the two men in her life, and she whispered into the
phone that she couldn’t really share these recent changes with Karl because
they wouldn’t make any sense for him.
All of this was said in a rather brilliant fashion. Ginny was quite perky and
even though she talked about this good feeling as belonging to the past, it
seemed to me as if it were at least partially still present. I had a lot of
thoughts about what she said and tried to explore them all systematically.

First, I wondered about the annoyance she must have felt toward me for
cancelling our session. She couldn’t get too far with that, of course, and I
almost had to say some things for her, such as: one would have thought that I
could have planned my day a little better, or that if I really cared for her, I

would have tried to see her. She had thought of some of these things but then
let me off with the excuse that I had to cancel everyone. At first she thought it
was because she wasn’t paying me, but then dismissed that interpretation by
saying that I was cancelling all my paying patients too. This incidently
indicates to me that I keep overlooking the whole question of Ginny’s not
being charged, which is much less important to me because the money my
other patients pay does not go directly to me anyway but to the University,
and perhaps I am not making this clear enough to Ginny, placing her more in
my debt than is really the case.

Another thing I tried to investigate was the meaning of the fact that her good
feelings vanished with my inability to see her. I told her that I had the fantasy
of a young child performing fancy dives on the diving board and saying all
the while to his mother “watch me, watch me,” and when suddenly after a
half hour he realizes that his mother hasn’t really been watching him, this
strips the pleasure from the entire procedure. In other words, it is lamentable
that Ginny has to feel good only for me. She denied this, insisting she felt
good for herself as well, but something was missing; my interpretation was
that she felt I didn’t care enough.

A lot of other things are going on in her life now that are upsetting her. She
must move from the house in which she is living, since her landlord and his
wife have just gotten a divorce and everything, including the furniture she has
been using for the past year, is being sold very quickly; Ginny immediately
berates herself for not dealing with this in a superhuman fashion. She has
volunteered to help the landlord who is incapacitated with sickness, and then
criticizes herself for not fulfilling this function with total equanimity, when of
course anyone would be upset for having to give up things he had lived with
and loved, including the landlord. It is characteristic of Ginny to take almost
any happening as a sign of her own inferiority or lack of grace. She feeds the
events of her day into a self-critical mill churned by the power of her own
self-hatred. I talked about this, pointing out some of the “shoulds” which
govern her self-perception and impose superhuman demands. She spoke
about a girlfriend’s visit and I tried to make her see their meeting from the
viewpoint of her friend; Ginny is aware of the fact that the girlfriend thinks
highly of her. I know that Ginny must be constantly exposed to a great many
good feelings about herself—the good feelings that I have about her are
shared, I suspect, by most of the people who have continued contact with her,
and I wondered with

her why all of these good feelings from others somehow never make a dent
on her basic core of self-hatred. That’s about where we ended the session
today.

Perhaps a bit more than before, I begin to see some light at the end of the
labyrinth. The mere fact that Ginny was able to have a two-day high is very
heartening. Sometimes a patient can hold inside himself this kind of
experience as a reference point for future progress, recognizing familiar
terrain when he gets near again. Ginny now tends to do the very opposite.
She remembers this peak and immediately realizes how dead she is the rest
of the time. However, I think we’ll be back at this point again many times in
the future.

April 21

D.R. YALOM

GINNY came in extremely distraught today. Furthermore, I was between 10

and 15 minutes late, which obviously didn’t help matters. I felt somewhat
guilty during the meeting for having been late because this was not the day to
have been late for Ginny. On the other hand, maybe it wasn’t harmful since it
helped her mobilize her anger a bit toward me. I was harried by the
architects in planning the new psychiatric building across the street, and as I
was leaving today for a few days, they kept pushing me over the time limit,
but still my lateness was not absolutely unavoidable. At any rate Ginny really
feels as though she’s slipped back several notches. She feels at her very
worst. What happened is that she’s been under a tremendous amount of
pressure. She must find a new apartment to live in within a week, all of her
furniture is being sold out from under her, Karl severly burned his hand
because of her negligence in the kitchen, she hasn’t been able to write for
three weeks, etc. etc. I felt concerned about her increased distress this week
and told her so. I’m sure that when the dust settles, she’ll feel a lot more
comfortable. However, 1 think it’s quite important now to see clearly what
she does to herself during times of stress.

What she does is to start doing things for everyone else, then she wallows in
a great deal of self-pity, and perhaps makes herself so pitiable that she ends
up being rejected by others. What’s different this time, however, is the nature
of her rage, which is much closer to the surface. Usually she swallows it
deeply and then feels bewildered and helpless with her never expressed,
never acted upon anger. She talked about how angry she was at having to
come down to

see me today. Though I was trying to pull her out of the mud, nevertheless she
had too much to do to take this much time out of her life and get sick on the
bus to boot. Furthermore, she woke up with thoughts of owning a gun and
shooting people. When she went to ask the secretary where I was, she had the
feeling that if I missed today’s session, it would be a fitting caption for the
week. She had a little trouble opening the glass window at the office and a
strong impulse to ram her fist through the glass. Karl had been thoughtless,
pushing her to go look at apartments when she was too tired to move and
making her go to a bookstore when she didn’t want to, then scolding her for
not having dinner ready, though in jest. Shortly after that she accidentally left
a red-hot pan on the counter and he burned himself; for a moment she had
thought it was poetic justice, and hated herself for that. (Obviously it is less
“poetic justice” than destructive impulses breaking repressive barriers). She
had been aware that it was unwise to leave this pan on the counter, thought it
was dangerous to leave matches next to it, but somehow managed to push it
out of her mind within a couple of minutes. She was angry with her father
today, and even with me, although she wasn’t able to talk about this too
freely.
There was so much going on, I had difficulty knowing what I could do to help
her; and at the end of the session I had the distinct feeling that I hadn’t been
very useful. Ginny walked out looking somewhat discouraged and downcast,
probably with the feeling that it had been a long trip to see me for no real
profit.

During the interview I had tried to make her realize that the situation was not
out of control as she imagined it to be: she retained her freedom of choice in
each instance and could take any of these problems one by one and think of
corrective moves. With some minor effort, for example, she could correct her
own untidiness and the messy rooms. However, she seemed much too
distraught for such practical suggestions to have any effect. Furthermore, she
stated that she was too harried this week to write up anything for me—she
had said everything she wanted to say last week and if she had anything more
to say, she would say it to my face. This sounded awfully challenging to me,
and I tried to help her move more deeply into the feeling but she wouldn’t. I
think that she may well be nourishing some anger toward me for having
missed several weeks ago. She said she knew I would say this, but that it
wasn’t true; in fact, it was silly to look back to the events of a month ago
when there were so many urgent things going on in her life.

At any rate, I had some contact with the old Ginny today, a return to
discouragement, pessimism, and puzzlement on my part and to Ginny’s
feelings of shame about her messiness and sloppiness; we were both sucked
into her pit of self-abasement.

May 5

DR. YALOM

GINNY started off by saying she didn’t have her report, she didn’t have time
to do it, but then muttered under her breath that she did have time to go to the
races. When I questioned her, she insisted she really was much too busy,
every moment of her time had been spent in packing and moving, and any free
time she gave herself was a necessary respite from the household situation.
She was depressed, not much was happening, she had said everything there
was to be said at the last meeting. All of this left me disgruntled and I felt an
urge to scold her for not writing the report, since that’s her part of the
contract she made with me. In fact, I even considered telling her that if she
wasn’t going to keep up her end of the contract, I wouldn’t keep up mine. But
that would make the writing extremely coercive and mechanical, and I also
hesitated from saying this because she was so dreadfully down. For the next
twenty or twenty-five minutes, we had an extremely dull session. It was
mainly a rehash of things she’s talked about before. I don’t think she uttered
one fresh or refreshing phrase. Mainly she served up once again a
nondescript selection of drab morsels from her self-negating smorgasbord.

I tried to find a way to cut into this constructively, but I was simply unable to
say anything to her during the first part of the interview. There was nothing I
could think of that would be very useful, nothing that I particularly felt like
exploring or reinforcing; so I found myself, quite against my will, rather
silent. I pointed out to her that she was being very little-girlish, that she was
speaking in a feeble timid manner and saying nothing new. She responded by
agreeing. She then told me a fantasy that she had had in the morning. The
fantasy had to do with my sending her to a little cottage instructing her to
write, and then my helper came along and had sexual relations with her,
which provided quite a jolly romp. After awhile, however, sex with the
helper got to be more than just fun in that it turned into incessant intercourse
on the verge of rape. She was then tempted to run away with him; however, I
came and persuaded her to stay

with the writing for at least another month or so. We explored the fantasy—
did she really want me to take care of her in a neat little cottage and even
provide for her sexual needs? It was a real mothering task that she was
asking of me.

What are some of the things she would want me to ask about? (I always find
it illuminating to ask patients what questions they would like me to ask them.)
She found herself unable to answer except to suggest I tell her more things to
do or ask her more specific questions about her shift in moods. She also
wanted me to tell her what to do.

I then proceeded for the last fifteen minutes of the interview to be a Mother-
extreme. For example, she had said that one thing she liked was when I
suggested she go on the train and she had gone on the train last time. I asked
her whether she went on the train today—she said no, and I asked her why
not, and we went into the details of why she hadn’t caught the train today.
Then I asked her exactly what she had done today, and she told me what time
she woke up and what she was thinking about. I asked her what she did then
and she talked about her washing and the fact that she hadn’t washed very
well and I pursued this by asking if she would like me to wash her and she
said no, but she’d like me to give her a “free shower.” It was a funny choice
of words, the

“free” made no sense; however, I couldn’t find out any more about that. She
then talked about breakfast, saying that she really wanted cereal and
strawberries, but wouldn’t permit herself to have that, even though it may
have meant that the strawberries would remain uneaten and become rotten.
She says it’s just one of the ways she has of depriving herself of what she
wants. Her mother in the past would help her decide what kind of food to eat.
I persisted in this line of questioning for awhile and we ended the interview
with my suggesting to her that she should have the strawberries and cereal
tomorrow, and that she should take the train next time.

This certainly livened things up in the interview. At one point she said she
felt very hot, almost like a sexual hotness, and then went on from there to talk
about something that sounded quite curious and rather intriguing; she had
almost decided today that she was not going to let me get to her and that she
was going to remain in control of me by being untouchable. She remembered
being that way in the group—aloof and emotionally unreachable. I asked her
more about how that would make me feel toward her. She said that the only
word that came to mind was “in awe of.” This seems to suggest that by not
being touched, by remaining somewhat dead, she manages to control me and
perhaps, through her frigidity, Karl. There is a tight, defiant fist inside that
fuzzy

mitten.

May 18

DR. YALOM

THIS WAS a very tense, unsettling interview. First of all, today was the day
we exchanged our written reports of the last few months. I haven’t done too
much thinking about them except to tell the secretary to get the write-ups
together.

This morning I was going to spend some time reading mine and perhaps
editing them to make them more intelligible to Ginny, since I haven’t been
proofing them after dictation. As I started reading, I became more and more
embarrassed and asked myself what on earth I was doing showing all of
these to Ginny and wondered what their effect would be on her. I finally
resolved all of this by stopping after reading a couple of the write-ups. I also
glanced over a couple of Ginny’s in the process but didn’t read hers
systematically either, since I felt we both ought to do that together this week
and talk about it next time. One thing that was evident to me was that in one
sense the tables are turned—Ginny often sees me as having the upper hand
and yet when we look at the use of language, it is quite clear that my language
is clumsy and unimaginative as compared to hers. At the beginning of the
interview I felt more and more apprehensive about the wisdom of sharing
these with Ginny, and told her that if she were so upset by the reports that she
had to call me, I would be available. She also seemed uneasy about reading
them and, amusingly enough, considered putting a comic book cover around
them so that Karl wouldn’t know what she was reading.

Ginny came in looking very well today. She had called and switched days so
she could come a day earlier because Karl was going to be driving her down
today. The whole meeting was rather tense and a lot of the tension was of a
sexual nature. Ginny talked about her intense sexual feelings, which seemed
to circulate around me or at least be tangential to me. When I asked her
whether feeling sexy was in any way related to seeing me today, she would
go from there to talk of masturbation, with a sense of gratitude for my having
given her permission, almost as if I were a priest-pardoner.

Then she talked about how upset she felt at calling me yesterday to change
the hour, how it was like her mother who had once forced her to call boys on
Sadie Hawkins day. I commented on the fact that in the last session she had
talked about having sex with my delegate or helper. She said that if she could

tell Karl everything she has been able to tell me, she’d feel much more easy
and would probably be able to allow herself greater sexual freedom with
him. I wondered if an extension of this line of thought might be that if she
were to have sexual relations with me, she would be able to unblock herself
further yet.

She said she sometimes thinks of that but doesn’t really permit herself to
think about it for long or to fantasize it. I suggested that she does at a
subintellectual level, since she gets flooded with sexual tension when she
comes into the office. I wondered if talking about it would help to exorcise
the tension which was present and which did seem to be blocking her today.

We had a hard time getting through the hour. Time seemed to drag. Maybe it
was the expectation of reading the reports. We discussed the way she looked
in her mini-dress, which she considered much too short; she felt embarrassed
about it, sorry she had worn it or sorry she had not worn long pants with it. I
asked what she thought my reaction to her dress was. She didn’t take me up
on this and I gratuitously told her that I hadn’t noted any of the unflattering
things she was saying, that it looked fine to me. I wondered too if her high
sexual tension today had something to do with Karl and me, both being in
Palo Alto today; she seems to feel very much caught between us. I didn’t say
this, though; I’m sure it would have been of little use.

I’m quite curious about her summaries and her response to mine. Next week
seems a long time away.

May 18

GINNY

I SHOULD have written my report before I started reading your reports. But
anyway I had a fantasy in the session last time—it belongs to my vulgar
dreams. See I was so nervous and thought that if I could have masturbated
before or right there, I would be relieved and could get on to the business at
hand. This bizarre thought had overtones and in fact was plagiarized from a
scene in The Story of O where a girl does it in her office on a swivel chair in
front of a man. But this really wasn’t what I was feeling. I’m not sure if all of
the above is real or just a clever pastime to get out of concentrating. When I
go blank, I try to align my thoughts to things I’ve read in books—secondary
sources of experience.
However, what was real is that when I do personal things, I imagine you
there lots of times. So in my transparency I couldn’t see what would be the
difference if you were there in my mind or were really there. At home, for
instance, you sometimes appear. I talk to you. That day in session it was like
coming in with a stomach-ache. It was just a practical remedy, I thought. I
had all that nervous energy and no sanctuary. And your office is like a
sanctuary for me—where I can say some of the things I need to, with amnesty,
without fear of being judged. When I need privacy other times, I station you
by my bedroom door, or next to my bed. Kind of like a psychological
bouncer. You watch over me, protecting and listening. Or if I run away, you
are the only one who somehow miraculously gets the address and zip code. I
knew that to tell you my fantasies would probably make you happy, but I
couldn’t. First because I knew my fantasies were outrageous, but mostly they
were a little trumped up and that I myself was sensationalizing it, maybe even
fabricating it to fill the void in session. But the simple feeling was just that
you are always there anyway.

Probably the pressure too of having to see a total stranger doctor the next day
and show him my womb—having to be jolly and open for him—yuk.

Gynecologists are a whole different ballgame.

I waited six days to write this. It’s the last time I will do it this way. From
now on I will be serious.

In your write-ups you call me Ginny. Whereas I just talk to you. But maybe
because of that I have to be more careful what I say, yours is a diary and
mine’s just a phone conversation where I’m always conscious that I am
connected to you and someone can eavesdrop.

* Literally, before a glass curtain with an audience of doctors.

III

Summer

(May 26–July 22)

May 26

DR. YALOM

THIS WAS the first interview after Ginny and I had a chance to read each
other’s write-ups. I have looked forward to today with some trepidation.

Primarily, I wondered if certain parts of what I had written might have an

adverse effect on Ginny. In addition, I felt personally embarrassed after
reading both sets of reports—some of my observations seemed sophomorish
and my language ungainly in comparison to hers. One saving grace, though,
was the fact that my accounts contained nothing but positive feelings toward
her, since that’s how I genuinely feel. At any rate, she came in rather bubbly. I
suggested we tape-record this session in case we want to come back to it
later. She said perhaps I should listen to the first few minutes of it, since I
would probably be disappointed and change my mind about recording. She
then went on to explain how a number of catastrophies had beset her since
our last meeting: scabies, vaginal fungus disease, laceration of her foot, huge
doctors’ bills, and then finally the fact that Karl had not been out of the house
much that week so that she had been obliged to read my reports hastily and
her own scarcely at all.

Her initial response (not an unexpected one) was to compare her work
unfavorably with mine. She felt as if she had taken a course, as it were, and
turned in a poor term paper. She said that by comparison with mine, her
papers looked puny and brief, whereas I had been willing to delve into things
more deeply. She pointed out that my writing them in the third person, talking
about Ginny, gave me a great deal more freedom than she had because she
wrote them to me and used the pronoun “you.” This observation really struck
me because I hadn’t noticed it before; it is so illustrative of the inequality of
the psychotherapeutic relationship in general. I would never have considered
writing them to “you.” And what about her addressing me as “Dr. Yalom”
and my calling her “Ginny"? Will it ever be comfortable for her to call me by
my first name?

For the most part, her feelings about the reports were positive; in fact she
said they had given her so much encouragement that she has decided not to
take a full-time job, which would have forced her to discontinue therapy. I
mused about what aspects of my writing had caused this reaction, but she
simply replied that she now felt ready to move on to the second phase of her
relationship with me. Recalling some of her past teachers, she noted that
when

they got around to giving her a symbolic testimonial dinner, it usually

signified the end of the relationship. In one sense, these write-ups were a
testimonial dinner. She apparently read them very quickly, focusing on all the
positive aspects, and came away with the feeling that she doesn’t have to
worry so much about winning me over and can go on to other stages with me.
She made quite an issue of the fact that she had no time to consume them
carefully because she couldn’t possibly read them around Karl, they were so
incriminating. She made me feel as if we were conspirators in a political
plot or lovers having an affair which had to be totally concealed from Karl.
Obviously there is a grain of truth in this because if Karl were to read
everything she has said about him, he might object to the mere fact that she
was so public with their private life. Though I think that’s the sum total of the
possible offense he could take. It is clear that she over reacts to the threat of
discovery; the secretiveness of it all, the careful concealment of the write-
ups in her room, the pumping of her heart when she furtively reads them lest
Karl come in and catch her at it.

The interview in general was rather nonproductive, aside from our sharing
with one another our reactions to the write-ups. Ginny was pleased to talk
about her ease in performing acts which had previously seemed major
obstacles. For example, in the past when the kitchen was in shambles, she
would bemoan the fact that the table was untidy and that she was the kind of
person who made such a mess. Now she finds, almost in wonderment, that
she can make the table tidy by rapidly cleaning it up.

We talked about money. Humiliation is her shadow: it is there when she begs
her landlord to fix the hot water heater, when she asks for free medical care
at the peoples’ clinic and when she dons her outfit for her job as a traffic
guard for school children, all the while praying silently that none of her
friends will see her. She has a deeply engrained sense of herself as a
demeaned person.
I tried to help her see that she is the demeaner and that if she wants to be
proud of herself, she has to do things in which she can take pride. So much of
her aggravation stems from the lack of money in her life, a problem with a
relatively easy remedy. I asked if she had seriously thought of putting her
writing talent to work. There I was again preaching my personal gospel and
without even a helpful text, since I had no concrete suggestions to add to the
expression of my confidence in her ability to find a way to earn money in a
manner appropriate to her talents.

May 26

GINNY

HE WANTED to record. I didn’t bother to think about that or ask why. I

didn’t let it affect me as I went on humiliating myself by enumerating my
diseases which were not crucial to anything but then were recorded to be
played back.

We were like Dick Cavett and his guest.

I talked about the General Practitioner and how I thought he was

overcharging me. I sort of wanted to ask your professional advice, but I still
felt unsettled after we’d talked about it. Maybe because talking is not acting.
This morning I was awakened by dreams of confronting him. Mostly I trust
everybody since I am too dependent not to. I react to someone rather than act
first. They put me in a place, set my borders and limits. If they are bad, my
stamina usually holds on longer than they do till they have passed. But this
one doctor kept getting in deeper to my nightmares. Mostly because I have
been getting cut up and infected. You are never a bad doctor in my dreams,
only once when I was sure you did not like my encounter group leader, M. J.,
and I knew how wrong you were because your background and philosophy
could not come to terms with his magic and psychodrama, however short-
lived.

Maybe as a result of reading the write-ups, I experienced sensory dreams, in

which I was bracketing and gliding, back and forth. I’m sure these reflect
happiness somewhere.
In talking about the write-ups I breezed over them too much. You were
covering your face and removing your eyeglasses. And laughing in a way
half-startled and shocked, and I knew you were, but I wasn’t sensitive to it.
You had given a lot more in the write-ups than I had, told a lot more. And I
kind of cantered over it all without thanking you. In my mind I could do that
because I promised myself next week I would look at them more closely.

I think I slur my words when I talk to you. I drop g’s sometimes. Just to feel
sloppier.

Even though I’m always saying how much I want to repay you, sometimes I
know what you want and deliberately don’t give it, staring at your shoe or the
table. You want me to speak freer and to begin not to hold back thoughts, but
it doesn’t look like I’ll let myself be broken of the habit. I take no
responsibility for what I say, maybe that’s why my write-ups are not as full
as yours.

In the session I knew I was optimistic, but that’s because I was removed from
actual challenges and felt comfortable. We were talking about what I would
do next week, not what I had to do then. I can be very happy when I imagine
things that are not on my back yet.

Yesterday I told you how I would have to start doing things. You usually tell
me. The focal point was the kitchen table. My training ground. But it was a
revelation the first time I realized there was a path. How I could conquer
trivia, not let it mount up against me.

By putting things off, I suspend my active life. Then when I am most passive,
most of the things I haven’t done and all the things that I have put a

“hold” on, spin around, swirl in an inertia. Sometimes I like therapy because
I feel it is a perfectly safe time. When I have only to prepare to do something
but don’t have to do it yet.

I know that Karl hates my inertia, my backing away, my production numbers.

I hate it too but am kind of stuck. I do a lot of things with energy but seem to
stop just short of perfection and a goal. In this way the kitchen table becomes
like a great mesa with dust and tumbleweed that blows against me, no matter
how much I straighten up. I know my problem has something to do with
suspension of action and feeling. Sometimes I am terribly nervous. Something
in me wants to do something. My desires are like a horse at the starting gate,
that moment suspended, the red flag up, the horse straining and tense. If the
horse is pulled back and strains too much within the gate, when the gates
finally open and the race begins, he will relax all his tension and run the race
badly, or at least have a bad start. The jockey has to know when to restrain
and tense the horse, only seconds before the gates open so he will run with
speed. Sitting in the waiting room, waiting for you, I tense up. Most times by
the time I get to your office I’m just glad to be out of the starting gate, out of
my tension, and run a slow race for both of us.

June 2

DR. YALOM

A VERY important, puzzling hour with Ginny. The kind of hour I would have
expected last week. She began by saying that right after our last hour she
mailed out several things she had written to Mademoiselle. Then she told me
that over the weekend she had had a terrible panic during which she lay
awake

all night. She explained this on the basis of her yeast infection—she and Karl
tried to have intercourse but she was very tight, it was “as though her vagina
were sewn together.” In the morning he asked her what was wrong and she
told him some of the things we had talked about months ago—that she would
appreciate it if he would make love to her longer, which might enable her to
get more satisfaction. That following night they tried again and failed, which
caused her to become very tense and upset, and lie awake all night,
fantasying that Karl would leave her and all the while hoping he wouldn’t
hear the loud internal echo of her imaginary conversations with me. Again,
she portrayed herself as the child or the slave in relation to Karl, wondering
what he was feeling and what she might do for him and what he might like
her to do, without ever a thought of the reciprocal perspective.

Very quickly she added in passing that she had reread the write-ups and in
fact had started reading them before she went to bed on the night of the panic
attack. She jokingly said that since then she doesn’t read them at night
anymore, only during the morning or day. This sounded to me as if it were
terribly important, and we spent, needless to say, the rest of the hour on it.

To my mind I made heroic efforts to track down Ginny’s reactions to my

reports. She was incredibly resistive. I have not seen her quite so explicitly
resistive to any issue in all the time I have known her. When I asked her
about the write-ups, I had to cut through several layers of debris before we
got into anything that was close to her feelings. She would start off with,
“Well, I smiled when I read such and such,” or “I felt that I was not being
genuine or didn’t take responsibility for asking such and such in a session.” I
kept pressing her to share with me her reactions to the revelations about me
she had found in the reports. Surely she knows some things now that she
hadn’t known before, how did that make her feel? She avoided this on
several occasions. I practically had to get her up against the wall and pin her
arms behind her to make her talk.

Some of the things she finally mentioned were exactly the ones I had felt most
sensitive about writing, i.e., my borrowing phrases or techniques which I had
read or heard from other psychiatrists and “using them” in my work with her;
my hoping that she would see certain books in my office to make her think me
better read; the innuendoes that I had worked on some problems similar to
hers in my own therapy; my sexual or lack of sexual feelings toward her,
which made her feel “squeamish.” When we pursued the meaning of the word

“squeamish,” we didn’t get anywhere, except that she felt it was like “getting
a

love letter from an older boy” which she used to read with her mother when
she was younger.

She felt ashamed of evoking any feelings in me. She said she wasn’t worth it,
that she wasn’t really “large enough,” she wanted to be invisible. On a
couple of occasions she said, “If only you could have seen me that night
when I was panicked.” I tried to find out what she would have wanted me to
do that night, or what she could have expected from me, especially in the
light of my reports, which disclose how fallible I am. She couldn’t answer
that except to say that she likes to be with someone when she is troubled, like
her father or mother, when they would take her into their bed. I wondered
aloud whether she was upset at the loss of my “perfection.” She denied that,
although at one point she mentioned that when she was leafing through the
notes trying to restore her memory, she had a sudden impulse just to throw
them on the floor in a dramatic flair. On another occasion toward the end of
the hour she said something which suggested she was angry because I was so
much in her mind whereas she was so little in mine. This startled me. It was
quite the opposite of what she usually says—usually she presents herself as
so lacking in importance that she doesn’t deserve any regard at all. I think
that her desire to be the sole recipient of my attention is the primary feeling.
And the other feeling, of being so small or insignificant, is really a way of
compensating for her sense of greed.

I felt very sorry that I hadn’t tape-recorded this session. It’s difficult for me,
even now immediately afterwards, to capture its flavor, and I would like to
be able to go over it. Naturally, I am concerned that the reports have made
her feel somewhat badly. On another level, though, I have no doubt at all that
they will hasten our work. When she said that it sounded as if I had worked
on some similar problems in my own therapy, I said I had and asked how that
made her feel. She evaded the question. Unfortunately I have to teach a class
now and must end this report knowing I have captured only a small fragment
of the hour.

June 2

GINNY

YOU’RE RIGHT. I don’t want to write this. I feel like I gave away a friend
by giving you back those write-ups. And a friend who only had stayed for a
short visit. At the same time I was relieved that the occasion was past. I say I
want them back sometime to look at and concentrate on, but that may be just
my “I’ll

cry tomorrow” alibi. The part that made me cringe and which I remember
just now is when you talked about my self-pitying cycle and getting sucked
into it.

That’s seeing me as a lump. The writings are horribly incriminating of me. I

don’t believe I am totally the way I am described by myself or you. Karl
would surely leave me in a minute if it were true. And yet I nurture the “poor
me” of the reports, supply transportation for it to come here each week, and
keep away the less familiar stronger elements in me. It’s easier to be stomped
on than be the one who stomps.

I’m sitting here trying to fantasize you saying, “You know I like you Ginny.”
Then I get squeamish and say, “You idiot.” But I can’t go farther.

The bad night was not the focal point of the week, so I wonder why it became
the only thing we talked about in session. I should have stopped it.

When I came into session I felt calm and open. But I put myself back into last
Sunday night, like jumping into a well where you have once been caught. I
started to explain the situation—it happened like this, see—and suddenly I’m
right back where I started.

Yesterday when I left I realized there was nothing you could write in the
write-ups or I could write that would magically change what didn’t happen
and give it sense. I know you feel sucked in, now that I’ve read your
comments.

But I can’t come to a conclusion with words out loud. I never have. We
nibble on little bait, a real fish is way below. The small things we catch, I
throw back.

I know the only way we have of getting at anything is talking. But I get so
self-conscious. I felt very bad about the session because I hadn’t
concentrated the way you wanted or on what you wanted. If we had been
meeting twice a week, I could have jumped in again. Maybe I wouldn’t
though. I meet Karl every night and postpone things with a promise to work
on our lives.

But I think you and I still want different things. I want to be mellow and calm
and cry, and you want rational answers and leadership qualities.

The rest of the day should have been bad and discouraging but I didn’t allow
that. I wanted to erase and reverse the day and not follow my visions full
circle, and I didn’t.
June 11

DR. YALOM

FOR ME this was one of the least involved, least tangible meetings I have
had with Ginny. As soon as she left my office, she left my mind, and now
some four hours later, I can scarcely remember the interview; only that I had
a strong sense of lack of work, lack of movement.

The most striking part of the session was the very beginning when Ginny
hurled two tiny Ginny bolts at me. First she said it seemed over the phone
(when she called to change the appointment) that I hadn’t really wanted to
see her this week. Then she added that she was a little ambivalent about
coming today since she could have gone to the races instead and this is the
last day of the season.

For some period of time then she talked about her depression, about her
discouragement, about the fact that the last meeting had been a very bad one
in which I was pressing her for some type of answer which she did not know
and could not produce. (In fact, this was very much the case, since last
session I spent most of the time trying to navigate her into the area of her
feelings on reading the notes.) I made a couple of tenuous attempts in this
session to pursue that question but it doesn’t seem as if we’ll be talking about
the reports for quite some time.

She then told me how she habitually makes inventories of all the bad things
about herself. I, for want of a more original tact, prodded her to mention
some of the good things that had occurred this week. Well, she had tried out
for a theatrical group and had written a funny poker form for some of her
friends, which proved to be hilarious but without commercial value. In
response to my interest in her acting, she told me that she sometimes acted
through her mother, by asking her mother to portray a scene, which she could
then mimic perfectly.

She has thought of being a professional actress and apparently has

considerable talent. She couldn’t really own that and began to go through
some subtle and elaborate moves to undermine whatever positive thoughts
she may have let slip out. For example, after admitting that she acts pretty
well, she immediately added that she is simply putting on an act, i.e., not
really feeling the feelings in the way that she should. It does get very
wearying for me and at times I feel as if I’ve exhausted my inventiveness in
encouraging Ginny to look at herself in a different way.

And so we ended without really having said “hello” today. The only hopeful
signs were some flickerings of rebellion, for example, her initial comment
that she believed I had not wanted to see her today. Oh, yes, also she arrived
some fifteen minutes late, having taken a bus which could not possibly

have gotten her here on time. Furthermore she was somewhat directive in
recalling a dream she had last night: ‘Til tell you about it, but I don’t want to
spend much time talking about it.” The dream was that I couldn’t see her in
individual therapy, but that I did allow her to sit in on one of my classes. In
that class I wrote a few words on the board, which she wrote down in her
notebook.

It was some type of psychological jargon, like names of various diseases.

Then, feeling sorry for her, I saw her privately for ten to fifteen minutes. The
fact that we were both writing things down, I on the blackboard, she in her
notebook, brought to my mind the whole issue of the write-ups. The dream
(and her initial comments) reflect her fear that I do not wish to see her but
underneath this surface concern I sense the first delicate blades of her overt
resistance to therapy.

June 11

GINNY

I EXPECTED to be disappointed with last Friday’s therapy. Instead when I

left I felt better. But this is Monday and only certain things stand out in my
mind.

First, when we talked about my crying over Lassie. I thought it was a bad
thing, an example of a childish emotional mentality. But you said some
people could not even do that. This rejuvenated me, because it was
something I hadn’t thought of, except in a satiric light. Karl vomits when he
catches me with the last five minutes of Lassie.
I think when we counted up plusses, I was roping you in. It’s like
remembering plots of a novel never written. The plusses are very far
removed if they cannot sustain me and motivate me. And they are dry to go
over.

When you thought I was being phoney, I enjoyed that. I think I’m always so
sincere even to my own dullness. It must have really been bad, uncomfortable
for you, if you thought I was phoney.

I came away from the session optimistic. Though I sensed that you did not
enjoy it. But that didn’t detract from my pleasure.

June 15

DR. YALOM

ROUND 3 (or is it Round 4 or 5) in the Ginny get angry series. I put so much
pressure on Ginny today, I can’t believe it myself, and I wonder what she’ll
do this time and how many more times we’ll have to go through the cycle.

It all began when she walked into my office crest-fallen and depressed
saying, “We had another ‘lump’ talk last night.” (She was referring to an
earlier conversation when Karl had accused her of being a sexual lump). The
gist of this talk was that Karl had relentlessly criticized her because of her
many failures—a criticism she considered justified on his part. He was
asking for some interaction with her, for some kind of spontaneity, and
everything he said about her was “absolutely true.” She couldn’t respond to
him or responded as though she were someone else sans emotions. It was a
total nightmare, she just waited until it was over so that she could be
mercifully relieved from everything. Since then she’s been besieged with
fantasies of his leaving her and she thought for sure that “this was it.” She
comes to me today in a very self-critical, self-deprecating mood and I knew
if I were to spin around with her for awhile, I would be sucked into her
despair and self-disgust. It was important today to think first and feel second.

My first response was to try and find out what she would have said to Karl
had she not been so paralyzed. She couldn’t really come up with anything,
except to say that a “real woman” might have stuck up for herself a bit more.
Several of her statements implied that she must have been sitting on
considerable indignation and anger but couldn’t come to terms with these
emotions.

A review of last night’s chronology clarified what had happened. The

scenario went like this. Ginny spent from 5:00 to 7:00 trying to cook a new
dish, roast pork loin. The meal was a semi-failure, edible but not interesting.

Karl, who reads during his dinner anyway, read a crossword puzzle all
through the meal and criticized her as if she were a waitress, saying the pork
was poor and the potatoes were not done, etc. Following dinner he was to
have taken her to a friend’s so she could get a shower. (She can’t shower at
home because there is still brown water coming in from the tap which
somehow has never been fixed.) He refused to drive her over to Eve’s,
obliging her to take a streetcar. Following that, when she came home he was
gone, leaving a note that he had gone out to have some beers and hoping that
he would get over his bad mood. She was relieved by the note. When he
came back he was probably even more upset because she hadn’t
acknowledged the note. He sat watching television a little bit and then shortly
after 12:30 they turned off the set and she

was asleep in a few minutes. Ginny says that since she gets up at 6:30 in the
morning, she becomes very tired by midnight. In any event, Karl was angry
with her for falling asleep so early.

From this point on in the interview, I came down extremely hard on Karl and
very consciously too. What I wanted to do was to turn Ginny on her head and
for once help her stop thinking of all the things that Karl finds unsatisfactory
in her, so that she will stop living in the shadow of fear of his sudden
desertion. I wanted her to entertain the thought that Karl has certain severe
flaws, and thus I said to her, “How long are you going to give Karl to
straighten up?” I pointed out as clearly as I could that she turns off anytime
she has any anger. She can express anger only passively, for example by not
cleaning the house, or by not clearing all the clothes off the chair. She replies
she’s never been able to clean the house. I said I thought that was ridiculous
and that she could do it anytime she wanted to, but doesn’t, as a means of
expressing her anger. That’s what we call passive-aggressive. At this point
she suddenly burst out crying and expressed the wish that she were a five-
year-old child again, where she wouldn’t have to worry about doing anything
for anybody. I pressed on into the subject of Karl’s flaws, supplying many
leads along the way. We got to such things as his lack of intuition, his lack of
sensitivity to her, his constant reading, especially at meals, his need to
control which is so oppressive that her friend Eve doesn’t like to have him
around. He criticizes her, she said, because she’s not growing, not improving
her abilities. I asked her if reading crossword puzzles all the time and doping
out races can be construed as self-improvement. It doesn’t seem as if he’s
been growing either.

We talked, or I talked, about his lack of generosity, the fact that he still
charges her money for the tolls on bridges, whereas he can earn $40 a day
whenever he pleases to work. I told her that I think the response of almost
any other woman to his dinner criticism would have been, “Who the hell are
you to criticize me?”

I kept saying to Ginny, “Is this the kind of man you want to live with?” while
she responded that she won’t have to because sooner or later he’ll leave her.
I kept pressing her with the question, “Do you want to spend the rest of your
life with a person like this? If not, how much longer are you going to give
him to change?” I wondered about the possibility that she is also depriving
him of any chance to grow because she never gives him any feedback, and
I’m sure that that was what some of the fuss was about last night. She cried a
couple more times during the session. We talked about his lack of praise for
any of her virtues or talents. He doesn’t say anything about her writing or
about her clever

parodies or about her acting; wouldn’t another woman want and expect some
positive response to these things?

She heard me giving her some explicit instructions and asked somewhat
tremulously if she has to do it right away since they have an important poker
game at their house in three days. I honestly feel that if I had told her to go
home and tell Karl to fuck off, she might well have done it this very day. She
pointed out, however, that it would seem forced. Of course, that’s part of the
real danger that I face with Ginny: she’s so passive, so puppet-like, she’ll do
exactly as I tell her to do, which may not help her feel totally autonomous in
the long run. Well, screw it, that’s just one of the risks we’ll have to take. I
think I’m beginning to feel we ought to work with behavior first, feeling later.
At any rate, I was extremely indelicate and rather powerful during the
meeting, in that I didn’t even allow Ginny to tell me how she felt I was
coming across. I don’t know what shell do with this, but in the past it’s been
this kind of session which she’s most appreciated.

June 15

GINNY

THE SESSION gave me a lot of information and some strength. Whenever

this happens, I always wonder—what would I do without you and the
session?

I felt I was really there. At the same time I didn’t care how I was affecting
you, for once. At the end I knew I was exasperating you, but that didn’t bother
me either, although I felt a little tired from being so tepid.

Before the session I had been so much in a fantasy. This is how I deal with
things. Fantasy is resilient. I had no expectations about the session. I went
into it blind. I was fantasying so much I didn’t even think about the session. I
wasn’t even going to bring up the night before since it seemed so obvious. Of
course I was glad when I did, and once I did, I don’t think I backed away
from myself except toward the end.

Your word “indignation” sent up sparks in me. Once my father was playing
with me but took a nickel I knew was rightfully mine (just a small thing). I
wanted it back; he was teasing me, and when he finally gave it to me, I
started crying. Maybe because I felt so sorry for all the bad things I had
inside, indignation. Karl teases too all the time. I would rather think nothing
than think something bad of someone. Suspend judgment and everything. I
don’t think

you’re going to get me to express bad thoughts about people, though I would
like to try. I’m from the school of Bambi—Don’t say anything at all if you
can’t say something good.
I could hear your voice all throughout the session, by friction, trying to catch
my voice and give it some fire. I kept resisting, as your voice grated more
and more on my ears. I felt hostile to you. That you were trying to manipulate
me. And wanted me at least to mimic you in ferocity.

But the change in me afterwards was incredible. I realize that any anger or
friction in my life paralyzes me. I dread it. I lay quiet and restless and tense
at night waiting for it, that anger ambush. I fear any confrontation. But now
(or at least for three hours after the session) I have been welcoming it. I
waited for it.

As an opportunity to expand myself and find myself. (Karl was almost too
nice to me. Why didn’t he do something characteristic—insult my hamburgers
—so I could let loose and haul one at him?) I felt more alive because I
wasn’t waiting in fear to go empty and blank at the first sign of trouble. I felt
larger than myself, rather than smaller. More surprises happened. And for a
few days afterwards I didn’t fantasize, for what was all around me felt
pleasant and powerful. I also didn’t write the write-up completely because
when we have a good session, what has happened seems to evade words and
to be still happening.

Of course, I have fantasied since then, dreaded since then, and procrastinated
a lot. I need more than one jolt. But even that small push you gave me allows
me to coast for awhile, free from fear and full of feeling. That is wonderful.
Why don’t you scream a little more?

June 23

DR. YALOM

THINGS ARE rather gay and silly and bilaterally coquettish. There was an
obvious disparity between Ginny’s demeanor and the content of her talk. Her
content was “down"—she was desperately hoping I could do today what I
did last week; her demeanor was high-spirited. She wore a rather absurd
costume with Farmer John clodhoppers and overalls. During the interview
she said she felt somewhat awkward about the shoes, but that she blistered
whenever she wore any other kind. Last time she had wanted to look nice and
had worn
another pair, but her feet blistered. I didn’t pick up her comment about
wanting to look nice the last time, but perhaps I should have.

Her main message was that what we had done last time was very helpful to
her. She had had a different attitudinal set all week, especially in regard to
Karl.

It wasn’t so much that she had the opportunity to answer him back, but that
she was set to do so should he torment her in any way. It seems as if her set
conveyed something to Karl, so that he was quite different during the week
and in fact more self-critical than she’s noted in the past. For example, he
would say

“What a slob I’ve been,” or “Look at the mess I left at the table” Once or
twice she actually did stick up for herself. But she knew she could never fight
back if Karl were to make some sort of sexual insult. I tried to push her into
what kind of insult that might be. She said, well he might accuse her of faking
orgasm. I wondered then what she might say to him in return. (I wanted her to
know that, though I don’t advise this kind of sexual insult between couples as
a good way of fighting, if it came to that, she too had some ammunition with
which to fight back.) I was merely trying to bring her to the point of realizing
that she has as much right as he has to attack unfairly.

On another matter she refused the right to have judgments about people.

She spoke of her sister who is very judgmental of her, but she, Ginny, cannot
bring herself to respond in kind. Finally I was obliged to act as Ginny’s
mouthpiece, to say that her sister is pretentious and sometimes acts like an
ass, and to instruct Ginny to say these things after me. In the midst of our
discussion about the sister and about Karl, Ginny interrupted to say, “I wish
we could do what we did last time.” I found this very odd since I thought I
was doing just that. I think she says “do it” and “don’t do it” in the same
breath.

In general, though, Ginny is right. Active instruction in the art of aggression is

perhaps the best thing for her now; if we can do this for several weeks in a
row, then it will probably permanently change her feelings about herself. Yet
I shy away from becoming so authoritarian because I fear that will only
enhance her dependency; my telling her to be aggressive still conveys the
message of submission to me. It is also clear that she can’t follow me for
more than a week at a time.

Nevertheless, she had a good week, she even won money at poker, and it was
only in the last couple of days that she started going down again. Going down
means that she’s spent the last two days in daydreaming, as was the case the
entire week prior to our last meeting. She intimated at the beginning of the
interview that what she’s really not doing is writing. What difference does it

make if she stands up to Karl about doing the dishes, the important thing is
that she is not writing. She had written something last night that she wanted
me to see and was sorry she hadn’t typed it up, but it had something critical
of Karl, which stopped her from typing in his presence; she’ll bring it in in
the future.

She is still with the acting group, doing improvisations in the evenings, and
may well get a job with them in the fall. It is incredible for me to think of her
as willing and eager to act à l’improviste—one of the most terrifying of all
situations—I would no sooner do that than parachute into Mt. Etna. I have a
hard time reconciling it with the picture of Ginny as “timid” and
“frightened.”

I spent the last part of the interview focusing on the writing, not with great
inventiveness. What would it take to make her start writing? What is she
writing? What is she not writing? I tried to push her into thinking about
tomorrow; what would her schedule be? Could she start writing at 10:00, if
she wanted to? I tried to determine what would mobilize her will. She got
angry at this, responding with genuine irritation, and I was taken aback. Now
ten minutes later I can reflect almost with pleasure on the fact that she was
able to do this. She said that she thinks she will write tomorrow and will
start at 10:00

o’clock. I ended the session by jotting down on a piece of paper “Write at

10:00

a.m.,” folded it up and gave it to her. She jokingly said she would pin it on
her blouse. It is kind of a joke as she sees it, but I’m dead serious and have a
hunch we’ll be hearing more about that piece of paper. I feel rather
enthusiastic, optimistic, definitely high today after seeing Ginny. It was an
exciting hour and she was really quite charming. She told me a couple of
jokes, funny things that she had done during the week, and I got a much
clearer sense than ever before of how much fun it must be for Karl to live
with her. Obviously I’ve known this intellectually for quite some time, but
rarely see the jaunty, witty side.

June 23

GINNY

I NEVER really got to deep feelings. I have been dawdling. As you said, the
real issue is writing. When you kept nagging me about why I wasn’t writing, I
had to form an answer and mumble it out; I guess I could have gotten angry.

Because I felt bugged, because it sounded like my parents trying to coax my

“gifts” into something constructive. And obviously these apparent talents are

encrusted with something else that makes them hard to mine. But I always
feel I have to answer. I’m strung out on “I’m going to’s.”

I phased out today, like when you’re saying the obvious about writing or
making judgments. I pretend to listen to you and go along with you, keeping
up my side of the conversation when really I don’t take any of it personally
or seriously. So I want you to change the subject but I do this by grinning
rather than saying I’m bored.

On the way home in the bus I fell asleep and woke up with a start, dismayed,
to realize the session was over. It wasn’t a bad session. It’s like ordering the
wrong thing in a restaurant. You’ve missed your chance till next time and
have to digest what you’ve eaten.

It always seems that the follow-up session after a good session is poor in
comparison. Cause I know that the one before injected me with new strength
and purpose. Whereas last time I just came and was my unchanging self—a
butterfly under glass. And I think it’s a ruse to talk about my muse (no!) to
talk about my writing. If there’s one thing worse than going back to my past,
which I know you don’t like from reading your write-ups, its going into my
future. It’s true, if I were writing, or if I could stand up for myself and not
feel ashamed of separating myself from other people by judgments or
emotions, the therapy and I would be improved. For instance, I think that
there are things in Karl I really don’t like, mean silent things that are not all
of him. But I stop in front of the bad things and go dead in sadness and talk
about my bad things instead. Why can’t I just tell him and myself what I don’t
like, what’s wrong, what should be thrown out, given up to Goodwill and
then we could move on realistically, and I wouldn’t feel ashamed or
incriminating. I’d just be growing and so would he.

If I could only admit there are some things I don’t like about Karl, and other
things I love, then I wouldn’t try to kill it all.

Just as you want these write-ups to be about what happens in the session, I
think the session should stick to what I am doing. It seems like I am living in
an

‘if clause in therapy; my life dangling from a hanging if. Because when we
talk about writing, or what I might write, I gloss and glide with optimism and
not till I get home and the 10 o’clock hour comes and I start sticking pins into
myself or turn into Mrs. Slothman, do I realize it was an impersonation of
myself that came to Palo Alto and buzzed for an hour with someone like my
father who knows I’d be all right if I just wrote.

Of course I’ve left this write-up till too late, so only general impressions of
the session and myself are remembered or induced.

I really wanted to read you last week what I had written in my journal from
the night before and what I kept alluding to. At least then you could have
heard that side of me. And maybe you would have seen how self-indulgent
and easy it was.

June 30

DR. YALOM
IN GENERAL my feeling is that I’ve wasted an hour and Ginny, I guess, has
wasted several hours. It takes her three or four hours to get the bus, walk here
from the station and then go back. Although of course I try to rationalize my
sense of wasted time. What do I tell students? Oh yes, it’s time spent

“strengthening the relationship” Therapy is a slow construction project,

requiring months and years, one can’t expect something tangible from each
hour—there are hours of frustration that you and the patient have to sit
through together. If the therapist requires and expects personal gratification
from every therapy hour, he will either go mad himself or move into a crash
program of break-through psychotherapy, like primal screaming, a form of
madness itself.

The mature therapist moves deliberately and patiently, that’s what I tell my
students and that’s what I tell myself today. But there are times when it is
difficult to maintain the faith. At any rate, things started off by her telling me
that she was in a very bad mood, she had lost her wallet a couple of days ago
and had just learned about it today. She had had a bad ride down. She had
been approached sexually by a fifteen-year-old boy when she was lying out
in the park before our session and, furthermore, she hadn’t been able to tell
him off!

She had lost $3.00 at a poker game in the first hour of play and then retired to
her bedroom and pouted and sulked while the game continued for at least
another four hours. She had had several job interviews, without success and
so forth.

I hardly knew where to start. The common thread in everything she said was
some dimly perceived anger. For a moment I let my own fantasy play and the
smoky image that came to mind was a huge lava bed with bubbles coming up
and puffs of anger exploding to the surface and Ginny being confused and
overwhelmed by it all. I decided to investigate all of these incidents, so that
Ginny would recognize and possibly re-experience the trail of her anger.

I was also most curious as to whether my “Write at 10 a.m.” note had had any
effect. Ginny said she had written yesterday and the day before (with no
mention of the rest of the week). She tended to negate her accomplishments
by pointing out that she had been able to write for only an hour and a half,
although seven pages were completed during this time. I baited her by
nagging about the writing. Why hadn’t she written last week? Why doesn’t
she write continuously? I suspected if I nagged enough, we’d see some anger
surface at me.

Then we did things like talking about the poker game and her anger at a
friend who came late, whom Ginny publicly defended on the grounds that she
was baking cookies, which made Ginny feel like a fool when the friend
arrived cookie-less; her anger at having lost so much money so fast; her
anger at one of her male friends who broke a door, which made Ginny fear
the landlord would kick them out; her anger at everyone for staying all night
and the feeling that the landlord would dislike their harboring so many great
drunken types; her rage then at the little boy who made a sexual advance
toward her, and her furor at herself for not being able to say something like
“beat it” or, “get out of here, you creep.” Instead she merely picked herself
up and walked away, saying good-bye and thinking of what her friends might
have said to him. Of course, then she looked at the other side and thought
how badly that would have made this fifteen-year-old feel. Then she talked
about her anger at me, especially how she would feel at the end of the hour. I
tried to get her to pretend it was the end of the hour, four o’clock instead of
three-thirty. What were some of the things she would then like to say to me?
She gave this only a token try. I continued to push her more about the writing
and she almost flared up, but said only “O.K., O.K., I’ll write.” What she
didn’t say was “for Christ’s sake, get off my back.”

I said that for her and she smiled wanly. It looks as though her patience is
finally being tried and I think it is a good thing—how long have I been
pushing her to feel and express her anger?

In any event, we both left with a vague unsatisfied feeling. I spent some time
asking her to look at the bright, positive side of her life. Though everything
seems black to her today, the situation with Karl is surely much improved.
She’s quite convinced now that he really loves her. She’s able to answer him
back on several issues. Somehow or other, things have gotten freed up for her
sexually.

She is writing, she is not lonely, she has several friends, and I insisted that
these things are much closer to the core of Ginny than the trivial items she
had mentioned. Her response to this was that she had told me at the start of
the

session that these were trivial items. Here again, she was close to being
angry with me and I phrased her anger for her. “It was stupid for me to have
said that since you already said it at the beginning of the hour.” Ginny sort of
smiled again, in tacit acknowledgement. As I dictate this interview it begins
to sound better than the way I experienced it during the passage of the hour.

June 30

GINNY

I FELT cocky and giddy, but wanted to feel sad and truthful. (You would say
—

Ginny, find other words, the bright side of cocky and giddy.) My anger makes
me feel both alive and dead. I’m right in the middle of it with an upset
stomach.

The more aware of the feeling of anger I am, the more spunk I have. Then
something inside of me throws a blanket over my head. And I kind of walk
around without direction but in a general frenzy.

At the end of the hour, when you said 4:20 was actually a better time for you
to meet, you showed just enough mundane assertiveness to give me an
example of a person standing up for what he wants. I like to see you strong
and reacting just like an ordinary person. Somehow I learn from these
encounters, however trivial.

Again I felt entertaining today but I didn’t bother to question if you wanted to
be entertained. I should ask if that gets us anywhere rather than just barrel
along under my own nervousness.

How do I get into deeper thoughts? You said at the end that things were going
fairly well in my life but that I was only bringing up the petty things.
I can’t concentrate with you on things you want me to think about. I remove
myself from the person you are speaking to.

July 12

DR. YALOM

LAST WEEK I missed my interview with Ginny. I had two colleagues in

town most of the week, we were working day and night on a book on
encounter groups, and I started cancelling out most of my appointments when
I saw that we wouldn’t be able to finish what we had to do. I called my
secretary and told

her to call Ginny to see whether she could possibly come in on Friday. My
secretary misunderstood me and cancelled Ginny’s appointment altogether,
which was not what I had wanted. I later found out Ginny couldn’t come in
on Friday. Once I learned this, I tried to call Ginny at home to see if she
could come in at some other time, but could not reach her. I was rather sorry
that all this had happened but at the same time I knew that I was too swamped
and too harassed to have been very effective in seeing her on Wednesday.

Ginny came in today and I explained what had happened to her. Her response
to this was not even to acknowledge what I had said, but to tell me that she
felt extremely depressed and had been now for some time; she used the word
“bored” as well. The next thing she did was to ask me whether I had been at
the movies last Monday, she thought she had seen me there. I told her that I
hadn’t. I then made an orthodox and, I think, accurate interpretation: it
sounded to me as if she had some unstated feelings about my cancelling since
she immediately talked about being depressed and then imagined she had
seen me at the movies, hoping it was me so I could watch her behavior,
watch her touch Karl, watch her eat popcorn, watch her drink coke, watch
her eat Mound bars.

This wish to see me more was, I think, created to deal with her hurt at my
cancelling our time together. She denied all of this and laughingly suggested I
had a good imagination, indeed I must be “writing a novel.”
Then again in an extremely depressed tone she continued telling me how
badly she had been feeling. Curiously some of the content of what she said
seemed rather hopeful: she may have gotten a job which she really wanted,
teaching English to foreigners at an adult education school. Though it looks
certain, she won’t know definitely for a couple of days. Since there was no
obvious cause for her depression in any of the things that she brought up, I
was convinced that my cancelling last week was important and decided to
pursue it stubbornly today.

When she talked about her relationship to Karl, how uptight she felt and how
unable she was to tell him she was feeling badly, I began thinking of the
parallels between Karl and me. Whenever Ginny feels she had done the
wrong thing with Karl, she fears he will throw her out, and the same with me.
So I tried to help her say some of the things to me that she couldn’t say either
to Karl or to me. I continued to hone in very hard on her feelings about my
missing last week. I kept saying to her that she was not really expressing her
true feelings.

She grew slightly impatient with this, but I persisted, and she went on to say
that she felt just a bit of disappointment. I told her to take that little bit of

disappointment and examine it through a magnifying glass and tell me what it

looked like. She then admitted she had been sorry it was my secretary
calling; couldn’t I have called her myself? And she added that some of her
friends who were at her place when my secretary called made fun of her for
seeing a psychiatrist anyway; they say it is the psychiatrist who makes her
feel bad and if she stopped seeing me, she’d be O.K. Mainly, she said, it was
just a big bore not to have had something to do during the week I had
cancelled.

We moved deeper and deeper into her feelings, and I said to her that she now
has permission to ask me any question she wants. As she had all sorts of
fantasies about last week, why didn’t she check them out? So she asked me
what I was doing last week and I told her. She then asked if I had any
curiosity about what was happening to her. I told her that I did, which was
true. I kept asking her to pose other questions which she really wanted to
know. She felt blocked and could go no farther. I told her that I thought her
depression was really a reaction to my not having seen her, that it probably
had a long history and went back a long time in her life, and I thought she was
really saying to me,

“See what you’ve done to me,” and that she depressed herself in an effort to
punish me. She responded to this somewhat affirmatively. I wondered if she
doesn’t do something comparable with Karl. Then I tried to boggle her mind
and change the frame by saying, “Your mission is accomplished, I do feel
guilty and badly that I didn’t see you last week and your being depressed has
now worked. There is no further need for you to continue. Now let’s go on to
the next episode.” She laughed at this. At one point early in the interview she
did have the ability to say, “Can’t you give me something, can’t you give me
some spark to get me out of this?” which is again an unusually hearty
statement from Ginny.

I told her that I would feel so much closer to her if she could come into the
interview and give me hell if she were upset about something that I did
wrong, rather than coming in, sitting on her ass and pretending she was in a
morgue, as a way of attempting to injure me for having hurt her. I told her I
was sure the same thing was true with Karl and that if she felt put upon by the
relationship, or if she felt the relationship was unsatisfactory in any way, she
was deliberately insuring it would end by not opening up to Karl some of her
feelings. By not talking about her pain, she puts herself even further from him,
as she does from me.

July 12

GINNY

YOU ARE too intellectual sometimes and encourage my own farfetched

analogies. Like when you asked how I felt about missing the session. And
because I didn’t see you then, isn’t that why I thought ! saw you in the
movies?

It’s a kind of burlesque of psychiatry, like a script we are both writing. If I

thought you were thinking like that, I’d know we were both just chatting
meaninglessly.

I disliked the grin on my face whenever I answered one of your questions.

It’s like when I’m in upon myself, I’m grim with no expression. But as soon
as you summon me, give me a lead and a chance to respond, I’m all giddy.

I liked the technique of putting a magnifying glass over a specific incident to

try and etch out all the emotions. That’s sort of putting life in slow motion.

Which is what I like. Only I think the incident was not big enough. Actually
there were two sides, or emotions, I felt. I gave you the one I thought you
were prodding me for and wanted—that is, when you called, I was
disappointed and a little angry. The other side of my miser’s coin is that I
was relieved—one trip less. Save $2.00, more time to do other things, and
no Greyhound.

The only time I felt something in the session was when I hurt you, by
suggesting I didn’t care if I didn’t see you. Then I felt guilty and sad. I felt
removed from the self that is so off-hand, without emotions.

I was filled with hope and at the beginning of a new chapter when you said to
try out my questions and needs on you before I risk them on K. “Try it out on
me,” you said. And that seemed like a great adventure.

But I’m always just browsing. At the end of the session, though, I was
revived. No matter how I’m feeling, I can be thoroughly revived, just by
attention. I liked your theory that as a way of getting even I become dead and
more depressed and succeed in making others feel guilty and your conclusion
that since I’d done it, now I could move on to something new. When you gave
me the article on Hemingway I had asked you about, that was a special prize.

I refuse though to take the individual beats, movements of the session

seriously. Maybe that’s why I can’t succeed in the write-ups generalizing as I
do, catching or slurring feelings, allowing them a few hours right after the
session, and then ignoring them, or not thinking back on them in the week.

July 22

DR. YALOM
GINNY called today and asked if I could see her at 3:00 rather than at 4:00.
As things worked out, that was convenient for me and I agreed. It was an
unusual thing for her to do, just the kind of request she’s usually afraid to
make. She started the hour by saying she had been in a terrible stupor for the
last two days, but before that had had an extremely good week. She
obviously wanted to tell me about the bad period, but I couldn’t help being a
bit more curious about the good one. She said that something had happened in
our last session which had been enormously relieving to her; it was my
“Mission Accomplished”

statement, that, through being depressed, she had succeeded in making me

feel guilty and my candor in suggesting that she cash in her winnings on this
maneuver and now devote her energies to something else. The importance of
this is that I made something explicit which she was doing implicitly and thus
stripped it of its strength because, to operate, it must remain unconscious.

This week’s problem concerns the two-week course she is presently taking in
order to teach English. She has, on two occasions, mispronounced Cuba
(Cuber) because of her New York accent. The teacher has caught her at it and
Ginny is strongly convinced she will fail the course, which could be a
catastrophe of the greatest magnitude. I began to work on this problem by
opening my huge grab-bag of various approaches and pitching them at her
one after the other. Some of the approaches were reasonably robust, some
were creaky old techniques that I rolled in on a wheelchair. I tried to help her
understand that this was hardly a catastrophe which could change the course
of her life in one way or another. I tried to point out that it was, in the long
skein of her life, a relatively trivial event and something quite distant from
the core of Ginny. I tried to make her think of things in the past which seemed
tremendously important at the time, but now had been all but forgotten, so as
to help her place this recent incident in a proper perspective. I wondered
why she feels that the teacher had the right to define her totally and that if he
flunked her out of the class, it would mean that Ginny is nothing. I even
ironically proposed that she imagine her epitaph as reading, “Here lies
Ginny, failed by Mr. Flood in the English-for-Foreigners Course.” I tried
another avenue of approach by suggesting that she may well be misperceiving
the situation. It didn’t seem too likely to me, as Ginny claims, that this teacher
really wants to fail her so he can
enjoy the exertion of power. I suggested that since she foresaw a possible
failure, she could do something to head off the anticipated “calamity.”
Perhaps the teacher has not yet had the occasion to see some of Ginny’s finer
points; perhaps he might have an opportunity, as the class goes on, to
appreciate certain strengths, such as her wit or tenacity. None of these
approaches was very effective. There she was, ten years old in a crisply
starched yellow dress, playing dodge ball, sticking her tongue out at me and
neatly ducking every throw I made. I have a hunch, however, that by sheer
intensity of effort I’ve done something to assuage her. Oh yes, another aspect
we worked on was her feeling that Karl must have thought her stupid when
she was unable to answer certain questions in the class (Karl is taking the
course with her). I wondered if that could be possible, since it seems
unlikely that Karl hasn’t already learned to appreciate her intelligence after
living with her so long.

Another subtheme in the interview was an article I had written with my wife
on Ernest Hemingway which I gave her at the end of the last hour. One of the
first things she said was that she had liked the article very much. Later she
said that she hadn’t understood I had written it with my wife. I suggested she
ask me whatever she wished about my wife. She asked “What does she
teach?”

and I told her French and Humanities and then asked if there were anything
else she wanted to know and she said, “No, that’s all.” All she would say
was that she hadn’t quite understood my wife was a professor too—she had
seen her once on the street and now she thinks she must have met her in the
University. I tried to pry up some other reactions, suspecting there were
feelings of jealousy and sensing some tension, but she could not or would not
continue.

One other theme was that she had had some fantasies last night of getting
sicker and sicker and of Karl running away with some pretty girl he knew
from his job, and that I would take Ginny away to some little cabin deep in
the country, which was a kind of hospital run by one of my colleagues who
was a good friend and who would help her get better by encouraging her to
express anger and do all the things she can’t do, and I would come and visit
her there once in awhile. I pointed out to her, of course, that this fantasy
arises in the wake of a very good week and that it seems dangerous for her to
have too good a week, since it brought with it the threat of having to stop
seeing me.

A last bit of self-criticism was Ginny’s lament that she isn’t “serious,” that
she’s never serious about anything she does, that she tends to be too
“flippant,”

even about therapy. I had a hard time understanding quite what she meant, as I

see her as quite serious. Her flippancy and sense of humor are very much a
part of her charm and I should hate for her to attempt to excise them
surgically. *

* Tapes and notes for the next three meetings have been lost.

IV

A Passing Winter

(October 26–February 21)

October 26

DR. YALOM

IT HAS BEEN three months now since I have seen Ginny. I have been so
busy I can’t say that I thought of her or missed her a great deal, but I realized
as soon as she came into my office that there is a kind of Ginny essence
which clings to me.

As soon as I sat down and spent even five minutes with her, I was
transported back to a different psychological place with old familiar terrain
—a place I hadn’t visited for many months. Ginny told me all the things she
has been doing. She had a steady job for three months, working forty hours a
week till she got laid off because of circumstances beyond her control. She
has continued to live with Karl and things have gone well with them. She no
longer dwells within the shadow of his immediate departure. They
occasionally talk about going to South America with the understanding that
they would go together, though she’s not sure she really wants to leave the
States. She’s made new friends and talked to them instead of me, but she’s
also had many fantasy conversations with me in my absence. After this
apparently “good report” she rested her case, and began to consider the
“wicked” side of her existence. She feels she has not been living
authentically but simply coasting along, smug and happy. I suggested she
reconsider her definition of living—maybe her real living doesn’t occur only
in her tortured moments. She asked whether I was serious, whether this is
what a psychiatrist considers progress. I told her she was afflicted with a
disease of hyper-consciousness and she conceded that she has always
watched herself too closely. She has been too much a part of the audience,
too little a member of the cast.

With Karl the relationship has decidedly improved; yet Ginny feels strongly
that she is not really relating to him, that she is not able to be profoundly

“serious,” and though she wants something different between them, she can’t
clearly explain what it is. When pressed, she said she wants Karl to look her
in the face and say her name. They spend all their time together, daytime and
nighttime. They work at the same job, both teaching in an adult education
center, and I gather they are busy enough to work the whole day together
without any particular strain. Nighttime is different, though, with the matter of
sex still painfully unresolved. Ginny feels she should be more honest with
Karl about her sexual inadequacy, that she should tell him everything, and I
feel,

though I do not say this to her, that there are some private subjects she should
keep to herself. She wishes she could have an encounter group meeting with
Karl where she could face him with her deepest fears, without his being able
to pass them off lightly. I suggested to her, not completely in jest, that she
bring him into the next session. She panicked at this and insisted that Karl
doesn’t believe in psychiatry.

At one point she said she’s the same Ginny she was when she started therapy.
I asked if she really believes that. When she repeated that she feels she is the
same inside, I could not refrain from pointing out the changes I’ve seen in
her. It is true, she admits, that her relationship with Karl has changed—he
does fifty percent of the housework now, she doesn’t have to pay for the
gasoline in the car anymore—but she quickly takes away these gains from
herself by saying that if it weren’t for me, these things would never have
happened. I tried to make her aware of her game, in which she disclaims all
her winnings by allotting them to me. By the end of the session she was fairly
angry with me and said that I was acting just like her parents when they tell
her everything is going to be all right.

She also discussed her concern about my publishing her reports, which
prompted me to ask if she remembered our agreement. She remembered I had
promised not to publish them without her permission, and added that, since
Karl knows who I am, under no circumstance could they ever be published
under my name. And that includes even after her death. Jokingly, she said she
wanted the movie rights as well. I must say, as she spoke, I felt disappointed.
But she is perfectly right, though as time goes on, she may change her mind
and feel differently about them or we’ll both publish them anonymously. But
we’ll probably just forget them, because I don’t think they are of the quality
that warrants publication.

November 1

DR. YALOM

A RATHER strange, touching, truncated hour with many intriguing ebbs and
flows.

I had a cast on my leg (a knee injury) and the office was all rearranged and
disordered, and I sat in a different place and Ginny sat down and just started
talking without commenting on the obvious. She’s the first person I’ve seen

who hasn’t immediately asked about my leg. She started off by saying she felt
like being silent today—let’s just do something different. The first ten or
fifteen minutes were quite strained. Ginny was obviously embarrassed and
when she started talking I sensed a definite sexual undercurrent in everything
she said.

She said that Karl was disappointed she had returned to therapy, that he
wished she would get so well she wouldn’t have to see me anymore. Later
she spoke of her inability to show me her feelings, adding that she doesn’t
show her feelings to either of us (me or Karl). Struck by her reference to “the
two men” in her life, I asked if Karl responds to me as the “other man.” Of
course, she denied it.

Later on she used the term “impregnable” in conveying her attitude toward
both of us, and immediately the word “impregnable” evoked in me fantasies
of pregnancy. She then went over the events of the past week, all of which
suggested an unusually good period; she and Karl had gone down to Big Sur
and things had gone very smoothly between them. She had a good time, but
there is something missing in her life and she doesn’t know what.

She told me a dream, though protesting it was unimportant. (Whenever I hear

that, my ears perk up; it always means an important dream is coming.)
Dream: There’s a psychiatrist and a girl and the girl is very weird, does
funny things with her hands. She’s schizophrenic. The psychiatrist likes her a
great deal, takes care of her for a long time, and then finally urges her to go
away with a boy who returns from Viet Nam. The boy is a combination of her
brother (in reality she has no brother) who went to Viet Nam to be killed, and
another boy. At first things work out very nicely with the boy, but then he
starts to be very mean to her, and she becomes more and more schizophrenic
and ends by becoming catatonic. In the dream, before she and the boy move
away, the psychiatrist teaches her how not to have children and also tells
them not to go very far away; later she tries to get a prescription filled for
birth control pills, but is afraid because she knows the psychiatrist will
check around and track her down through the pharmacies.

I tried to work on the dream but Ginny was strongly resistant. It seemed to
interest me more than her; her resistance smothered her curiosity. I told her
the dream reminded me of something we have often discussed—her feelings
that only by being crazy can she possess my attention and concern. I asked,
“Why would I tell you not to have children and not to move far away? Whose
voice was it telling you that?” She says she doesn’t know, it is almost like
her parents’

voice, but she knows that it’s not her parents saying this now. They would
like her to get married; so we came to the conclusion that the voice was her
parents’
voice speaking to her when she was a child, and that voice still continues
alive in her. That was all. Another rich dream vein goes unmined.

Why hadn’t she mentioned the cast on my leg? She said at first she hadn’t
noticed it was a cast, she thought it was just a piece of bandage. I asked her
what it made her think of. She said it looked uncomfortable—I was sitting in
unusual clothes and she could see the outline of my body more clearly—did I
have on knit pants? She had a fantasy of my watching television with my
pyjamas on. Underneath the pyjamas she saw something that looked like
white underwear, which was a cast. Her thoughts were scattered, hard to
follow. She never explicitly stated why she chose to ignore the cast. I can
only assume that the cast, and the leg therein, brings her too close to the
sexual strings between us.

She abruptly told me that Karl had said to her, “If you ever have a child, its
first words will be 1 can’t.’” (So my earlier intuition was correct: the word

“impregnable” was not without significance; it cropped up in the dream, and

when she talked about something missing in her life, she was thinking of the
lack of children.) Karl’s statement about her unborn child was cruel—cruel
on more than one level. I asked why she hadn’t said so to Karl; by not telling
him, she was only proving what he had implied: that she can’t do anything,
can’t even express her disapproval. Later on she said she liked my saying
that sort of thing and that’s what she wanted me to do. I accepted the
invitation by pursuing the phantoms of marriage and children, forcing Ginny
to face them with me.

“What do you want from Karl? Do you want to get married? Do you want
children? Why don’t you ask him to marry you or at least find out what your
status is? Are you going to be a common-law wife?” She said, “Oh, he would
live with me for five years and 360 days and then leave just before the time
expires” “Why do you put up with this? Either change the situation or stop
complaining about it.” She deftly cut my string of questions by saying in a
comical way, “Listen to you with your sprained knee.” And we both burst
into laughter.

She said she really doesn’t want to marry Karl because she still nourishes the
fantasy of living alone in a cottage in the middle of a forest. I refused to be
deflected and said that her fantasy was childlike and romantic and, besides,
in her fantasy world she’s never alone anyway; there is always some big
person there looking out for her. Who is that big person? Why would he
spend his life caring for her? Had he once been her father? Her father is not
going to be present for her forever; one day he will be dead and she will
have to continue

living. This brought tears to her eyes and she murmured that she doesn’t want
to think that far ahead, but I assured her that this is one of the stark facts of
life, which she must inevitably confront.

Earlier in the meeting, I had the feeling of her rebelling against me and
rebuking me for being a crazy psychiatrist, who, unlike most psychiatrists,
was getting her to look out rather than in. When I told her she looks in too
much, she said she looked in with a superficial glance and wished I would
stop criticizing her for being so introspective. All of this seemed like a
healthy sign in that she’s able to take some stand against me. One other thing
that came up was that she noticed Madeline Greer’s name on one of the other
offices and said I should be careful not to say anything to Madeline because
she knows her.

Irony of ironies! Madeline, a colleague of mine, is the only person who has
ever read any of Ginny’s notes. It turns out that Madeline is now dating one
of Ginny’s friends. What to do? I am too mortified to tell Ginny and reluctant
to discuss the matter with Madeline for fear of telling her more than she
knows—

I’m not sure she had connected the Ginny of the reports with the Ginny she
met in San Francisco.

November 1

GINNY

WHEN I went into session, I had no particular problems or grievances and

thought that everything was just going to be abstract. But I enjoyed the
session and found it helpful, maybe because you talked more than usual.
Of course, it’s only when we get to maudlin topics that I respond. Like when
you said I’m going to have to live half my life without my parents. It’s true
I’m more dependent on them than most people my age because I still refer to
myself in past contexts, not recognizing any change or growth. I mean I don’t
have a job that defines me, or another family. So I still feel like a freelance
special child.

When you did your little diatribe about my being special, I knew it was
outrageous and you were half-putting me on, but it’s true. That must be the
way I see myself. And it’s the special-ness that makes me reward myself with
special fantasies of despair, solitude, a spinster spine that curls in upon
itself. What I find most helpful in session is when I tell you something exact
I’ve done and you show me alternative ways I could have reacted to the
situation. This

reinforces other modes of behavior. Like when I told you about Karl saying
the first words a child of mine would ever say would be “I can’t” and my
only reaction was hurt, and then fear, and a need to sidle up to him and see if
he still liked me. When I behave that skunky way, I have to fantasize that the
real me isn’t what’s there every day, and that when I have no one to sidle up
to and please and need, I’ll find real punishment and real salvation. This
stops me from trying to change my behavior everyday and right now. It’s
when I can experiment with everyday life and change my old patterns that I
feel I’ve succeeded and grown. I don’t really want to go into exile and self-
torture. I like Karl and my surroundings and need all that.

November 9

DR. YALOM

A LACKLUSTER HOUR, rather plodding, with no real peaks of interest.

Ginny began by saying that she had had a bad time last night for a stupid
reason; it started when Karl said he wasn’t feeling well because he is
concerned about his future and his career. This occurred just before they
went to bed.

Once in bed, she started having fantasies of his leaving her and became upset
at the thought of being all alone. This incident set the tone of the rest of the
meeting since my associations were immediately that she should have found
out what was troubling Karl and then tried to do something to help him. When
I implied as much, she responded by asking “What could I have done? What
would your wife have done?” I groaned, “Oh, no!” And then she turned it into
a joke by saying, “What would Mrs. Nixon have said to President Nixon?” I
guess I never went back to her question, in one way because I didn’t think it
would help Ginny to know what my wife would have said, but also because
Ginny was asking for some personal information which I balked at giving. At
any rate, it soon took us to the fact that she and Karl don’t talk personally
about anything. It would never dawn upon Ginny to help Karl explore his
feelings about his future, and I’m sure this is, in part, why she can’t obtain
any clarity from him about their future together. There are strong rules in their
relationship which prevent serious personal talk of any nature from
occurring, although they talk about ideas quite splendidly for hours on end. I
felt her straining for instruction as to how she should break this pattern with
Karl. I asked her what she wants to know from him, which led her to what I
think is the crucial

question: What does their relationship mean to Karl? How long and how
deeply is he going to commit himself to it?

She then talked about a literary party where she acted like a ten-year-old girl
in the presence of some older people; she froze up because she felt she had
no essence. If Karl hadn’t been there, if other people hadn’t been there, she
would simply have curled up and become nothing because all she felt she
could do was bounce off other people’s ideas. I shared with her my belief
that it’s really quite the contrary, that she has an extremely powerful essence
which one always senses and recognizes. When she hears the “adults” talk,
she can’t carry on a conversation with them, but is perfectly able to sit back
and satirize it in her mind. Her conduct didn’t seem so very unreasonable to
me; why does she have to be the same as everyone else socially? She then
trapped me very deftly by retorting that if that’s the way she is, why am I
expecting her to change in her relationship with Karl? I squirmed out of that
one by arguing that people can be different socially, but when they relate
closely to one another, they generally have to talk about intimate matters,
unless they are so busy surviving or working together that they are personal
without talking about it. She and Karl spend so much time talking with others
about their inmost feelings and exploring them in their writing, it seems
inconceivable to me that they can continue to be with one another unless, at
some level, they communicate more personally.

Ginny said that the last small change in her life occurred when I forced her to
talk to Karl about the gasoline money—it was a painful, but somehow an
extremely important shift in their relationship. She wishes I would force her
to do something like that again.

There was a time today when I felt that Ginny had practically nothing more to
say to me, indicating that maybe she’s better, maybe she will be discontinuing
therapy before long. Certainly, there are problem areas, but all and all her
life is beginning to assume a more satisfying pattern.

November 9

GINNY

I BROUGHT UP the topics of conversation—my inability to talk with Karl

about serious things, for example. This is part of my one-dimensional nature,
and I think the way I behave with him is the way I do with you. So to know

how Karl feels—how do you feel? (I should have asked) and how long will
you both last? Ofcourse I have more fear with Karl, since more of my vital
time and organs and feelings are involved.

When you asked if I had learned anything from the group, that took me by
surprise. None of my experiences are stepping stones or progressions. I used
the group for the temporary companionship but anyway we didn’t ask too
many questions in the group that got truly answered, and any questions asked
toward me, I never answered too well. I break down on a rational line, am
more a vicious circle in the shape of a grin. We had two silences yesterday
but they were blank silences—you ask what’s happening and I say nothing.

I was glad Madeline had spoken to you and I imagined (not asking you) she
said I was sweet. But see, I confuse being serious with confession. When I
met her at the party I was acting like a paralyzed ingenue (my mother said
that you can do your “nothing act” at a party but don’t stand in one place so
people become aware of it). So after Karl brought you up at the party and
Madeline was encouraging, I told her I had been going to you for three years;
that this year I was writing for you. Now I didn’t have to or want to say that,
but when I can’t think of anything to say, I just tell anything pertinent to the
other person.

What you said yesterday about having to speak up was right but it had no
emotional impact, got no further than a magazine article. You and I just didn’t
get through to me. I didn’t feel too badly.

Walking to the station I felt optimistic, imagining I had already spoken to

Karl and everything was fine. Then in my fantasy animation you had to go on
a business trip and postponed next session, and so I called you up and said
how good everything was.

See how my mind dawdles or shortcuts all serious work and problems.

Even though I’m so on the outside, when we talked about my “presence,” I

liked it. But I know I need a special cadre around me to feel natural, to have
any presence. I can’t force myself to talk even when I’m making other people
uncomfortable by my silence. I can’t give. They have to give to me. I know
this isn’t important but still I feel spoiled that I can’t give the minimum in
ordinary situations.

November 16

DR. YALOM

A RATHER single-minded interview today and one which was quite

uncomfortable for me. I felt like a cheerleader or a second in a boxing corner
egging Ginny on. Essentially, she came in to say that she hadn’t done what I
had suggested last week—she hadn’t been able to bring up the question of
marriage to Karl—and ironically enough an opportunity to do so had
fortuitously been dropped in her lap. One of her friends had cornered Karl
and Ginny at a party and asked, half comically, “When are you two going to
get married?” Karl immediately replied that he’s not interested in marriage,
that he doesn’t call what Ginny and he have a “marriage.” Ginny said the
opportunity to talk to him about it that night was lost when she impulsively
invited everyone over to their house to watch a movie on T.V. until 4 a.m.
Karl was so angry at her for doing this that the evening ended with her having
to apologize to him to assuage his anger rather than vice-versa.

A couple of other troubling incidents arose; for example, the other night Karl
began to chew her out for having made a mistake in preparing some part of
the dinner, and started haranguing her about her many weaknesses. She
meekly agreed with everything he said and practically thanked him for telling
her. I tried to go over alternative things she could have said, wondering
mainly how it came about that their relationship was so denned that he had
the right to criticize her without her having the reciprocal prerogative. She
said, well, she could start telling him some of the things he did wrong, but it
was pointless because the fact is that he was absolutely right in his criticism.
I had to keep repeating over and over again: it isn’t whether he was right or
not, but how did the relationship get defined in that manner? I did some role
playing with her, repeating what Karl had said and asking her to respond in a
different way. She then began to make excuses, saying that she was just trying
to make him a gourmet dinner, or would he rather have hamburgers, which
she could make without a single mistake? I told her she was being very
indirect; couldn’t she say anything more personal? In the safety of my office
she role-played. She told Karl that he had hurt her; why did he have to cut her
down just before they went to bed? Then she slipped out of that
uncomfortable scene with the comical observation that she felt as if I were
putting her through a Samurai school, teaching her how to have her feet
planted in the right place, and how to hold the sword.

She told me of another incident in which she had blurted out “I love you” to
Karl during the week and Karl had made no answer, and I wondered why she
didn’t feel she had the right to inquire into his silence. She insisted she
knows
the answer already—that he does not love her and is not interested in
marrying her. Then I made two observations. The first was, if that were true,
is she interested in remaining with Karl? Is this “loveless” relationship all
that she wants in life? Secondly, I told her I have absolutely no faith in her
ability to collect data. As an example, I reminded her that she had for a long
time been unable to ask me to switch the hour of our meeting because she
thought it would upset me and when she finally screwed up her courage
enough to ask, she found out that she had been completely wrong in her
perceptions—the same may very well be true of Karl. She’s overlooking
many things, such as the fact that he has spent a good portion of his adult life
with her. And so we went on with my pushing her and pushing her and
pushing her to “say something personal” to Karl. I have some fears about
how this will go, and maybe I’m asking her to do something she can’t do, and
maybe this relationship with Karl is better than none at all. I guess in the
background of my thoughts is the memory of Madeline’s telling me how
hostile a person she thought Karl was when she met him. Maybe I’m overly
protective of Ginny but it does seem that Karl’s crapping all over her and I
do somehow want to rescue her from this guy or at least help her alter the
relationship so that it will be more livable for her.

November 16

GINNY

PERHAPS it’s a better sign that I don’t remember too much about what
happened yesterday. Sitting waiting for you I saw a tear-stained girl leave
her therapist and I felt those were the good old days, my past, “wet tissues,
big issues.”

Anyway by the time we started I had filled myself with anxiety, sure I had
nothing to talk about, sure I had to go to the bathroom. And felt that all I could
do is tell you things that were over, not meant for change. And then as we
started talking, I knew I would cry, especially when talking of that evening
with Bud questioning us about marriage. And I kept talking, but
concentrating, gloating, filled with my own trembling. And I kept this up a
long time until I finally put the spark out with my own tears. See, I’m not as
interested in the discussions as I am in the feelings they elicit. The tears are
much easier to have than the intelligence behind them.
And we came back to our old subject “Why can’t I talk up?” By now you
were playing Karl’s part, but I never really played mine. (Although I
remember now that’s what I keep asking you, to give me a chance to pretend
what I would do.) I know it’s a safe situation inside the office but I don’t
push myself.

At least you make me feel that I will never be kicked or thrown out. So like
when you say, “You’ll never stand up for yourself unless you can see that you
yourself can get out of the situation, that you have some say,” I knew that was
important, that I should remember and think about it, but I filed it away under

“another day.”

Somehow I felt like I had taken several steps closer to a starting line from
where we could begin. Even though I could have begun that very day, I
didn’t.

I knew I was just talking on after a certain point had been reached. As usual I
rationed my reactions and sensations. I was unable to concentrate. Perhaps I
should have told you the exact moment I strayed and we could have talked
about that. But instead I watched you trying to incite me, trying to get me to
move. But I already felt cozy and soggy as if I had just been lowered into a
crib.

When I kept saying “I feel dead,” I felt dead. All that was annoying you and I
felt ashamed how often it slipped out as an excuse. And I know if I would
stop thinking I were dead, I would be more open to feelings underneath.
Which I definitely think I had at last week’s session.

You seemed very impatient with some of my “apologies for the past,” as you
called them.

November 23

DR. YALOM

A TERRIBLE SESSION with Ginny today but to make it worse it comes

right on the heels of an equally bad session with another patient. My other
patient was very hostile, resistive, silent and distrustful of me, and I kept
trying to provoke her into some form of activity.

With Ginny there was an absolute dearth of anything to grab hold of or work
on. I gradually was overcome by a seeping feeling of futility of ever helping
Ginny change; she doesn’t want to make any changes in herself. At the end of
the hour I felt I was facing an absolutely smooth stone cliff with only the
tiniest chink in it for a foothold and that chink was my saying once more to

Ginny that she is unhappy because she doesn’t know whether Karl is ever
going to marry her and why doesn’t she ask him? That seemed to be the only
possible therapeutic ledge, and it had already been worn very thin.

She came in. The first sentence was that she had been feeling great until she
walked into this office. Then she stated that she has been typing up her story
and sending it around to magazines. It was obvious that she was ashamed of
not having followed my prescription of talking to Karl personally. To prevent
me from scolding her she offered me a reward in the form of her story.
Naturally I could have pointed this out to her, but so what? Much of the rest
of the hour was spent with Ginny lamenting the fact that she wasn’t “serious,”
that she shouldn’t talk at all because she is just babbling, without really
working on anything. She and 1 were so impersonal and distant through all
this that I finally invited her to ask me something directly. She finally said,
“How long will you continue to see me, continue to let me come and babble
and say I’m feeling fine?” I tried to answer her openly and honestly by
replying that I would see this through with her and that I didn’t take very
seriously her assertions that all was well when there are such obvious major
areas of dissatisfaction in her life.

She seemed rather gleeful at that news, just like a small child. Later on she
said that she was disgusted with herself, she wasn’t “leveling” with me, she
felt like a phony, even the ends of her smiles felt phony. I couldn’t do
anything at all to help her. I just repeated over and over the question: “Do
you want to change?”

Perhaps the status quo is too comfortable. I feel as though all responsibility
for change is being placed in my lap. She even wants me to set her goals for
her. I must have said the same thing in four or five different ways, but all to
no avail.

Today I had for the first time the thought that I’ve left therapy too open-ended.

Maybe I should just set a termination date, four months, six months. It would
probably speed up our work. I wonder sometimes whether she wants me to
do this. Perhaps she was asking for it today.

November 23

GINNY

BEFORE I went in I was afraid there was nothing to talk about, but then I
thought like magic it would work itself out. It would have, if I hadn’t been so
talkative and rigid. I was apologizing from the word go. I couldn’t be
spontaneous and change a bad situation or think my way out of it. Maybe
what

I did in session is what I’m doing here—just talking about myself in a selfish
way. It was one of the most uncomfortable times.

When I said that I wanted you to correct me and give me goals, I didn’t mean
household chores to fill my week—that would be too immediate and petty;
but I wanted things to do while in the office. Everything that happens comes
from the impetus to talk to you about what you think is important. You are the
master of ceremonies. So I blame you for our constant picking away at the
same old scabs, the same old crucial obviousness—does he love or even like
me, will Karl leave me? It’s like going over the same charade sentence in the
same way.

I was a vacuum inside yesterday. My life has settled like tum-bleweed

against a boundary fence and I am just catching my breath, until the next wind
and upheaval. Now sitting here at home without your comfort, I can think of
lots of things to say. About the boredom and pressure of this existence. How
Karl, before he gets into bed at night, will sometimes scale the walls with his
eyes, scan our home and say, “I hate this place. I hate it.” And I can’t believe
he is not really scanning me, using the house as a scapegoat to speak to me.
That doesn’t leave me with a feeling of love and abandon, and even when I
can reach out and tell him in a satiric way how that statement is just not love-
inducing before bed, and is kind of cruel, I am left with a great feeling of
uneasiness and dissatisfaction that he uses sentences like that, knows their
impact, and is just not sensitive or caring about us. And then I can think that
he’s going through really bad times himself, and is lashing out. Or maybe I
had no problems to solve yesterday. I felt like I was wasting both our times.

When you asked about goals I realized how outside any self I feel. I gave
civic answers. I might as well have been talking to a high school guidance
counselor.

I didn’t bother to listen to you when I was sort of interested in your opinions,
like when we were talking about my savings account. I use my savings
account like my talent. I let it sit there collecting interest, afraid to spend it
except minimally and spontaneously, while waiting for that emergency when I
will need my soul and money. Once again putting off. Saving myself for the
crisis or fatality.

I felt doubly bad thinking of the write-up afterwards. There’s so little to work
with when what we’re talking about is things not done, rather than things
done and gone wrong. But I felt a little angry that the whole session got off on
the wrong feet because I hadn’t talked to Karl. I guess I set it up that way by

acting childishly and telling you about my writing as something to please you.

But why couldn’t you change it?

You used to be able to relax me and try different ways when things weren’t
working. The session felt like an interview where I was applying for a job I
didn’t want.

A session like that is always contagious and half-way through I knew I would
punish myself afterwards, which I did. And that’s what depresses me—

that I can’t stop this, that I can’t ask you to help me, that you let me go on.
I should get angry when you keep baiting me with the status quo by saying
maybe I’m happy. I guess I’m supposed to leap up at that point and say, “no
no, it’s rotten.” But I don’t and that’s supposed to mean nothing’s wrong. You
yourself said it isn’t a successful status quo but that maybe I don’t mind.

Well, I don’t really want to give up my life with Karl, though you and my
own words push me toward it. I never tell you of the good times since they
come easily, naturally and are gone. And they are bordered on every side by
our silence, our inability to really say we need and love each other. . . .

I was justy putty in that chair trying to feign emotions and shape.

November 30

DR. YALOM

A VERY SAD little hour. Things seem to grow more and more bleak. I feel
discouraged, impotent, puzzled about which way to turn. Every once in
awhile there is a brief ray of hope which then doesn’t carry me very far. I
sometimes feel as though we share an illusion; both of us know it’s all
hopeless but we never dare speak the word.

She started off by saying that a few days after the last session one of her best
friends complained that she, Ginny, never really reveals anything about
herself. Her friend has no way of knowing what Ginny is thinking or feeling.

Since then Ginny’s been trying to be more open, but feels coerced, even
though her friend did not present it as an ultimatum. Obviously this parallels
what I have been saying to her these many months. There’s a bit of
hopefulness in it since, as she pointed out later in the hour, this at least gives
her someone else besides me with whom she can try to be different.

Then she went on to tell me how miserable she’s been since the last session,
which was so terrible for both of us. Immediately thereafter she experienced
a

devastating sense of finality, as if she had received a score marked with

indelible ink on her forehead and she could never change it. “Why not say to
yourself, ‘So what? The hour was a bummer! What’s final about that?’”

Something interesting, though, to whet my appetite for intellectual

stimulation. Since the last hour she has been absolutely obsessed with
fantasies, most of which are on the general theme of her life in the future. She
is thirty, perhaps thirty-five years old, living alone, miserable, unhappy,
working at some menial job, like in a department store. Occasionally people
see her, maybe I or her parents see her, and then the fantasy is terminated by
her going into a long weeping spell in which she feels great self-pity. I kept
asking myself as she describes this to me, what purpose is this fantasy
serving? The fantasy must be a wish. What would the wish be? My guess is
that in being unhappy, she would make me and her parents and Karl unhappy.
There’s clearly a great deal of hostility in this fantasy. I told her about a
scene in one of Beckett’s plays where the protagonist wishes his parents are
in heaven, but also hopes they are able to see him suffering down in hell.
None of the interpretations about hostility made any impact upon her. When I
pressed them a little harder in the interview, she admitted to having felt that
perhaps I should have done something different last time, that I should have
used some relaxation techniques, or maybe she should be in behavioral
therapy. That almost verged on criticism. I remarked on it, but in so doing,
extinguished it.

We ended up the session on the familiar theme of her inability to speak

personally to Karl. What’s happening now is that Karl is unable to find a job.

He applies for one after the other, is always turned down and is sinking
deeper into depression. She does pride herself on the fact that once this week
when he was lying on the bed, she asked him what was the matter. He said
that he was just down, but that it was something about him and not about
Ginny. I wondered why, during all this period, she hasn’t given him more
opportunity to talk about the pain he is obviously feeling. To me it is very
much like a child whose father is out of a job and not allowed to be privy to
such adult matters.

She said that this is indeed the way she feels. Any kind of change just
devastates her. She recalls that when she was five years old and her father
left a job at Sears, she went into hysterics at the news. Is she simply unable
to face the idea of some sort of change in her relationship with Karl? She
knows that they are hurtling toward a crisis. Karl obviously can’t continue
out of work, and if he doesn’t find a job soon, something will happen, he may
leave town or leave her. But she dare not ask.

She’s also gotten a full-time Christmas job for the next three weeks and will
probably not meet with me during this period. I didn’t have any strong
feelings about this, one way or the other. I’m a little sad not to see her, but
also I feel so discouraged and pessimistic right now that I welcome the
reprieve.

She was making some effort to be a little closer by looking at me very

directly and saying that at least she could do that, make that much contact
with me.

January 18

DR. YALOM

I HAVEN’T SEEN Ginny for a month. She has been working at a book store
over the Christmas holidays. Within a very few minutes we are back into the
same familiar dreary mire. To be with Ginny is a unique dramatic
experience.

It’s as though she brings her own gray stage setting and deftly arranges it in
the first moments of the hour. Very soon I am caught up in the drama. I
experience the world as she does: a strange, uncanny, circular despondency. I
begin to share her hopelessness. In today’s session it took the form of, “I can
never be happy with Karl because I can’t have an orgasm any more and I
can’t have an orgasm because these voices keep ridiculing me when I try to
have an orgasm.”

The “voices” are only the shrieks of her own self-hatred, and the more she
fails, at orgasm and all else, the more persistent and the louder the shrieks
become.

And so the snake devours its tail. And there’s no way Out. And my head
begins to swim after ten or fifteen minutes. And I feel helpless and irritable.
I tell her that she possibly never will have an orgasm during intercourse, that
fifty percent of the women in the world probably don’t have orgasms, that
she’s got the whole goddamn thing focused around whether or not she finds
the magic orgasm. She has a ready argument for this, presented, of course,
obsequiously: it’s the women from the last generation who don’t have
orgasms and everything she reads in the newspapers now demonstrates that
women are having more orgasms. It sounds almost comical, but in a sense
she’s right. I have maneuvered myself into an untenable position. What I
wanted to emphasize are the positive aspects of her life: she’s working and
earning money, her relationship to Karl has blossomed, he has become
extremely affectionate and caring, but she says she can’t imagine marrying
him because she can’t have an orgasm with him. That blows my mind. She
supports her position by citing

the number of divorces on the grounds of “incompatibility.” I want to point

out that incompatibility is not necessarily a missing orgasm, but what’s the
use, this is getting us nowhere.

Last night she had a sudden weeping spell for which she could find no
explanation. Today she has a headache. Last week when she called me she
was glad I couldn’t give her an appointment until this week. Obviously she’s
got mixed feelings about coming back to see me, but we couldn’t pursue them
very far.

Then she described a recurring fantasy concerning Karl and her girlfriend;
she wishes her girlfriend would invite her over to the house but tell her not to
bring Karl. She imagines how upset she would be at her friend and the angry
things she would say to her. Then she fantasized being at home alone in the
evenings feeling sorry for herself, while Karl was at the poolhall. (The only
reason for such fantasies is that aggression committed against her would
permit her to feel justified in aggressing back, if only in a fantasy.) I gave her
a simplistic interpretation that all her behavior is explicable in terms of her
unexpressed anger. I told her that her fantasies, her inability to take care of
herself in any form, her overtimidity, her respectfulness with me, her refusal
ever to hurt anyone, her refusal to find out from Karl what he intends for the
future—all stem from her stifled anger. She responded by saying that this has
been a wonderfully long interview. I pointed out that of all the things she
could have chosen to say to me, she picked a compliment. Well, this made
some sense to her and Ginny was terribly interested, as was I. However, we
both realized that it’s nothing new and in fact we have talked about her
unexpressed anger countless times, more times than I care to remember. It
really makes me think again of the word “cyclotherapy.” Ginny seems to feel,
however, that her anger may be getting a little closer to the surface, that the
smoldering irritation is a bit more real to her than it has been in the past. I
don’t know if this really is the case or if Ginny was offering up her anger to
placate my general sense of discouragement.

January 18

GINNY

I WAS NOT sarcastic within myself during the session. I concentrated on

what I was saying or thinking and this gave me energy. So it didn’t seem to
drag

ever. I covered so much—the vacation, my work, the new shoes, bedtime,

Eve.

Then Dr. Yalom finally tied them all up together (I am consciously going to
call you Dr. Yalom from here on. Calling you “you” makes it seem like
you’re just sitting across from me and so I strive to please you and delight
you and if I do criticize you, it’s with a smirk on my face. But your real name
might put a distance there and I’ll stop performing.). I realize I try to
compliment Dr.

Yalom, as at the end when I said, “this session has been wonderfully long,”
and Dr. Yalom reared up. It hadn’t dawned on me but I realize now I skirted
away from what he was putting before me to respond as though everything
were over and the bow was tied.

At the session anger was brought up again. Thinking about anger I can tie it in
even more strongly and help understand my berserk, nervous childish
behavior at work. I always asked one too many questions and put myself in a
position to gently infuriate anyone. I couldn’t just have a normal interchange,
no, I had to go several beats further. I was like a shadow who leaves a stupid
grinning body in the way of danger. A punching bag of vapor.

I always knew I was doing wrong, putting my foot in it, yet I seemed helpless
to stop myself. I probably enjoy feeling this self-spite.

In sessions I do it too, but some of it must be ingenuous to you, since it

doesn’t seem to anger you outright. For instance, telling you I like coming for
therapy because I’ve found a place that makes good black and white sodas
and a discount drug store. Dr. Yalom doesn’t defend himself, his time against
my yapping. I bare myself, I expose myself to see how small I can become. I
have no internal plan, no se/f-preservation, or the self I’m trying to preserve
is already a fossil. I was always scared to step out of line at work and did
exactly what was prescribed —taking no responsibility for any self-
motivation. In sessions too I probably wait for you to start the ball rolling. In
fact I do.

Immediately after session I thought of a picture of myself that I would like to

give you, a symbolic pose, so I guess at the very end I was thinking to please
you, and ingratiate myself with you once again because it’s a pretty picture.

I’m glad I talked again about the mess of consciousness, the tangled
scrambling voices that bombard me when I’m making love, and I hope he
realized as I did when I tried to explain that it is no longer the orgasm or lack
of it that is such a big issue but the confusion and hatred that I reap on myself,
that fill me up. Even when I enjoy myself and feel great pleasure as
afterwards when I usually get excited again with Karl still in me, it’s like a
clandestine pleasure—one I’m not sure Karl would approve of or
understand, he’d wonder

why I couldn’t come with him, why I dawdled so. He’d think it is only
second best, which it is, a situation that somehow I’ve confined myself to.
Especially since it used to be uncomplicated.

When I talked about the word “incompatible” I think Dr. Yalom thought I was
pulling his leg, which I wasn’t. I believed what I said, he doesn’t realize how
technically childish I am or stay or try to be. He’ll never convince me though
that that part of life—sex—isn’t one of the most important. And I can’t get by
by blotting it out, and concentrating on the kitchen table. While Karl is wrong
in so many of his schoolmasterish habits, in bed he is able most times to be
free and forgetting, if not forgiving. Then it doesn’t matter how many dinners
and books and words I serve up to Karl, if I can’t give him myself purely,
and completely, without feeling like I’m mimicking a woman.

I was with Dr. Yalom all the way, until the time when he changed the topic
from sex to my general relationship. Then that seemed too big and rangy a
topic to cope with and I couldn’t think about it. But I will try this week. I’ll
rehearse, if need be, since he’ll bring it up again and again. I guess I don’t
leave Dr.

Yalom much leeway with my censored topics. I refuse to talk about any
blame my parents might have. Whenever he baits me or I bait myself and say
“the ugly women were after me making sarcastic remarks,” he says, “Who
are these ugly women? Have you ever known them?” and the issue gets fuzzy
and we move on. We are both being transparent. Never give a psychiatrist an
even break.

He is always talking about assertiveness toward others, but I feel safer

thinking of assertiveness within myself. To control my own thoughts. (That
way no one will get attacked but my innards.) I know Dr. Yalom disapproves
when I express my goal to control my thoughts and integrate them and at the
same time still smoke grass. (I don’t deny him his sherry.) When I smoke
grass, the dry thoughts and sentences I have, actually get a taste and feel. The
thoughts released are already there and are just loosened up and animated,
allowed to scramble around and become fascinating and real. They’re
simmering ingredients already in the stew, so why ignore them?

Are you just looking at a phenomenon that will not change, or do you think I
can change? I know you’re answering yes, “but in small ways.” And I am
coming to see that that would be fine, because it’s the small things that cancel
my good feelings and make me so frustrated till I could die.

Addition to January 18

I told you I would show you the kind of thing I write when I get in my
frustrated, bleak mood. Here is something I wrote recently.
I took a walk to a street that was safe behind garages, a kind of weedy mews.
No traffic bulldozes the silence. The only noises are the close birds and the
faraway mindless fog horns.

The road slopes up. It has been paved privately and raspberry bushes
disguise it. Also green and yellow grass, nephews to weeds hide in it. And I,
too, hide. I came for a retreat. From up here the part of the city by the bay
looks like shells shallowly covered by tide, as the fog drowns all the rough
edges of downtown and leaves a standing white tower like some child’s sand
toy. Till night crashes in.

A few days before my period I always get mad. Maybe it’s the new
difference between working and not working. (I’m unemployed now.) My
body is swift and tireless but in three rooms begins to sag and putter. I have
at least two tennis sets in me today but no partner and the walks, this walk, is
limited by lack of purpose. Karl is an enigma. I don’t know if it’s my bad
mood constructing him into worse things or his own stinginess shining
through. He can spend fifteen dollars on cards and when I ask to go out to
dinner, not paid for, just accompanied, his face turns a sickly negative. Then I
get angry at myself, it’s my fault to bring up dinner when he’s unemployed.
My fierce concentration on leisure escapes. This lopsided eagerness to fill
my life with pastimes, hinging on other people. And always a draught.

Then seeing Larry again (an old lover) who gave me an incomplete scenario
to be loved and beautiful again. I stood stiffly by him giving him my smile,
allowing myself only baby steps and an instant replay afterwards. Anger
toward other people, I let it beat in me and grow like sexual excitement. And
resentment and hate. That’s how I thrash myself to sleep. Saying half
syllables to God, wishing He would clean my mind and soul of so many
indictments and images. My behavior is a reminiscent dream of the worst
scenes.

This lack of initiative and personal belief makes me feel most a victim when
I am being treated nicely, because I think “How kind of you, how merciful,
but

for this, this movie or dinner or call or dress, and I would be coiled in on
myself ready to spring and bite hard.”
But I fence these overripe feelings off. I make a Greek potato-tomato skillet,
and so playing the little Miss, I find salvation and a mercy of vitamins.

January 25

DR. YALOM

A CURIOUSLY playful, informal hour with Ginny. It’s especially puzzling to

me why that was so since I was exceedingly upset before the session. Three
hours before Ginny came in I had an extremely disturbing session with
another patient, which finally ended in my doing the one thing I try never to
do—acting irresponsibly, maybe even destructively, by completely losing my
temper. The patient ran out of the office. Afterwards I felt guilty because this
patient has been depressed and sleepless, and an additional disturbance is
the last thing she needs. Of course I can rationalize it in a lot of different
ways: my getting angry might be helpful to her, her contempt and anger would
have taxed the patience of St. Francis, a therapist is only human. No matter,
after she left I was shaken and seriously concerned she might do something
drastic, possibly even attempt suicide.

During the two hours between her session and Ginny’s I had a meeting with
the psychiatric residents, which gave me little time to reflect upon the
incident, so that coming to see Ginny, I began to dwell upon it and initially
was deeply distracted. However, it was very comforting to see Ginny, and I
managed to forget Ann, the other patient. I guess Ginny is so unlike Ann, so
nonthreatening, so very grateful for any little thing I give her, that it made me
feel comfortable to be with her. I live the drama of “Rosencrantz and
Guildenstern”; there’s another play offstage, other actors in the wings. I could
be writing a scenario starring Ann, with only a bit part for Ginny. That’s the
ultimate and terrible secret of the psychotherapist—the dramas on the other
stage.

I’m writing this the next day and it’s hard for me to get the sequence of events
clear in my mind. What I remember most, as I look back on the hour, was that
I felt Ginny to be more adult, less grinning, more buxom, more attractive.
What’s more I told her all these things. I encouraged her to ask me some
questions, as if that would be a more grown-up way of our being
together. She started off the interview very quickly by asking me what was
wrong. I denied there was anything wrong, but later on I told her that I had
been upset by another patient. Her response was a peculiar one. It was
almost as if she were sad because she couldn’t imagine my getting angry with
her and I told her that was true. Then she went on to talk about the fantasies
she’s had all week, which were just like the fantasies of the week before—
setting up situations in which she could be angry with people. I do think our
insights into her hidden anger have been useful because we now have a
clearer grasp of what this deluge of fantasies means.

She is very much aware of feeling and acting like a little girl and of her
constant grinning. Today she really stopped grinning for almost the entire
hour, and I felt decidedly different about her. She has gained a lot of weight,
she said, and naturally turned that into something destructive with the
irrational conviction that she’s going to be the same weight as her mother and
resents the thought that she may have her mother’s unfavorable traits without
any of the favorable ones. This is a typical example of Ginny’s magical
thinking. I responded only by letting her know how irrational I thought that
was, and how she turns any factor into something negative for herself. I
insisted that she actually looked much better. I almost found myself being
somewhat seductive to her. It’s interesting to note that when she left my
office, a friend who came in to chat for a moment commented on the
“attractive girl” who had just walked out.

Another question she asked was whether or not I would please pretend to be
twenty years younger. I told her I could not do that without a great deal of
embarrassment. She then asked me quasi-seriously to plan out her week for
her and tell her exactly what she should do. I responded in kind and gave her
several suggestions: talk openly with Karl, write two hours a day, stop
grinning.

Another subject she brought up entailed what I considered a bizarre way of

looking at her relationship with Karl. Karl is very depressed, out of a job,
and Ginny has a feeling that he will blame her for this, as if she has “pulled
him down.” To my mind, it is much more likely that he will see her from
exactly the opposite viewpoint, i.e., now that everything else has fallen down
about him, she’s the only thing he has. In fact, there’s some evidence for this
position, since he has recently been much more affectionate with her. At the
end of the hour she asked about reading my latest write-ups and I promised
that I’d get them together for next week. A refreshing, loose, free time with
Ginny.

January 25

GINNY

I THINK I wasn’t looking forward to therapy as I had nothing definite on my

mind and didn’t know what I could say. Before the session, as I told you, I
felt tranced, as if I could sit staring for hours. But after only ten minutes the
session began.

Dr. Yalom acted strangely, sitting low in his chair and smiling, with his hand
covering his mouth in my pauses. Later he said he was feeling nervous and
told me why, which I found interesting. I pictured the scene briefly, some girl
being sarcastic to him time after time and him finally getting angry. I
wondered why something like that hadn’t happened between us—what with
my slow progress in circles. And God I am sarcastic, not toward him but
myself. He said it would be hard to find my anger (which sounds like a great
phrase). In other words he couldn’t be angry with me unless I, like the girl,
had been ceaselessly angry at him. The thought was very exciting. Then I
realized how limited our scenario was as a result of me and the therapy-just
up on my little perch where I can’t be touched except by certain gentle
emotions, innuendos and whimsy. Maybe that’s why there’s such a loud bitch
in me, because I have to supply all the bad things to myself, all the real life
hard knocks feedback. I’m not exposed to a tenth of the spectrum of emotions
that other people are. I envy emotions and girls who run out or are bodily
thrown out of psychiatrists’ offices.

I kept talking on and on, had no idea how it was coming across, so believed
the worst. I wasn’t plumbing any new feelings. But Dr. Yalom sat so quietly,
yet with a lot of expressions on his face, that I thought he must be getting
dizzy with my droning and searching for a topic. When I asked him what he
was thinking, he said I seemed better. He could respond more to me this way
than at other times. If he had said I was awful and talking nonsense, I could
gladly have believed that too. I had no judgment. When I asked why I seemed
better, I had no inkling up my sleeve. He said I seemed better because “you
are more serious. You’re acting ten years older, you’re more buxom.” I had
just told him about my ten more pounds of weight since last session. He said
a sentence I wish I could quote but I’ve already imagined it wrong, something
like “you look better, more buxom, more womanly and you’re not grinning.”

I didn’t allow myself any sensual response or afterthought until later. We had
been talking about the angry girl and how she got his angry response. And

I said, at least that way she gets responses, and he said, yes but I don’t have
to respond to you that way. There are other ways, (pause) And one part of me
was touched and pleased and excited by the great implications and
compliment. And another was sarcastic and funny, not uttering anything on the
audible level, but so used to its own jokes, not having to say “Oh ya buddy.
That’s what they all say.”

Later all this had a good effect, somehow I did feel better, more serious,
whole and joyful. Trekking back through the woods passing Stanford’s grave,
I was different from the genius ingenue I usually am. I was a womanly type,
eating hors d’oeuvres and drinking from a crystal glass in one hand and Dr.

Yalom and his wife and some friends (in the other hand)? and talking and
mature. But the world seemed clearer, I was concentrating, I was alive.

Standard time is wearing off so it really was lighter at 5:15. The world was
light. When I got home I was full of fun and joy and when Karl touched my
paunch and I came up with some quip, he said “What did your shrink say to
you today?” (I was prancing around by then) I said he had told me how
womanly I was. “So that’s the kind of things he says,” said Karl with just as
much fun.

P.S. Key words in session—good tact, good timing. There will always be
conflict between the ideals of openness, love, gut reaction, the great
universal hard things (as I imagine and dream of them from afar) and
obtainable therapy goals (maybe the others are the realm of religion) but I
believe in the first, maybe as a shield against having to work on the small
things, the assignable things, and as a way against admitting any success. And
Dr. Yalom is always trying to show me that all people are hidden. Okay,
maybe they are. But not all are afraid. I’m afraid with my hiding. Dr. Yalom
is trying to make me feel comfortable with my bum rap.

February 1

DR. YALOM

A DIFFERENT KIND of session from last week. No playful seductive

underpinnings to the interview but we were quite relaxed and going about our
business in an adult way. She came in and told me (surprise of surprises) that
she’d had a good week. No, on second thought she started off the interview in
a discouraged tone. The first thing she said was that she had tried talking to
Karl

and it had failed. As she went on to describe the incident, it seems that she
had indeed tried to talk personally to Karl but in a negative, critical fashion,
and it had gone very badly. She was reading one of his short stories and
commented that he speaks in an authoritarian way just like the characters in
that story. He responded defensively, asked for some concrete examples, and
ended up saying he was really too shaky for her to upset him like this. She
concluded, therefore, that if he’s too upset to talk about this, he’d be too upset
to talk about even more important matters. However, everything else that she
had to say about the week was generally encouraging. She took a trip to
Yosemite with another couple and had a marvelous weekend. Karl hadn’t
gone because he wanted to do some writing. When she came home he told
her how empty his life had been without her. It’s quite clear to me, and to
Ginny as well, how abruptly their relationship has switched. She is no longer
in a position of great fear that he’ll suddenly announce he is leaving her; the
shoe is on the other foot, it’s apparent that she’s in the ascendant position and
that he needs her at least as much as she needs him.

She then went on to say that the only thing that’s really standing in her way
now is the dread of night and of sex. I at first tried a rational approach,
pointing out to her that that’s really a small percentage of her life, a few
minutes, at most an hour or two. She took an unusually brave stand against
me, dug in her heels and retorted that that’s a very misguided opinion on my
part and all the popular magazines disagree with me. She pulled me up
smartly. Well, then I proceeded to investigate with a good deal more
seriousness (and I am taking Ginny more seriously) the whole issue of what’s
been happening in bed with Karl. We’ve gone over it many times, but this
time I understood more clearly. Her night sexual terrors did not arise with
her previous boyfriend because he would masturbate her. With Karl, in the
beginning, things were good sexually, very natural. She didn’t have to ask
him to masturbate her. Then she started to tense up, to clutch and the vicious
circle was drawn: tension blocked her spontaneity, she dreaded and berated
herself for her lack of spontaneity, and more tension was generated. With
Karl the primary problem is that she continues to be afraid to ask Karl to
help her, she somehow thinks that he would object to doing certain things,
would consider it kind of a defeat or a cheap way out. She explained the
difference in the two men by saying that the first boyfriend was Jewish and
that Jewish boys are more sensitive and conflicted about sex and anxious to
please the girl because of their own particular conflicts with their

Jewish mothers. What could I say to that streak of wisdom? She plunged me
into thought about my own mother.

I surfaced and pressed her to investigate her fears; just what is she afraid of?

It’s clear that Karl will do nothing to harm her; what really stops her from
approaching him? She described what usually happens at night, They go to
bed holding each others’ hands, each of them lying there, and she is afraid to
say anything to him. If she said what she wanted, it would be to ask Karl to
call her by name or to look at her or to hold her. I tried to persuade her to
make some move toward him, to put her arm around him, or kiss him or tell
him that she feels frightened and would like him to hold her. It is exactly this
type of gesture which she finds most frightening. Then she blurted out, semi-
jokingly, that she wasn’t going to try anything like this when I was going to be
out of town for two weeks. I had forgotten I was to be away. From everything
Ginny said, I got the feeling that she feared this was her final step in therapy.
What would happen to us, I asked, if she were able to talk intimately with
Karl? What would she and I have to talk about? I said it half in jest and half
seriously because I think it is crucially pertinent. She would rather stay in
therapy than get well and give me up. However, she replied in a rather
interesting fashion. She mused that she’d be something like her friend Eve. If
she ever got past this, she’d have to begin seriously to consider her position
outside, she’d have to beat her fists against the world, to find a career, to
look for her place in life. I was stunned by her response because it means that
Ginny is beginning to come close to thinking seriously about these issues. I
don’t think I’ve ever felt so strongly in all the time I’ve seen her that she has
indeed changed. Suddenly she’s begun to move very quickly.

And all this follows last week’s “buxom” session. An incident from my year
in London comes suddenly to mind. Somehow, the thing that I remember most
from my analysis with Dr. R.—— was when he referred to me, matter of
factly, as highly intelligent. Somehow that meant more than all the other
erudite insights he offered. I wonder if it shan’t be the same with Ginny, in
that of all the work I’ve done with her, most of all she will remember that
one day I referred to her as buxom and attractive! She’s moved in such an
opposite direction from the patient I had screamed at before my last session
with Ginny.

Ann called to tell me that at least for the time being she would discontinue
treatment. I feel that I’ve really failed with her, but it’s with a sense of relief
that I view not seeing her again, for awhile. With Ginny, however, I will miss
meeting with her next week. I immediately think of my colleague’s reaction

when I went over some of my reports on Ginny with him a year ago. His first
comment was, “You know I think you’re a little bit in love with Ginny.”

February 1

GINNY

IT’S DIFFICULT to write this report. We talked about my effort to talk to

Karl, how it backfired, leaving me feeling anxious. And all the reversals that
have happened. My excuses in thinking him strong, unshakable and these
being reasons to hide my own weaknesses. Now that we’re on the same
plane, he as nervous as I, I’m still unable to talk openly and I still feel
anxiety and pressure.

Perhaps because Karl’s anxieties seem like natural reactions to his present
situation of having no job, whereas mine seem indigenous. Karl is a healthy
person when it comes to the world, to doing things. You chide me saying —
are crosswords and racing and gambling healthy? I think they are, making life
a game, trying to compete against boredom. Only Karl’s lingering physical
sicknesses are a sign that he is at war with something. I’m hardly ever
physically sick and have had to play the complete nurse to his convalescent
self, many times. His sicknesses, whether rooted psychologically or
physically, tend to block our lives, and put a shadow over any plans.

The big feeling I got out of yesterday’s meeting was that I was unable or
unwilling to think about my future. And that I can’t answer your questions and
don’t ask questions of myself.

You told me to work on small things this week. I’ll try.

But the haziness of the session has left me maudlin and dopey. (Maybe this
has more to do with trying to get unemployment insurance and standing in line
day after day.)

It annoyed me that I told you about my friend smoking grass while driving.

This preyed on my mind and left me feeling soiled and a traitor. I could tell it
was a juicy bit for you and you disapproved. Whenever that happens I
always feel a huge generation gap and you become like a parent. Besides it
was a throw-away issue. Just trying to make dead-end conversation.

I got this image of someone who is going nowhere and even dawdling at that.
That’s the way I acted. Fatalistically, I don’t like talking about sex either.

And since that was a large part of my blabber yesterday, no wonder it

bothered me. It seems like using words about it is the wrong medium, and the
subject

gets squashed and diminished and seems taken care of when it really isn’t. It
just becomes a black and white porn issue, instead of all the overtones and
good things we have in it. Karl and I do some great fluid talking; in fact we
engage each other wonderfully and make funny comments and really laugh
and are happy. And then the lights go out, and there is no bridge, no dusk
between the evening talking and scattering of images and making love, when I
somehow feel we are strangers and Karl doesn’t want me.
It was comforting when you said I seemed closer than usual to a beginning.

I think I wanted the same responses from you this week that I got last week,
you know about being pretty and buxom, and when I didn’t get them, I felt I
had slid back, that I was flat-chested, figuratively.

February 21

DR. YALOM

A REAL BUMMER. One of the most awkward, strained, unanimated hours

I’ve ever spent with Ginny. It follows my having been out of town for a week
and her having cancelled on Friday of last week. She started off saying that it
hadn’t been a bad two weeks and in fact she had a few days of total well-
being.

She doesn’t know how they started or how they stopped, but she does know
that during these times she lost her alienating self-consciousness and was
able to write and live with some ease. This morning she woke up hours
ahead of time feeling extremely badly. All day she’s been anxious,
disconcerted, confused and distracted. She said she has a sense of not being
able to pull herself together, that people were staring at her on the bus, that
she looked like a slob. Somehow I felt that despite the number of things she
said, I had little to work with. I naturally chose the subject of her waking
early and feeling badly all day, wondering what this had to do with her
coming to see me, and got a dearth of information. In fact, there was so little
information I was convinced that this was the most important area to
investigate.

I put together the picture of Ginny having good times while I was away and
then cancelling on Friday when it would have been possible (though a trifle
inconvenient) for her to come in. Today she was clearly upset. I asked her
whether, in fact, she would prefer not to be here. From this point on things
got much worse during the hour. I learned, at the end of the session, that she
had mistakenly heard me say that I didn’t want her to come anymore. When
all else
had failed in my attempt to get her working, I tried to make her confront the
question of why she continues therapy. What is it she wants to change about
herself? No more sure-fire method to evoke anxiety than to pose that
question.

My analyst in Baltimore, a sweet little old lady, always jolted me with it

when I dragged my ass in therapy. Ginny responded that in a few weeks she
should be able to come up with a 250-word essay on why she’s coming. It
was evident that she was angry and things were less warm and more strained
between us than before. She remarked that when I took off my glasses and
looked at her, my face was just like the face of a lot of other people on the
bus. What she meant by this, as I was to find out rather laboriously, was that I
wasn’t Dr.

Yalom so much any more and perhaps less of a friend. Previously she had
seen me as a special friend without differentiating me qualitatively from her
other friends.

Apparently her change of attitude toward me had been triggered by my

suggestion, at our last meeting, that if she really conceived of her major
problem as her inability to have an orgasm, she should consider the
possibility of specific hypnotic or Masters and Johnson sexual therapy. When
I repeated this suggestion today, she was startled to realize that she had
virtually dismissed it without considering it at all; so maybe she isn’t really
interested in therapeutic change.

At one point she said that she doesn’t want to have a sexual therapist because
it would mean starting with someone else and she doesn’t want to do this
with me because it would be too embarrassing to deal specifically with that
material (although we deal with it all the time). She did point out that,
sexually, things are exactly the way they were years ago and that she seems to
have made no progress in this area, which makes her feel very bad for not
having worked in treatment. I suggested that it must make her feel
disappointed with me, since I was supposed to be helping her, but she denied
this.

I commented, perhaps a bit snidely, that maybe she was anxious this morning
because she must have a symptom when she comes in to see me. She
conceded that perhaps she was deliberately trying to make me angry. She
knows that anyone would be angry at someone who talked on for an hour the
way she was talking. Somehow it was all not very convincing. I was
confused about what was happening during the hour and I told her this
several times, but we made little headway. It got worse. She replied with
several inane statements about her determination to have a good week for me
with interesting material

for our next session. Things spiraled further downwards and I felt extremely
impotent and discouraged.

Well, so much for this dismal session. Ginny’s convinced that she brought it
with her into the room because she was feeling concentrationless all day
long.

Perhaps that’s so. However, I’ve been very distracted the whole hour and
cannot help recalling that I had another session just like this only a couple of
hours ago; so I have to bear at least partial responsibility for this
unprofitable hour.

At the end I gave Ginny our reports for the last six months, we will both read
them before next week.

February 21

GINNY

OF COURSE with no more discipline than a piece of gum, I read part of your
reports before writing my own for the last session. This will color what
could have been the grimness of my report.

When I think back to the session I feel a little angry at both of us. I was angry
that you tried to delve into my lifeless anxious mood for so long. I guess quite
naturally you tried to find the shoe that fit my aching foot through a multiple
choice of reasoning: was I anxious because we had missed two weeks?

My sister? Karl? I was your willing associate. As it turned out the mood and
feeling were prelude to one of my rare colds, and the Bayer man could have
told us and freed us from that topic.

Since I came in already defeated, you talked about therapy not going
anywhere. You asked if I thought of it as therapy anymore. I think I said “No”

but without thinking. And I suggested that I should write two hundred and
fifty words on my goals. Were you more than a friend and if I thought of you
as a friend, could we get anywhere?

I read only a few write-ups that night, but it was enough to turn me into lead.
I felt so heavy and had to go to bed. It’s funny, from your side of the write-
ups I get a sense of danger, that all is exposed. From mine, everything is
slightly jolly and cryptic and nothing stated simply. Halfway through the
week, reading the reports, everything about me seemed so bleak. I felt
ashamed. Last week I had accused you mildly of wanting to end therapy. You
said I was putting words into your mouth, but when I read the write-ups, it’s
obvious to

me that you are bored and depressed and feel caught up in my own static
plunge.

I was not able to concentrate on this too long. Then I remembered a scene
with M. J., the encounter group leader. He was speaking to a girl who had
had a much more miserable life than I. She had dramatized it beautifully so
that we all experienced it almost and were sympathizing. Then M. J. said that
she had had twenty miserable years and she was going to have another twenty
miserable years, right straight ahead of her. He offered to dance with her and
tried to make her laugh, but she held onto that sacred image of miserableness
and the old habits. He galavanted around her like a frog, and made her an
offer to dance free of pain and her memory. Somehow she saw what she had
been doing, an involuntary smile crept on her face, and from then on her life
really changed. She made it change. I was still a sponge who seemed never
full enough of pity. They told me I was in a hole and would never get out.
And I just sat as I do in your office. No jokes were appropriate. And you go
with my pace and we lug out together. It would even be fun for me to bring a
pack of cards in, and then when we get stuck, we could at least finish gamely.

So this week mechanically I said I would change, force myself. I haven’t.

Yet somehow I feel more alive.

About sex therapy. In the last two weeks I’ve thought how nice it would be,
but in session I couldn’t take the responsibility and come out and ask just
what you meant and how to go about it. So I went ring around the rosy. It was
like suggesting sex therapy to a three-year-old.

When I want to concentrate the conspiracy inside puts little images that
mislead me. Instead of answering your questions I looked at your face and
compared it to this guy I hardly know who is attractive with a beard and all.

And since you kind of slumped in that chair like a fraternity boy or someone
cosy reading a book or drinking beer, I found it easy to digress. If I could
have fantasized out loud, something would have happened, but no, I just shop
a lot of attitudes and feelings without buying any. And so remain nothing in
front of you and me. Like when I saw your sock. I felt like a puppy, like I
could get down on all paws and start biting your inside-out sock, and these
giddy thoughts cross my adult path every few seconds.

A Final Spring

(February 29–May 3)

February 29

DR. YALOM

DURING the week Ginny and I read each other’s reports. I was feeling
somewhat uncomfortable going into the session because although I had set
aside a good part of today to read them, some unavoidable circumstances
(such as people coming in from out of town) had severely limited my free
time and obliged me to skim most of them, especially my own. This was
particularly unfortunate, since Ginny had read all the write-ups with extreme
care. Unlike the last reading this time she had gone over them several times,
and in fact could quote some of the lines.
It was a moving and intense hour for me and I think for Ginny as well. One of
the most striking things she did in the session is the very thing she does in her
relationship to Karl; she dances away from the stage of real emotions. She
avoided both the positive and the negative aspects of her feelings toward me
until I pushed her into them. The negative ones came up first; they sprang
from my having shown her early write-ups to Madeline Greer, the psychiatric
social worker who knows Karl. I of course hastened to explain to Ginny that
Madeline hadn’t seen any of the reports for over a year; it would have been
unthinkable for me to show them to her after I discovered that Madeline knew
Karl, nor, for that matter, would Madeline have read them. It was obvious
that Ginny was deeply mistrustful and had the right to be profoundly angry at
the professional liberty I had taken in sharing her “case material” with
another colleague. I think I would have been terribly hurt and angered had
this happened to me. Yet she reported to me only a brief flicker of
indignation.

There was more distrust evident in her statement that she was sorry she had
told me about her friend (a sociology graduate student) who smokes a joint
every morning because I might use that against him.

She was very much struck by the alternation that occurred in our sessions—

after a good one, she would invariably “disappoint” me the next time. She
also noted a discrepancy between our respective appraisals of several of the
sessions, she feeling good about them while I thought they had gone poorly.

She was distressed to discover that I was much more discouraged and
depressed by her than I had led her to believe. I wondered whether or not she
wasn’t also attuned to some of the positive things I had said, and she
acknowledged that by conceding that a few of my comments made her feel

very good. It was only bit by bit that we edged into one completely positive
section of my notes, and she did this by proferring the idea that I had really
revealed more of myself than she had of herself—she was referring to the
incident when my colleague had said that maybe I’m a bit in love with Ginny.

She slipped gently into the subject by wondering who the analyst was and
then by commenting on my courage in being so honest and open. However,
she avoided the heart of the matter: the word “love.” When I asked her
specifically about her reaction to this, she said, with obvious emotion, that
she had experienced a feeling of unworthiness and that she genuinely wanted
to change for me, now. We discussed her reading the reports at home, where
she had to throw them rapidly in a drawer if she heard Karl’s footsteps. I
observed, as I had months ago, that it sounded like a novel where the heroine
frantically thrusts love letters out of sight at the approaching steps of her
husband.

Another example of the therapeutic use of the notes hinged on her feelings
about publishing them. She talked about this issue, but didn’t ask me directly
if I intend to publish them. And when I asked her outright why she didn’t ask
me, she drew herself up with effort in order to frame the question, whereupon
I told her that of course I wouldn’t without her permission. She then went on
to relate some of her fantasies of throwing gasoline on them and burning them
in my office, but added that her fears had more to do with the thought of
hurting Karl than of revealing herself. She added that she thought my writing
had much improved since the last batch. She also asked me if I was seriously
considering setting a time limit on therapy, so that she could brace herself for
some months of very intensive work. I told her that I wasn’t sure but that a
logical time would be the end of June, since I am going away for three
months in the summer. She skirted the question of termination by asking
where I was going, and we never did get very explicit about her feelings of
stopping at the end of four more months. Her evasiveness and my own
ambivalence have, I suspect, become partners behind our backs.

The last thing she mentioned was a Sports Illustrated magazine she had seen
in the waiting room with my name on it; she asked whether I read it because
Karl did too. I told her that I was interested in sports but that the magazine
was more my sons’ than my own. Still, I was pleased to have her ask me a
question person-to-person. In fact, this was again a session where I felt
Ginny to be a grown woman. The grin was gone, she was less embarrassed
than I’ve seen her for awhile, and the vibes were very good between us. She
talked about how all the little problems are gone now; she’s past the stage of

gasoline money, past the poker tantrums, past the incompetent cooking and the
cleaning up of tables. Now the bigger issues —her life, her rights, her future
with Karl. In fact, for the first time ever, she had the fantasy coming down on
the bus today that in the future she and Karl would live in different houses
and see each other only for dates. It was also interesting to note that my
interpretation about her need to fantasize other people acting unjustly to her
so that she might feel righteously angry was very effective in damping those
fantasies. She hasn’t had them since.

A good, hardworking session, which I end with a feeling of relief because, if

truth be told, there was very little I held back in the reports she read. I was
being as honest with her as I can think of being with anyone.

February 29

GINNY

NO MATTER WHAT, I did not want a session like last time and prepared
myself inwardly to be calm and eager. I started this preparation the night
before by reading the reports again, instead of watching T.V. It was a less
emotional reading than the first time. I copied down quotes that moved me. I
knew that Madeline would be brought up and tried to remember the hot
searing feeling I got the first time I read that you were showing them to her.
Also I had lost the report I wrote for you. It turns out I had hidden it in my
underpants drawer which is so filled with other junk that it got pushed down
into the next drawer which is Karl’s underpants drawer. The report of yours
had traveled from my underpants to his. I discovered the reports in his
drawer today. Thomas Hardy would chuckle at this irony.

Anyway the session started a little late since I waited to be fetched rather
than take the initiative at your door. In my own mind I had dressed better than
usual. This made me a little self-conscious since I thought you might think I
was playing up to you. But it wasn’t mentioned and so it passed. I tried to
draw first by asking you about the reports. But you won that. We both made
the same observations—about the pendulum effect of good and bad sessions.
You told me of your disappointment in my holding back both in session and in
writing.

There is no way for me to answer that. I only have glib muscles; it’s all I
know how to use. The first layer. It’s the contradiction between us since I’m
sure I can’t get any deeper without tears or emotions. I feel resistant when
you expect

more than I can give. I feel this whole thing was set up for talking and that the
therapy situation with both of us in our leather corners, comfortable, friends,
makes it very difficult for me to find my panic. I’m not used to finding my
words buried very deep—they are mostly a surface energy and
improvisation. I get a hopeless feeling of ever breaking through by just
talking and answering questions.

Then we brought up Madeline. You were disappointed again in my distrust of

you. That doesn’t mean anything to me; I can’t take responsibility for
initiating a negative feeling and thinking this could really hurt you. So when
you tell me I must distrust you, that just glides off my back like water. It
doesn’t change the way I feel about you. There’s no dislike in my distrust. It’s
something that’s over with. I feel discouraged. Because I don’t distrust you.

Even though I felt I could look at you in the session, it was to no avail since I
didn’t have anything new to say.

We brought up limiting the therapy to four months, to come to an end when

you go to Europe. This still seems so much in the distance that it doesn’t
frighten me. I feel so tight and loose at the same time that I can’t seem to
force myself into making this the most concentrated, important four months
and tie all my loose ends together. I see myself going out with a whimper.

When you explained about your colleague and we brought up the subject of
love, I realized how far away I was, cause I felt myself coming back with
those words and getting vulnerable again. I titillated myself with a little bit of
emotion and sensation, and then stopped.

March 7

DR. YALOM

A CURIOUS HOUR. It began as an arid stroll through the desert-desolate

and empty, but in an odd way, pleasantly scented. Eventually the scene of the
stroll changed but the fragrance remains and we ended up, I think, feeling
very close and deeply engaged. She began with a paradox. First, she had
vomited a few minutes ago because she suddenly felt very nauseated on the
way up the steps to my office. Second, she’d had a relatively good week. I
tracked down the nausea as best as I could, ran into blind alley after blind
alley, till finally I was so tired that I was perfectly willing to settle for the
lame explanation that it resulted from a free facial which she had had at a
cosmetic store in Palo Alto. I

made a dutiful attempt to ask why on earth she was having the first facial of
her life on the way to see me today (being nobody’s fool, I wondered, could
it be for me?). No, she daintily demurred in response to my unasked question
and proceeded to tell me about the special bargain for facial cosmetics
which she had been planning to take advantage of for some time. I tried to
find the trail leading into her feelings about stopping therapy in the summer,
but we didn’t get back to that till later on, at which point it was the key to
considerable rich material.

Lots of resistance, but very soft resistance. Ginny told me how good and
warm and pleasant she felt, that she wasn’t anxious, but that there simply
wasn’t anything to talk about. Karl’s gotten a part-time job. Things are
definitely going better for her and him, she tells me almost in passing. She
throws out, like a trivial crumb, the fact that sex is now much better between
them and that they are having more intimate psychological talks. Sometimes it
astounds me the way my patients do this, forgetting all the months and months
of work we’ve done to get to this point, and then as though by the sheerest
whim they decide to let me know about the progress they’ve made.

Then she asks, can she keep coming for four months even if she continues to
have nothing to say? I press her for her feelings about ending in June and
make it even stronger by saying “only four more months” She denies any
strong feelings, imagines how much fun it will be to write me a letter in the
future, and indulges in the fantasy of calling on me when she returns to town
as a famous woman. There was a lot of emotion tied to this fantasy and her
eyes filled with tears; I kept pushing her back into the tears, which seemed to
be asking, “Would I take the time to see her?” She said that the fantasy of
calling on me filled her with pleasure. Could it really happen? I answered,
“What on earth would stop you?” From reading all my notes and knowing me
so well, she could have surmised what my response would be. Yes, she
realized that.

We spent some time talking once again about her writing. She said that she’s
really been blocked for about four weeks, has done virtually no writing, and
at the same time doesn’t miss it too much because her day is pretty full. She
misses her writing only when she feels she has nothing important to do and is
wasting time, but things have been going well enough with Karl and she finds
her life to be pleasantly engrossing. I wondered if I hadn’t so aligned myself
with the writing that she saw it as mine and not hers. Perhaps she does not
write to avoid giving me satisfaction. But I ignored my inner voice and, like
the parent of a Hollywood child-star, I suggested we chart out her day and
schedule

two hours for writing tomorrow morning. Ginny seemed quite receptive. She
ended up the hour with a question, which was unusually direct. What would
it be like if she were to see me more than once a week? Maybe the week
between talks is too long (her previous therapist had said that if she doesn’t
see her three times a week, it’s not worth coming). This makes clear to me
how poignant the idea of stopping entirely must be to her. She doesn’t let
herself really believe that she will stop therapy and always imagines she will
see me when I return from my summer vacation. I guess I’ve handled it the
same way because I can’t really imagine not seeing her in the future.

March 7

GINNY

IT’S HARD to write anything different about the session from what we
comment on while it’s still happening.

The important part was when we discussed my feelings instead of random

ideas. I felt grounded momentarily. When I think about leaving you I get very
sad. And yet I half-played with the idea of stopping session right away and
only coming when I have something new to say. I don’t know why I said that
and then in the same breath I wondered if therapy would change if I could
have it twice a week. These were both ways of breaking and tampering with
my stronghold against therapy as it has been. It’s like you know your husband
is going to walk out on you unless you do something.

For once you asked me whether I wanted to continue talking about a certain
subject, my nausea. You must have learned from the readings how I
sometimes blame you for continuing with hopeless topics.

I got a facial ‘cause it was there, as I stumbled through Macy’s on the way to
your office. And the fragrances and eye liners and lipstick all made me feel
slightly sick and in drag.

There’s such a difference from when I just tell you things—the boy grabbing
me, the cosmetic lady, the haircut, and when I really feel something.

It’s like I’m there but there’s also an interpreter who only translates a third of
what is said, ingoing and outgoing. And when he doesn’t translate, I can stand
at ease (though playing tense). Maybe I feel things will become more acute
after therapy is over. And I can be masochistically serene, swooning in my
own mischief and fantasy, and head-felt misery. And that now I am too
pampered by

therapy and comforted by you so even when I feel hopeless about my

standing still and driving you to yawn, I end by feeling rejuvenated and
happy, being near you, having an audience with you, Papa Yalom. Until the
write-up when I force myself into an inward stare and pessimistic forecast.
But why do I feel bubbly one moment, and dezone it as something unreal the
next moment?

March 15

DR. YALOM

GINNY started off by reassuring me that she has spent time writing yesterday
but quickly retracted her “offering’’ by informing me that it was only a few
uninspired scraps. Enough! Enough of this shameless transference,
countertransference, minuet. This is the last dance. She cannot be for me the
writer I always wanted to be. I must not be for her the mother who lived
through her daughter. So I laid it out for us. “Why do you tantalize me with
the gifts of your writing"? (Why do I allow myself to be tantalized?) Why do
you not write during the week instead of regularly waiting till the day before
you see me? (Why do I want you to write so much?) Are you writing now
only for me? (Why not? I make it clear that this pleases me!)” She did not
answer, but no matter, I was speaking as much to myself.

In passing, again, she mentioned a couple of obviously very positive moves.

For example, Karl got angry with her and told her that he doesn’t want to go
out to dinner with her any more, that it’s a waste of money and he doesn’t see
spending money for nothing (this was a day after he had lost $25 gambling).

Apparently Ginny held her ground and told him she’d like to go out for
dinner.

What was the point of her working and making money if she couldn’t do the
things she wanted to do? And then she left the house and took the dog for a
walk. When she came back she had the fantasy that perhaps Karl was going
to leave her completely, and much to her surprise (but not to mine) it was
quite the opposite, he was solicitous, even apologetic. She seemed puzzled
about this and I told her that the more she can oppose him, the more she will
be appreciated as a separate person. I said “nobody likes a namby-pamby,”
my psychiatric adage for the day. We both joked about that. Another incident
had to do with their sex life. One evening, sexually stimulated, Ginny had
dressed herself up nicely, but Karl obviously was disinterested in sex that
night, which troubled her

sufficiently to wake her in the middle of the night. She told Karl what was
bothering her and he took it very seriously and discussed it thoroughly with
her.

After that she seemed to be really stretching, looking around for things to talk
about, and I finally had to say to her that it does actually seem as if she’s
getting better and for once she had to agree with me. There’s no question
about the fact that she’s feeling more and more comfortable with herself. She
said she’s disappointed that therapy has to go this way—she had been,
expecting some miraculous breakthrough full of sound and fury. Her life,
even though it is beginning to be more satisfying, has no “mystery.” Other
people have a secret life, they cheat, have affairs, or adventures; they live
dramatically, whereas she has no comparable excitement in her life and
furthermore is choiceless, having only one choice in everything she does. I
tried to debate that point logically with her. It’s quite apparent that she has
choices in almost everything she does.

She only experiences herself as having no choices. But that didn’t take us too
far.

Then she talked about her mother’s disappointment with her. In her mother’s
eyes she has no career, no marriage, and no children: so she’s a zero across
the board. I looked into the subject of marriage and children and nagged her
once again to consider whether she wants to get married and wants children
and if so, what is she going to do about it? Would she continue with Karl if
she were certain he would never provide her with these things? Even though
we still had a few minutes to go, she picked up her bag and started to leave.
It was clear that I was pushing her too hard, but nonetheless I chided her for
not sharing some of her hopes for the future with Karl, since she wants him to
share his with her. She has never seriously mentioned to him that she wants
children or tried to pin him down about marriage. Perhaps I’m being unwise
and unrealistic in expecting her to confront him with marriage and children.
Perhaps she is doing it in a much more sensible, well-paced manner.
However, she is twenty-seven years old, her childbearing days are almost
half over, and I thought I would stir up a bit more anxiety by prodding her on
these matters.

We’ll see next week.

I asked her whether there was anything she wanted to ask me today, just to
continue helping her to be assertive. She asked me how I thought the session
was going and I told her that I felt things were cozy and comfortable and that
she was searching for subjects to talk about. She heard that immediately as a
scolding and said that next week she’s really going to work hard to find
things to work on. She brought up the subject of termination by saying that she
was

very depressed yesterday (we usually meet on Tuesdays, this week we met
on Wednesday because of a committee meeting I had to attend). She wonders
if my not seeing her is going to leave a big empty space in her life.

March 15

GINNY

THE MORE tame the session is, the harder it becomes to do the write-ups.
For most of the time I was enjoying the things we were saying—what I had
said and done to Karl that week. Then at a few minutes to five when I was
ready to leave and you gave us some extra minutes, I felt all the good things
go down the drain, as you rephrased things that had been happening to me in
a different light and I acquiesced. For instance, me having nothing to say
about moving, feeling that I had no freedom or secret self, that my writing
was boring, etc. I sold myself short. I played the bad things up.

When I got home I realized I had given you ammunition to condemn my

mother with (she writes that my letters brighten her somewhat shredded
existence). And also by my saying that Karl and I are boring (“an all-time
first”

you say), I seem to be betraying my relationships. I hate these good guys, and
bad guys in therapy. That’s the way they stack up in my mind. And what’s
stupid is that I too love letters, that letters brighten up my existence, and that
Karl and I are boring, as you and I are boring. Why can’t things just be,
without seeming bad or wrong?

And then my checklist for my progress:

career

marriage

children

You blame that on my family even though that little test originated in my
mind. My mother has never said these things. It’s more like an outside
appraisal of myself that I give the word “mother” to. But it’s unfair. It’s me
playing the mother. Dampening my day-by-day reality. Of course, the family
would like one out of two, or two out of three by the time the bird reaches
twenty-seven.

Anyway all of that seemed to happen in the last five minutes when I sunk my
anchor again in the muck.

But it felt like a very good day yesterday. Therapy didn’t detract. I enjoyed it
until I got home.

April 4

DR. YALOM

I HAVEN’T seen Ginny for the past two weeks. One week I was out of town
and the second week she cancelled because she was working. She came in a
few minutes late, saw me sitting in my chair and meekly asked whether or not
she should wait outside. Later she told me how disappointed and limp she
felt because she would have liked to have rushed into the room and said with
emotion, “Boy, am I glad to see you” or something to that effect. She’d called
a couple of times that day without reaching me and my secretary wasn’t sure
if I were expecting her; so she got on the bus to come in without fully
knowing whether I would be here. I gather that on the way she felt a good
deal of anger and subsequently guilt about the anger, so that she was almost
afraid to see me when she first came in the room.

She immediately, however, launched into her relationship with Karl, which is
undergoing a great deal of turmoil. It appears that Karl has suddenly and
drastically changed as a result of an explosive confrontation with Steve, a
close friend. Steve sounds like a threatening judgmental person, who came
down hard on Karl. They got into a furious argument. Karl was so overcome
with anger he ran outside to defuse. He decided to submit, returned to talk in
a conciliatory tone to Steve, whereupon Steve fiercely humiliated him all the
more. After Steve left, Karl broke down, cried for a while and subsequently
became much more willing to examine his feelings. He spent some time
talking with a friend, who suggested that Ginny and Karl join an encounter
group in Berkeley. Karl, much to Ginny’s surprise, was very sympathetic to
the idea. As a result of this Karl has been much more open with Ginny; he’s
been loving, gentle and kind to her and able to say some things that he’s never
said before.

For example, he has let her know now that there were days in the past when
he deeply resented her; slowly the whole unspoken substratum of the
relationship is becoming available for examination. Ginny is somehow
encouraging Karl to do this but, by and large, is not saying a great deal more
to him than she has before. At least, so she tells me.

Despite all this rather good news, the session today lacked energy. She
seemed tense, a bit withdrawn, somewhat discouraged with herself for not
being closer, and I couldn’t find any way to stir things up. I had a part in
subduing her feelings. There is something about me, I think, which doesn’t
allow people to express unadulterated joy and enthusiasm.

In the last month she’s been working and writing, has had one very good
week, two fair ones and one dreadful week in which she went into a tailspin
because of a swelling on her cheek which plunged her into cancer fantasies,
until a doctor reassured her of its benignancy.

At one point, she asked if I thought she was hopeless. I told her that wasn’t
my feeling at all, although I wasn’t being totally honest, since I was
uncomfortable and concerned about the lifelessness between us. She said she
felt hopeless because so many good things are happening and yet somehow
she’s not responding to them emotionally the way she should. Slowly,
inexorably, the wheels of change grind on; somehow I play a part in it, at
times I’m not sure how, but Ginny bit by bit is slowly changing, slowly
evolving and growing. Her relationship with Karl, although I hear it through
an unreliable narrator, is obviously deepening and becoming more
meaningful.

Then she said she wished she could always be the way she was in M. J.’s
encounter group since she was so easily able to play an enthusiastic role
there. I agreed that it’s easy to play a role on a vacation cruise and she
quickly caught my putdown. But she sees as well as I that her role-playing in
the encounter group had absolutely no generalizability outside; she remained
untouched in her relationship with other people despite a few magic days of
real feeling at the beginning.
Some transference material came up to which I didn’t know how to respond.
When I stood up to get a pipe, she seductively asked, “Would you offer a lady
a tiparillo?” Later she mentioned that a friend of hers had written a letter
from Germany complaining about the bureaucratic system and life there in
general. This seemed relevant to the distance in our relationship and
probably to her wish that I wouldn’t go to Europe this summer, but she didn’t
seem eager to pursue my inquiry.

All in all, a kind of disappointing session for me personally, because we

remained distant and uninvolved, and yet at the same time I was pleased
because she told me good news of changes she’s making on the outside.

April 4

GINNY

I HAVE delayed writing this, so see it from an afar of about six days. At the
start of the session I thought you looked different, that you were angry or
unfriendly. It had been three weeks since our last session but this time you
didn’t dwell on that.

I was so prepared for you to do me wrong, thinking that you wouldn’t be

there. All afternoon I had interspersed little bits of fantasies with my black
and white soda (at the University Creamery). I was conniving in my busy
tenth-seeded mind all the possibilities of your not being there, because the
therapy day had been postponed. Also on the bus I had just started Sylvia
Plath’s The Bell Jar, which moved me. I was quite willing to suffer
vicariously with the heroine of that book. I was more involved with her than
with myself.

I don’t remember too much of what happened except that at the end, like
before, I felt I had betrayed those closest to me.

I filled you in on the previous week and specifically the weekend with the
illuminating shocking fight between Karl and Steve and Karl’s reactions and
how that was changing our life. But there again, I can’t believe I do more
than get ideas in my head, and never flush them out with emotions or my
reactions to things. If ever I had a change to chirp, it was last week when
something was finally beginning to happen. But instead of enjoying it fully, I
premeditated problems and acted like what had happened was over. You kept
insisting that now that the gates of honesty and pain had been opened (by
Karl) it would be hard to retreat to our former existence and now was the
time to talk to Karl, not just listen, which was good advice—and then you
always ask, “Well, what would you like to tell him?” which stumps me. I
have a reservoir of faults and weaknesses and I imagine I can’t talk without
bringing them up, so as usual I couldn’t answer you. I feel I have to change a
lot for Karl, but right now what I must do for him is be near and listen. I
admire the way he lets his emotions run through him. I think he is working on
something else, a bigger river than just our relationship. Perhaps his family
and other beginnings, which are very twisted and buried in him. It would be
moody and selfish of me to ask for some of that action now; besides I think
his thoughts will lead to us. The fight has opened up our relationship and
made me see new things in Karl that I had only suspected.

I also brought up the bump on my face (bump sounds more tentative than
lump). This bump deflates my best times and helps me, depressed, be
concave.

I guess I did a little hypochondriac thing with you. Always holding myself
back. Even if I had gushed out my worst worries, that would have helped.
You reassured me a bit by saying there’s nothing to worry about in that part of
the face.

April 11

DR. YALOM

GINNY started off the session in an unusual way. She read me something she
had been writing while she was waiting for me. It was mainly an account of
her feelings that day, of what had passed through her mind in a shopping tour,
and it was a very touching little vignette which sparkled with bright
metaphors. I felt a great deal of pleasure at hearing her read to me and once
again I am convinced of her very considerable talent. The other feeling I had,
though, was that it was all so frothy, and I wondered if she would ever write
about more compelling, larger issues. Here I am, in the vernacular, “laying
my trip on Ginny,” judging work only by the profundity of the issue which it
faces. For the last months I have been deeply engrossed in reading Heidegger
just because he deals with the most basic issue of all—the meaning of being
—but it’s been a terribly self-punitive venture for me since his language and
thinking are so agonizingly opaque. Why must I expect others to deal with the
same crushing issues?

There were other reasons for her reading this to me aside from simple
sharing. In the account, she mentions the fact that she’s applying for some
jobs, which might make her terminate therapy even more quickly, and she
also mentioned that Karl is thinking more seriously of starting therapy.
Naturally, irony of ironies, he’s thinking of calling Madeline Greer, the one
person in the world who has read some of these reports. It would be very
awkward, I think, for Madeline to treat Karl, knowing that she has a secret
she can’t share with him. When I told Ginny these fears, she felt she is getting
in the way of Karl’s treatment. Obviously, it’s all blown out of proportion,
because of all the people in the world, why does he have to see Madeline?
It’s even more absurd in that Madeline is in Palo Alto, whereas there are
hundreds of good therapists in the San Francisco area.

Ginny looked very pleasing today, well groomed, with an attractive blouse
and long skirt. I also noted that our chairs had been placed rather close
together by the cleaning man, and I felt cozy sitting next to her, whereas
yesterday with a male patient I felt very uneasy sitting that close to him and
moved the chairs away. She talked some more about the bump on her cheek.
This time I got up to feel it to see what all the fuss was about, since her
doctor now suggested there may be some sort of growth there and I began to
get a little alarmed myself that it might be a sinus tumor. It seems like nothing,
perhaps an infection of a lacrimal gland. Naturally, however, Ginny has
blown it out of all proportion and fantasizes it’s a cancer eating away at her
face.

She’s definitely still very up. Things have gone increasingly well with her
and Karl, although they do have their down periods. I tried very hard to make
her understand the fact that she’s had an up period with him where she’s now
changed the rules of what can or cannot be talked about and this should give
her some strength. And that when things go wrong she really does have the
right to say, “Things aren’t going as well for us as they were a couple of days
ago—let’s talk about it.” 1 told her that I wondered what it was that stopped
her from saying this to Karl besides “sheer terror.” There I am being kind of
cute and clever with Ginny and enjoying the pleasure of making her laugh.

We talked about Karl’s getting into treatment and how she felt about that,
when here she is ready to graduate. She felt a little angry that Karl is just
now starting therapy, maybe a bit concerned with all the new demands he’ll
make on her. She even fantasied that he was standing right outside the door,
which is why she was speaking in a whisper. I wondered what it was that he
might hear.

She said, ‘Well, if he heard me say that I’m static and won’t change as I did a
few moments ago, then I think it would be all over.” Here again Ginny
expressed her sense of the precariousness of the relationship, as if one
statement overheard from the person to whom you are obviously deeply
committed could cause a total break-up. When I put it in those terms, she
could see the absurdity of her statement, but still it isn’t very convincing to
her.

We did get into one interesting implication of Karl’s decision to enter

therapy, which is that the therapist will help him see all the negative things
about Ginny, just as I in therapy came down heavily on Karl’s negative
aspects.

Thinking about that, I conceded that perhaps Ginny was right. Obviously we
did focus on his negative traits because that’s what Ginny presented to me as
problems, and I never did ask her to talk about the positive things that were
going for Karl. When I asked her today, she mentioned some of them. She
took

it a bit further and pointed out that she’s felt all along that I really wanted her
to break up with Karl. In a sense, this meant that for quite some time, many,
many months in fact, she must have had a sense of somehow defying me by
staying with him. This seemed important to me, and I looked into myself and
thought about it for a long time. I honestly believe, and told her so, that I
never unequivocally wanted her to break up with Karl, but hoped she would
be able to make this relationship work to a better extent than it had.
(Parenthetically I might add, though I didn’t say it to her, if they continue to
relate as they are now, then I wouldn’t feel too upset if she were to break off
with him because she has grown so much that she is capable of other,
possibly deeper relationships.) I wanted her to see the distinction between
my urging her to leave him and my trying to make her come to terms with the
fact that she has the right to leave him. Once she realized that the decision
about leaving or staying was hers, as well as Karl’s, she would not need to
live helplessly under Karl’s terrible swift sword which at the moment, at the
utterance of one wrong word or the commission of one wrong act, would
descend and sever their bond forever.

The last theme was one that has come up over and over again, and I’m not
sure how to deal with it. She pointed out how emotionless she is. She would
have liked to come in and say in a very animated way that Karl really is
going to start therapy and “Can you beat that?” She kept knocking herself for
showing so little emotion to me. Now, what am I to do with that? I think, to
some extent, her lament has validity in that she still is unusually mild and
meek with me. She never loses her temper and often is somewhat childlike.
On the other hand, however, I like Ginny quite a bit and if she were doing the
other things, it would be playing a role. Much emotion does pass between us
and I end up feeling that she is judging herself harshly and unjustly. I keep
saying to her, “So what if you had said it in a different way, what would it
mean? For me it would only mean that you were playing at something other
than what you are.” She keeps saying that she’s not satisfied with the way she
is, that she can’t be spontaneous enough. She even brings up failures in
spontaneity that she’s had in past encounter groups in such a way as to punish
herself. I tried to make her realize how terribly insignificant that was, as
compared to the real life changes she has been able to make with Karl over
these many months, and with me. It all has a circular quality about it,
however, because we’ve been through it so many times. At one point she
spoke of a visit with a friend who has a one-and-a-half-year-old child and
she is struck by the child’s wish that she, Ginny,

repeat certain things over and over again. Ginny feels the same way in
therapy.

There are some things she enjoys saying and some things she enjoys having
me do over and over and over again. (Psychotherapy and cyclotherapy.)
Lastly, I tried to bring her to terms with the fact that we really would be
stopping in a couple of months. She has never fully accepted this; her fantasy
of writing me long letters is just another way of denying the end of therapy
and us as “us". I think that in the next sessions I’ll have to spend an
increasing amount of time on her feelings about terminating, her positive
feelings toward me and those that are intertwined with her relationship to
Karl, where I am sometimes used to arouse his jealousy. She surprised me by
suggesting that I might see the two of them together for a session or two. I
think I will do that—it might be a constructive way of aiding termination.

April 11

GINNY

I THOUGHT last week when I told you about Karl wanting help too that you
were really taken aback. I might have become a little suspicious about why
you should be so adamant against his coming down on a regular basis to see
Madeline. “It’s so far . . . she’s not the only therapist. . . .” It was as if I could
be the only prima donna and that was wrong—because right now I’m stable,
it’s Karl who’s hurting, who needs help. I feel guilty too because the only
person Karl trusts—Madeline—is ruined for him, in a way. I want Karl to
have therapy very much, even though I’m a little scared. I think with both of
us in therapy, our life will be less oblivious. I hope Karl will challenge and
not just condemn me.

We talked about how I’ve changed—I keep bringing up this old self and it
must be discouraging to you. When you were talking about how I’ve changed,
I thought, why can’t I just be happy, why must I “be grabbing at straws” to go
back to the past and bring in the encounter groups to show how I’ve gone
down. You like your argument about K and me—that you’re not trying to split
us up but trying to make me realize that I have the freedom to leave if I
wanted, that I could make a choice, and not just be a reflex to something he
did. Well, I like my argument too. I feel so confined, I want the freedom not
to act the way I do—to be able to have secrets, to be exuberant with no echo
chambers, not to always speak to myself and not to always hear myself.

I read the journal to you to impress you, gain your favor, to show what I can
do easily, gleefully. It took five minutes away from my shopping.
April 19

DR. YALOM

A WEIRD vaudeville-like hour. Very odd, very puzzling. Ginny comes in and
says in a very ebullient way that she’d like to read me a satire she wrote. She
then read me a spoof of our last session she had written during the week. It
was absolutely hilarious. I burst out laughing as she read it. It was full,
however, of references to sexual feelings about me, her need to please me,
her need to have me learn from her. I asked her if it would be fair for me to
use the content of the satire to help us in the analysis during the rest of the
hour. She treated it all in a very giddy, evasive way. We used the word giddy
many times and there was indeed a giddy, racy quality. At one point she said
she felt like doing back flips for me or a tap dance on my desk. I’ve never
seen her quite this high.

In fact, a lot of good things have happened to her—she’s gotten a part-time,

well-paying research job for the next four months, where she’ll be working
with children; she went to the medical clinic, got a complete workup and was
given a clean bill of health (the lump on her cheek proved to be of no
consequence); she’s been writing, with some ease, and things have been
going well for her in general.

However, there’s a very dark side which is that Karl is obviously becoming
more and more distressed. He has been withdrawing from her, having crying
spells and moods of despondency during which he’s been unwilling to talk to
anyone. He has slowly begun to investigate the possibility of getting into
treatment. The other thing is that her parents are down, because her sister has
had a recurrence of a serious illness.

So in some respects her giddiness and euphoria were impure. My hunch is

that though she does admit some superficial feelings of “I should be guilty,”
she is enjoying the fact that others are suffering while she is on top. At one
point she compared herself to a waterbug skimming across the surface of the
water quite freely, while others, for example her parents and her sister and
Karl, are half submerged, like tin cans floating with their paint peeling off,
perhaps even like polluted fish underneath the surface. This was one of the
times where I clearly saw what was happening to her and yet opted not to
press any

interpretation. I felt that I could too easily ignite her guilt and begin a
depressive conflagration. It is only too human a thing to feel up when others
are down. I think that she and Karl are on a seesaw, where it is not possible
for both of them to feel up at the same time. Karl still argues with her and
picks at her, but now she needn’t take his criticism too seriously; in a sense
she’s gotten what she wanted for so long—his depression is her guarantee
that he will not leave her.

Her happiness spills over: she’s been turning on the radio when she comes
home from work, feels full of life, is seeing her friends, and writing a lot of
funny letters. I fear she’s probably due for a comedown and will possibly get
depressed after this meeting. But in the long run I think she’s clearly on an
upward trend.

I had a hard time knowing what to do in the hour; to analyze her mirth would
have resulted in its dissolution. I tried to explore some of her sexual feelings
about me, which were revealed in the satire. No dice, She skittered away,
saying that these are just fantasies, that when she starts writing she just lets
herself go and they don’t necessarily mean much. She wrote the spoof just to
demean her feelings and herself. Then she said that she did have some
pleasant fantasies about me—if she saw me socially, she would just like to
walk with her arm around me and feel close to me.

We talked again about Karl and what she could do to help him. I tried,
blandly, to help her realize that maybe this is a time when she could be
particularly helpful to him. Perhaps being more open and direct with Karl,
even with some of her negative feelings, may be a way of showing real
caring. I’m thinking of group meetings for drug addicts, the Synanon Game
where gross attack is often called “hard love.” She could understand this
because one of her friends is doing this very thing to her husband.

Even sexually, things are opening up a bit for her because she was able one
morning, recently, to tell Karl that she was almost to the point of orgasm and
could reach it, if only he would touch her. He responded to this quite matter
of factly by saying, “I can’t read your mind, why didn’t you tell me?” I tried
to underscore the fact that she’s taken the difficult first step and should find it
easier in the future to tell him what she needs, or better yet, to guide his hand
where she wants it to be. She simply wouldn’t discuss this with me, under the
assumption that talking about it would jinx the whole thing; so I left that too.
By the end of the hour I was feeling uncomfortable, not knowing where I
could move now that would be helpful to her. I have such mixed feelings. I
am very glad to see her looking happier, feeling good, and what’s more, I feel
that a

good deal of it is solidly based, but I have the uneasy feeling that it might all
come crashing down very quickly because, for Ginny, good feelings which
have their foundations upon others’ misfortunes will be evanescent. We shall
see.

Ginny’s Satire

THE MISFIT

I thought of doing a satire of the session which would be my imagined self

that I’m always nagging you with.

Enter bubbling blond, breathless and dying to speak, words spilling all over,
like coffee to go. Dr. takes deep breath, waiting for adventure. Devilish look
in eye. Girl shows doctor lump on face. Because it’s infinitesimal, doctor
comes close to touch it—touches girl’s face, then neck, then shag. Girl rears
up, back arches, with terrific cry explains how she is in her second prime,
tells many fantasies of petting with doctor in the happy hour at cocktail bars.
Doctor would like to interrupt with questions and interpretations but girl
never stops spilling the beans. Through session her face goes from flushed
feminine (by Elizabeth Arden) to deathly white, as both love and death rush
in her mind. She collapses finally in soft weeping after telling how adoring
her boyfriend is becoming, how he wants to open up and buy a massage
parlour with her (for a tax loss) and how she doesn’t deserve any of it. The
doctor tells her she is more buxom even than last week. She hands him her
therapy report—five pages, single spaced—every gesture, whimper, thought,
dream recorded.

When she leaves, stronger than a thousand facials, she feels relaxed, young.
She will be able to leap chores in a single bound. This week she will not be
trapped to her kitchen floor, and her table won’t be cluttered like a St.
Vincent de Paul’s. All her silences will be pure. She will advance on the
world.

The doctor carries her to the door. He would like to go home to his pot roast,
but he daren’t. There is so much to write. His memory is ignited. He has
learned so much, too much from the girl.

She walks past Stanford’s grave and the spring sun squints at her from every
tree. She feels at one with the cacti, and the palm.

Once on the Greyhound bus her strong face keeps away all of the Third
World who are traveling the bus. Go Greyhound and leave the minorities to
us.

She takes a whole seat and falls asleep. Her dreams, like dictaphone
machines, play back her doctor’s voice and touch. As the bus speeds away,
she vows in

her mind to dedicate all her books “to her doctor.” And then so people will
not think it is to her chiropodist or her gynecologist, she sings, “to Dr. Y. who
gave me the freedom to cry, the oomph to fly, and ten reasons not to die.”

Written by Ms. Fits

April 19

GINNY

I THOUGHT yesterday we were just like two friends getting together. Except
that only I talked about my problems. I really was happy and would have
been more at ease if it weren’t supposed to be therapy. I loved the way you
laughed at the piece I wrote. Then of course you wanted to know if it were
fair to use it as evidence, as incentive for the session. And I cut you off from
doing what you wanted to. What I had written was a larger than life
caricature and by it I both exposed and protected myself. I was also horribly
sarcastic, which is the easiest way for me to be. Only later riding the bus
home I thought I might have disappointed you, by tantalizing you with it, then
stopping discussion.

I tried to draw off some of my energy in the session, thinking of Karl and
feeling guilty. None of this was emotional though. Maybe because I don’t
really feel guilty; I even welcome what is happening in order to help us.

Part of me judges the whole session as superficial. But the part that laughs
and relaxes enjoys it immensely.

I never thought of myself as ebullient yesterday until you brought it up. By the
end of the session, though, I was going stale. I’m too lazy to struggle after
something, to find a straight path and keep after it. Instead I succumb to the
old wraps to cover myself up in.

April 23

DR. YALOM

ONE OF the dullest hours I’ve ever spent. The minutes stretched out
interminably. Suddenly it was as though there was absolutely nothing for us
to talk about. It was as if Ginny had rummaged through all of our interviews
of the past year, picked out the most tedious parts of each, rolled them into a
big ball and bounced it for an hour in my office today. I wasn’t feeling too
well, having

had a bad night’s sleep, and I kept wondering if it was me. But I don’t think
so.

I had a great deal going on today and was pretty much up to everything else.

She simply didn’t bring up any issue we could work on, nor could I find any
way to help her discuss anything. In fact, she came in and said straight off that
she didn’t know what she was going to talk about, she had thought about it but
gave up and finally decided not to plan anything. I suggested we take a look
at the calendar and make up our schedule; it turned out that we have about
eight more sessions left. She wanted some assurance that she could see me in
the fall just to review the summer, and also that she could write me in
Europe, and then also asked jokingly whether she could trade some of the
interviews in June for some in September. I told her that I’d like to see her in
September, but only to review the summer. I tried to make it clear that June is
“termination.”

Then she said that Karl had started therapy and it looks as if it is going to be
helpful. She wonders if she shan’t be jealous of all the attention Karl will
get; perhaps she will have to manufacture some convincing complaints. After
that, a large frothy nothing. Every time she mentioned something and I tried to
get hold of it, there was just nothing there. The happiness she felt at the last
session lasted for several days. She knows she should use our remaining time
for something useful. Her friends tell her that she should come to terms with
her mother and father. O.K., so I try to go into what “coming to terms” means.
She doesn’t have any idea. The more I press, the more I realize that there is
nothing to be gained. She has a friend who is going to several encounter
groups and is really “learning who he is.” I tried to explore that with her, but
she recognizes the encounter group “highs” as something no longer useful for
her. She talked about not responding to some insults Karl had thrown her way
—stale and non-nutritious material. She talked about her feeling that she
should be doing more in life, taking advantage of her opportunities, sitting
straighter. . . . I no longer know what the hell she is talking about and I try to
confront all the “shoulds”

that she carries around with her, wondering if those aren’t in fact her
mother’s voice.

I guess I’d like to hear her say that everything is really going well, for my
own reassurance. To the best of my judgment, though, things do go well, so
well that she has to struggle hard to keep on being able to present herself as a
patient. There are only a few minor discontented areas, such as her inability
to oppose Karl on some occasions and also a few disturbing dreams, one of
them having a lesbian theme. But I’ve never worked much on dreams with
Ginny because she hides behind them and I’m trying to find Ginny, not
understand

her. At this stage of therapy I could see the dream she presented for what it
was: a Lorelei beckoning me into therapy without end. I simply closed my
ears and told her she’s always going to have dreams like this—it’s a part of
being human. I’m not quite sure what I wanted her to talk about. Maybe, we
really are finished and I’m dragging it out too long. At any rate, I’m sure
she’ll have a real downer from this interview. I’m left already with a rather
bad taste in my mouth.

I feel that I did nothing to help her; everything I tried was halfhearted because
I seemed to know in advance that it wasn’t going to be much help.

April 23

GINNY

I’VE GOTTEN the session mixed up by the night that followed. Rather the
night drained any of the fun out of the session. I woke the next morning hating
you. The way I’ve been in the session—flippant, gay, mushy, not at all sure
inside how anything was going, asking you to find out; not bringing up new
things, acquiescing, saying yes I was happy, yes I was sad, being anecdotal
rather than emotional, a puppet state.

Anyway that night all my worst fears poured out. K asked why I was so timid
with him, afraid to talk to him, and if I were so afraid, how had I stayed with
him so long? These are obvious things I always thought inside myself but you
told me I was chiding myself for nothing. The same horribly stagnant quality
in me these last months in session had not gone unnoticed. As in session, I
can’t say anything to him without playing it first inside my mind, with a
whole background of canned voices and derision. In session when I droop
and you say, “What are you thinking?” then my head bobs up, I grin and say
something. And this is progress? You should have kicked me in the head or
thrown me out. I would rather have suffered from you, tested out my pain
with you, whom I’m not sharing all my feelings, furniture and food with. I
would rather have stood up to that, as a test case, then have to drown now, at
night.

The first hint of silence, of criticism, of need on K’s part, and the most
overwhelming fear explodes and it feels like an anchor that sinks, holding me
dead for eight hours. I’m not able to sleep, I imagine the worst corners of my
fate, I lavishly fantasize even while the thing is happening and something is
being asked of me. I hate every redeeming feature that makes me survive in
the

day. I join hands with the worst Ginny of college board nights, of any test that
demanded something from me.

Anyway I held off writing this cause it had nothing to do with you or the
session and is or should be directed against me. You are only an accessory,
having shared our little bubbling hour.

I forgot what we talked about in session. I asked you how you would change
me, this was filler material. You said I could be more assertive. Oh yes, you
said it was so hard for me to think of anything wrong. What a joke.

May 3

DR. YALOM

ONE UP one down. Ginny really is right, the sessions do alternate strikingly
in their meaningfulness. This was an odd session in which I felt both busy (by
which I mean that I was doing whatever it is I am supposed to be doing with
people: I was working because I had something into which I could sink my
teeth) and, on the other hand, genuinely despairing for Ginny. I couldn’t avoid
the feeling that perhaps nothing has really changed after all, that perhaps
she’s just as fucked up as she always was, that perhaps the behaviorists are
right and I should just try to deal with her behavior, giving her instructions on
how to change and how to behave. A feeling that it’s all too overwhelming
persisted for the first 15 to 20 minutes, but then gradually things began to
make more sense.

The crucial event for today’s session occurred last week right after our last
meeting. That night when Ginny was in bed with Karl, he asked, “Ginny, why
are you afraid of me?” Apparently she handled that situation very badly. She
couldn’t answer him, he kept pressing her, she ended up feeling like a
terrible failure, and things grew worse and worse. Well, I had many thoughts
about this, almost all of which I shared with her. First I said that here was the
long-awaited invitation. She’s always lamented how impossible it was for
her and Karl to really talk, that she’s always had to sit on her fear and her
feelings because Karl wanted it that way, and here he had finally offered an
unequivocal invitation to open verbal discourse. I tried to role play it with
her, giving her suggestions as to what she might have answered; I tried to
help her formulate what it was she really feared. What was this terror that
paralyzed and muted her? She answered that she was afraid he would leave
her; but because he’s so critical of every

little thing that she does, she is also frightened of his presence. In the role
playing I reinforced almost every statement she made. Almost any utterance
is better than mutism, better than being the blob or shadow which I imagine
she must be so often to him. Perhaps I was too hard on her but I kept trying to
make her see that she’s got so much to say which Karl wants to hear, but I
don’t think I came across in the most supportive way. I asked her whether she
wanted to continue role playing or to talk about why she is afraid of me, the
latter being closer to a real life situation. She said she’d rather do that, so I
asked her why she was afraid of me; was it because I must get sick of her at
times for not changing, or for being the way she was last week? Did she feel
after last week that something bad was going to happen, that I’d punish her
for not taking anything seriously? I admitted that at times I am disgusted, like
last week, but that is not my overall feeling.

I then made an interpretation to her, which I think is probably true; by

continuing to fail with Karl she’s attempting magically to keep me at her side.

She refuses to grow, refuses to change, and it’s a reaction to our impending
termination. She smiled and said, “I knew you’d say that.” But we couldn’t
take it very far. We also considered whether she wants to drive Karl away. I
gave her some specific instructions as to how she could respond to him when
he criticizes her. Why does he have to be so critical of her, in general? Why
is it that she can never be critical of him? I asked her what she’d like to say
when he complains about her incorrect way of washing the dishes. She said,
well, sometimes she’d like to say “fuck off.” I told her that if I were he, I’d
much rather hear that than nothing at all. So once more, in the endless
revolving sequence of cyclotherapy, I gave Ginny a pep talk and sent her
back into the ring with huge pillows of boxing gloves on. She does make me
feel that she is so helpless.
I suggested to her that she should think seriously of bringing Karl into the
office next week. She’s indicated that she may very well do it, if he’s willing.

That would be a fascinating hour!

May 3

GINNY

THE SESSION was helpful to me. You took a more active part. After I told
you about the fiasco of Karl asking me why I was afraid, we role played.
When

Karl asked me, I froze, and whatever I thought of, didn’t say. I was on remote
control, too busy eating away at myself to do anything to help.

But this time magically when you asked why I was afraid, the sentence was
allowed to touch me. The way I know is I stop gabbing inside and have a
blank moment in my head, and something better takes hold of me. You gave
me confidence that anything I said to Karl’s question could be an answer, as
long as I spoke and didn’t bury it.

I didn’t know that you would think I rigged up the fiasco to show I did need
therapy and you. But when I thought about it, it seems just like what you
would think of. I think for once you’re wrong. I have a bad habit of not
speaking clearly. Of getting lost. This whole time in therapy has been like a
giddy detour, with me the one not wanting to find the right road. I couldn’t
answer Karl; I usually don’t answer you. I feel better. I don’t want to be
pounced on. If I had succeeded more with you, I would have with Karl and
vice versa. It’s not because I want to keep the stalemate we’ve had that I so
often fail.

When you told me how you felt about the session before—that it was

“disgusting"—it made a big impact. Not at the moment (then I thought it was
cute). But since, I’ve been thinking of it (“disgusting” it makes me feel bad). I
only think of myself. What myself thinks someone else is thinking, if I could
know your reactions instead of imagining them. And I know what you’ll say:
“ask.”

To take away part of the guilt for subjecting you to my bouts, of course, I
fantasized writing a journal for you this summer. It would be better than the
write-ups. And in giving it to you in the fall, I would have to see you at least
once. The fantasy deteriorates. I think how I would have to roast other people
in talking about them. And I’m glad I don’t have to write it.

I can’t remember whose suggestion it was to bring Karl. A good guess would
be yours. A very generous offer. I thought at the time it would be wonderful.
When you think how scared I used to be of that, you see how far you had
inspired me yesterday. Then you made a joke of my worst fears—a shotgun
session with you asking Karl when he intends to marry me. It’s funny when V.
(previous therapist) had a session with my parents and me, I didn’t say a
word. I was like a little deity with her picture on the wall. One was
conscious I was there, glowing, rooting for both sides against me in the
middle.

When I got home I thought I have only about four sessions left. I couldn’t bear
to waste one, to share one, to play the spotless ingenue again when I’ve gone
a few slippers beyond that. If Karl comes, I want it to be really good.

I’ll feel like a martyr who sacrifices a session because it is the right thing to
do. But I really dream about a good session with the three of us.

VI

Every Day Gets a Little Closer

(May 10–June 21)

May 10

DR. YALOM

ENTER THE WORLD. Something very different happened today. Ginny

brought Karl with her. I had been very tired all day, having slept little the
night before, and therefore ambled somewhat drowsily into the waiting room
to collect Ginny and bring her into my office. Suddenly I see this man sitting
next to her, and it dawns on me that this must be Karl. At the end of last
session I had seriously suggested that she bring him, but as she had never
taken up similar offers in the past, it never really occurred to me that she
might have the courage to issue the invitation and that Karl might accept.
Whenever we had previously considered such a move, Ginny had not thought
Karl would be willing to entertain the idea. At any rate, there he was. My
fatigue and drowsiness rapidly vanished and I rode a keen wave of interest
the whole hour.

In fact, it was one of the most interesting hours I’ve spent for a long, long
time.

Karl was so different from what I had anticipated. With considerable

certainty I had envisioned him as a dark-haired, gruff, heavily bearded
individual, who would be closed or challenging or hostile to me. Instead, he
was quite the opposite, delightfully open, free, courteous—an extremely
handsome blond man with long straight hair. Ginny was well dressed and
well groomed, and I experienced a great deal of pleasure at being together
with these two terribly attractive people who, despite everything else they
had to say, obviously have warm, tender feelings for each other. At times
during the interview I felt little pangs of jealousy, for I had always
considered Ginny mine, and suddenly I see what a really distorted illusion
that has been. She’s been so much more Karl’s than mine. He lives with her
all day long, he sleeps with her at night, and I have her for a single hour a
week. But these are only passing thoughts. I was very interested in Karl and
he did most of the talking. With a marked self-assurance at the beginning of
the session, as I was sipping a cup of coffee, he asked whether he could have
one too. I realized that I had been remiss in not offering him one and ushered
him into the coffee room, where he, with considerable aplomb, helped
himself.

I started off by suggesting that we consider the problems that exist between
the two of them, and fairly soon we got into a very constructive use of time.

With refreshing openness Karl discussed his annoyance at Ginny’s failings—

the badly washed dishes, the badly cooked dinners, etc. He wishes she were
more competent and more effective. Ginny countered with the assertion that
the kitchen was spotless today, and then Karl passed on to a somewhat higher
level of demand—that she be able to tackle problems in the outside world. I
gradually heard very clearly something Ginny has been saying that I haven’t
been fully appreciating, which is that Karl is really telling her: “Be
something other than what you are. Be different. In fact, be just like me.” I
bided my time and finally implied as much to Karl. I wanted to say it gently
so that he wouldn’t feel attacked, for I imagine he must feel like an
uncomfortable outsider here with me and Ginny who have spent so much time
together.

However, he accepted my interpretation very, very easily. Later on, we were

able to conclude that not only did he have clear ideals for Ginny, which he
elaborated explicitly, but that he had some very strong ideals for himself, and
he responded most vigorously when he spotted certain traits in her which he
disliked in himself. He dislikes her docility and her passivity and certainly
he abhors any traces of these traits in himself.

I was proud of Ginny today. She kept speaking up, talking back to Karl, she
even brought up the issue of his leaving her, but she said it so quickly that it
was almost passed over. I was reluctant to pick it up since we were too near
the end of the hour for something as loaded as that. She revealed how
frightened she was of him and he confessed that he makes her frightened,
perhaps even intentionally. He was quick; he easily understood that there is a
price to be paid for having his own standards for Ginny—she will squelch
parts of herself which he would like to see. I think this was a very important
insight for Karl—

he heard it and, I believe, allowed it to register.

Karl is not a closed, defensive person, and I should imagine he could work
well in therapy. Apparently he has some severe identity problems and a
relentless drive to be the person he thinks his parents expect him to be. He
has much therapeutic work ahead but considerable ego strength.

I am curious to see Ginny’s next write-up, for I wonder what this meeting
meant to her in terms of transference toward me and in terms of her feelings
about me vis-a-vis Karl. Somehow I’ve always underestimated Karl, never
appreciated him and never understood what a potentially good thing Ginny
has going for her, and conversely, I can see how attractive Ginny is in so
many ways to Karl.

At the end of the hour, I tried to confirm my feeling that the session had been
a constructive one by asking if they were able to talk as freely as this at other
times. (Will I never stop needing applause?) Of course, they said no, they

are talking much more freely now. I tried to extend this into the future to keep
the new options open by asking Ginny whether she may henceforth be able to
tell Karl when she feels somewhat squelched by him. She said she thought
she could.

May 10

GINNY

IT WAS so funny to see you round the corner ready to welcome me, and then
get surprised by seeing Karl.

Naturally I had not thought about what was going to happen, ignoring the
inevitable. I was proud of both of you. And my silences sometimes seemed
like indictments against me, so I jabbered.

I learned a great deal. There was a moment when I seemed to understand my

behavior toward Karl. I never imagined Karl was so dissatisfied as he said.
And later I mulled over this to distraction and anger. I saw how I had
webbed myself in groceries, cooking and cleaning or recriminations about
not cleaning, and that this full-time pastime wasn’t appreciated at all. Of
course I know that in therapy I always exaggerated and tended to overstate
the case and maybe Karl, in the luxury of an audience, exaggerated too.

You kept emphasizing how one-sided things were with Karl wielding all the
criticism toward me. All my feelings were responses toward something he
had once thought about me. All his goals were him and all mine were us.

I never thought that Karl might inhibit me, but maybe that’s true. I think you
were wrong suggesting I deliberately leave a glass dirty so as to hit him
where it hurts. Of course, I’ve always irked people by doing things only half-
way, not following through. I fade, though unintentionally. I take half breaths,
never fully exhaling.

After the session we were alive with all that had been brought up. And as we
elaborated on what had been said some of my buoyance was caught up in an
awful undertow. Karl felt that my being so afraid of his leaving was what
hemmed him in; that I would fall apart. He wanted me to have my own life.
He thought this weakness was the most despicable part of me. He wants me
to get my own life and I almost finished the sentence —so he will not be
afraid to leave me.

The tables were turned. I had always thought I was protecting you from
Karl’s abuse. But he thought you were wonderful, intelligent. I almost plotzed
when he expressed a wish that he should come back. He thought it was weak
of me to have considered not taking him.

I really enjoyed it and was grateful to you. You seemed to be my true friend.

May 10

KARL

I HAD no real idea what to expect, although, having just started therapy in a
group, some of the nervousness that I might have felt was allayed. Still, I felt
like I was entering some new territory which I couldn’t quite see, and had
never quite seen, and maybe now I was going to find out if it was really
there. Just after we went into your office I saw your coffee and asked for
some; I think I wanted time to get my bearings more than the coffee.

We ended up sitting in that triangle arrangement, with you at the apex since
you were against the shorter wall. I wondered if I shouldn’t be sitting next to
Ginny or she next to me, but soon became glad that we were across the room
from each other. It made me able to talk more freely and I felt very
comfortable exactly that far away from both of you. I had room to move and
whatever I said, even something that had not been said before, didn’t seem to
be aimed at you or Ginny but more like pushed in a big ball of words across
the space which gave her time to prepare to receive it.

My fear was that we would get sidetracked, trying to shove our larger
emotions into the boxes of our smaller points of annoyance, which had been
happening in the therapy group and had been leaving me feeling unconnected
with them, brittle, a little hysterical over not much. But when I began to talk, I
felt like it was coming from the core and that what I was saying was exactly
what I felt. At times I wondered why I hadn’t been able to say it before. Your
few comments always helped to nudge us into the unexplored corners. I think
some of my ease came from my discovering that it wasn’t going to be Ginny
and you, who knew more about me from Ginny than I knew about me from
Ginny, against me. I had decided that I would not fight if that came about
since I had had many of my self-confidences shattered recently with the
results being good; but the thought of our hour of shock and bewilderment and
of the next

few days or however long it would take to work through it again wasn’t
appealing. When I saw that wasn’t going to happen, I felt like giving.

I worried from time to time that I was talking too much but I was also
worried that I might not be able to say those important things in just that way
again. I am still worried that I am not the listener I once was. I had always
assumed that if I withdrew and shut people off, they would hammer to get in;
instead, I think they often just shut you out. But during the session I was sure I
was being heard and it almost made me drunk.
On the other hand, I find that in writing this I am more fascinated with my
own responses and motivations than I am with considerations of how Ginny
feels or felt about it all and I suppose somehow and someday I am going to
have to face the questions of whether that is how I treat people or whether
that is how I would treat any lover or whether that is how I treat Ginny alone.
If it should turn out to be the latter and if that meant that I should leave her, it
would be very difficult for two paradoxical reasons. On the one hand, I
would have a kind of horror at having to face life alone again, but on the
other hand, I feel trapped because I think my leaving Ginny would crush her,
that after this time together and letting her build her days around me it would
be abominably cruel for me to leave her alone. I would be afraid for her sake
to leave for my sake and so I pull back and forth in a room where I am
growing restless; at the same time I am afraid of what I would find on the
other side of the door—at least the room is familiar and often reassuring—
and afraid of what would happen in the room when I had left. Some of this
Ginny and I talked about after we left your office, but I’m not sure what to do.
Often when she annoys me I think, right at the time too, that I am judging her
on superficial values that I should have outgrown by now. I tell myself that I
feel what I feel because she does not fit a high school pattern of coolness that
I haven’t shaken off, though it seems unworthy of her and me; and I don’t
know enough about myself or about life to tell whether what I am seeing in
all that rough is a diamond or a few glints of sunshine off a piece of glass.

May 24

DR. YALOM

AFTER the last session I wasn’t quite sure whether to expect Ginny alone or
Ginny and Karl today, but they both appeared again and, surprisingly enough,

Karl handed me a long write-up, which I hadn’t asked for. Ginny rather
apologetically pointed out that hers was all soggy and messy and has yet to
be typed. She seemed to be unusually ill at ease and unable to decide
whether she should give it to me or not. This opening gambit turned out to be
an accurate predictor of her behavior the rest of the meeting.

We started off by Ginny saying that the last interview had been very good and
enjoyable during the session and that they had done a tremendous amount of
talking afterward. She’s not sure what other repercussions resulted from our
meeting, but she knows they have been talking more and fighting more. In
response to my question about the content of these discussions, we moved
fairly quickly into some important material. Most of the discussion was
between Karl and me, with Ginny remaining largely on the sidelines. She
explained some time later that she was feeling tired and somewhat out of
things, because she’d had her eyes dilated that day and also because she’s
gotten a new job. That wasn’t the whole story.

Karl immediately tackled the issue of his being afraid to leave Ginny because
she might fall apart. If ever there was a core subject for a couple, this was it
—Ginny and I have on so many different occasions debated why she could
not talk with Karl about the future of their relationship. It was a compelling
experience to sit there and hear them discuss something so matter of factly
that Ginny had been dreading to bring up for month after month after month.
Karl feared Ginny would be depressed and go to pieces if he were to leave
her, and that he would subsequently be overwhelmed with guilt when he
realized what he had done to her. I asked about the effects on him and he
admitted fearing the same thing for himself; he’s never enjoyed living alone
and he’s not sure whether he wants to. He is, however, tempted by the
challenge, feeling that it’s somehow a failing for him never to have been able
to succeed in being entirely self-sufficient. To my way of thinking, living
together because they are afraid to live apart is a meager basis for a
relationship and I said so. It’s hard to imagine anything enduring which is
built on so insubstantial a foundation.

Throughout the session I kept trying to encourage Ginny to speak up, so that
Karl would know what she was thinking and be less obliged to read her
mind. A good example of this occurred in a long argument they had recently,
too detailed to go into here, but which consisted of Ginny’s wanting to go out
with friends, Karl’s refusing and then consenting to go out anyway when he
noticed by Ginny’s long face that she was terribly upset. They both ended up

having a bad time. Was it not possible for them to learn explicitly from each
other how important the occasion was for each of them and then make a joint
decision which would somehow make room for their respective needs?
(Easier said than done, said I to myself, as I reflected upon comparable
debacles with my wife.)

I suggested that Ginny may have some investment in appearing fragile since it
is one way of keeping Karl bound to her. Obviously she didn’t enjoy my
saying that. In fact, it’s similar to the interpretation I’ve often made to her
about her relationship with me, i.e., that she has to remain sick in order to
keep me. At one point in the session she showed a not-so-fragile, almost
hearty Ginny by vehemently refuting one of Karl’s statements. When he said
that she had no understanding of how important a certain article he was
writing was to him, she flashed back almost fiercely, “how do you know?”
and went on to demonstrate that she was fully aware of his feeling and had
tried, though ineffectively, to convey to him her own concern about the
article. Having so often prompted Ginny from behind the scene, I found it
thoroughly satisfying to watch her defend herself.

Karl then returned to the theme of Ginny’s incompetence. He cited an

example of a recent party where Ginny had appeared very foolish because
she didn’t understand a joke that everyone else obviously understood. In my
office Ginny was painfully embarrassed-she didn’t quite know why she had
misinterpreted the joke. Furthermore, Karl felt very embarrassed. In fact, all
three of us were caught together in a tangle of embarrassment. I didn’t know
how to turn this awkward scene into something constructive, except by
pointing out that all the demands for change were very unidirectional; Karl
makes many demands for Ginny to change but she never makes comparable
demands of him. She said that what she’d really like to change in Karl is his
constant criticism of her, which makes for a mind-boggling Gordian knot.
Karl looked embarrassed and he was; I tried to find out why. I think he is just
beginning to sense that his demands on Ginny were unrealistic and unfair. But
we didn’t really get too far into that.

I wondered about Ginny’s inability to criticize Karl, whereupon they both

agreed that, until two or three months ago, Karl was virtually unassailable. In
fact, had she criticized him, he would have become irrationally angry.

Therefore, only an obsequious, self-effacing Ginny could have stayed with

him.
I wondered also whether her so-called incompetence wasn’t somehow a
function of her inability to criticize him openly and whether the only form of

retaliation available to her wasn’t a passive aggressive one—continuing to

do the little things that pissed him off. Karl really dug that interpretation
because it supported what he had always believed—that Ginny could, if she
wanted to, do the household chores. Ginny received the interpretation with a
wan, sickly smile. All in all, I think she was unnerved by the session. I tried
to check it out at the end of the hour by asking if she felt picked on by the two
men who seemed to be hitting it off so well. Did she feel a bit left out of the
triangle? She evaded me and my question, and at the end of the meeting
seemed to slink out of the office. Karl, on the other hand, thanked me heartily
and shook my hand.

Although I didn’t leave the session with a very good feeling (I let it run over
ten minutes in a vain attempt to recoup some of last week’s vigor), it is clear
that these meetings have changed something for the better between the two of
them: they will no longer be so distant and closed and obliged to resort to
mind reading and guesswork. Some rules of the relationship are now
permanently altered. We agreed to meet as a couple for the next two sessions
and then Ginny would have the last two sessions to herself. I wish that I had
started seeing the two of them together quite some time ago. Everything is
moving quicker now.

May 24

GINNY

I GUESS I let Karl do most of the talking. I was feeling very tired, pre-
migraine, and became full-fledged migraine by the evening. Some of what I
said seemed to come out of nowhere (like telling you I had started work) but
I was confused and didn’t know how to share the session.

You seem so much more directive in these sessions, initiating questions,

summing up. Of course Karl supplies you with a lot more information than I
ever did.
I thought it was funny that one of my prime fantasies (being alone, living
alone) should be Karl’s too. It’s a kind of unrealistic stake to compare our so
much shared existence to. And to berate our respective weaknesses in
needing someone. Listening to Karl tell it, I could identify and see how it is
an easy pasture to let your imagination go wild in.

Karl didn’t think that I would be the one to leave, which coincided with my
own appraisal. I used to talk to you and you’d say, “Well, why couldn’t you
be the one to leave?”

It seems like the major time I was in therapy with you, my home life was
stuck and static, Karl and I both tacitly in limbo, a little wounded and trying
to heal.

Karl also seemed to go through the same thing I did in therapy, being full of
doubt as to the value of our relationship, to the point where the
overwhelming verdict seemed to be to get out, and yet we both try to avoid
that direction, because basically we like each other. I was touched by his
diamond/milk bottle dilemma. Which one am I? With all these cartons I guess
a real glass milk bottle has some value.

The session seemed to touch mildly on important, crucial issues but it was as
if we were predisposed to be kind to each other and just look at old on-going
wounds without trying to open them to infection.

I wanted ten minutes alone with you. For Karl and I had talked about sex
during the past two weeks with a little breakthrough. But I felt I couldn’t
bring this up at the session. I was like a creaky hinge on the door of
conspiracy. You were most constructive when you asked us to explore how
we let each other know how we feel. I think we all maintained a sense of
humor. I was surprised to learn that Karl thought I wasn’t interested in his
writing. I thought I had shown great, constructive interest. It’s true at a certain
point he changed his writing style, abandoning a personal, evocative one for
a more professional abstract one (writing more for a commercial market—
Playboy, no less), and I favored the first, because I am really starving for
glimpses into Karl’s family and memory and I think the more personal
writing about his childhood and adolescence helped him to feel his
imagination and its neglected content. That night some of my friends called,
interrupting Karl’s writing silence; I was unaware my popularity with Karl
had plummeted, that he was furious, taking it as a sign I did not care about his
writing because I didn’t tell my friends not to call me. I would fight back if
only I knew I was being silently attacked.

Since the last two sessions I’m more able to stand up for myself because I
see that Karl does take things seriously and is constantly making judgments
about me; that my evasions and silences are not just blank spots but big black
marks against me. Just the fact of going here together makes us feel much
closer. And we’re more caring in everything—fights, talks, etc. I only wish
this had started earlier so that I could have had my cake and eat it too. And
be close with each of you.

May 24

KARL

THE SECOND time I think I felt over confident and wanted a rerun of the
week before, which had accomplished so much. I was less aware of you as a
presence and felt myself to be on the center of the stage, which is where I
usually try to move when I start feeling sure of myself in a situation.
However, I found that I couldn’t speak so closely to my feelings and that the
discussion kept getting sidetracked and issues manufactured since we were
with a therapist; that is the tone of discussions with some of our friends
whom Ginny likes and I don’t. On the other hand, the best things that came out
of the session seemed to go very deep—I am thinking particularly of your
suggestion that Gihny continues a kind of sloppiness about the kitchen, etc.,
as a protest against values I judge her by, but which she doesn’t hold herself;
while, at the same time, she is afraid to confront me directly. Although that
sentence is confused, I did get the point.

I don’t think I have learned what to expect from other people. Last night I
came home about eleven after playing cards. I was disgusted with myself for
going to the game since I had work to do and it was a night I could have had
with Ginny. I was afraid of backsliding. We talked for several hours and I
began to feel more comfortable and at ease and had renewed confidence that
I could do what I want to do. Without Ginny, I would have spent the night
brooding and growing more convinced of my purposelessness and ultimate
failure. I told her all this, too, which was really like icing on a cake. Where
had I been all these years, I asked myself? Why had I never seen that comfort
and sharing was something to value and something that would not exist
without her? Since I am just starting to realize what Ginny can do for me, I
have only just started to realize what I can do for her.

I think that’s really all I have to say because what I have talked about so far
has been of great moment. I don’t quite know what to add. You will see me
only one time and Ginny only twice more and I suppose you might be
interested in the relation between our meetings and what is happening
between Ginny and me. I can’t be really sure since I am still so close to all of
it and want to stay that way for a while. I think I was lucky to get to see you
when I did since it was at a crucial time for us, but it was also at a time when
I was ready to hear what I might have been afraid to listen to before. I also
think that what

happened in the first visit enabled me to see that problems could be solved
and the second session helped isolate some of the problems. One other thing:
in the second session I became worried about boring you when the
discussion would drift to what I myself found boring. I was amazed when you
would choose exactly those things—say the dirty dishes—to press. Later I
decided that I might be consistently using boredom as a defense. There are
things that do bore me; but it can also be a convenient mechanism for keeping
myself blind to what I should or could see.

Would the progress that has been made have happened anyway without our
meeting? I don’t know. I don’t think it would have happened so quickly since
you acted as a catalyst that got me to relax enough to confide in Ginny.

I think that’s all I can say right now.

May 31

DR. YALOM

I’VE BEEN in this business for a long time, but the interview today
represented one of my peak experiences as a therapist. I felt so happy that I
was near tears on a couple of occasions. It was so good, for once, to see the
fruits of long and very hard labor. Maybe I’m exaggerating in a spirit of self-
aggrandizement, but I don’t think so. I kept remembering all the time and
effort I’ve spent seeing Ginny and also all the hard work that she’s done over
all these months.

Everything seems to have been pointing toward today, and everything fell
into place—all the issues that Ginny had talked about with me, all the fears
that were so irrational, all the things that she was afraid to say, afraid to
bring up, afraid to face, she faced today in the session and has faced on her
own with Karl during the past seven days. When I think of all we’ve gone
through and now how quickly we are moving, I begin to believe once again
in my work, in the slow, sometimes intolerably slow, business of building
firmly and well.

They both came in feeling very, very good about one another, saying they had
spent much time over the weekend talking together in a way they never had
before. They aired their respective feelings about Karl’s leaving, about
Ginny’s fear of Karl, and so many other unspoken, crucial matters, which
brought them very close to one another. Karl said that suddenly the house felt
different to him, that it was one of the first times in his life that he really
wanted to be with and close to someone. And so the first part of the session
was a kind of

testimonial banquet. I basked. And then I wondered aloud whether we should

rest on our laurels or move into new areas. Neither of them could think of
anything else they wanted to discuss. Secretly I wanted Ginny to bring up
something she has never dared to mention to Karl—her night panics when she
is full of terror and afraid to give expression to her sexual needs. Delicately I
hinted to her to venture into this sensitive area, pointing out that it was hard
for me to bring up certain issues because I feared I might be breaking
confidentiality. She played the ingenous maid, assuring me I could bring up
any subject I wished. I told her that I didn’t know which ones. Karl laughed
and wondered whether I wanted him to wait outside. Ginny was clever, witty
and lovely today. When I said “well, I’ll just take a chance and select at
random,”

Ginny said straight-faced that if I ask the right question I’d get a free
refrigerator.
Although I really wanted them to discuss sex, I thought I’d better start with a
safer topic. I asked Ginny how she now felt about Karl’s family; does she
still feel that he is ashamed of her and doesn’t want to introduce her to them?
They talked about that very briefly, and I wonder in retrospect whether they
didn’t deliberately gloss over the subject. They then moved on to Ginny’s
feelings about her sister’s engagement and then to Karl’s bad relationship
with one of their friends, Steve. When Karl started to explain his quarrel
with Steve, I had to confess that I already knew about it; it must have been a
strange experience for Karl to have seen me only twice and yet realize how
very well I know him.

I feel close to Karl and like him. I have to dig my spurs into myself to jar me
out of the blind matchmaker role. My work with Ginny doesn’t hinge on their
getting married; what does matter is the quality of their relationship. Once
experienced, a deep and honest intimacy will be with each of them forever,
even if they were never to see one another again. I believe, with the faith of a
convert, that this encounter may enrich future, yet unmet loves.

Then Ginny stated, almost in passing, that as a matter of fact she had talked to
Karl just last night about sex. I was astounded, although I tried not to show it.

Specifically, she had told him that she “needs some help” in getting full
satisfaction. Subsequently she lay awake for two or three hours trembling,
fearing she’d really upset Karl, and then had the courage to ask him how he
felt (he had been awake too, worrying about other things). He answered that
he hadn’t been at all upset by that. Ginny’s fear was that they had felt so close
all day and that somehow she was “spoiling” things by bringing up a
problem, as though it would mar their perfect day. I wanted Karl to let her
know that the

contrary was true. It was exactly the reverse: when she brings up a
“problem”

she doesn’t distance him, but draws him closer. Karl agreed with me and I
told him that I wished he would even say it again. And I gradually told him
quite explicitly what Ginny had already suggested, which is almost their last
remaining secret—that Ginny’s worst time of day is the night, and it is her
fear of what happens after she turns of! the light that so terrorizes her days.
Once that was made very explicit, and once Karl really knew it, I felt it was
one of the most powerful therapeutic acts I’ve ever taken. I repeated myself a
couple of times so that he would fully understand. I reiterated to Ginny that
she can now share her anxieties with Karl and that the night panic doesn’t
have to happen again.

We moved from there to my asking Karl whether the reverse was ever true

—whether he ever worried about Ginny’s criticizing him or judging him, and
he said he never did. So I pressed harder by asking, well, does he care
whether she cares about him, and he said, that’s true, he does care very much.
And then we got into some interesting material where he admitted that he
deliberately doesn’t allow himself to think about that because then he doesn’t
have to worry about losing something, or losing Ginny. I told him he pays a
very dear price for his feigned indifference and ostensible lack of worry—
the price is distance, distance from others and from his love for others. He
agreed with me, adding that that’s why last night was such an unusual
experience for him; today he could hardly wait to get home and felt so good
about talking to Ginny. I imagined out loud that this whole business must have
a long history. (I said that, I think, to help him start thinking about his past in
preparation for his own therapy.) We ended up by apportioning our last three
sessions. Ginny wants Karl to come again next week and perhaps the week
after. She first said that she wanted at least a couple of sessions for herself,
but now she says that she wants only the last one alone. She realizes, as do I,
that the joint sessions are tremendously important.

May 31

GINNY

LAST SESSION was the most traumatic of the three. I was bringing in things
to please you—the fact that Karl and I had been talking more openly. But you
acted like we were two smug liars (not so strong). Of course, I was sitting on
a

powder keg and when you went fishing for new material, wondering what
important topics had not been covered, I knew the end of my silence was
near.
The night before in a surge of warmth and truth toward Karl, I had started to
broach the subject of my sex problems. As soon as I did, I realized I had
kicked my foot in my mouth. We were just getting close, and before we could
relish it very long, I gave us a problem that’s so large and crucial, and one,
as you always reiterated, which wasn’t a good place to start with. “Start with
small things like gasoline money,” you’d say, but we were too close to bring
up bridge tolls and stuff. Anyway, we talked about sex for awhile that night
and after that, when we both tried to go to sleep I had my usual excruciating
time.

Unwilling to toss and ulcerate till dawn I asked Karl what he thought of what
I had said. And he told me he was glad it had been talked about and we
would go on from there.

So the’following day when you asked what’s new, was I nervous! I sat there
nearly fainting, telling you nothing was wrong. Then you brought up Karl’s
reluctance to confirm me with his parents. This was not as crucial—I didn’t
care whether or not you brought it up because Karl not only withholds me
from his parents, he withholds himself from them. I think he will have to
come home to his parents first before he can take me home with him. But I
think you were fishing for just how far you could go into sacred topics.

I brought up sex, feeling so ridiculous and matronly, as though I were middle

aged with a tea cup and a topic sentence. I didn’t want to waste the session,
being deadpan. I can’t remember too much of what we said, except that I said
a lot, and wished I could have amnesty and have nothing held against me
afterward.

By opening the subject, I have left myself open to the most wonderful hopes
and worst punishments. Everyday is like therapy now. And change is the
goal. I don’t think that’s ever been my goal before. I no longer need you to
play Karl’s part, he plays it all the time now, and I try to tell him things. The
secrets and intrigues we had are all coming out and I don’t know what’s
taking its place. I’m making contact with gut reactions. Karl playing himself
is more forceful than you playing him. Only because there are consequences.

I tried to reassure Karl after session that every night I don’t lie there at the
edge of destruction. I wish we had started this long ago. Now that there is
such a strong undertow.

I’m coming face to face with my own resistance.

May 31

KARL

I DON’T have any comments on the session itself. All this week and the
week before I have been preoccupied with my article and since I have been
working well, I haven’t been anxious for too much psychological trauma
which might prevent me from continuing. I have, however, tried to bring out
Ginny and we have gotten some things said, but this has been a little one-
sided since I always make sure that I am well in control of myself before
saying anything to her about myself. I am talking around my core; I am not
telling her my deepest, awfulest fears and compulsions possibly because I
don’t quite face them myself, but also because it would be an unburdening
that would leave me helpless before her and I’m not sure I want that. Isn’t
that, I wonder, something to be saved for someone else? On the other hand I
have, like Ginny, trouble experiencing immediate sensations, particularly
physical ones, without feeling ironic about myself and the situation, so that I
don’t know whether the problem is mine or whether she is the wrong one,
and that with another woman the problem of feeling would not present itself
so strongly.

June 7

DR. YALOM

THIS WILL probably be the last time I see Karl, the last two sessions having
been promised to Ginny alone. This hour was in many ways a downer
compared to last week and I was somewhat disappointed by the suspense,
caution, tenseness, and distance in the session. Ginny was obviously anxious:
her legs were crossed tightly and her little foot was shaking back and forth.
Karl gave an appearance of being extremely relaxed. He did something that I
have never seen anyone do in my office, which was to take off his heavy
boots and sit there in his socks. Ginny was taken aback, asked what he was
doing and said she wished he would at least have worn darned socks, as one
had a hole in it. I felt that somehow or other this was a comment by Karl on
his and my parity, which was important for him in maintaining his place in
the relationship with the three of us. (And thus I said nothing.)

Grindingly, laboriously, we finally unearthed an issue. Last night while

watching election returns, Ginny had fallen asleep and Karl barked at her,
saying she would never change. This told by Ginny. When Karl told the story
it then turned out that what he meant by “you’ll never change” was that he had
some sexual plans for that evening. He was waiting for Ginny to be more
lively and assertive and instead she fell asleep. It was very disturbing for me
to realize that Ginny had neglected to mention the sexual component of the
story; it made me shudder to think of what an unreliable reporter of events
she may have been in the past and how much time we may have spent dealing
with issues which were the purest of gossamer in substance.

At any rate it became clear that Ginny felt censured by Karl; she was the
judged and he was the judger. The election night incident represented in
microcosm so much that goes on between the two of them. I told Ginny, for
example, that she has a tremendous amount of evidence which demonstrates
how much she has changed, even over the past few weeks; how then can she
accept his definition of her as a person who doesn’t change? That was a
superb try on my part but utterly without impact.

Another attempt was to contrast their different perceptions of change. Karl

wants some outward behavioral sign, whereas Ginny has made many changes
in the way she feels about him, although it may not get translated into
behavior.

I then suggested to Karl that perhaps he ought to try to enter into Ginny’s
experiential world in order to perceive her sense of change. That fine
suggestion was scarcely acknowledged.

The next thing I did, which usually gets results when something is really
screwy in the atmosphere, was to comment on how strained I thought
everything was today. Karl said that he had been feeling weird and it had
something to do with his group therapy meeting. From there he soon moved
into the admission that he does seem to have a need to be dominant to people
and to encounter new people around the issue of dominance. If he can be
dominant to others, he then loses interest in them and writes them off. But
those people who present a challenge are the ones whose opinions concern
him, perhaps even unduly. I tried to make him see how different it is for
Ginny, who approaches individuals from an opposite set. In fact, Ginny
looks, she said, for individuals who can dominate her. She likes to idolize
and idealize individuals.

I tried to reinforce some of the things that we did last wreek to consolidate
our gains. I reminded them that the old taboos are dead, that we had new,

enlightened rules and encouraged them to continue taking gentle risks with
one another. Apparently they had an extremely good day on Sunday when they
went out to dinner because Ginny was somehow able to make it clear to Karl
that she wanted to go out to dinner; they’ve done some talking and she’s been
feeling closer to him than ever before. All in all, however, I found myself not
entirely satisfied with Ginny. I wanted her to perform better and I felt like a
frowning parent disapproving of my child’s timidity. She knows better, she
can do better. “Stand up and speak out!”

Karl began the hour, incidentally, as he had the previous one, by asking me if
he could get a cup of coffee, which I thought was in the same general
ballpark as taking off his boots. While he was getting the coffee, Ginny
mentioned that she wished we had started this so much sooner, things seemed
to be moving so much more quickly now. She’s right, of course, but forgets
that they weren’t ready for it when I urged her to bring Karl in months ago.

Sometimes I wonder why I ever see a patient individually without at some

point seeing the next closest person. I’m not sure, however, how much more
work we could do on a long-term basis; maybe just a few sessions like this
and then going back to the individual setting might be the best thing for them.

June 7

GINNY

I FOUND it difficult to talk. I wanted to keep “THE THING IN THE

NIGHT” private. We weren’t very explicit and I was pretty uncomfortable
because everything that happens now has immediate repercussions. Was it me
who finally brought up the subject? Talking about the incident of my falling
asleep the night before, you got to hear Karl’s version and mine, and we both
got to hear each other’s. I became confused. You thought I was talking about
the election returns when I was talking about sex. I thought that was obvious,
and didn’t need more translation. I guess I don’t give enough strength to my
voice and words, and allow them to settle about me like vapor.

Karl is a night person able to undergo hours of television and then expect a
lively time about twelve-thirty, but grass and TV always leave me sleeping
after an animated short while. In the early morning, however, I’m fine,
refreshed, and Karl is like a seventh-month fetus, not ready to face the world,
snarling not

talking. My sleeping habit to him is a real character flaw; his goes unnoticed
by himself.

You concluded that Karl thought I was unchanging. I guess you were
disappointed when I agreed with him, thus confirming his verdict. I believe I
am unchanging in the sense that, unlike him, I’ve never gone after something
just to succeed; sometimes it happens naturally or miraculously. However, I
do sprout new leaves. And hopes, which is my innocent, flimsy version of an
ego.

In session I changed, and at home with Karl my range of emotions and daring
were greater. But I still allowed myself to be led by the rope in session, and
only tentatively took the initiative.

Karl talked a lot about how he’s limited his friendships because dominance
has always been so crucial to him. And you said that maybe I wasn’t enough
of a challenge for him and that’s why he resented and dismissed me so often.
I thought you did this to show his weaknesses as well as mine. And each one
of your sentences was like a free handout to me, a giveaway topic sentence.
You wanted me to leap in; you sounded the bugle call.

There’s a lot I wanted to say last session. I felt constrained and embarrassed.
To me Karl is giving two messages—an opening of the door, a patience, a
freedom, an understanding, but on the other hand he envisages certain
progress, certain clarity of expression, healthy steps. Mirror imaging his own
hopes. He expects these now from me immediately, as though they can be
delivered like milk. Especially in sex; he wants me to strip away all the
negative layers of fears and “I can’t’s”. An instant overnight evolution. He’s
saying, “I want your freedom and I want it now.” He’s less patient than you,
less ready to hold a microscope over my new small accomplishments.

I am amazed how Karl grows. Even his weaknesses seem to enlarge him.

He has so many resources within himself. It is as if he has the possibility of

becoming so many people, and not remaining entrenched in his own
personality.

June 7

KARL

I JUST READ over what I wrote for you last week and it seemed like it was
written by someone else. I don’t know quite what I was thinking of I feel now
that I have to have some thoughts and I just don’t. It was easy enough for me
in

the early sessions, when I didn’t feel so personally concerned, to sit back
afterward and think about what went on, but the last two, after which I felt
completely drained, have been something I have had to recover from. During
the sessions I wasn’t observing, which is what I am used to doing, and now,
although I remember what we talked about and remember feeling that my life
and my problems seemed very clear to me, that feeling is gone now. I cannot
say so succinctly now what I said then, and the feeling of being intimate with
you and Ginny and myself is now much less intense. Ginny and I have talked
and I have tried to give to her, to tell her what my stomach squeezes tight in a
last effort to keep hidden. It has all been very disturbing to me. I haven’t
written one word on my article since last Tuesday because when I sit down
to write I find I have lost confidence in what I am writing and that then makes
me doubt myself even more and makes it even harder to write anything. Then
I tear myself away from my desk and do what I can to calm myself down.
When I get calm, which usually takes until evening, I also feel empty because
I don’t think I have done anything worthwhile. Another day of my life is gone
and I have done nothing but exhaust my nerves. Ginny is no help to me during
times like that and I don’t know who would be. My old values, bad and
confining as they were, are disintegrating and I don’t know quite what to
replace them with.

When I write, this translates into my not being able to find an appropriate
point of view and I want to write something that reflects more than confusion.
I can understand why patients build up a dependence on the therapist, and I
don’t want that and I think it tends to make me reticent about the sessions
themselves.

I think deep down my fear is that none of this is going to work. That’s my
problem to deal with, but right now, feeling another day of inactivity coming
on me, Fm ending up afraid.

June 14

DR. YALOM

THE next-to-the-last interview. It started off badly. Ginny knocked on the

door, I told her to come in, it was already fifteen minutes after the hour. I
looked absolutely astonished because I had totally forgotten our appointment,
being preoccupied with some pressing writing. I don’t think this related to
Ginny because, in fact, I had already done the same thing with two other
patients this week. I am under a great deal of pressure before getting away
this summer to

finish a chapter for a book and prepare a talk for a large annual convention
this Saturday. So it took me a minute or two to get oriented and I mumbled
something to Ginny about my secretary not being here today, which was true,
and that I had forgotten to keep track of the time.

Then we started off and the opening five minutes were enough to really throw
me into despair. Jesus, it was the same old Ginny. Things were tense and
tight, she talked about wishing Karl were here so he could make things go.
She talked about her feelings of lifelessness and her long sieges of fantasy.
She talked about phasing out of the interview, as she has so often in the past.
She went off into a long business about the fact that she can’t have an orgasm
with Karl and that she feels that this is going to be the deciding and fatal
factor for the two of them.

I was beginning to sink into a hopeless pit. Why is everything so goddamned

complicated? Why can’t there ever be a happy ending? Why can’t she take
what she’s gotten from me, keep it and own it and make it a part of her? I was
so stunned that I acted like an automaton whose behavior was programmed
from one of our sessions of six months ago. I questioned her exclusive
fixation on the sexual issue. There obviously were many other important
things going on between her and Karl. It sounded peculiar to me for her to
consider the whole relationship as revolving around the axis of the orgasm.
Surely she was not going to continue to measure her whole worth in terms of
orgasmic units. I told her that if sex were really the problem, we could do
something about that; she could go to a sex counselor, to people who
specialize in the Masters and Johnson technique. I made many old-time
unhelpful comments like this, sensing all the while a kind of willfulness in
her plunging regression.

About that time I suddenly came to my senses and began to use my head; and
it all became very clear to me. I had to understand what she was doing in the
terms of “termination,” which was now looming very large. I reminded her
that although we’ve planned a meeting in the fall, it would just be a single
hour, and we must really consider this to be our next-to-the-last session. Then
I grew absolutely convinced that the reason she was feeling lifeless was to
prevent herself from feeling strong emotions about our impending separation.
I bit into that interpretation and hung on like a bulldog the rest of the hour,
and am convinced that it was the right thing to do. I was so clever trying all
the cute little stunts I could think of to help her remove herself just a bit from
the situation but still be able to express her feelings about me and ending
therapy.

When she said she was saving up her emotions for next week, I asked if she
could say today what she would say then. I wondered if she could foresee the
contents of the letter she would write me this summer. I wondered if she
could tell me what she would be feeling at this very moment, if her
lifelessness weren’t so consuming today. Gradually things began to come out
—she would miss me. She was so jealous in the first session when I paid a
lot of attention to Karl and she was very upset when Karl asked if he could
come back next time, knowing she would have to share me with him, though
it worked out for the best, she admitted. She thought I was so great in the way
I dealt with Karl and she had so much admiration for me and so great a
feeling of trust for me. She would miss me. There would be a big void in her
life. She’s been seeing me privately for almost two years and was in group
therapy with me for a year and a half before that. Then she said that if she
weren’t really lifeless and had to talk about her feelings, she would have to
cry a great deal and face very deep emotions and then what would she do
next week? I told her at least half a dozen times I was absolutely convinced
her life-lessness was there today to prevent her from experiencing and
expressing what she was feeling. I wondered if she would be embarrassed to
communicate to me some of her positive thoughts about me. She said that she
would miss me and I told her I would miss her too. She said that she has seen
people in group therapy as she is now, just waiting for the right question. I
asked her what the right question would be and when she said, “What are
your feelings about Dr. Y?” I repeated her words. She began to cry, and
admitted that she was indeed experiencing some very powerful feelings
which she doesn’t usually allow herself to feel; they were good kinds of
feelings and she doesn’t know why she won’t let them out. She said that it’s
masochistic because she knows it would be good for her to share these
emotions with me. She would miss my sense of humor—it was different from
Karl’s.

I wondered if my keeping her waiting at the beginning of the hour didn’t

contribute to the lifelessness. She denied this but I’m not totally convinced.
She said that she didn’t mind my being late because, in a sense, she could
spend a little more time in my environment. However, at the beginning of the
session when I asked her how she felt about stopping, she said, “How much
longer could you go on with me?” As if she were someone so disgusting that
I could not continue seeing her. I couldn’t get her to elaborate on that self-
deprecating question but I’m sure that intermingled with all the positive
feelings are also some negative ones, such as anger at my leaving; and her
lifelessness in part
reflects a punishment. I tried to get into this with her by commenting that even
though she wasn’t experiencing any conscious annoyance with me for
stopping, her actions were expressing it for her. For example, she feels she’s
not doing very good write-ups for me and that she’s generally regressing,
which obviously disappoints me, since I would be so greatly pleased at any
sign of continued progress in herself and with Karl.

She pointed out a number of ways that the joint sessions have been helpful,
primarily in facilitating communication between her and Karl to an extent that
would have been unthinkable before my sessions with them. She went so far
as to aver that the sessions wouldn’t be totally wasted even if Karl should
decide to leave her —they’re something she can own and carry into other
situations.

She looked forward almost with glee to writing me long letters but I think
that’s a way of avoiding termination; expressing love longdistance probably
seems easier. I didn’t reveal too much of my feelings toward her today except
to say I would miss her, and I reflected on the cruelty of psychotherapy which
prizes caring, yet severs it mechanically. She seemed very moved at the end
of the interview and I think the lifelessness was gone. She did something
she’s never done before—she held out her hand to me, although reluctantly. I
shook her hand and touched her shoulder as she was leaving the office. How
obscene it is that I had forgotten she would be here today. When I am with
her she fills my life so much; it’s amazing to me that I put her out of my mind
at other times during the week. I guess compartmentalization like this is
necessary for survival in this crazy business of titrated love.

June 14

GINNY

ON THE BUS home I had plenty of time to steep In my own thoughts and
juices. You might be right that this lifeless show-and-tell I brought you is a
shield against having to experience the end of therapy with you. I can’t bear
to think about it. Maybe that’s why the next-to-last week I bring you a résumé
of troubles and undone things. To show you I can’t graduate from you.

You said that if I allowed my feeling to flow, therapy would really be over.
I’d know it. I can’t bear not to see you any more. You kept asking me if I
were angry about the rigged setup of therapy where you get so close and
dependent and then cut off. Well, of course, I’m angry and the way I show it
is my old

pattern—hurt myself, drain and dull myself, so you know I am hurting, and so
you end by feeling bad.

In the brief time when you almost succeeded in making me give something,
feelings, tears, I was tingling all over, and still I couldn’t go all the way,
which would be more than the recording inside myself, but to take a fling and
spontaneously say what hurt, what I felt and give it to you. Through the walls
I could hear someone else in therapy next door weeping constantly.

What I did today, I did to protect myself. You wanted me to say how I felt
about finishing and I didn’t really do that. I said I liked you. (Lamely.) But
that’s different from thinking about ending. You’ve always thought I was
fragile. That’s because I have so much damn packing around me. I hope like
anything that we can get close next week, or else I’ll feel so indebted to you,
so like I’ve failed.

I’ve always trusted you. And you’ve been good to me. Maybe I wanted more
and that’s why I fought you so this year. (Passively, by feeling in myself I
wasn’t growing a lot of the time.) I felt like I was goading you to some
forceful act toward me. To get rid of the hanger-on, the disappointer.

If you suddenly were to surprise me with some extra months of therapy, I’m
not sure I would be too happy, in spite of all this moaning. Some of my
deadness I think is a reaction against the trap of therapy, of having to come in
here each week and tell you how much I care about you, about me, about
Karl.

And having to come to life just so I can hurt.

Last week you kept reiterating that you wanted me to tell you what I thought
of you, not for your sake but for my own sake. But I think it really was for
you. Then you could have felt we had accomplished something. Some time,
maybe later in the summer when it has sunk in, I could tell you or write you.
And with that easy promise, I glide away. I keep praying away in my head to
do something heroic for you, not today but tomorrow, tomorrow.

June 21

DR. YALOM

THE LAST HOUR. I feel very shaky, very sad and very moved. My feelings
toward Ginny are among the best kind of feelings I have ever had. I feel very
close, very warm, very unselfish and very tender toward her. I feel I know
her fully and wish only good things for her.

It was such a difficult hour today, but then it’s been like that all week. I’m
leaving for ten weeks in a couple of days and I’ve had to say goodbye to so
many patients, so many people, that it’s tarnished my saying it to Ginny. For
example, today I had two groups that I said goodbye to. One is a group of
psychiatric residents which will resume again in approximately three months,
but in that group there were two women who will not continue because they
are finishing their training and I had to say goodbye to them, and both of them
felt very moved and so did I, though not to the extent that I feel with Ginny.
But anyway, it’s been a week of goodbyes and a week of my coming face to
face with the specter of termination which I read about in the literature and
tell my residents they’re not handling very well. How do you “handle”
something that dwarfs you?

What was I supposed to do with Ginny today? Have her go over and tell me
again how marvelous it’s been, or how much I’ve helped her get in touch
with her feelings about Karl, or try to give her some guidelines about the
future, or review her progress, or what? We were both tormented, I no less
than she.

Both of us kept looking at the clock. I ended actually a minute or two early
because I felt we couldn’t stand it any longer and I just didn’t want to have to
play out the ritual of staying together for the whole fifty minutes. I asked her
what she was thinking. She asked me what I was thinking. She had to strain to
produce thoughts. One of the first things she said was that she had been
physically ill after the last hour with flu, and that it generally happens that
way after a particularly bad hour. That caught me by surprise and forced me
to review in my mind the last hour. She said that she had been so selfish,
hadn’t given anything, had in fact phased out. I told her that I was surprised to
hear that since I thought she had done so much. Talking about last week was
good; one firm little ledge of “therapeutic work” that we could stand on
during the hour today.

I asked what she wanted to be doing in five or ten years from now. We talked
about having children. She asked how old I was when I first had a child and I
told her I was twenty-four. I tried weakly to ask if Karl’s not wanting
children might even propel her into making a choice about their future
together

—the well-worn issue of whether Karl is the only one in the relationship
who has choices, a theme so hoary and encrusted I felt somewhat ashamed to
present it. It’s never made any impact and God knows it’s not going to be
helpful now.

She’s never going to be an active chooser. However, she is so charming that

she will always be chosen and that’s important too, I guess.

I was obviously feeling very disorganized today. My office was in its

customary state of disarray; in fact, it looked something like a junk shop with
papers, books, briefcases strewn all over the floor. I am leaving in a few
days, and still have a couple of articles to finish up. She asked me what they
were about, and then offered jokingly to help me clean the office, and
suggested that we didn’t have to stay the whole time. I tried to correct any
feeling she might have that I was covertly intimating I was too busy to see
her, but she knew I wasn’t saying that. I almost considered for a while
accepting her offer of helping me clean up. That idea seemed fetching to me. I
wonder why. I guess it would have been a way of allowing her to give me
something. A way also of our doing something together other than this
routinized psychotherapy, since that’s what we call being together.

She lamented her customary style of gliding along on life. I implied that it
might be helpful for her to be without a therapist now, to be on her own
power without the propulsion of the weekly hour which allows her to glide
along for the rest of the week. When I asked if she planned to go into therapy
again, she mentioned bioenergetics. I winced visibly, whereupon she
commented, “There you go, being gossipy again.” Did she really forgive me
for setting a time limit on therapy? After all, if I really cared for her, I would
go on seeing her forever.

Ginny didn’t respond to that directly, but said that she realizes there are other
people who need me more, although sometimes she has tried to hide her
progress from me, perhaps as a punishment in retaliation for my ending
therapy.

She talked a good deal about next autumn, about writing me, about my
knowing her address, about where I would be, about wanting to continue
knowing me personally. I told her that she could write to me in France, that I
would like to continue knowing her, but I also wanted her to know for sure
that we were really at the end of her therapy. The letter writing and the single
visit we would have in the fall would not diminish that fact. She said that she
really did understand.

When I stopped the hour and said, “Well I guess the time has really come for
us to say goodbye,” we both of us remained frozen for a few seconds. She
started to cry and said, “You are so wonderful to have done this for me.” I
didn’t quite know what to say but the words that came out of my mouth were

“I’ve gotten a great deal from this too, Ginny.” And so I have. I went up to
her while she was still sitting to take her hand and she put her arm around me
and just hung to me for a minute and I put my hand in her hair and stroked her.
I think that is the first time I’ve ever embraced a patient like that. It filled me
with

tears. And then she left the office, not a borderline character disorder, an
inadequate personality, an obsessional psychoneurotic, a latent
schizophrenic, or any of the other atrocities that we perpetrate daily. She left
as Ginny and I will miss her.

June 21

GINNY
YOU TAKE my petty coping and calm, and play down all the detours that I
take to get there. I admit I’m capable now of leading a normal life. In your
office it seemed like I was trumping up problems. But sometimes my life
seems very limited, without roots to real nourishment. I’m like a house plant
firmly entrenched in a pot. Unless I am watered and moved, taken to the sun
and away from it, I won’t last. But even with some of my roots exposed,
sticking out of the flower pot into the air, and even with the pot too small, I’m
doing nicely.

There is a chance I can go on like this without need of being transplanted.

Maybe living my life like I am now, posing small problems for myself, like
the house and food, will give me some small encouragement. And Karl is a
whole new ballgame.

I imagine psychiatry as being able to bridge the gap between the real self and
the hibernating, dreamt self. I’m in a calm siege now holding out against my
inside. I feel okay.

I wonder how mundane I can get before you give me an A for recovery. I
don’t want to be dynamited out of my warmed curled-up self. I prefer to lull
myself into excited memory. Or so it seems.

Our problem together is still defining what is real. So much of what you do
and I say in session, I frown at in retrospect. I suppose I had illusions of
spilling out of my cleavage this last session with emotions and tears. I’ve
seen too much theater. And maybe I am angry that I have not turned into a
mental patient under your guidance, and that I couldn’t give you more of a
fight.

And sometimes I think “what the hell”? I feel like dandelion fuzz, blowing in
the breeze, not settling anywhere, yet. I feel ecstatic, even though that old
chorus sings, “What do you have to be ecstatic about?” At least you are my
friend, and I envision the day when I can pound on your door.

Doctor Yalom’s Afterword

THE “FINAL” SESSION was not the last meeting with Ginny. Four months
later, shortly before Ginny left California permanently, we talked again. It
was a tense and melancholy meeting for me, not unlike seeing an old
girlfriend and straining to recapture the once lovely, now withered mood. We
didn’t “do therapy” but chatted informally about the summer and the
impending move.

She loved her summer job as a teacher of children in a child development

project, and instead of writing dry observational research notes, apparently
overwhelmed the research team with picturesque and poignant observations
of the children. I chuckled as I imagined their faces reading her reports.

The dreaded calamity had occurred: Karl had decided to take a job in a city
two thousand miles away. But he made sure to tell her in a number of ways
that he wanted her to come with him. Ginny felt clearly that she had more
than one choice—she could go with Karl, live with him, marry him, but if
that didn’t work out, she felt easy with the thought of making a life without
him. She seemed less desperate, more confident. I no longer experienced her
as lying on a taut sheet of anxiety.

Ginny moved away with Karl and passed out of my mind for several months
until the day when I stuffed our reports into a briefcase, brought them home
and asked my wife to read them. My wife’s reaction persuaded me to
consider the material for publication, and ten months after our final interview
I phoned Ginny to discuss it with her. Though she had reservations, she was
willing for our venture to be published (so long as she could protect her
anonymity) and we each agreed to edit our parts, to write a foreword and
afterword, and to share royalties equally. Over the phone I detected none of
the old, desperate stagnation so typical of Ginny early in her treatment. She
sounded (as, of course, I wanted her to sound) active and optimistic. She had
made some new close friends and was actively writing. She had sold her
first piece of writing for three hundred dollars, an uncanny event since it
precisely fulfilled a fantasy she had described to me at the beginning of
therapy. Things with Karl still sounded unsettled, but it was clear that the
rules of the relationship had been changed: Ginny appeared more powerful
and more resourceful.
A few days later I received a long letter from her, which I quote in part: Dear
Dr. Yalom:

. . . I don’t know how I feel. I go from hot flashes to pushing It out of my

mind, to concentrating on the money factor which I certainly could use. I wish
my part were better. In looking back, I only spent a few minutes on the write
ups some times.

However, that’s just me. I am trying to finish my novel now—

and I write five pages a day, which sounds great except that it takes me about
fifteen minutes a day to write five pages. I’ve always written fast. I write by
the rhythm method-just sounds and rhymes, no intellectual thoughts, no
thinking. It all seems to be ordained, this spontaneous backlog of words.
Mine are so sloppy—you must be thinking this was subconscious on my part
to throw you off the track from publishing them. I wish my life were different
now so I could feel those write ups were distant memories, and I have now
gone to bigger and better things and emotions. I felt stuck so much of the time
in therapy—the only time I ever got my pinions was when I cried. I felt like I
had taken my giant steps when we first knew each other, and that somehow
I’ve been taking little tied Japanese steps back ever since, except for a few
melodramatic psychodramas when I could be the emotional character I’ve
always wanted to be. This is all an exaggeration, of course. I know some
wonderful things happened—the best—our friendship. If you think the write
ups will have some value, I trust you.

Let me tell you a little about my life here.

. . . X is very much like Palo Alto without its lushness or money.

The University is pre-sixties. The student body is so calm—if you gave them
a brick, unlike at Berkeley, they would just begin to make a barbeque pit with
it, never think of smashing a window. We live in an old house with a
backyard that looks like where old fishing rods come to die—it is filled with
living and dead bamboo.

. . . I took a big job as a freelance writer, and recently sold a short story for
$300. I’ve also done some articles for a magazine.
. . . I recently attended a woman’s consciousness raising group and wrote
some personal observations about it which will be published. I will send it
to you when it comes out. It’s lucky they didn’t ask for each woman to come
forth with her story. I would have to call mine “Ginny and the Gasoline
Money.”

. . . Karl’s and my relationship has not changed much. We are still

comfortable with each other, and sometimes loving. We’ve had our quota of
late night dramas where I’ve slipped back into the terrible fear. I’m still in
that nightly labyrinth. We are just ourselves, which is not too emotional but
friendly. I speak out now. A while ago Karl told me that I had no goals or
ends. I gave us three months to try and evaluate our relationship . . . the
longer I stay here the closer Karl and I become, but I have no direction and
our future seems like a sentence that can either be kept or edited out.

. . . I am feeling fine. Most of the time I’m happy—though my mind can go

either way. When I force myself to write, for however short a time, I’m
happy. I waited so long to write to you because I have always imagined
myself as on a brink and I’m waiting for the story to send you that you want to
hear.

. . . Karl, in one of our fights and resulting deadly silences, said

—"Oh, I was just thinking of Dr. Yalom wishing he were here.”

We both send our love. Your friend,

Ginny

Then silence. I took up my role with the other Ginnys in my life participating
in the dramas which unfolded on the revolving stage of my office.

No! How pretentious! And how untrue! I know how much of myself I give to
each of my patients and the truth is I gave more to Ginny. More of what?
What is it that I gave more of? Interpretations? Clarifications? Support?
Guidance?
No, something on the other side of technique. My heart went out to Ginny.
She moved me. Her life was precious to me. I looked forward to seeing her.
She was starving but very rich. She gave me a great deal.

Some fourteen months after the “final session” she visited California and we
met twice. First, a work-social meeting with my wife. Ginny arrived,
accompanied by her best friend. Ginny wanted us to meet but had cautioned
me before to say nothing that would betray that we were writing a book
together.

That made for some awkwardness. The friend, a dark-haired charmer, stayed
a few minutes. When she left it was just Ginny, my wife, and me. We
discussed the manuscript and chatted over sherry, tea and some goddamn
homemade cookies. Not knowing what I wanted, I knew what I didn’t want—
small talk and the intrusion of others.

I abhor the professional-social marshland. We try to appear at ease but are

not. Ginny shows her social manners. She acts, she tries to amuse my wife,
but we both know she is barely paddling ahead of a tidal wave of self-
consciousness. We are conspirators, we participate in the social charade and
pretend we do not. My wife calls me Irv, Ginny cannot mouth the word and I
continue orbiting as Dr. Yalom. I do not give her explicit first name
instructions under the spell of some murky rationalization that she needs to
keep me in professional orbit for use at some future time. Even more bizarre
is my recoil at my wife’s familiarity with me in front of Ginny. I forget, what
was it I was planning to do for Ginny? Oh yes, “to aid reality testing so that
she would work through her positive transference.”

A few days later Ginny and I talked in the snug, unambiguous comfort of my
office. There, at least, each of us “knows our place.” We analyzed our
feelings at the social meeting. Ginny’s friend so lauded me for my warmth
and ease (so much for her perceptivity!) that Ginny pummeled herself for not
having taken more advantage of her time with me. One interesting thing
occurred before we started. She presented herself to my new secretary who
asked, “Are you a patient?” Ginny replied quickly, “No, I’m a friend.” That
felt good to both of us.
My wife was waiting to talk to Ginny about some sentences in the manuscript
and twice during our talk knocked on the door. The first time I said that we’d
be five more minutes. But we talked for much longer, and my wife, growing
impatient because she had another appointment, knocked again. This time
Ginny preempted me and, to my amazement, said almost sharply, “just a few
more minutes.” When the door closed she burst into tears, real tears, as the

present flooded in: “I just realized I really have only a few more minutes. It’s
not that your wife has you all the time but this time is really precious to me.”

She cried for both of us, for the time we would never have again, for joy at
having, finally, “spoken out” and (alas) from sadness at not having spoken up
more in her life. (We were both saddened by the reappearance of that
pleasure-stripping imp who berated her, even in the midst of success, for not
having succeeded even more.)

A short time after she returned home Ginny sent me a letter with dramatic
news:

. . . When I got home again Karl and I were kind of strangers again. . . . He
sort of ignored me, and I felt like a child ignored by a father. Karl could
deprive me of things—going swimming, doing this, doing that. If he didn’t
want to do it, we just didn’t go. Finally I confronted Karl and said that we
weren’t getting along at all. He said “I know. I want out.". I didn’t protest this
time, and by the next day Karl had already moved out. (Two days ago). . . .
No one blames the other and maybe we didn’t have any future. It’s now the
second day and I have a hollow stomach but my mind is much better. I don’t
intend to fall apart.

I just feel awfully sad and unbelieving. At first I thought I was going to go
right back to California. But I would rather have my feet on the ground and
try to live my life alone—independently so I’ll have done it and don’t ever
have to be scared again. I’m going to stay here as long as I can. Karl says he
was burned out with me. I believed it. I sensed it. . . . I want to get healthy
and strong—I want to struggle out of this. I’m beginning to have insights.
When my worst moments come, when I become desperate, I just have faith
that it must pass and that you can’t die from hurting. (A mucky line!) In
crying, though it leads nowhere, at least it is something, and as you know, I’m
partial to tears. If things get too bad here, I’ll go to a doctor who can give me
some Valium, but I’m a Christian Scientist when it comes to tranquilizers.
Last night I slept O.K., and I woke up feeling sad but not really scared.

I know that I’ll be able to make it here, and I’m going to start looking for a
job. I know the next few weeks will be slow and hurting. I keep forgetting
and remembering, not being able to believe that Karl won’t be here again.
We didn’t part in anger, just sadness.

Though she hadn’t asked for it, I crammed some gratuitous psychotherapy
into an envelope and shot it back to her.

Dear Ginny:

A shock all right, but not without premonition on my part too. I feel badly for
how badly you are feeling now and will feel for the next couple of months,
but yet I don’t feel unambivalently badly, and I can see by your letter that you
don’t either. I think the fact that Karl was able to do this and do it apparently
so quickly means, to me, that he has been doing it in his head for a long
period of time. I don’t believe things like that can be done in one’s head
without the other person getting some sense of it which has resulted in a kind
of global, dulled feeling for you, and which has restrained your growth over
these months. All I can do to help (which I know you are not asking me to do)
is just to remind you that what you are in the midst of will pass.

After your shock and feelings of panic, I suspect a period of real grief at your
loss and a feeling of hollowness or emptiness might set in. Perhaps even then
some feelings of anger (God forbid), but the course of such things is always
something around two to three to four months, and after that I think you will
come out on the other side much stronger than ever.

I am really impressed with the strength that you seem to be summoning now.
If there is anything that I can do to help during this bad period, please let me
know.

With the tunnel vision of a surgeon who is convinced that his operation was
successful, regardless of the fate of the patient, I was convinced that her
letter was full of strength. The break with Karl did not token a failure:
therapeutic

success is not synonymous with her making it with Karl (though I had, myself,
slipped into that error during our first joint sessions.) Furthermore, Ginny
had played some part in the final break, though not as active a part as she
would have liked. It is quite common that, when one member of a pair
changes and the other does not, the balance of their relationship is so altered
that they cannot stay together; possibly Ginny outgrew Karl, or at least now
realized that, because of Karl’s judgmentalism, the relationship is stunting for
her; possibly only now can she really envision living without Karl and
permit him to leave her. After all, he often intimated that he wanted out but
since he believed that she would disintegrate, he was bound to her by guilt,
the most unsatisfactory cement for a union. Perhaps now Karl recognized her
increased strength.

Perhaps now they were both liberated and could act with freedom in their
best interests.

My optimism was confirmed. I learned from phone conversations over the

next four months that she reacted marvelously well. She mourned her loss,
licked her wounds and then opened her door and walked out into the world.

She sought out friends; she got a full-time job as a writer for a literary
foundation and continued to freelance; she dated, soon selected a man and
gradually developed a deep and tender relationship with him. She feels
content and most comfortable with him, partly because of his characteristics
—he is nonjudgmental, gentle and solicitous—and, I like to think, partly
because of her new strengths and her increased ability to communicate, to
trust and to love.

***

The closest this book came to not being published occurred when I asked a
colleague, a devout Freudian analyst whom I much respect, to read the
manuscript. After reading the first thirty pages, he commented that “this is
what Wilhelm Reich used to call the ‘chaotic situation,’ where the therapist
says to the patient whatever happens to spring to mind.” Happily, several
favorable readings by other colleagues provided sufficient reassurance to
permit me to publish the book and to refrain from altering the text. Still, as I
reread the manuscript there is an appearance of capriciousness in my actions,
which conceals the fact that the entire course of therapy took place within the
framework of a generous but rigorous conceptual system. In the following
pages I shall describe that system and discuss the therapeutic principles
which guided my behavior.

Recall, first, the state of affairs at the beginning of our individual work
together. Ginny chugged into individual therapy leaving behind a wake of
discouraged and defeated therapists; there were lessons to be learned, errors
to be avoided. She had frustrated two highly competent analytically oriented
psychotherapists who had endeavored to foster insight, to clarify the past, to
modify the growth-stunting relationship with her parents, to interpret her
dreams, to appreciate and diminish the influence of her unconscious on her
waking life. A bioenergeticist had attempted unsuccessfully to reach and to
change her via her body musculature; he had suggested muscle relaxation,
new methods of breathing and tension relief via vomiting. She had met and
outmaneuvered some of the best encounter group leaders who had not
hesitated to use the very latest confrontational methods: nonstop marathon
groups lasting twenty-four-forty-eight hours designed to erode resistance by
sheer physical fatigue, nude groups to encourage total self-disclosure,
psychodrama complete with mood music and dramatic stage lighting to
enable her to do in the group what she never dared to do in life,
“psychological karate” to help her reach and express her anger by a variety
of rage-provoking techniques including physical assault, and vaginal massage
with an electric vibrator to overcome sexual unease and to achieve vaginal
orgasm.

She had staunchly resisted my best efforts and those of my co-therapists in

group therapy for a year and a half, and we wearily decided that it made little
sense to continue. Throughout this time, however, her strong positive feelings
for me and her faith in my ability to help her never faltered. To be sure, this
positive transference had, thus far, been more a hindrance that a boon to
Ginny’s therapy.
To explicate this last point let me make the distinction between primary
benefits and secondary gratifications in psychotherapy. Patients seek therapy
for some relief of suffering; this relief (and often the necessary concomitant
personality change) constitutes the primary benefit—the raison d’etre of
psychotherapy. Not infrequently, however, the patient derives some strong
gratification from the actual process of being in therapy; he may enjoy the
unceasing, unending solicitude, the rapt attention paid to his every thought,
the reassuring presence of the omniscient, protecting therapist, the state of
suspended animation when no important decision need be made. Not
infrequently the secondary gratifications may be so great that the wish to
remain in therapy becomes greater than the wish to be cured.

Such was the state of affairs in Ginny’s therapy. She attended the group not to
grow but to be with me, she spoke not to work on problems but to gain my
approval. As we learn from her therapy notes, she was not part of the group
but part of the audience and cheered me on as I forged to the rescue of other
stricken patients. Ofttimes the co-therapists and the other members observed
that Ginny appeared to stay sick for me; to get well meant to say goodbye.
And so she remained suspended in a great selfless wasteland, not so well as
to lose me, not so sick as to drive me away in frustration.

How to turn this transference to therapeutic account? Surely there must be a

way to harness Ginny’s unswerving and, to some extent, irrational faith in me
in the service of her own growth. And, since Ginny had moved to another
city, how to do it with structural limitations that made it impossible for us to
meet more than once weekly?

My overall plan was to orient therapy almost entirely around the axis of our
relationship. I hoped to fix our gaze, insomuch as was humanly possible, on
what occurred between Ginny and me in the immediate present. Our
temporal-spatial territory was to be the here and now, and I planned to
discourage any excursions away from this focus. We would interact
intensively, analyze our interaction and repeat the sequence for as long as we
were together. Simple enough, but how would this lead to therapeutic
change? My rationale for this stance derives from Interpersonal Theory.

Briefly put, the theory of interpersonal relationships posits that all

psychological disorders (which are not caused by some physical insult to the
brain) stem from disturbances in interpersonal relationships. People may
seek help from a psychotherapist for a variety of reasons (depression,
phobia, anxiety, shyness, impotence, etc.), but underlying these reasons and
common to all is an inability to establish satisfying and enduring
relationships with other people. These relationship difficulties have their
origins far back in the past in the earliest relationships with parents. Once
established, disturbed methods of relating to others advance forward to color
subsequent relationships with siblings, playmates, teachers, chums, lovers,
spouses and children. Psychiatry, then, becomes the study of interpersonal
relationships; psychotherapy, the correction of distorted interpersonal
relationships; and therapeutic cure, the ability to relate appropriately to
others rather than on the basis of some pressing, unconscious personal needs.
Although the origins of maladaptive behavioral patterns lay in the past, the
correction of distortions can occur only in the

present and nowhere better than in the most immediately present relationship
—

that between patient and therapist.

One additional basic assumption is necessary to help us understand how the

therapist-patient relationship can alter maladaptive interpersonal patterns.
The therapist assumes that the patient, provided that the atmosphere is a
trusting and unstructured one, will soon display in his relationship with the
therapist many of his major interpersonal difficulties. If he is arrogant, vain,
self-effacing, deeply suspicious, seductive, exploitative, alienated, frightened
of closeness, contemptuous or any of the infinite number of disturbed ways
one may be with others, then he will be that way as he relates to the therapist.
The therapy hour and therapist’s stage become a social microcosm. No need
to take a history, no need to ask for descriptions of interpersonal behavior;
sooner or later the entire tragic behavioral scroll is unrolled in the office
before the eyes of both therapist and patient.

Once the patient’s interpersonal behavior is recapitulated on the stage of the

therapist’s office, the therapist begins in a variety of ways to help the patient
observe himself. The here-and-now focus on the therapist-patient
relationship is thus a two-pronged one: first, there is lived experience as the
patient and the therapist interlock in a curious paradoxical embrace, at once
artificial and yet deeply authentic. Then the therapist, as tactfully as possible,
shifts the frame so that he and the patient become observers of the very drama
which they enact.

Thus there is a continual sequence of emotional enactment and reflection

upon that enactment. Both steps are essential. Enactment without reflection
becomes simply another emotional experience, and emotional experiences
occur all our lives without resultant change. On the other hand, reflection
without emotion becomes a vacant intellectual exercise; we all know
patients, iatrogenic mummies, so bound with insight and self-consciousness
that spontaneous activity becomes impossible.

Once the self-reflective loop is established and the patient is able to witness
his own behavior, the therapist helps to make him aware of the consequences
of his actions, both upon himself and upon others. This done, the real crunch
of therapy begins: the patient must, sooner or later, ask himself, “Am I
satisfied with this? Do I want to continue being this way?” Eventually every
road in every form of therapy leads to this point of decision, and patient and
therapist must linger there until the arrival of the energy-supplying core of the
change process: Will. We make our puny attempts to hasten the development
of Will.

Generally we do battle with the forces of counter-will by attempting to

demonstrate that the anticipated dangers of behaving differently are

chimerical.

Our efforts are, for the most part, however, effete and indirect; generally we
perform rituals, make obeisances, or merely grit our teeth waiting for Will to
emerge from the vast darkness in which it dwells.

The therapeutic edifice I have described has yet one more supporting beam,
without which the whole structure would topple. The changes that occur in
the inner sanctum of therapy must be generalizable. Therapy is a dress
rehearsal; the patient must be able to transfer his new ways of behaving with
the therapist to his outside world, to the people who really count in his life. If
not, then he has not changed, he has merely learned how to exist graciously as
a patient and will be in analysis interminably.
The flow chart I have just presented reeks of the experimental laboratory.

Psychotherapy never has such steel-spectacled efficiency; it must be a deeply

human experience—nothing vital can come of an inhuman mechanistic
procedure. Nothing, then, so neat; therapy as it actually transpires is less
contrived, less simplistic, more spontaneous than the flow chart suggests.
The therapist does not always know what he is doing; at times confusion,
even bedlam, reigns; the stages are not clearly demarcated and rarely
sequential.

Psychotherapy is a cyclotherapy, as therapist and patient together ascend a

rickety, low gradient, spiral staircase.

Perhaps it would be appropriate now after reviewing these broad basic

tenets of interpersonal psychotherapy to describe my initial impressions of
Ginny’s interpersonal pathology and how I hoped to help her. Ginny’s basic
interpersonal stance was one of self-effacement. There are, after all, many
ways of approaching others: some people strive for dominance, others for
acclaim or respect, others for freedom and escape. Ginny sought for one
primary commodity from others—love, and at any cost.

Her basic interpersonal stance had pervasive ramifications for her inner life
and her external behavior. It dictated what she would cultivate in herself and
what she would suppress, what she feared and what she enjoyed, what filled
her with pride and what with shame. She cultivated any trait which, in her
appraisal, made her more lovable. So she nurtured the hostess parts of
herself, her amusing chirping wit, her generosity, her selflessness. She
suppressed traits which belied this idealized image of goodness: her rights
were scarcely recognized, much less honored—they were sacrificed on the
altar of self-effacement; rage, greed, self-assertiveness, independence and
personal desire were all regarded as saboteurs to the regime of love—all
were exiled to the

remotest region of the mind. They surfaced only in impulsive, out-of-the-blue

flashes or, heavily disguised, in fantasies and dreams.

More than anything else she feared loss of love and lived in terror of
displeasing others: she responded to the threat of losing Karl’s love with
panic, not unlike the panic of a young child deprived of the care of
individuals necessary for biological survival. Furthermore, she could never
be loved enough. She could never stop pressing herself to be better, more
selfless, more pleasing. She was not permitted personal pleasure; if she
wrote well, or enjoyed sex, or simply basked in luxurious well-being, the
other, flagellant self intervened in the form of an appropriate antagonist: guilt
(and ensuing paralysis) for writing frivolously or briefly; ridicule or self-
consciousness to stifle the approaching orgasm; charges of sloth to poison
her well-being.

Ginny’s interpersonal pathology was not subtle; when I first began working
with her I was very aware of these patterns and their consequences for her
growth. At the beginning of therapy I wanted to communicate my
observations to her. I wanted very much to say two things: (1) Your frantic
search for love is irrational; it is a frozen piece of ancient behavior
transported into the present, and ill-suited for your adult life. Your panic at
the threat of love-withdrawal, appropriate no doubt in earliest infancy, is
similarly irrational; you are capable of survival without stifling nurturance.
(2) Not only is your request irrational, but it is tragically self-defeating. You
cannot possibly secure an adult love through childlike terror and self-
effacement. To insure that their daughters obtained a husband, Chinese
parents crippled them by binding their feet in early childhood. You do even
greater violence to yourself. You suffocate the person you could become, you
have condemned most of yourself to an early grave.

You suffer from your daily travails and your small failures, but there is,
underneath it all, an even greater suffering because you know what you have
done to yourself.

But sentences cannot say these things. I was to say them many times and in
many ways through the embrace of therapy.

I planned to get very close to Ginny, to encourage her to re-experience all

these ancient, irrational needs in her relationship with me: her sense of
helplessness and need for my nurturance, her fear that I would withdraw my
love, her belief that she could keep me only by self-sacrifice and self-
immolation, her conviction that I would abandon her were she to take adult-
like strides. I hoped that we could periodically step back from our
experience so that

Ginny could not only understand her patterns of relating to me but also
appreciate their limiting, crippling nature.

Once the relationship became potent and a self-reflective stance was

established I hoped to demonstrate that she was capable of establishing a
richer, more adult relationship with me. In effect, I hoped that Ginny would
begin not only to grow increasingly dissatisfied with her present hierarchy of
needs, not only in a wistful way to desire change, but to consider change as
an actual possibility. I could forsee many tactics but my basic strategy would
be to oppose, in any way possible, those forces which smothered her will.
For example, Ginny rarely permitted her will to emerge because she feared
that it was incandescent rage, that it would result in loss of control, massive
retaliation and rejection. By reacting supportively and encouragingly to all
glimmerings of self-assertive expression, I hoped to demonstrate to her the
fanciful nature of her fears and help her progressively transform more of her
wishes, through will, into action.

The plan to write and exchange reports appealed to me for many reasons.

First, and most simply, it forced Ginny to write. She had been blocked for
months. I knew I was on treacherous ground and had to walk carefully to stay
on the side of Ginny the person who fulfilled herself deeply when she wrote.
I had to avoid viewing and treasuring Ginny as an indispensable but inert
receptacle containing a great and coveted gift.

The format had other, more subtle implications. Most important was that it
reinforced the self-reflective loop in the here-and-now focus. There was no
dearth of emotion between Ginny and me; in fact too often I found myself
trying to shake free from the swirl of feelings that encircled us. Writing and
reading the reports helped Ginny (and me, too) gain perspective, pull herself
out of the eye of the storm, observe and understand her behavior with me.

The notes were also an exercise in self-disclosure for both of us. I hoped that
Ginny in the peace of her solitude could give voice to some of the stifled
parts of herself. I planned to reveal more of myself in the notes than my
personal vanity and professional reserve permitted me to do in the sessions. I
especially hoped that she, by appreciating my foibles, my doubts, my
bewilderment and discouragement, would adjust her unrealistic over-
evaluation of me. Her childlike looking-up-at-me-with-wonder gaze often
made me feel helpless and lonely. I wanted her to know that. I wanted her to
climb out of that antediluvian gully and look at me, touch me, talk to me face-
to-face. If she could do that and if I could show her that I could accept,
indeed, welcome the

hidden parts of herself as, one by one, they poked their timid heads through
the lattice work of her self-effacement, then I knew that I could help her
grow.

To read the text that Ginny and I have written is an enriching experience for
me; few psychotherapists have had the opportunity to review from a dual
perspective the entire course of therapy in such exquisite detail. I am struck
by many things. Let me begin with the obvious discrepancies in perspective
between Ginny and me. Often she values one part of the hour, I another. I
press home an interpretation with much determination and pride. To humor
me and to hasten our move to more important areas she “accepts” the
interpretation. To permit us to move to “work areas,” I on the other hand
humor her by granting her silent requests for advice, suggestions,
exhortations, or admonitions. I value my thoughtful clarifications; with one
masterful stroke I make sense out of a number of disparate, seemingly
unrelated facts. She rarely ever acknowledges, much less values my labors,
and instead seems to profit from my simple, human acts: I chuckle at her
satire, I notice her clothes, I call her buxom, I tease her when we role play.

The analogy to Rosencrantz and Guildenstern is an important one for me.

That the therapist is the protagonist in many, varied, simultaneous dramas is

his ultimate terrible secret. Furthermore, despite all pretenses at total self-
disclosure it is a secret that cannot be totally shared. It brings home with
great vividness some of the paradoxes of psychotherapy. Our relationship is
a deep and authentic one, yet it is antiseptically packaged: we meet for the
prescribed fifty minutes, she receives computerized notices from the clinic
business office. The same room, same chairs, same position. We mean much
to one another, yet we are characters in a dress rehearsal. We care deeply for
one another, yet we disappear when the hour is up, we will never meet again
when our “work” is done.

I imply to Ginny that we strive for egalitarianism, yet the notes expose our
essential apartheid. I write to a third person “Ginny,” she to a second person

“you.” I do not, even in the safer recesses of the notes, reveal to Ginny what I
expect her to reveal to me. Her visit to me is often the central part of her
week; often she is one of several patients I see on a particular day. Usually I
give her much of my presence but sometimes I cannot draw the curtains on
earlier dramas with other patients. I expect her to take me into herself, to let
me mean everything to her and yet, for the most part, I keep her
compartmentalized in my mind. How can it be otherwise? To give everything
to everyone every time is to leave nothing for yourself.

Despite the fact that the reports contain a vast number and variety of
techniques, I have no sense that my therapy with Ginny was technique-
oriented. Rather, the specific techniques were entirely expendable and
employed in the service of the conceptual scheme I have presented. Though I
shrink back at dissection, I shall attempt to demonstrate this by reviewing
some of the techniques and discussing the rationale behind their use.

The major techniques I employed fall into three clusters: (a) interpretative
(b) existential (c) activative (by which I mean exhortation, advice,
confession and absolution, role playing couple therapy, behavioral
modification, and assertive training).

Interpretation is a mode of illumination. Much of our behavior is controlled

by forces which are not in awareness. One might in fact offer as a definition
of mental illness that we are mentally ill to the extent to which we are guided
by unconscious forces. Psychotherapy, as I practiced it with Ginny, strove to
illuminate the darkness—to reclaim psychological territory from the
unconscious by the floodlight of the intellect. The interpretative process was
one stage of the effort to aid Ginny to assume active control of her life.

What kind of interpretations did I make? For what types of “insight” was I
hoping? It is commonly assumed that interpretation, insight, and the
unconscious refer only to the distant past. Indeed, to the very end of his life
Freud held that successful therapy hinged on the complete reconstruction of
early life events which shaped the mental apparatus and reside now in the
unconscious. Yet, in my work with Ginny I did not attempt to excavate the
past; on the contrary I assiduously avoided it and charged Ginny with
“resistance”

when she attempted to look backward.

I wished to help Ginny explore her unconscious (insofar as it shackled her)

and I did not wish to explore the past. Is there a contradiction? I can best
explain my stance by asking that you consider the unconscious as an
abstraction consisting of two coordinates: a vertical, temporal coordinate
and a horizontal, ahistoric cross-sectional coordinate. The vertical temporal
coordinate extends backward into the past and forward into the future. The
temporal historical, developmental coordinate is a familiar concept. Few
will dispute that events from the distant past, long forgotten or repressed,
shaped our personality structure and control much of our behavior. What is
not so obvious is that we are also controlled by the “not yet"—by our
projections into the future. The goals we have set for ourselves, the ways we
wish to be regarded ultimately by others, the perspective cast on life by
death, the longing we have to be

remembered, all the diverse and symbolic forms assumed by our need for
immortality-all may be out of awareness and all may profoundly influence
our inner life and external behavior. We are as pulled by the magnet of the
future as we are pushed by the deterministic thrust of the past.

But it was the horizontal ahistoric coordinate of the unconscious that was the
particular target of my interpretative efforts. At any given moment in time
there are layers upon layers of forces operating out of our awareness which
influence our actions and feelings. For example, Ginny was influenced by the
dictates of her idealized image, by the pride system which determined what
aspects of herself she would value and what she would suppress, by her
irrational need for love and her conviction that self-assertion was evil or
dangerous. To be sure, one could argue that these unconscious ahistoric
forces are shaped by past experiences. But that is not the point; temporal
causality is an inessential frame of reference in the therapeutic endeavor.
Archeological excavation, the search for the whence, the primordial cause—
intriguing issues, but not synonymous with the therapeutic process. Not
irrelevant either though.

The intellectual chase often serves to maintain the therapist’s interest and
enthusiasm; it combines with the patient’s dependency to form a therapeutic
epoxy locking patient and therapist together long enough for the major
instigator of change—the therapeutic relationship—to grind into movement. I
enjoy the diggings also, but, if I can, I try to hold my curiosity in abeyance
and to focus on the many-layered forces, conscious and unconscious, which,
in the immediate present, shaped Ginny’s thoughts, feelings and behavior.

Much of my interpretative work revolved around “transference” —Ginny’s

unrealistic relationship to me. Rather than discuss her reluctance to stand up
for her rights or her inability to express anger in abstraction, I attempted to
examine these difficulties as they were manifested in her dealings with me.
Therefore, I tediously asked Ginny to express all of her feelings about me.
My first task was to help her recognize feelings and later to express them. I
had to rely on indirect evidence at first and deduce her feelings. She denies
any strong feelings about me, yet regularly is sleepless or filled with panic
the night before a session. She has a migraine headache immediately
preceding or following the session, or vomits on the way to my office. When
I cancel a session she has no reaction, yet she misses or arrives late for the
next session or immediately lapses into a depression to punish me (through
guilt) for my inconsiderateness. Often the richest vein to mine was her
fantasy life: Karl leaves her, I take her away to a cabin in the woods, I care
for her, feed her, send her my assistant for a sexual

romp. Though she usually disowned them, these were her fantasies and,
therefore, her wishes; I pursued them however I could. I confronted her
continually about her behavior with me and encouraged her to take risks.
Why could she not disagree with me? Ask me any questions? Dress
attractively for me? Express her disappointment with me? Get angry? Tell me
she cared about me? Later I will speak of the value of behaviorial change as
a primary technique, here I employed behavior in the service of the
interpretative approach. By encouraging her to dare do the things she
dreaded, I hoped to make her aware of the opposing, frightening unconscious
forces.
So I made interpretations—at first to assist her to retrieve the feelings that
had been pushed into unawareness, then to suggest regular global patterns in
her behavior, then to help her comprehend the unconscious assumptions
which dictate these patterns.

But insight, even perfect illumination, is not enough. Change requires an act
of will. Earlier I described the elusive nature of will and suggested that, in
one way or another, all techniques are ultimately aimed at rousing and
strengthening will—the will to change, to grow, and, most important for
Ginny, the will to will. Interpretative techniques are often the first steps
toward the resuscitation of will. First we simply help the individual to be
aware of the current which sweeps him along through life. Some unmoving
object—a tree, a house, a silo, a therapist—is required to help the pilgrim
patient know he is moving and not at his own volition. Once the existence of
the current is appreciated then, through reason, the patient is helped to gauge
the strength and the nature of the current.

And so he becomes aware both of the absence of will and of the shape of the
forces which have replaced it. Knowledge provides the first step toward
mastery.

The existential and the activating techniques provide further steps in the
development and maturation of will: existential techniques foment the
germination process while activating techniques coax the tendril upward
once it has broken through the earth. First consider the “existential”
techniques. I encase the term in quotes and use it with trepidation because it
has become abstruse and vulgarized. Like an old gavel or academic gown it
is carted in to lend dignity to any occasion. Therefore, I shall be as precise
as possible. By

“existential” I refer to an approach which is vitalistic, nondeterministic and

non-reductionistic, an approach which focuses on the “givens” of existence,
on contingency, on meaning and purpose in life, on will, on decision and
choice, on commitment, on shift in attitude and life perspective. There is no
standard set

of existential techniques; on the contrary, the approach is by definition

nontechnique oriented. For the purpose of this discussion I consider any
method I used to turn Ginny’s head in the direction of these issues as an
“existential technique.”

What is the relationship between this approach and the development of

“will”? Admittedly, unclear and unsystematic. I tried through my

interpretative efforts with Ginny to remove obstacles to will, to weaken the
cohorts of counter-will. I cannot describe these efforts in a trim, methodical
fashion. It will have to do to say that I fertilized the soil, that I was an
accoucheur to the birthing of will.

I tried a variety of methods to coax, urge, coerce Ginny to recognize the

intrauterine kicks of her unborn will. Repeatedly I reminded her that she had
both voice and choice in her future; she was responsible for herself. She
gave others the right to define her but even this act was choiceful; she was
not so helpless as she believed. I challenged her life perspective in a number
of ways.

Could she not view her current dilemmas from another vista point, from the
perspective of the long skein of her life? What was core Ginny and what was
peripheral—something quite extrinsic, something that would pass away,
something that at the end of her life would be a meaningless speck? What of
the future? In ten years did she still want to be in a loveless, barren
relationship—all because she dare not speak, dare not act? And what of
death? Could the knowledge of death not help her free herself from the
ebbtides of basically unimportant events? I chided her or tried to shock her.
“What would you like written on your tombstone? ‘Here lies Ginny, flunked
in her foreign language school by Mr. Flood?’ Is that sufficient meaning for
your life? If not then rise above it, do something about it.” . . . “The everyday
events consume your energy, submerge your will only when you lose
perspective of your total life, only when you actually believe these events are
central to your being.” . . .

“You can vanquish them with your own resources: you will know, if you only
listen and look deep enough into yourself, that the events and your reactions
to them are your vassals—you have constituted the world, the event, the
reaction, they are entirely dependent upon you for their existence” . . .
“Nothing occurs, nothing exists until you create it. How then can an event or
a person control you?” . . . “You have willed them into being, you have given
them power over you, and you can take away that power because it belongs
to you. Everything emanates from your will.”

Sometimes I thought of myself as raining upon Ginny’s tin roof. I wanted to

pour, to fling sheets of water from all directions at once. I wanted to drench
her.

But I had to restrain myself lest I succeed only in establishing a neural

anastomosis in which Ginny’s body would obey my every wish. A
psychotherapeutic Catch-22: Do what I suggest, but do it for yourself!

In addition to “interpretative” and “existential” techniques, there was a third

major facet to my therapy with Ginny. I call it “activation” but it could go by
other names: behaviorial modification, behavioral manipulation,
desensitization, deconditioning, etc. To describe this part of my work does
not please me, I take little pride in it, it is demeaning to me and to Ginny. She
loses her dignity, she becomes thingish, an object whose behavior I must
modify. And yet there are those who will claim that any change that occurred
in Ginny was mediated primarily and precisely through these techniques. And
the arguments they can muster will be compelling ones.

So we must get on with it. Behaviorial therapy is an approach to change

based on learning theory. More mechanistic even than instinct-based
psychoanalysis, it ignores insight, self-knowledge, consciousness, meaning—
in short much that constitutes the very essence of our humanness. Not that
there is an explicit conspiracy to dehumanize man; it is only that these
factors, so a behaviorist would claim, are largely irrelevant to the process of
change.

Learning takes place in man, as in lower orders of life, according to certain

explicit and quantifiable processes—by operant conditioning (the reward,
extinction, or punishment of certain behaviors); by modeling (imitation of
some valued individual); by principles of classical conditioning (the
temporal or spatial approximation of a critical stimulus and an indifferent
one); by an active trial and error stance in contrast to a passive or receptive
attitude.
Psychopathology is learned behavior which is maladaptive and rigid.

Psychotherapy, a process of unlearning old behaviors and learning new ones,

proceeds according to the rigorous tenets of learning theory.

To explicate let us consider briefly the application of these techniques.

Imagine that a patient has a single, well circumscribed problem: an irrational

fear of snakes. Imagine, too, that since he is a gardener, the symptom is a
disabling one and his motivation for therapy is high. A behaviorial therapist
would gradually expose the patient to the feared stimulus in situations in
which he could experience little anxiety. Profound muscular relaxation
blocks the development of strong anxiety. Therefore, while in a state of deep
muscular relaxation, often induced hypnotically, the patient is asked to
imagine looking at

a picture of a snake, then perhaps to imagine seeing a snake one hundred feet
away, then closer, then to look at a picture of a snake and finally after several
hours to see a snake, and then perhaps to handle one. The principle is simple:
exposure to stimuli previously regarded as dangerous under situations so safe
that the fear response is inhibited. If repeated many times the stimulus-fear
sequence is extinguished and the new learning is transferred out of the
laboratory or therapist’s office back to the home situation. Modeling is also
encouraged; for example the therapist may take walks with the patient on high
grassy lawns, or may handle a snake in the patient’s presence.

I have over-simplified the procedure by using an elementary paradigm, but

for our purposes it is sufficient. Consider now how learning theory
techniques pervaded my work with Ginny. She had an irrational fear (a
phobia, if you will) of self-assertion. She acted as if some calamity would
ensue were she to demand her rights or express anger or merely a conflicting
opinion.

Our testing laboratory was to be our relationship; I attempted to establish an

environment of such trust, nonjudgmental acceptance and mutual respect that
the fear response would be inhibited. Then I proceeded to expose Ginny to
the dreaded stimulus as I encouraged her in graduated steps to assert herself
with me. The encouragement took many forms from coaxing, counsel, and
persuasion to model setting, demands and ultimatums. At times I was a
playful, cajoling uncle, or a persistent Socratic gadfly, or a stern, demanding
director, or a second in a boxing match resolutely inspiriting Ginny from
behind a post in a corner of the ring. I wanted her to emerge, to ask me
questions, to demand that I be on time, to request a more convenient hour, to
contradict me, to be angry with me, to express her disappointment with me. I
put words in her mouth: “If I were you, I would feel. . . .” When the
assertiveness emerged, and it came slowly and feebly, I welcomed it
(“reinforced” it, if you must). Transfer of learning or generalization was the
next task. I proceeded to urge her to take some small steps with Karl. I role
played Karl with her, we rehearsed imaginary mini-confrontations ranging
from such issues as gas money, to housekeeping chores to Sexual foreplay.

Each of these assertive forays was reinforced not only by my acceptance but
by the nonappearance of the fantasied holocaust. Each hitherto dangerous act
was made safer by the safety of my office. Then the great step outward: our
meetings together with Karl. Potentially dangerous, of course, but still less
risky than the same confrontation without my presence.

There was, of course, far more behaviorial modification than desensitization

to the fear of self-assertion. Ginny could not be “herself” in so many other
ways. She could be accepted or loved only by acting or performing, she
could not voice her despair, her fear of disintegration, her deep sense of
emptiness, her love. I asked her to show me everything. Try me, I said, I will
stay with you, listen to you, accept you in your entirety.

Therapy viewed in this way was a carefully scripted dress rehearsal, an

exercise in deterrorfication, an enterprise whose task it was to make itself
unnecessary, to extinguish itself. But of course it was more. It refused to
accept its fate. The frame dissolved, the actors began to exist in their roles,
the director refused to remain a behavioral engineer.

***

So much for the theory behind my therapy with Ginny, for the techniques and
their rationale. I have delayed as long as I can. What about the therapist, me,
the other actor in this drama? In my office I hide behind my title,
interpretations, my Freudian beard, penetrating gaze and posture of ultimate
helpfulness; in this book, behind my explanations, my thesaurus, my
reportorial and belletristic efforts. But this time I have gone too far. If I do
not step gracefully out of my sanctum sanctorum, almost certainly my
analytic-colleague reviewers will yank me out.

The issue, of course, is countertransference. During our life together Ginny

often related to me irrationally, on the basis of a very unrealistic appraisal of
me.

But what of my relationship to her? To what extent did my own unconscious

or barely conscious needs dictate my perception of Ginny and my behavior
toward her?

It is not entirely true that she was the patient and I the therapist. I first
discovered that a few years ago when I spent a sabbatical year in London. I
had no claims on my time and had planned to do nothing but work on a book
on group therapy. Apparently that was not enough; I grew depressed, restless
and finally arranged to treat two patients—more for my sake than for theirs.
Who was the patient and who the therapist? I was more troubled than they,
and, I think benefited more than they from our work together.

For over fifteen years, I have been a healer; therapy has become a core part
of my self-image; it provides me meaning, industry, pride, mastery. Thus,
Ginny helped me by allowing me to help her. But I had to help her a great
deal, a very

great deal, I was Pygmalion, she my Galatea. I had to transform her, to

succeed where others had failed, and to succeed in an astonishingly brief
period of time.

(Though this book may seem lengthy, sixty hours is a relatively short course
of therapy.) The miracle worker. Yes, I own that, and the need was not silent
in therapy: I pressured her relentlessly, I gave voice to my frustration when
she rested or consolidated for even a few hours, I improvised continuously.
“Get well,” I shouted at her, “get well for your sake, not for your mother’s
sake or for Karl’s—get well for yourself.” But, very softly, I also said, “get
well for me, help me be a healer, a rescuer, a miracle worker” Did she hear
me? I scarcely heard myself.
In still another more evident way the therapy was for me. I became Ginny and
treated myself. She was the writer I always wanted to become. The pleasure
I obtained from reading her sentences transcended sheer aesthetic
appreciation. I struggled to unlock her, to unlock myself. How many times
during therapy did I go back twenty-five years to my high school English
class, to old frayed Miss Davis who read my compositions aloud to the
class, to my embarrassing notebooks of verse, to my never-begotten Thomas
Wolfeian novel. She took me back to a crossroad, to a path I never dared take
for myself.

I tried to take it through her. “If only Ginny could have been deeper,” I said to
myself. “Why did she have to be content with satire and parody? What I
could have done with that talent!” Did she hear me?

The healer-patient, the rescuer, Pygmalion, the miracle worker, the great
unrealized writer. Yes, all these. And there is more. Ginny developed a
strong positive transference toward me. She overvalued my wisdom, my
potency. She fell in love with me. I tried to work with that transference, to
“work through” it, to resolve it in a therapeutically beneficial way. But I had
to work against myself as well. I want to appear wise and omnipotent. It is
important that attractive women fall in love with me. And so in my office we
were many patients sitting in many chairs. I struggled against parts of myself,
trying to ally with parts of Ginny in the conflict against other parts. I had to
monitor myself continuously. How many times did I silently ask myself, ‘Was
that for me or for Ginny?” Often I caught myself engaging or about to engage
in a seduction that would do nothing but foster Ginny’s exaltation of me. How
many times did I elude my own watchful eye?

I became far more important to Ginny than she to me. It is so with every
patient, how could it be otherwise? A patient has only one therapist, a
therapist many patients. And so Ginny dreamt about me, held imaginary
conversations

with me during the week (just as I used to converse with my analyst, old
Olive Smith—bless her staunch heart), or imagined I was there at her elbow
watching her every action. And yet there is more to it. True, Ginny rarely
entered my fantasy life. I did not think about her between sessions, I never
dreamed about her, yet I know that I cared deeply about her. I think I did not
permit myself full knowledge of my feelings and so I must awkwardly deduce
these things about myself. There were many clues: my jealousy toward Karl;
my disappointment when Ginny missed a session; my snug, cozy feelings
when we were together (“snug” and “cozy” are just the right words—not
clearly sexual but by no means ethereal). All these are self-evident, I
expected and recognized them, but what was unexpected was the eruption of
my feelings when my wife moved into my relationship with Ginny. Earlier I
described our social meeting in California after the end of therapy. When
Ginny left I was morose, diffusely irritated and sullenly refused my wife’s
invitations to talk about our meeting.

Though my phone conversations with Ginny were generally brief and

impeccably professional, I was invariably uneasy at my wife’s presence in
the room. It is even possible that I invited, ambivalently, my wife into our
relationship to help me with my counter-transference. (I am not sure, though;
my wife generally helps me in editing my work.) All these reactions become
explicable if one concludes that I was in the midst of a heavily sublimated
affair with Ginny.

Ginny’s positive transference complicated therapy in many ways. I wrote

earlier that she was in therapy in large part to be with me. To get well was to
say goodbye. “And so she remained suspended in a great selfless wasteland,
not so well as to lose me, not so sick as to drive me away in frustration.”
And I?

What did I do to prevent Ginny from leaving me? This book has insured that
Ginny never will become a half-forgotten name in my old appointment book
or a lost voice on an electromagnetic band. In both a real and symbolic sense
we have defeated termination. Would it be going too far to say that our affair
has been consummated in this shared work?

Add then Lothario, lover, to the list of healer-patient, rescuer, Pygmalion,

unborn writer, and still there is more which I cannot or will not see.

Countertransference was always present, like a gauzed veil through which I

attempted to see Ginny. To the best of my ability I tugged at it, I stared
through it, I refused, as best I could, to allow it to obstruct our work. I know
that I did not always succeed, nor am I convinced that the total subjugation of
my irrational side, needs and wishes would have promoted therapy; in a

bewildering fashion countertransference supplied much of the energy and

humanity that made our venture a successful one.

Was therapy successful? Has Ginny undergone substantial change? Or do we

see “a transference cure,” she having merely learned how to behave
differently, how to appease and please the now-internalized Dr. Yalom? The
reader shall have to judge for himself. I feel satisfied with our work and
optimistic about Ginny’s progress. There are remaining areas of conflict, yet
I regard them with equanimity; I have long ago lost the sense that I as the
therapist have to do it all. What is important is that Ginny is unfrozen and can
take an open posture to new experiences. I have confidence in her ability to
continue changing and my view is supported by most objective measures.

She has now terminated a relationship with Karl which, with retrospective
wisdom, was growth retarding for both parties; she is actively writing and,
for the first time, functioning well in a responsible and challenging job (a far
cry from the playground worker or the placard-carrying traffic guard); she
has established a social circle and a more satisfying relationship with a new
man.

Gone are the night panics, the frightening dreams of disintegration, the
migraines, the petrifying self-consciousness and self-effacement.

But I would have been satisfied even without these observable measures of
outcome. I wince as I confess that, since I have devoted much of my
professional career to a rigorous, quantifiable study of the outcome of
psychotherapy. It is a paradox hard to embrace, even harder to banish. The
“art”

of psychotherapy has for me a dual meaning: “art” in that the execution of

therapy requires the use of intuitive faculties not derivable from scientific
principles and “art” in the Keatsian sense that it establishes its own truth
transcending objective analysis. The truth is a beauty that Ginny and I
experienced. We knew one another, touched one another deeply, and shared
splendid moments not easily come by.
March 1, 1974

Ginny’s Afterword

KARL AND I had been together for eight months in the new state and had
rarely connected in a personal way. My world got smaller and smaller. Karl
would go off on trips; he found colleagues. He led his life away from the
house.

Occasionally our similar sensibilities, sense of humor and dinner would put
us side by side. But even when we spent a lot of time together, it was as
inanimate objects—like a chair and couch next to each other in a hotel lobby.
Karl would have to be questioned before he would tell me anything about his
day or give me anything. He even withheld his wonderful fault—the long
stories of his day.

And my conversation seemed to come out of nowhere since in the day I had
been nowhere. I was fearful, sure that Karl sensed the claustrophobia of my
mind and tension.

I accepted my boundaries growing smaller and smaller. But I began to feel so

redundant—like I was living a part of my life again and again—never getting
beyond it. I was loving my man only slightly, losing him in our oblivion. I
still didn’t have a job, just freelance bouts with writing; my discipline was
only seasonal (when it was warm and lovely, I headed for a kid’s type of
existence).

The days got old real fast and then hung on long and ominous. I was living a
miniature life as a hardened dreamer, and feeling ashamed, apologetic,
because the circumference of my life was about the size of a marble. Hours
of day and night accumulated against me.

I had an aversion to life. Before, in the mornings I used to wake up fast and
lively like a latent farmhand, but lately I had dreamt of milking my own blood
out, of not having to go on. That brink which I had seemed constantly
mounted on, became a wall. I rebelled by fantasies of writing, leaving, living
strongly alone—the usual. Building continuous dialogues out of silence.
Using my love life with Karl and dragging it into fuller dreams at night while
he was asleep.

All the while my real voice in the real world diminished.

Karl and I seemed to have quit dalliance so fast. There were no

anticipations. You get bored or ready to leave listening to a clock tick. Well
Karl and I were like clockwork.

It wasn’t always that way. Dr. Yalom had really given us a generosity and
hope toward each other. Back in California when Karl was trying to survive
in

life without the curriculum of a job or any pay check prestige, I remember he
used to often go to the library and try to write. Once he brought back a page
of his aims and (small victory) he read them to me. There were no aims and
only a few thin innuendos that had anything to do with positioning me in his
life. (This after over two years together.) It hurt me and I spoke to him about
it. I didn’t betray what I wanted to say even though I watered it down with a
few tears. I wanted to be part of his life and not just a few years of shared
rent. I wanted something with him that changed from day to day, something
that he thought about and cared for. Not just a duffel bag that he remembered
when he was moving.

Because we had had that moment of sharing—he, his writing; me, my anguish
—he promised me that the good days were ahead and then, you know, I
thought they were. Anyway there was a good night ahead when we played
liar dice on green felt, and I won. And we ate a second dinner about 11:30
and smoked and ate yogurt and listened to music. And touched each other a
long time and made love. And I responded and felt wonderful. But just stayed
this side of consciousness a long time and felt sad, which is a euphemism. I
never could break out of the pattern by completely relaxing or forgetting. And
I thought bitterly —•“ridiculous me, always on some brink.” My mind was
definitely top heavy and would not give its consent to my body. I couldn’t get
off of the tread mill that haunted my mind during sex and life with Karl.

The days just got worse, more oblivious. I had reserved no real time for any
destination or goal that required my own abilities alone. I’d chosen to be a
lizard in the desert, flattered by the sun. Only I had human nerves and wits. I
had been living tongue-in-cheek and withering. And my panics at night
increased and didn’t drizzle off in the morning. My mind let out a stampede
on my body. I lay helpless, sacrificed until daylight rounded the feelings up,
then my bruised body could leave. These panics I’m sure were caused by the
lack of hope between Karl and me, and the knowledge that soon I would be
abandoned. (If I tried to conjure up Dr. Yalom at these times, it was only to
put him into my melodrama.)

Even Karl’s judgmental side waned into apathy. He ignored me. I could talk
back to him on factual matters, stand up in that way thanks to Dr. Yalom, but I
couldn’t demand feelings. I couldn’t ask him about our future. As John Prine
says, “A question ain’t really a question, if you know the answer too.” * I
was fearful; Karl sensed my tension. But I think it was the truth that was
tensing me.

You have to do all the emotions when you’re the only one involved in a

relationship. There was no intuition on Karl’s part. I was trumping up love

songs and come-ons. Whole nights of snuggling and near misses. I could be
close at night when he was unconscious.

I guess I lost track of who Karl was. Not that he left many tracks around the
house worth following. They all led to work. There was just no give. Karl
was as good as anyone in terms of fun, of talks, games and latent sensitivity,
but he narrowed his compass terribly: in fact, just downright sliced off a few
directions. And I followed, not allowing my wants to impinge, to influence
him, to lighten our life.

I was like a needy child with a cruel stepfather; the situation was ridiculous.

I was standing up to offer him my seat but he was getting off at the next stop
anyhow.

Finally, desperate, unable to consume my own silence and the shared

resistance to our life together, I said, “Karl, we’re not getting along worth a
shit.” And he said, “I know. I want out. I’m burnt out.” And by the next night
he was gone.
 ***

Karl is gone. But this is not the day that my life came apart, it is just the echo
finally returning from a long severing cry. I’m scared. I can’t eat and I
wouldn’t take odds on the sleep that lies before me. I’ve tried to separate
what was just need, dependence and appliances from what were real feelings
and love for Karl. The radio, T.V., books, his; plus the silence, greed,
laughter, car rides. I’m trying to get an honest feeling about Karl that is not
jumbled up with necessities and nausea. And trying to feel that my own
presence exists.

Karl’s presence is still about me—his name still sounds familiar, not far
away, not years gone. I still quote him and know his desires and qualms. I am
sure that Karl was not just a habit. The piano was a habit. I gave it up after
seven years—no tears. Sometimes Karl’s leaving is a feeling and sometimes
a reality. Most times it’s a sadness that exists without being born of any
particular fact. After several weeks, though, I realized I couldn’t stay at this
level of just perfect perception of a painful situation. Karl will not come
back; it will not happen, even if unwisely I wish it with my whole being (we
know how whole that is). I wake up from dreams where Karl has been active
in taunting me; losing him in my sleep as I lost him in my life.

This time of sadness and utter dampness became uninhabitable. I knew I only
had a death wish and a death sentence to choose, if I let timidity and
condemnation hold me to this spot of rejection. The space where my smile
used to be felt fractured. Anyway too much of my grief was self-inflicted and
well deserved—the backlash of years of standing still and waiting. Leading a
clean life as an empty slate. Karl’s leaving was too connected to the
emptiness and boredom of my life to be wholly pure and sentimentalized.

I’m scared because always I’ve thought of myself as buried except for the
fingertips of friends and chance talky acquaintances helping and laughing
with me. So I’ve always had to station myself where I could be bumped into,
and part of Karl was meeting people with him. I could live by carefully
tossed-out asides and clever ideas. I felt if I ever lost my positioning, just a
few degrees askew of the mainstream, that no one would ever see me again,
that I would lose all chance.
And in fact I have given my life up to chance till now. I have shivered in fear
and grown in my trances. And now if life is to go with me at all, I must get
out and live, not wait. It seems all I did was give my energy to the minutes,
while waiting for the next coincidence. (Coincidence—a good name for a
horse that will win once in-a-while but mostly lose.) I put all my soul on
pass, watching someone else be the mover and thrower.

Now I have to move, go ahead with an out-going unginny life, as Dr.

Yalom might say. A life where I don’t use mediators to cushion and introduce
me to and from the world; don’t knock into dreams when I’m doing the
simplest things, and try to engage in forthright conversations in which my
loose ends aren’t coyly used to flagellate and downgrade me. No one can
delve into my brain and bring out some thinking, no one but me.

I realized the difference between thinking and what I’d been doing
spontaneously for so long—worrying. In worrying, I only mulled over the
bad alternatives. Thinking is progressive, extending. I never did it. And
fantasying is still-life thinking, knowing you’re never going to do anything
about your visions. I’d been used to letting people handle the pragmatic side
of life, while I became a genius at tangents.

No man will ever choose to live with my osmosis till death do us part. I will
have to inhabit myself or there will be nothing there. No, now I must move
aggressively and without any magic tunes or coincidences. I am just ordinary.

***

Life became hard; there was no love life to soften it. However, even by the
standards of the most over stretched soap opera, the mourning time was over.

But I sometimes said stupid things that were consoling instead of getting on
with it. “I shall not see Karl again with his eyes closed or touch his sleep in
the morning.” But if I were to stay crying and nuzzling souvenirs of Karl’s
and my time together, I’d be like a steady teenager going around and round a
dead top ten.
I’ve skipped the final beat of recognition that Karl is never coming back; I’ve
also lost an inch of soft clouds that padded my brain and kept it from perfect
sighting of distress, but also happiness. Glacier-like tears that will take
months to make their way down my mind are still there, but I forget them. I
don’t cry much anymore. I try to ignore a growing nostalgia for those tears.

There is more silence and the few tears are surrounded by anger.

Pain, I got to know you, and I’m not going to waste any more precious time
with you. How frustrating for Dr. Yalom to hear me ranting and raving over
the glories of tears and nightmares. I’m not going to try to define myself any
more by pain and tears. I don’t need them to make me human. I never want to
follow this circle again.

Besides, deep down, past the desperate feelings of abandonment, there is a

feeling of Tightness, that I really wished for Karl and me not to be together,
that I had wanted to get out, seethed with it, hoped for his decision, but as
usual, a staggering inertia made up of pity and fear had kept me in the
situation.

***

Every day seems a little longer

Every way love’s a little stronger

Come what may, do you ever long for true lovefrom me?

Love like yours will surely come my way. *

Strangely now I am more reconciled to the loss of Karl than to the finality of
my time with Dr. Yalom, even though I never really gave in to therapy. I
never completely believed in the emaciated self I brought into Dr. Yalom’s
life each week. Because I knew that on the outside (the real world) I could
be sort of vivacious and dramatic and happy and had several wonderful,
long-time long believing friends. And I’d had normal and almost normal talks
and days with
Karl. But I did not want to give up the part of me which touched Dr. Yalom
because it seemed what little I said there was more resonant and had deeper
echoes than any quips and puns I spun off ouside. Often I played dead, but
whether I was dead silly or just dead, I still had a lightness, optimism and
lease on life and knew it. I never allowed much pain.

At times I acted in his office, deliberately subduing my spirit to coincide

with the therapy hour. I could be mock indignant, but never angry. Yet I did
want to dig down and strike something real, something in me that could
initiate and not just tag along. Some emotional geyser, instead of our
vaudeville patter, with Dr. Yalom using his psychiatrist’s hook, and me my
self-conscious back-talk, to pull the curtain down.

The write-ups too were sometimes deliberately somber and serious or

sloppy and fluffy. I seemed to have no other jargon but what was already in
me; I couldn’t force myself to reach for the healing words he wanted; I
couldn’t have Clinical Mouth and answer his questions in kind; give the
straight psychiatrist’s party line. Every time Dr. Yalom asked me a healing
question, I’d be quiet, or worse, grin. Because I knew how easy it would be
to resort to my old self; I wanted to find something new, something other than
the stamina of nerves and illusions that clothed me.

I didn’t defend myself. In a sense I let the scenario be written by others and
then followed, hearing many cues but delivering only a few lines. One of Dr.

Yalom’s most predictable questions was, “What do you like about me, or
Karl, or yourself?” That question was almost as far away as the other side of
the coin,

“Ginny, isn’t there anything you object to in me?”

I knew he was trying to draw me to reality, and I suppose I even knew reality,
but it had no impact on me. I can’t bear to look at people objectively, though I
don’t mind swatting at them with metaphors. It is easier for me to adapt and
accept than judge. I hate to distance people by limiting them to their roles,
like “mother,” “father,” “psychiatrist"—each person has his own particular
justifications. I guess I could defend them all, even at my own expense, in my
stillness, because it hurts more to put them down, to hate them.
 ***

I think I achieved something personal with you, Dr. Yalom. You tried to bind
it up in a ribbon of therapy, and I was always a little suspicious, or worse,

sarcastic (takes less energy) about what you fed me, even though I said I was
starving.

I feel there will always be a whole unreconciled area, a gap in therapy—that

our aims were different. You could not know how it felt to be blank or, on the
other side of the coin, vivaciously alive and inspired. The times I was free
made me realize that my goal should always be to seek that feeling of
warmth, of no subconscious corners, of straightness. The answers to your
direct questions sometimes didn’t seem to be my answers. I wasn’t interested
in a hierarchy of questions and answers. All the time I was not really
searching for change but for a man whom I could talk to as I did to you, who
would question and understand me, have your patience, and yet be separate
from me.

Dr. Yalom, you always rooted for me, trying to get me out of low tide and
back into the flow of things. I watched you, fascinated at times, but when I
got out of your vision, there was so little current. Now I draw you around me
again, like small waves, and the illusion is that I am moving, and not grafted
to the stillness of dusk or the impression of sand.

Actually I think that simile and metaphor and all the ones I threw at you in my
reports and talk (all five billion) are one thing and I’m another. I used them
as a veil, until I could talk directly to you.

***

I didn’t stay down for the full count of suffering. Maybe I don’t have the guts
to be knocked out totally. I can only fantasize that moment. (After all the
premonitions and previews I gave you of what would happen to me if I were
ever truly abandoned, maybe the least I could have done is expire.) For a
month I did live a private, painful life. But by the end of that time, the
resilient streak in me was up. I found out that the friends I had were still
around me. All that was missing was Karl’s deadening presence and
unhappiness.

I am now mid-way through a day with no close feelings of anxiety. I’ve

gotten a job doing some research and writing, thanks to others who helped
me.

It’s no salvation but gives me money, so I can stop stockpiling a few

promises of things I should do but can’t afford. I’ve always drizzled my
money away, not using it to see any future or goals. Healthy people seem to
reach out and hold more and more of life while withdrawn people such as
myself, hold less and less of life.

I’ve got to change that—I can feel the distance I must go. Friends become
scary as I realize I cannot be just a presence, a spirit, all my life. My friends
are saying that they want more of me. These are some of the messages that
Karl gave me, only there seems more love and giving in the bargain. Of
course, all these changes make me grit my teeth since challenge freezes me
still. I know I need more than a few declarative sentences and some marching
music.

Practically every task must be brought up to a human level. My best friends

tell me to choose my words and deal with things more chronologically and
make choices. Try for an unginny life.

Not only have I stopped suffering, but despite my initial resistance, I’ve met
another man. I’m surprised how quickly the past has stopped. He cares for
me and is attracted to me. And I am attracted to him, in fact, cannot keep my
hands off him. I really find myself feeling more like a woman and less like a
girl. My brain is much less calculating and is more at home with voices than
the mere echoes and dreams I used to feed it. I have confidence that registers
as warm flashes in my stomach and a constant energy. The fear and dread are
gone.

Maybe they have turned into irony which at least is softer and not so
flattening.

In any case, irony is flimsy stuff compared to the good days I am having.
There are still plenty of problems though. I feel my life is contingent on
certain securities—having my own nest, some money, my new friend whom I
want to see often, and a close girlfriend who is precious to my life, as close
as a shadow. And I still am disorganized; the kitchen table spreads out over a
whole floor, a whole room. I feel scattered a lot of times, both in terms of
possessions springing out of closets and in things to do.

Maybe things will grow bad. Then I can fight back. I only got smaller by
shrinking away from problems and burdening you with my silence. I want to
achieve something personal in my life, not always go after the performance.
My mind feels really slack as though it had studied the world through a series
of mirages, which I tried to describe dutifully to you, Dr. Yalom. Now when I
rake my brain for some factual matter, I wish I had tried to talk more, even if
it weren’t all pure, instead of holding out for the sentence whose emotion
was one hundred proof.

I stared off into a lot of space in your office, going back and forth in time and
not settling. Now I feel sure I could find your face and so find mine, and talk
clearly or be quiet. You are the you understood of these pages.

The brokenness of yesterday is patched. My pain is perennial but so is my

happiness.

In your office I was stringing jokes like worry beads through my fingers. I
was happy just for your company (which was always natural and giving) but
I was scared to live like other people. I didn’t really want a therapist’s
office, but a nest; I tried to pull you down into my hibernation and helpless
calm. You didn’t let me succeed at just nodding or pretending to dream.
When your art succeeded, you revived us both.

As often as I curled up, you uncurled me.

March 1, 1974

* “Far from Me,” © copyright 1971 by Cotillion Music & Sour Grapes
Music. Used by permission.
* “Every Day,” by Norman Petti and Charles Hardin, © copyright 1957 by
Peer International Corporation. Used by permission.
Document Outline
Cover Page
Title Page
Copyright Page
Editor’s Foreword
Doctor Yalom’s Foreword
Ginny’s Foreword
I The First Fall (October 9–December 9)
II A Long Spring (January 6–May 18)
III Summer (May 26-July 22)
IV A Passing Winter (October 26-February
V A Final Spring (February 29–May 3)
VI Every Day Gets a Little Closer (May 10-June 21)
Doctor Yalom’s Afterword
Ginny’s Afterword