Authors: Irvin D. Yalom

Tags: #Psychology, #Movements, #Psychoanalysis, #Research & Methodology, #Emotions

Love's Executioner (3 page)

Now, if death is inevitable, if all of our accomplishments, indeed our entire solar system, shall one day lie in ruins, if the world is contingent (that is, everything could as well have been otherwise), if human beings must construct the world and the human design within that world, then what enduring meaning can there be in life?

This question plagues contemporary men and women, and many seek therapy because they feel their lives to be senseless and aimless. We are meaning-seeking creatures. Biologically, our nervous systems are organized in such a way that the brain automatically clusters incoming stimuli into configurations. Meaning also provides a sense of mastery: feeling helpless and confused in the face of random, unpatterned events, we seek to order them and, in so doing, gain a sense of control over them. Even more important, meaning gives birth to values and, hence, to a code of behavior: thus the answer to
why
questions (Why do I live?) supplies an answer to
how
questions (How do I live?).

There are, in these ten tales of psychotherapy, few explicit discussions of meaning in life. The search for meaning, much like the search for pleasure, must be conducted obliquely. Meaning ensues from meaningful activity: the more we deliberately pursue it, the less likely are we to find it; the rational questions one can pose about meaning will always outlast the answers. In therapy, as in life, meaningfulness is a by-product of engagement and commitment, and that is where therapists must direct their efforts—not that engagement provides the rational answer to questions of meaning, but it causes these questions not to matter.

This existential dilemma—a being who searches for meaning and certainty in a universe that has neither—has tremendous relevance for the profession of psychotherapist. In their everyday work, therapists, if they are to relate to their patients in an authentic fashion, experience considerable uncertainty. Not only does a patient’s confrontation with unanswerable questions expose a therapist to these same questions, but also the therapist must recognize, as I had to in “Two Smiles,” that the experience of the other is, in the end, unyieldingly private and unknowable.

Indeed, the capacity to tolerate uncertainty is a prerequisite for the profession. Though the public may believe that therapists guide patients systematically and sure-handedly through predictable stages of therapy to a foreknown goal, such is rarely the case: instead, as these stories bear witness, therapists frequently wobble, improvise, and grope for direction. The powerful temptation to achieve certainty through embracing an ideological school and a tight therapeutic system is treacherous: such belief may block the uncertain and spontaneous encounter necessary for effective therapy.

This encounter, the very heart of psychotherapy, is a caring, deeply human meeting between two people, one (generally, but not always, the patient) more troubled than the other. Therapists have a dual role: they must both observe and participate in the lives of their patients. As observer, one must be sufficiently objective to provide necessary rudimentary guidance to the patient. As participant, one enters into the life of the patient and is affected and sometimes changed by the encounter.

In choosing to enter fully into each patient’s life, I, the therapist, not only am exposed to the same existential issues as are my patients but must be prepared to examine them with the same rules of inquiry. I must assume that knowing is better than not knowing, venturing than not venturing; and that magic and illusion, however rich, however alluring, ultimately weaken the human spirit. I take with deep seriousness Thomas Hardy’s staunch words: “If a way to the Better there be, it exacts a full look at the Worst.”

The dual role of observer and participant demands much of a therapist and, for me in these ten cases, posed harrowing questions. Should I, for example, expect a patient, who asked me to be the keeper of his love letters, to deal with the very problems that I, in my own life, have avoided? Was it possible to help him go further than I have gone? Should I ask harsh existential questions of a dying man, a widow, a bereaved mother, and an anxious retiree with transcendent dreams—questions for which I have no answers? Should I reveal my weakness and my limitations to a patient whose other, alternative personality I found so seductive? Could I possibly form an honest and a caring relationship with a fat lady whose physical appearance repelled me? Should I, under the banner of self-enlightenment, strip away an old woman’s irrational but sustaining and comforting love illusion? Or forcibly impose my will on a man who, incapable of acting in his best interests, allowed himself to be terrorized by three unopened letters?

Though these tales of psychotherapy abound with the words
patient
and
therapist,
do not be misled by such terms: these are everyman, everywoman stories. Patienthood is ubiquitous; the assumption of the label is largely arbitrary and often dependent more on cultural, educational, and economic factors than on the severity of pathology. Since therapists, no less than patients, must confront these givens of existence, the professional posture of disinterested objectivity, so necessary to scientific method, is inappropriate. We psychotherapists simply cannot cluck with sympathy and exhort patients to struggle resolutely with their problems. We cannot say to them
you
and
your
problems. Instead, we must speak of
us
and
our
problems, because our life, our existence, will always be riveted to death, love to loss, freedom to fear, and growth to separation. We are, all of us, in this together.

Love’s Executioner

I do not like to work with patients who are in love. Perhaps it is because of
envy—I, too, crave enchantment. Perhaps it is because love and psychotherapy are fundamentally incompatible. The good therapist fights darkness and seeks illumination, while romantic love is sustained by mystery and crumbles upon inspection. I hate to be love’s executioner.

Yet Thelma, in the opening minutes of our first interview, told me that she was hopelessly, tragically in love, and I never hesitated, not for one moment, to accept her for treatment. Everything I saw in my first glance—her wrinkled seventy-year-old face with that senile chin tremor, her thinning, bleached, unkempt yellow hair, her emaciated blue-veined hands—told me she had to be mistaken, that she could not be in love. How could love ever choose to ravage that frail, tottering old body, or house itself in that shapeless polyester jogging suit?

Moreover, where was the aura of love bliss? Thelma’s suffering did not surprise me, love being always contaminated by pain; but her love was monstrously out of balance—it contained
no
pleasure at all, her life wholly a torment.

So I agreed to treat her because I was certain she was suffering, not from love, but from some rare variant which she mistook for love. Not only did I believe that I could help Thelma but I was intrigued by the idea that this counterfeit love could be a beacon that might illuminate some of the deep mystery of love.

Thelma was remote and stiff in our first meeting. She had not returned my smile when I greeted her in the waiting room, and followed a step or two behind me as I escorted her down the hall. Once we entered my office, she did not inspect her surroundings but immediately sat down. Then, without waiting for any comment from me and without unbuttoning the heavy jacket she wore over her jogging suit, she took a sharp deep breath and began:

“Eight years ago I had a love affair with my therapist. Since then he has never left my mind. I almost killed myself once and I believe I will succeed the next time. You are my last hope.”

I always listen carefully to first statements. They are often preternaturally revealing and foreshadow the type of relationship I will be able to establish with a patient. Words permit one to cross into the life of the other, but Thelma’s tone of voice contained no invitation to come closer.

She continued: “In case you have a hard time believing me, perhaps these will help!”

She reached into a faded red drawstring purse and handed me two old photographs. The first was of a young beautiful dancer wearing a sleek black leotard. I was startled, when I looked into the face of that dancer, to meet Thelma’s large eyes peering out at me across the decades.

“That one,” Thelma informed me when she saw me turning to the second photo, of a sixty-year-old handsome but stolid woman, “was taken about eight years ago. As you see”—she ran her fingers through her uncombed hair—“I no longer tend to my appearance.”

Though I had difficulty imagining this shabby old woman having an affair with her therapist, I had said nothing about not believing her. In fact, I had said nothing at all. I had tried to maintain complete objectivity but she must have noticed some evidence of disbelief, some small cue, perhaps a minuscule widening of my eyes. I decided not to protest her accusation that I did not believe her. This was no time for gallantry and there
was
something incongruous in the idea of a disheveled seventy-year-old infatuated, lovesick woman. She knew that, I knew it, and she knew I knew it.

I soon learned that over the last twenty years she had been chronically depressed and in psychiatric treatment almost continuously. Much of her therapy had been obtained at the local county mental health clinic, where she had been treated by a series of trainees.

About eleven years before, she began treatment with Matthew, a young, handsome psychology intern, and met weekly with him for eight months at the clinic and continued to see him in his private practice for another year. The following year, when Matthew took a full-time position at a state hospital, he had to terminate therapy with all his private patients.

It was with much sadness that Thelma said goodbye to him. He was, by far, the best therapist she had ever had, and she had grown fond of him, very fond, and for those twenty months looked forward all week to her therapy hour. Never before had she been as totally open with anyone. Never before had a therapist been so scrupulously honest, direct, and gentle with her.

Thelma rhapsodized about Matthew for several minutes. “He had so much caring, so much loving. I’ve had other therapists who tried to be warm, to put you at ease, but Matthew was different. He
really
cared, he
really
accepted me. No matter what I did, what horrid things I thought, I knew he’d accept it and still—what’s the word?—confirm me—no,
validate
me. He helped me in the way therapists usually do, but he did a lot more.”

“For example?”

“He introduced me to the spiritual, religious dimension of life. He taught me to care for all living things. He taught me to think about the reasons I was put here on earth. But he didn’t have his head in the clouds. He was right in there with me.”

Thelma was highly animated—she snapped her words off and pointed down to the earth and up to the clouds as she spoke. I could see she liked talking about Matthew. “I loved the way he tangled with me. He didn’t let me get away with anything. He always called me on my shitty habits.”

This phrase startled me. It didn’t fit with the rest of her presentation. Yet she chose her terms so deliberately that I assumed they had been Matthew’s words, maybe an example of his fine technique! My negative feelings toward him were rapidly growing, but I kept them to myself. Thelma’s words told me clearly that she would not look kindly at any criticism of Matthew.

After Matthew, Thelma started therapy with other therapists, but none ever reached her or helped her value her life the way he had.

Imagine, then, how pleased she was, a year after their last meeting, to run into him late one Saturday afternoon at Union Square in San Francisco. They chatted and, to escape the swirl of shoppers, had coffee together in the café at the St. Francis Hotel. There was so much to talk about, so much that Matthew wanted to know about Thelma’s past year, that their coffee hour extended into the dinner hour, and they walked over to Scoma’s on Fisherman’s Wharf for crab cioppino.

Somehow it all seemed so natural, as if they had shared meals like this countless times before. In reality, they had had a strictly professional relationship which had in no way splashed over the formal patient-therapist boundary. They had learned to know each other in weekly segments of precisely fifty minutes, no more, no less.

But that evening, for reasons Thelma, even now, cannot comprehend, she and Matthew slipped outside everyday reality. Neither looked at the time; they silently colluded in pretending that there was nothing unusual about talking personally or sharing coffee or dinner. It seemed natural for her to adjust the crumpled collar of his shirt, to brush the lint from his jacket, to take his arm as they climbed Nob Hill. It seemed natural for Matthew to describe his new “pad” in the Haight, and so very natural for Thelma to say she was dying to see it. They had chuckled when Thelma said that her husband was out of town: Harry, a member of the advisory board of the Boy Scouts of America, spoke at Boy Scout functions somewhere in America almost every night of the week. Matthew was amused that nothing had changed; there was no need to explain anything to him—after all, he knew everything about her.

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