Love's Executioner and Other Tales of Psychotherapy

by Irvin D. Yalom

  Her self-deception was particularly evident when she discussed Matthew. “He has a gentleness about him that touches the life of everyone who comes into contact with him. The secretaries all loved him. He said something caring to each of them, he knew all their children’s names, he brought in doughnuts for them three or four mornings a week. Whenever we went out during the twenty-seven days, he never failed to say something that would make the waiter or the store clerk feel good. Do you know anything about Buddhist meditation practice?”

  “Well, yes, as a matter of fact, I—” But Thelma didn’t wait to hear the rest of my sentence.

  “Then you know about ‘loving-kindness’ meditation. He did that twice a day and taught me the practice as well. That’s exactly why I would never, not in a hundred years, dream that he would treat me like this. His silence is killing me. Sometimes when I get deep into thought, I feel that it would not be possible for him—the person who taught me to be open—to devise a more terrible punishment than total silence. More and more these days”—here Thelma lowered her voice almost to a whisper—“I believe he is intentionally trying to drive me to suicide. Does that sound like a crazy thought?”

  “I don’t know if it’s crazy, but it sounds like a desperate and terribly painful thought.”

  “He’s trying to drive me to suicide. I’d be out of his hair for good. It’s the only possible explanation!”

  “Yes, thinking that, you have still protected him all these years. Why?”

  “Because, more than anything in the world, I want Matthew to think well of me. I don’t want to jeopardize my only chance for some kind of happiness!”

  “But Thelma, it’s been eight years. You haven’t heard from him for eight years!”

  “But there’s a chance—a small one. But a two-percent or even a one-percent chance is better than no chance at all. I don’t expect Matthew to love me again, I just want him to care about my being on this planet. It’s not too much to ask—when we walked in Golden Gate Park, he almost sprained his ankle trying to avoid disturbing an anthill. Surely he can send some of that loving-kindness my way!”

  So much inconsistency, so much anger, almost mockery, standing cheek by jowl with such reverence. Though I was gradually entering her experiential world and growing accustomed to hyperbolic assessments of Matthew, I was truly staggered by her next comment.

  “If he would call me once a year, talk to me for even five minutes, ask about me, show me his concern, then I could live happily. Is that too much to ask?”

  Never had I encountered one person giving another more power. Imagine—she claimed that one five-minute phone call a year would cure her. I wondered whether it would. I remember thinking that if everything else failed, I wasn’t beyond trying to set up that experiment! I recognized that the chances for success in therapy were not good: Thelma’s self-deception, her lack of psychological mindedness, her resistance to introspection, her suicidality—all signalled, “Be careful!”

  Yet her problem fascinated me. Her love obsession—what else could one call it?—was powerful and tenacious, having dominated eight years of her life. Still, the roots of the obsession seemed extraordinarily friable. A little effort, a little ingenuity should suffice to yank the whole weed out. And then? Underneath obsession, what would I find? Would I discover the brutal facts of human experience that the enchantment concealed? Then I might really learn something about the function of love. Medical researchers discovered, in the early days of nineteenth-century medical research, that the best way to understand the purpose of an endocrine organ is to remove it and observe the subsequent physiological functioning of the laboratory animal. Though I was chilled by the inhumaneness of my metaphor, I wondered: Might not the same principle hold here? So far it was apparent that Thelma’s love for Matthew was, in reality, something else—perhaps an escape, a shield against aging and isolation. There was little of Matthew in it, nor—if love is a caring, giving, need-free relationship—much love.

  Other prognostic signs clamored for my attention, but I chose to ignore them. I could have, for example, given more serious consideration to Thelma’s twenty years of psychiatric care! When I was a student at the Johns Hopkins Psychiatric Clinic, the staff had many “back room” indices of chronicity. One of the most irreverent of these was poundage: the heavier the patient’s clinical chart, the worse the prognosis. Thelma would have been a seventy-year-old “ten pounder” at least, and no one, absolutely no one, would have recommended psychotherapy.

  As I look back on my state of mind at that time, I realize that I simply rationalized away these concerns.

  Twenty years of therapy? Well, the last eight can’t be counted as therapy because of Thelma’s secretiveness. No therapy has a chance if the patient conceals the main issues.

  The ten years of therapy before Matthew? Well, that was a long time ago! Besides, most of her therapists were young trainees. Surely, I could offer her more. Thelma and Harry, with limited financial means, had never been able to afford to see anyone other than student therapists. But I was currently funded by a research institute to study the psychotherapy of the elderly and could see Thelma for a minimal fee. Surely this was an unusual opportunity for her to obtain therapy from an experienced clinician.

  My real reasons for taking on Thelma lay elsewhere: first, I was fascinated by encountering a love obsession at once deeply rooted and in a vulnerable, exposed state, and I was not to be swayed from digging it out and investigating it; second, I was afflicted by what I now recognize as hubris—I belived that I could help any patient, that no one was beyond my skills. The pre-Socratics defined hubris as “insubordination to divine law”; I was insubordinate, of course, not to divine law but to natural law, the laws that govern the flow of events in my professional field. I think I had a premonition at the time that, before my work with Thelma was over, I would be called to account for hubris.

  At the end of our second hour, I discussed a treatment contract with Thelma. She had made it clear that she would not commit herself to long-term treatment; and, besides, I thought that I should know within six months whether I could help her. So we agreed to meet once a week for six months (with the possibility of a six-month extension, if we thought it necessary). Her commitment was to attend regularly and to participate in a psychotherapy research project, which entailed a research interview and a battery of psychological tests to measure outcome, to be completed twice, at the beginning of therapy and six months after termination.

  I took pains to inform her that therapy would undoubtedly be unsettling, and attempted to get her to promise to stick with it.

  “Thelma, this continual rumination about Matthew—for shorthand, let’s call it an obsession——”

  “Those twenty-seven days were a great gift,” she said, bristling. “That’s one of the reasons I haven’t talked about them to other therapists—I don’t want them to be treated as a disease.”

  “No, Thelma, I’m not talking about eight years ago. I’m talking about now and about how you cannot live life because you continually replay past history over and over. I thought you came to see me because you wanted to stop tormenting yourself.”

  She sighed, closed her eyes, and nodded. She had given me the warning she wanted, and now she leaned back in her chair.

  “What I was going to say was that this obsession—let’s find a better word if obsession offends you——”

  “No, it’s O.K. I understand what you’re saying now.”

  “Well, this obsession has been a central part of your mind for eight years. It’ll be difficult to dislodge it. I’ll need to challenge some of your beliefs, and therapy might be stressful. I need your commitment to hang in there with me.”

  “You have it. When I make a resolution, I never go back on it.”

  “Also, Thelma, I can’t work well with a suicide threat hanging overhead. I need a solemn promise from you that for the next six months you will do nothing physically self-destructive. If you feel on the verge,
call me. Phone me at any time and I’ll be there for you. But if you make any attempt—no matter how slight—then our contract is broken, and I will not continue to work with you. Often I put this down on paper and ask for a signature, but I respect your claim to always honor your resolutions.”

  To my surprise, Thelma shook her head. “There is no way I can promise you this. I get into moods when I know it’s the only way out. I’m not going to close off this option.”

  “I’m talking about the next six months only. I’m not asking for any longer commitment, but I won’t start without this. Do you want to think some more about it, Thelma, and we’ll schedule another meeting next week?”

  She immediately became conciliatory. I don’t think she had expected me to take such a firm stand. Even though she gave no evidence of it, I believe she was relieved.

  “I can’t wait another week. I want us to make a decision now and to start therapy right away. I’ll agree to do my best.”

  “Do my best”—I didn’t feel that this was enough, yet hesitated to get into a control struggle so quickly. So I said nothing but simply raised my eyebrows.

  After a minute or a minute and a half (a long silence in therapy), Thelma stood up, offered me her hand, and said, “You have my promise.”

  Next week we commenced our work. I decided to maintain a sharp focus on relevant and immediate issues. Thelma had had sufficient time (twenty years of therapy!) to explore her developmental years; and the last thing I wanted to focus on were events dating back sixty years.

  She was highly ambivalent about therapy: although she regarded it as her only hope, she never had a satisfying session. Over the first ten weeks I learned that, if we analyzed her feelings toward Matthew, her obsession tormented her for the next week. If, on the other hand, we explored other themes, even such important issues as her relationship with Harry, she considered the session a waste of time because we had ignored the major problem of Matthew.

  As a result of her discontent, our time together became ungratifying for me as well. I learned not to expect any personal rewards from my work with Thelma. I never experienced pleasure from being in her presence and, as early as the third or fourth session, realized that any gratification for me in this therapy would have to issue from the intellectual realm.

  Most of our time together we devoted to Matthew. I inquired about the precise content of her daydreams, and Thelma seemed to enjoy talking about them. The ruminations were highly repetitious: most were a fairly faithful replay of any one of their meetings during the twenty-seven days. The most common was their first encounter—the chance meeting in Union Square, the coffee at the St. Francis, the walk to Fisherman’s Wharf, the view of the bay from Scoma’s restaurant, the excitement of the drive to Matthew’s “pad”; but often she simply thought of one of his loving phone conversations.

  Sex played a minor role in these thoughts: rarely did she experience any sexual arousal. In fact, though there had been considerable sexual caressing during her twenty-seven days with Matthew, they had had intercourse only once, the first evening. They had attempted intercourse two other times, but Matthew was impotent. I was becoming more convinced that my hunch about his behavior was correct: namely, that he had major psychosexual problems which he had acted out on Thelma (and probably other unfortunate patients).

  There were so many rich leads that it was hard to select and concentrate on one. First, however, it was necessary to establish to Thelma’s satisfaction that the obsession had to be eradicated. For a love obsession drains life of its reality, obliterating new experience, both good and bad—as I know from my own life. Indeed, most of my deeply held beliefs about therapy, and my areas of keenest psychological interest, have arisen from personal experience. Nietzsche claimed that a philosopher’s system of thought always arises from his autobiography, and I believe that to be true for all therapists—in fact, for anyone who thinks about thought.

  At a conference approximately two years prior to meeting Thelma, I had encountered a woman who subsequently invaded my mind, my thoughts, my dreams. Her image took up housekeeping in my mind and defied all my efforts to dislodge it. But, for a time, that was all right: I liked the obsession and savored it afresh again and again. A few weeks later, I went on a week’s vacation with my family to a beautiful Caribbean island. It was only after several days that I realized I was missing everything on the trip—the beauty of the beach, the lush and exotic vegetation, even the thrill of snorkeling and entering the underwater world. All this rich reality had been blotted out by my obsession. I had been absent. I had been encased in my mind, watching replays over and over again of the same and, by then, pointless fantasy. Anxious and thoroughly fed up with myself, I entered therapy (yet again), and after several hard months, my mind was my own again and I was able to return to the exciting business of experiencing my life as it was happening. (A curious thing: my therapist eventually became a close friend and years later told me that, at the time he was treating me, he himself was obsessed with a lovely Italian woman whose attention was riveted to someone else. And so, from patient to therapist to patient goes La Ronde of obsessional love.)

  So, in my work with Thelma, I stressed to her how her obsession was vitiating her life, and often repeated her earlier comment that she was living her life eight years before. No wonder she hated being alive! Her life was being stifled in an airless, windowless chamber ventilated only by those long-gone twenty-seven days.

  But Thelma never found this thesis persuasive—with, I now think, good reason. Generalizing from my experience to hers, I had mistakenly assumed her life to have richness that she was missing because of her obsession. Thelma felt, though she did not explicitly say so at the time, that the obsession contained infinitely more vitality than her lived experience. (Later we were to explore, also with minimal impact, the reverse of that formula—that it was because of the impoverishment of her life that she embraced the obsession in the first place.)

  By approximately the sixth session, I had worn her down and—to humor me, I believe—she agreed that the obsession was the enemy and had to be extirpated. We spent session after session simply reconnoitering the obsession. It seemed to me that the source of its hold on her was the power she had given Matthew. Nothing could be done until we diminished that power.

  “Thelma, this feeling that the only thing that matters is for Matthew to think well of you—tell me everything you know about it.”

  “It’s hard to put into words. The idea of him hating me is unbearable. He’s the one person who has ever known everything about me. So the fact that he could still love me, despite everything he knew, meant so much.”

  This, I thought, is precisely the reason therapists should not become emotionally involved with patients. By virtue of their privileged role, their access to deep feelings and secret information, their reactions always assume larger-than-life meanings. It is almost impossible for patients to see therapists as they really are. My anger toward Matthew grew.

  “But, Thelma, he’s just a person. You haven’t seen him for eight years. What difference does it make what he thinks of you?”

  “I can’t tell you why. I know it doesn’t make sense but, to the bottom of my soul, I believe that I’d be all right, I’d be happy, if he thought well of me.”

  This thought, this core false belief, was the enemy. I had to dislodge it. I made an impassioned plea.

  “You are you, you have your own existence, you continue to be the person you are from moment to moment, from day to day. Basically your existence is impervious to the fleeting thoughts, to the electromagnetic ripples occurring in some unknown mind. Try to see that. All this power that Matthew has—you’ve given it to him—every bit of it!”

  “I get sick in my stomach at the thought of his despising me.”

  “What goes on in another person’s mind, someone you never even see, who probably isn’t even aware of your existence, who is caught up in his own life struggles, doesn’t change the person you are.
”

  “Oh, he’s aware of my existence, all right. I leave a lot of messages on his telephone-answering tape. In fact, I left a message last week to let him know I was seeing you. I think he ought to know that I’m talking about him to you. Over the years I’ve always called him whenever I’ve changed therapists.”

  “But I thought you did not discuss him with all these therapists.”

  “I didn’t. I promised him that, even though he never asked it, and I kept that promise—until now. Even though I didn’t talk about him all those years, I still thought he should know which therapist I was seeing. Many of them were from his school. They might have even been his friends.”

  Because of my vindictive feelings toward Matthew, I was not displeased with Thelma’s words. On the contrary, I was amused when I imagined his discomfiture over the years when listening to Thelma’s ostensibly solicitous messages on his tape. I began to relinquish my ideas of striking back at Matthew. This lady knew how to punish him and needed no help from me in that task.

  “But, Thelma, go back to what I was saying earlier. Can’t you see that you’re doing this to yourself? His thoughts really can’t change the kind of person you are. You let him influence you. He’s just a person like you or me. If you think poorly of a person with whom you never have any contact, will your thoughts—those mental images circulating in your brain and known only to you—affect that person? The only way that can happen is through voodoo influence. Why do you surrender your power to Matthew? He’s a person like anyone else, he struggles to live, he’ll age, he’ll fart, he’ll die.”

  No response from Thelma. I upped the ante.

  “You said before that one could hardly have deliberately designed behavior more likely to hurt you. You’ve thought that maybe he was trying to drive you to suicide. He is not interested in your welfare. So what sense does it make to elevate him so? To believe that nothing in life is more important than that he think well of you?”