Love's Executioner and Other Tales of Psychotherapy

by Irvin D. Yalom

  The group focused upon the issue of secrecy—not the issue that now most fascinated me, though nonetheless a relevant therapeutic issue. Members wondered about Dave’s hiddenness; some could understand his wish to keep the letters secret from his wife, but none could understand his excesses of secrecy. For example, why did Dave refuse to tell his wife that he was in therapy? No one bought his lame excuse that if she knew he was in therapy, she’d be very threatened because she’d think he was there to complain about her, and also she’d make his life miserable by grilling him each week about what he had said in the group.

  If he were, indeed, concerned about his wife’s peace of mind, they pointed out, look how much more irritating it must be for her not to know where he went each week. Look at all the limp excuses he gave her for leaving the house each week to attend the group (he was retired and had no ongoing business outside the house). And look at the machinations he went through to conceal his therapy-bill payment each month. All this cloak and dagger! What for? Even insurance forms had to be sent to his secret post office box number. The members complained, too, of Dave’s secretiveness in the group. They felt distanced by his reluctance to trust them. Why did he have to say “letters of a certain relationship” earlier in the meeting?

  They confronted him directly: “C’mon, Dave, how much extra would it cost to come out and say ‘love letters’?”

  The group members, bless their hearts, were doing just what they should have been doing. They chose that part of the dream—the theme of secrecy—that was most relevant to the way Dave related to them, and they whacked away at it beautifully. Though Dave seemed a little anxious, he was refreshingly engaged—no game playing today.

  But I got greedy. That dream was pure gold, and I wanted to mine it. “Does anyone have any hunches about the rest of the dream?” I asked. “About, for example, the smell of death and the fact that the envelope contains something that ‘is immune to death, decay, or deterioration’?”

  The group was silent for a few moments, and then Dave turned to me and said, “What do you think, Doc? I’d really be interested in hearing.”

  I felt caught. I really couldn’t answer without revealing some of the material Dave had shared with me in our individual session. He hadn’t, for example, told the group that Soraya had been dead for thirty years, that he was sixty-nine and felt near death, that he had asked me to be the keeper of the letters. Yet, if I revealed these things, Dave would feel betrayed and probably leave therapy. Was I walking into a trap? The only possible way out was to be entirely honest.

  I said, “Dave, it’s really hard for me to respond to your question. I can’t tell you my thoughts about the dream without revealing information you shared with me before you entered the group. I know you’re very concerned about your privacy, and I don’t want to betray your trust. So what do I do?”

  I leaned back, pleased with myself. Excellent technique! Just what I tell my students. If you’re caught in a dilemma, or have two strong conflicting feelings, then the best thing you can do is to share the dilemma or share both feelings with the patient.

  Dave said, “Shoot! Go ahead. I’m paying you for your opinion. I have nothing to hide. Anything I’ve said to you is an open book. I didn’t mention our discussion about the letters because I didn’t want to compromise you. My request to you and your counteroffer were both a bit wacky.”

  Now that I had Dave’s permission, I proceeded to give the group members, who were by now mystified by our exchange, the relevant background: the great importance of the letters to Dave, Soraya’s death thirty years ago, Dave’s dilemma about where to store the letters, his request that I store them, and my offer, which he had so far declined, to keep them only if he agreed to inform the group about the entire transaction. I was careful to respect Dave’s privacy by not revealing his age or any extraneous material.

  Then I turned to the dream. I thought the dream answered the question why the letters were loaded for Dave. And, of course, why my letters were loaded for me. But of my letters I did not speak: there are limits to my courage. Of course, I have my rationalizations. The patients are here for their therapy, not mine. Time is valuable in a group—eight patients and only ninety minutes—and is not well spent by the patients listening to the therapist’s problems. Patients need to have faith that their therapists face and resolve their personal problems.

  But these are indeed rationalizations. The real issue was want of courage. I have erred consistently on the side of too little, rather than too much, self-disclosure; but whenever I have shared a great deal of myself, patients have invariably profited from knowing that I, like them, must struggle with the problems of being human.

  The dream, I continued, was a dream about death. It began with: “Death is all around me. I can smell death.” And the central image was the envelope, an envelope that contained something immune to death and deterioration. What could be clearer? The love letters were an amulet, an instrument of death denial. They warded off aging and kept Dave’s passion frozen in time. To be truly loved, to be remembered, to be fused with another forever, is to be imperishable and to be sheltered from the aloneness at the heart of existence.

  As the dream continued Dave saw that the envelope had been slit open and was empty. Why slit open and empty? Perhaps he felt that the letters would lose their power if he shared them with others? There was something patently and privately irrational about the letters’ ability to ward off aging and death—a dark magic that evaporates when examined under the cold light of rationality.

  A group member asked, “What about the dirty old shoe with the sole coming off?”

  I didn’t know, but before I could make any response at all, another member said, “That stands for death. The shoe is losing its soul, spelled S-O-U-L.”

  Of course—soul, not sole! That’s beautiful! Why hadn’t I thought of that? I had grasped the first half: I knew that the dirty old shoe represented Dave. On a couple of occasions (for example, that time he asked a woman member forty years younger for her phone number), the group had come close, I thought, to calling Dave a “dirty old man.” I winced for him and was glad that the epithet had not been uttered aloud. But in the group discussion, Dave took it upon himself.

  “My God! A dirty old man whose soul is about to leave him. That’s me all right!” He chuckled at his own creation. A lover of words (he spoke several languages), he marveled at the transposition of soul and sole.

  Despite Dave’s jocularity, it was apparent he was dealing with very painful material. One of the members asked him to share some more about feeling like a dirty old man. Another asked about what it felt like to reveal the existence of the letters to the group. Would that change his attitude about them? Another reminded him that everyone faced the prospect of aging and decline, and urged him to share more about this cluster of feelings.

  But Dave had closed down. He had done all the work he was to do that day. “I’ve gotten my money’s worth today. I need some time to digest all this. I’ve taken up seventy-five percent of the meeting already, and I know that others want some time today.”

  Reluctantly, we left Dave and turned to other matters in the group. We did not know, then, that it was to be a permanent farewell. Dave never returned to another group meeting. (Nor, it turned out, was he willing to resume individual therapy with me or anyone else.)

  Everyone, no one more than I, did a great deal of self-questioning. What had we done to drive Dave away? Had we stripped away too much? Had we tried too quickly to make a foolish old man wise? Had I betrayed him? Had I stepped into a trap? Would it have been better not to have spoken of the letters and to have let the dream go? (The dream interpretative work was successful, but the patient died.)

  Perhaps we might have forestalled his departure, but I doubt it. By this time I was certain that Dave’s caginess, his avoidance and denial, would have ultimately led to the same result. I had strongly suspected from the beginning that he would likely drop out of the group. (Th
e fact that I was a better prophet than therapist, however, gave me little solace.)

  More than anything, I felt sorrow. Sorrow for Dave, for his isolation, for his clinging to illusion, for his want of courage, for his unwillingness to face the naked, harsh facts of life.

  And then I slipped into a reverie about my own letters. What would happen if (I smiled at my “if”) I died and they were found? Maybe I should give them to Mort or Jay or Pete to store for me. Why do I keep troubling myself about those letters? Why not relieve myself of all this aggravation and burn them? Why not now? Right now! But it hurts to think about it. A stab right through my sternum. But why? Why so much pain about old yellowing letters? I’m going to have to work on this—someday.

  7

  Two Smiles

  Some patients are easy. They appear in my office poised for change, and the therapy runs itself. Sometimes so little effort is required of me that I invent work, posing a question or offering an interpretation simply to reassure myself, and the patient, that I am a necessary character in this transaction.

  Marie was not one of the easy ones. Every session with her demanded great effort. When she first came to see me three years ago, her husband had already been dead for four years, but she remained frozen in grief. Her facial expression was frozen, as well as her imagination, her body, her sexuality—the whole flow of her life. For a long time she had remained lifeless in therapy, and I had to do the job of two people. Even now, long after her depression had lifted, there remained a stiffness in our work and a coldness and remoteness in our relationship that I had never been able to alter.

  Today was a therapy holiday. Marie was to be interviewed by a consultant, and I was to enjoy the luxury of sharing an hour with her and yet being “off duty.” For weeks I had urged her to see a hypnotherapist in consultation. Though she resisted almost any new experience and was particularly fearful of hypnosis, she finally consented with the condition that I remain present during the entire session. I didn’t mind; in fact, I liked the idea of sitting back and letting the consultant, Mike C., a friend and colleague, do the work.

  Furthermore, being an observer would provide me an unusual opportunity to reevaluate Marie. For after three years it was possible that my view of her had become fixed and narrow. Perhaps she had changed significantly and I had not taken note of it. Perhaps others would evaluate her very differently from the way I would. It was time to try to see her again through fresh eyes.

  Marie was of Spanish descent and had emigrated from Mexico City eighteen years before. Her husband, whom she had met while a student at the university in Mexico, had been a surgeon and was killed in an automobile accident one evening while rushing to the hospital on an emergency call. An exceptionally handsome woman, Marie was tall, statuesque, with a boldly chiseled nose and long black hair swirled in a knot at the back of her head. How old? One might guess twenty-five: perhaps, without her makeup, thirty. It was impossible to think that she was forty.

  Marie was a forbidding presence and most people felt daunted and distanced by her beauty and hauteur. I, on the other hand, was strongly drawn toward her. I was moved by her, I wanted to comfort her, I imagined embracing her and feeling her body unfreeze in my arms. I had often wondered about the strength of my attraction. Marie reminded me of a beautiful aunt who wore her hair the same way and played a major role in my adolescent sexual fantasies. Perhaps that was it. Perhaps it was simply that I was flattered to be the sole confidant and protector of this regal woman.

  She concealed her depression well. No one could have guessed that she felt her life was over; that she was desperately lonely; that she wept every night; that in the seven years since her husband died, she had not once had a relationship, even a personal conversation, with a man.

  For the first four years of her bereavement, Marie made herself totally inaccessible to men. Over the past two years, as her depression lessened, she had arrived at the conclusion that her only possible salvation was to develop a new romantic relationship, but she was so proud and intimidating that men regarded her as unapproachable. For several months I had attempted to challenge her belief that life, real life, can only be lived if one is loved by a man. I had tried to help her broaden her horizons, to develop new interests, to value relationships with women. But her belief was deeply held. I eventually decided it was unassailable, and turned my attention to helping her learn how to meet and engage men.

  But all our work had come to a halt four weeks before when Marie was thrown from a cable car in San Francisco and fractured her jaw, suffering extensive facial and dental damage and deep lacerations in her face and neck. After being hospitalized for a week, she began treatment with an oral surgeon to repair her teeth. Marie had a low threshold for pain, especially dental pain, and dreaded her frequent visits to the oral surgeon. Moreover, she had damaged a facial nerve and suffered from severe and relentless pain on one side of her face. Medication had been of no value and it was to relieve the pain that I had suggested a hypnotic consultation.

  Under ordinary conditions Marie could be a difficult patient, but after her accident she was astonishingly resistive and caustic.

  “Hypnosis works for stupid people or people with weak wills. Is that why you’re suggesting it for me?”

  “Marie, how can I persuade you that hypnosis has nothing to do with will power or intelligence? The ability to be hypnotized is simply a trait someone is born with. What’s the risk? You tell me that the pain is unbearable—there’s a good possibility a one-hour consultation will offer some relief.”

  “It may sound simple to you, but I don’t want to be made a fool of. I’ve seen hypnosis on TV—the victims look like idiots. They think they’re swimming when they’re on a dry stage, or that they’re rowing a boat when sitting in a chair. Someone’s tongue was stuck out and she couldn’t get it back in.”

  “If I thought that sort of thing would happen to me, I’d feel as concerned as you. But there’s all the difference in the world between TV hypnosis and medical hypnosis. I’ve told you precisely what you can expect. The main thing is that no one is going to control you. Instead, you’ll learn to put yourself in a state of mind where you can control your pain. It sounds like you’re still having trouble trusting me and other doctors.”

  “If doctors were trustworthy, they would have thought of calling the neurosurgeon in time and my husband would still be alive!”

  “There’s so much going on here today, so many issues—your pain, your concerns (and misconceptions) about hypnosis, your fears of appearing foolish, your anger and distrust of doctors, including me—I don’t know which to attend to first. Do you feel the same way? Where do you think we should start today?”

  “You’re the doctor, not me.”

  And so therapy had proceeded. Marie was brittle, irritable, and despite her avowed gratitude to me, often sarcastic or provocative. She never stayed focused on any issue but quickly moved on to other grievances. Occasionally she caught herself and apologized for being bitchy, but invariably, a few minutes later, was once again irritable and self-pitying. I knew that the most important thing I could do for her, especially in this time of crisis, was to maintain our relationship and not allow her to drive me away. Thus far I had persevered, but my patience was not unlimited, and I felt relieved to share the burden with Mike.

  I also wanted support from a colleague. That was my ulterior motive in the consultation. I wanted another to bear witness to what I had been going through with Marie, someone to say to me, “She’s tough. You’ve done a helluva good job with her.” That needy part of me did not act in Marie’s best interests. I did not want Mike to have a smooth and easy consultation: I wanted him to struggle as I had to struggle. Yes, I admit it, a part of me was rooting for Marie to give Mike a hard time: “Come on, Marie, do your stuff!”

  But, to my amazement, the session proceeded well. Marie was a good hypnotic subject, and Mike skillfully induced her and taught her how to put herself into a trance. He then addressed
her pain by using an anesthetic technique. He suggested that she imagine herself in the dentist’s chair getting an injection of novocaine.

  “Think of your jaw and cheek growing more and more numb. Now your cheek is very numb, indeed. Touch it with your hand and see how numb it is. Think of your hand as a storehouse of numbness. It becomes numb when it touches your numb cheek, and it can transfer that numbness to any other part of your body.”

  From there it was an easy step for Marie to transfer her numbness to all the painful areas of her face and neck. Excellent. I could see the look of relief on her face.

  Then Mike discussed pain with her. First, he described the function of pain: how it served as a warning to inform her just how much she could move her jaw and how hard she could chew. This was necessary, functional pain in contrast to the unnecessary pain stemming from irritated, bruised nerves which served no useful purpose.

  Marie’s first step, Mike suggested, was to learn more about her pain: to differentiate between functional and unnecessary pain. The best way to do that was to begin to ask the right questions and to discuss her pain in depth with her oral surgeon. He was the one who knew the most about what was happening in her face and mouth.

  Mike’s statement was wonderfully lucid and delivered with just the proper mixture of professionalism and paternalism. Marie and he locked gazes for a moment. Then she smiled and nodded. He understood that she had received and registered the message.

  Mike, obviously pleased with Marie’s response, turned to his final task. She was a heavy smoker and one of her motives in agreeing to the consultation with him was to enlist his help in stopping. Mike, an expert in this field, began a well-practiced, polished presentation. He emphasized three major points: that she wanted to live, that she needed her body to live, and that cigarettes were a poison to her body.