I met with Phyllis and Marvin as a couple for several more sessions. I reinforced their new, more open mode of communication and instructed them in some fundamentals of sexual functioning: how Phyllis could help Marvin sustain his erection; how she could help him avoid premature ejaculation; how Marvin could approach sex less mechanically; and how he could, if he lost his erection, bring Phyllis to orgasm manually or orally.
She had been housebound for years and now rarely ventured forth alone. It seemed to me that the time was ripe to interrupt that pattern. I believed that the meaning, or at least one meaning, of her agoraphobia was now obsolete and could be influenced by paradox. I first obtained Marvin’s agreement to help Phyllis overcome her phobia by promising to follow any suggestions I gave him. I then instructed him to say to her, punctually every two hours, phoning her if he were at work, these words precisely: “Phyllis, please don’t leave the house. I need to know you are there at all times to take care of me and prevent me from being frightened.”
Phyllis’s eyes widened. Marvin looked at me incredulously. Could I possibly be serious?
I told him that I knew it sounded crazy, but persuaded him to follow my instructions faithfully.
They both giggled the first few times Marvin told Phyllis not to leave the house: it seemed ridiculous and artificial; she had not left the house in months. But soon irritation replaced the giggle. Marvin was irritated with me for making him promise to keep repeating the same stupid statement. Phyllis, even though she knew Marvin was following my instructions, grew irritated with him for ordering her to stay at home. After a few days she went to the library alone, then shopping, and in the next few weeks ventured farther than she had for years.
I rarely employ such manipulative approaches in therapy; usually the price is too high—one must sacrifice the genuineness of the therapeutic encounter. But paradox can be effective in those instances where the therapeutic foundation is solid and the prescribed behavior explodes the meaning of the symptom. In this case, Phyllis’s agoraphobia was not her symptom but their symptom, and it served to maintain the marital equilibrium: Phyllis was eternally there for Marvin; he could venture forth into the world, provide for their security, yet feel secure in the knowledge that she was always there waiting for him.
There was a certain irony in my use of this intervention: an existential approach and a manipulative paradox ordinarily make bizarre bedfellows. Yet here the sequence seemed natural. Marvin had applied to his relationship with Phyllis the insights he had obtained from a confrontation with the deep sources of his despair. Despite the discouragement (depicted in his dreams by such symbols as being unable to rebuild a house at night), he had nonetheless proceeded upon a radical reconstruction of his relationship to his wife. Both Marvin and Phyllis now cared so much for the other’s growth and being that they could genuinely collaborate in the process of wrenching a symptom from its socket.
Marvin’s change initiated an adaptive spiral: liberated from a restricting role, Phyllis underwent enormous change in the space of a few weeks and continued and solidified that improvement in individual therapy with another therapist over the next year.
Marvin and I met only a few more times. Pleased with his progress, he had realized, as he put it, a good yield on his investment. The migraines, his reason for seeking therapy, had never returned. Though his mood swings still occurred (and were still dependent on sex), their intensity had diminished considerably. Marvin estimated that the mood swings were now approximately the same as they had been for the previous twenty years.
I, too, felt satisfied with our work. There is always more that can be done, but overall we had accomplished far more than I could have anticipated at our initial session. The fact that Marvin’s anguished dreams had stopped was also reassuring. Though I had received no messages from the dreamer for the last several weeks, I had not missed them. Marvin and the dreamer had fused, and I spoke to them now as to a single person.
I next saw Marvin one year later: I always schedule patients for a one-year follow-up session—both for their benefit and for my own edification. I also make it a practice to play for the patient a tape recording of part of our initial session. Marvin listened to ten minutes of our initial interview with great interest, smiled at me, and said, “Who is that jerk, anyway?”
Marvin’s quip has a serious side. Having heard the same reaction from many patients, I have come to regard it as a valid marker of change. Marvin, in effect, was saying, “I’m a different person now. I hardly recognize that Marvin of a year ago. Those things I used to do—refusing to look at my life; trying to control or intimidate others; trying to impress others with my intelligence, my charts, my thoroughness—they’re gone. I don’t do that any more.”
These are no minor adjustments: they represent basic modifications in personhood. Yet they are so subtle in character that they generally elude most research-outcome questionnaires.
With his usual care, Marvin had come prepared with one-year follow-up notes which reviewed and assessed the tasks we had addressed in therapy. The verdict was mixed: in some areas he had maintained his changes; in others he had done some backsliding. First, he informed me that Phyllis was doing well: her phobia about leaving the house remained much improved. She had joined a women’s therapy group and was working on her fear of attending social functions. Perhaps most impressive was her decision to address adaptively her concern about her lack of education—by enrolling in several college extension courses.
As for Marvin? He had no further migraines. His mood swings persisted but were not disabling. He was still periodically impotent but brooded about it less. He had changed his mind about retirement and was now working part-time, but had switched fields and was doing more real estate development and management—work that he found more interesting. He and Phyllis still related very well, but at times he found himself aggrieved at her newfound activities and felt ignored by her.
And my old friend, the dreamer? What of him? Did he have a message for me? Although Marvin had had no nightmares or powerful dreams, he knew there were nocturnal rumblings. The night before our meeting, he had had a short dream which was full of mystery. It seemed to be trying to tell him something. Perhaps, he suggested, I could understand it.
My wife is in front of me. She is naked and standing with her legs spread apart. I am looking through the triangle of her legs off into the distance. But all I can see, far away on the horizon, is my mother’s face.
My final message from the dreamer:“My vision is bounded by the women of my life and imagination. Nonetheless, I can still see far into the distance. Perhaps that is sufficient.”
AFTERWORD
On Rereading Love’s Executioner at Age Eighty
When I agreed to write a postscript for Love’s Executioner, I had no idea of the emotional adventure ahead of me. I wrote this book twenty-five years ago and, since then, had not once read it in its entirety. This view backward to the writing of an earlier self was thrilling and poignant, but also dismaying and embarrassing. The flush of pride I first experienced quickly gave way to a sense of deflation: “This guy writes a lot better than I can.”
At first I thought I would be encountering myself as a very young man, but a bit of arithmetic led to the realization that I was no sapling when I wrote this book: I was in my mid-fifties! That was surprising since the writer seems so youthful, energetic, and often unrestrained and sophomoric. And outrageously active—often charging at a patient’s defenses with a battering ram! I wish I could have supervised him and settled him down.
And yet there are so many things I like about this younger self. I like the way he avoided diagnosis or categorization. It was as though he were seeing for the very first time each particular set of complaints and personality characteristics, as though he truly believed each individual was unique and required a unique therapy approach. And I liked his willingness to put up with uncertainty and to undertake the laborious task of inventing a different therapy for each p
atient. I felt sorry for the discomfort he experienced in each course of therapy. He lacked the confidence provided by an established school of thought, a professional home such as a Freudian, a Jungian, a Lacanian, an Adlerian, or a cognitive-behavioral one with an all-embracing explanatory system. But I was pleased he never believed he knew unknowable things.
And such audacity. His amount of self-disclosure was outrageous twenty-five years ago and set most therapists’ teeth on edge. And still it seems outrageous. I personally feel shocked. How dare he disclose so many of my private matters? My secret cache of love letters, my compulsive work habits, my inexcusably unkind, judgmental attitudes toward obese people, my love obsession that prevented me from being fully present at a family beach vacation. Despite such behavior, I am nonetheless proud of his putting nothing in the way of forging a true therapy encounter; I would do exactly the same today. I remain convinced that a therapist’s judicious self-disclosure facilitates the course of therapy.
Love’s Executioner was a pivotal turning point for me. During my first several years as a member of the Stanford University Medical School faculty, I had been heavily involved in psychotherapy teaching, research, and publishing in professional journals. I developed a specialty in group therapy and, during my first sabbatical, embarked on writing a textbook on group therapy. After finishing this book, I turned to another interest that had long been percolating under the surface—the role of existential concerns in human life and human distress. After a decade of study and research, I wrote a textbook, Existential Psychotherapy , intending not to establish a new field but to make all therapists more aware of existential issues. Four major existential concerns—death, meaning in life, isolation, and freedom—play a crucial role in the inner life of every human being and constitute the thrust of that book.
Once this book was finished, I continued to develop new ideas about the utilization of these existential concerns in therapy, but gradually came to the conclusion that such ideas are best expressed through the narrative form. It did not escape me that the ideas of some of the most important existential thinkers—for example, Camus and Sartre—are most vivid and compelling in their stories and novels rather than in technical philosophic works.
Nor did it escape me that narrative played a vital, if covert, role in my textbooks. I have heard from many teachers and students that the numerous tales—some a few pages long, some merely a paragraph or two—I had interspersed in both The Theory and Practice of Group Psychotherapy and Existential Psychotherapy vastly increased each book’s effectiveness. Students have told me they were more willing to plod through dry theory knowing there would likely be an interesting tale just around the bend.
And so I gradually developed the notion that the best way I could convey my ideas to students, and enhance an existential sensibility, was through narrative. In 1987, I took the plunge and resolved to write a different kind of book, a book in which I would put story first and theoretical discussion second. In no way was I deviating from my role as a teacher of psychotherapy—I was simply going about it in a different fashion. Love’s Executioner was meant to be a collection of teaching stories aimed (like all my subsequent stories and novels) at the young psychotherapist and all other people, including patients, interested in psychotherapy. The mother book fueling the ideas for the stories was Existential Psychotherapy.
There was yet another component in this decision. I had always wanted to be a storyteller. As long as I can remember, I’ve been a voracious reader and somewhere in early adolescence I began yearning to be a real writer. That desire must have been percolating on the back burner as I pursued my academic career, for as I began writing these ten stories, I sensed I was on the way to finding myself.
Books and places are bonded together in my memory. Whenever I reread or even think about a book I’ve read, I immediately visualize the place where I first read it. Rereading Love’s Executioner evoked a stream of delicious memories that began in 1987 when my youngest child left home for college, and my wife and I set off around the world for a year’s sabbatical. First, we became acquainted with Japanese culture, as I taught for two weeks in Tokyo; then, two weeks of travel in China where my wife, a feminist scholar, lectured to university students and teachers. On my last day in China, I spent an afternoon alone wandering through the back streets of Shanghai and came upon a handsome but entirely deserted Catholic church. After making certain I was alone, I entered the confessional booth (appropriating the priest’s seat) and meditated upon the generations of priests who had heard confessions in this box. I envied their ability to pronounce, “You are forgiven.” What therapeutic power! While sitting in that seat of power, I had an extraordinary writerly experience. For an hour, I slipped into a reverie in which the entire plot of “Three Unopened Letters” came to me. I scribbled the essentials of the story on the only paper available to me: the blank pages of my passport.
It was in Bali that I began to write in earnest. We settled into a two-month stay in Kuta on Bali in an exotic house that had a high wall around the large lush garden property but no interior walls other than hanging shades. Needing no reference books for my writing, I traveled light and had only a stack of my session notes for about fifty patients. The atmosphere was exotic and otherworldly. Birds in iridescent colors boldly perched in the intricately twisted trees of the garden and caroled strange melodies. The perfume of unfamiliar blossoms intoxicated me where I sat in the garden reading all my notes over and over again. As memories of my sessions flowed through my mind over the days, a story would, almost without my noticing it, take root and develop such energy as to compel me to put aside all other notes and devote myself to that particular story. As I started writing, I had no idea where a story would lead or what shape it would take. I felt myself almost a bystander as I watched it develop organically. I had often heard writers say a story writes itself, but it was only then that I understood what they meant as one after another of my stories wrote itself. After two months, I had an entirely new and deep appreciation of an old anecdote I had heard in high school about the nineteenth-century English novelist William Makepeace Thackeray: in it, as he came out of his study, his wife asked how the day’s writing had gone. He responded, “Oh a terrible day! Pendennis [one of his characters] made a fool of himself today and I couldn’t stop him.” Soon I became used to hearing my characters talk to one another. I eavesdropped all the time—even after finishing the day’s writing, when I was strolling arm in arm with my wife on one of the endless buttery sand Balinese beaches.
Soon I was to have another writerly experience, one of the peak experiences of my life. At some point while deep into a story, I observed my fickle mind flirting with another story, one that appeared to be slowly taking shape beyond my immediate perception. I understood that as a signal—an uncanny one—to myself from myself that the story I was writing was coming to an end, with another on the way.
I had written all my previous books with pencil and paper with the help of my Stanford secretary, who typed them out. But it was now 1987—time to modernize and switch to a computer and printer. I taught myself to type on the flight overseas by means of a video game in which, when letters attacked my spaceship, my only defense was to punch an attacking letter before it detonated my ship. The computer was one of the earliest and still unreliable portable models, and the printer even more unreliable, giving up the ghost after one month in Bali. Alarmed at the prospect of my work disappearing without a trace into the computer’s innards, I sought help. There turned out to be only one printer in Denpasar, the major city of Bali, and it was located in a computer school. From it, through either begging or bribing (I’ve forgotten which), I obtained a precious hard copy of my work to date.
Inspiration came quickly in Bali. I had no distractions (in those halcyon days before e-mail) and have never written better or more quickly. While there, I wrote the title story of Love’s Executioner, as well as “In Search of the Dreamer” and “If Rape Were Legal . . . ,” and tran
scribed the notes I had made in my passport in the confessional for “Three Unopened Letters.” I wrote “Two Smiles” and “Do Not Go Gentle” in Hawaii and the remaining stories in Paris, most of them in a café down the street from the Pantheon.
My initial plan was to follow each story with a few paragraphs discussing the theoretical points it illustrated. I soon found this plan unwieldy and instead put all the theoretical material into a fifty-page epilogue in which I explained in depth what my book was really about. Shortly after I had sent the manuscript to my publisher, I was contacted by Phoebe Hoss, an editor from hell (but also from heaven), with whom I was to have a long, ferocious struggle. She was absolutely persuaded that no theoretical explanation whatsoever was needed, and that I should let my stories speak for themselves. We battled for months. I submitted one version after another; each one was returned to me considerably shortened until, after several months, she had reduced my fifty-page prologue to about ten pages. As I reread the book now, I am reminded once again that she was absolutely right.
Though I feel proud of this book, I have regrets about one story—“Fat Lady.” Several obese women have e-mailed me that my words seriously offended them, and today I would probably not be so insensitive. Nonetheless, though I have put myself on trial several times and found myself guilty, let me take advantage of this opportunity to state my defense. I am the main character in this story, not the patient. It is a story about countertransference—that is, irrational, often shameful, feelings a therapist experiences toward a patient that constitute a formidable obstacle in therapy. My negative feelings about obese people prevented me from achieving the deep engagement that I believe is necessary for effective therapy. While I struggled internally with these feelings, I had not expected my patient to perceive them. She had, nonetheless, accurately sensed my feelings, as she recounts at the end of the story. The story depicts my struggle to work through these unruly feelings in order to relate to the patient at a human level. However I may deplore those feelings, I can take pride in the denouement expressed in the story’s final words: “I could get my arms all the way around her.”
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