To my mind, “good” therapy (which I equate with deep, or penetrating, therapy, not with efficient or even, I am pained to say, helpful therapy) conducted with a “good” patient is at bottom a truth-seeking venture. My quarry when I was a novitiate was the truth of the past, to trace all of a life’s coordinates and, thereby, to locate and to explain a person’s current life, pathology, motivation, and actions.
I used to be so sure. What arrogance! And now what kind of truth was I stalking? I think my quarry is illusion. I war against magic. I believe that, though illusion often cheers and comforts, it ultimately and invariably weakens and constricts the spirit.
But there is timing and judgment. Never take away anything if you have nothing better to offer. Beware of stripping a patient who can’t bear the chill of reality. And don’t exhaust yourself by jousting with religious magic: you’re no match for it. The thirst for religion is too strong, its roots too deep, its cultural reinforcement too powerful.
Yet I am not without faith, my Hail Mary being the Socratic incantation, “The unexamined life is not worth living.” But that was not Dave’s faith. So I curbed my curiosity. Dave scarcely wondered about the ultimate meaning of his clutch of letters and now, tight and brittle, he would not be receptive to such an inquiry. Nor would it be helpful—now or probably ever.
Besides, my questions had a hollow ring. I saw much of myself in Dave, and there are limits to my hypocrisy. I, too, had my sack of letters from a long-lost love. I, too, had them cutely hidden away (in my system, under B for Bleak House, my favorite Dickens novel, to be read when life was at its bleakest). I, too, had never reread the letters. Whenever I tried, they brought pain, not comfort. They had lain there untouched for fifteen years, and I, too, could not destroy them.
Were I my own patient (or my own therapist), I would say, “Imagine the letters gone, destroyed or lost. What would you feel? Plunge into that feeling, explore it.” But I could not. Often I thought of burning them, but that thought always evoked an inexpressible ache. My great interest in Dave, my surge of curiosity and fascination, I knew whence it came: I was asking Dave to do my work for me. Or our work for us.
From the outset I had felt drawn to Dave. At our first session six months before, I had asked him, after a few pleasantries, “What ails?”
He responded, “I can’t get it up any more!”
I was astonished. I remember looking at him—his tall, lean, athletic body, his full head of glistening black hair, and his lively elfish eyes belying his sixty-nine years—and thinking, “Chapeau!” “Hats off!” My father had his first coronary at forty-eight. I hoped that when I was sixty-nine I’d be sufficiently alive and vital to worry about “getting it up.”
Dave and I both had a proclivity to sexualize much in our environment. I contained it better than he, and had long since learned to prevent it from dominating my life. I also did not share Dave’s passion for secrecy, and have many friends, including my wife, with whom I share everything.
Back to the letters. What should I do? Should I keep Dave’s letters? Well, why not? After all, was it not an auspicious sign that he was willing to trust me? He had never been able to confide much in anyone and certainly not in a male. Although impotence had been his explicit reason for choosing to see me, I felt that the real task of therapy was to improve the way he related to others. A trusting, confiding relationship is a prerequisite for any therapy and, in Dave’s, might be instrumental in changing his pathological need for secrecy. Keeping the letters would forge a bond of trust between us.
Perhaps the letters might give me additional leverage. I had never felt that Dave was securely lodged in therapy even though we had worked well with his impotence. My tactic had been to focus on the marital discord, and to suggest that impotence was to be expected in a relationship with so much anger and mutual suspicion. Dave, who had been recently married (for the fourth time), described his current marriage in the same way he described his previous marriages: he felt he was in prison and his wife was a prison guard who listened to his phone conversations and read his mail and personal papers. I had helped him realize that, to the extent that he was in prison, it was a prison of his own construction. Of course, his wife tried to obtain information about him. Of course, she was curious about his actions and correspondence. But it was he who had whetted her curiosity by refusing to share even innocent crumbs of information about his life.
Dave had responded well to this approach and made impressive attempts to share with his wife more of his life and internal experience. His action broke the vicious circle, his wife softened, his own anger diminished, and his sexual performance improved.
I had turned, now, in treatment to a consideration of unconscious motivation. What payoff did Dave get from a belief that he was imprisoned by a woman? What fueled his passion for secrecy? What had prevented him from forming even one intimate nonsexualized relationship with either man or woman? What had happened to his cravings for closeness? Could these cravings, even now at sixty-nine, be excavated, reanimated, and realized?
But these seemed more my project than Dave’s. I suspected that, in part, he agreed to examine unconscious motivations simply to humor me. He liked to talk to me, but I believe that the primary attraction was the opportunity to reminisce, to keep alive the halcyon days of sexual triumph. My connection with him felt tentative. I always felt that if I probed too far, ranged too close to his anxiety, he would simply disappear—fail to show up for his next appointment, and I would never be able to contact him again.
If I kept the letters, they could act as a guy line: he couldn’t simply float away and disappear. At the very least, he would have to be up front about terminating: he’d have to face me and request the letters back.
Besides, I felt I had to accept the letters. Dave was so hypersensitive. How could I reject the letters without his feeling I was rejecting him? He was also highly judgmental. A mistake would be fatal: he rarely gave people a second chance.
Yet I was uncomfortable with Dave’s request. I began to think of good reasons not to accept his letters. I would be making a pact with his shadow—an alliance with pathology. There was something conspiratorial about the request. We’d be relating together as two bad little boys. Could I build a solid therapeutic relationship on such insubstantial foundations?
My idea that keeping the letters would make it harder for Dave to terminate therapy was, I realized quickly, nonsense. I dismissed this angle as being just that—an angle, one of my dumb, harebrained, manipulative ploys that always backfire. Angles or gimmicks were not going to help Dave relate to others directly and authentically: I had to model straightforward, honest behavior.
Besides, if he wanted to stop therapy, he’d find a way to get the letters back. I recall a patient I saw twenty years ago whose therapy was pockmarked with duplicity. She was a multiple personality whose two personae (whom I shall call Blush and Brazen) waged a deceitful war against each other. The person I treated was Blush, a constricted, prudish young thing; while Brazen, whom I rarely encountered, referred to herself as a “sexual supermarket” and dated the king of California pornography. Blush often “awoke” surprised to find that Brazen had emptied her bank account and bought sexy gowns, red lace underwear, and airline tickets for jaunts to Tijuana and Las Vegas. One day Blush was alarmed to find an around-the-world airline ticket on her dresser, and thought that she could prevent the trip by locking up all of Brazen’s sexy clothing in my office. Somewhat bemused and willing to try anything once, I agreed and stored her clothes under my desk. A week later, I arrived at work one morning to find my door broken open, my office rifled, and the clothes gone. Gone also was my patient. I never saw Blush (or Brazen) again.
Suppose Dave did die on me? However good his health, he was sixty-nine. People do die at sixty-nine. What would I do with the letters then? Besides, where in the hell would I store them? Those letters must weigh ten pounds. I imagined, for a moment, interring them together with mine. They might, if discovered, provide m
e some cover.
But the really major problem with keeping the letters had to do with group therapy. Several weeks before, I had suggested to Dave that he enter a therapy group, and over the past three sessions we had discussed this at great length. His penchant for concealment, his sexualization of all transactions with women, his fear and distrust of all men—all of these traits, it seemed to me, were excellent issues to work on in group therapy. Reluctantly he had agreed to begin my therapy group, and our session that day was to be our last individual meeting.
Dave’s request for me to keep the letters had to be seen in this context. First, it was entirely possible that the imminent transfer to the group was the factor behind his request. No doubt he regretted losing his exclusive relationship with me and resented the idea of sharing me with the group members. Asking me to keep the letters might, thus, be a way of perpetuating our special, and private, relationship.
I tried very, very delicately to express that idea, in order not to provoke Dave’s exquisite sensitivity. I was careful not to demean the letters by suggesting he was using them as a means to an end. I was also careful to avoid sounding as though I were minutely scrutinizing our relationship: this was a time to nurture its growth.
Dave, being a person who needed extensive time in therapy simply to learn how to use it, scoffed at my interpretation instead of considering whether there was any truth in it. He insisted that he had asked me to keep the letters at this time for one reason only: his wife was now doing a major housecleaning and working her way steadily and surely toward his study, where the letters lay hidden.
I didn’t buy his reply, but the moment called for patience, not confrontation. I let it go. I was even more concerned that keeping the letters might ultimately sabotage his work in the therapy group. Group therapy for Dave was, I knew, a high-gain but high-risk venture, and I wanted to facilitate his entry into it.
The benefits might be great. The group could offer Dave a safe community in which he could identify his interpersonal problems and experiment with new behavior. For example, he might reveal more of himself, get closer to other men, relate to women as human beings rather than as sexual organs. Dave unconsciously believed that each of these acts would result in some calamitous event: the group was the ideal arena to disconfirm these assumptions.
Of the many risks, I feared one particular scenario. I imagined that Dave would not only refuse to share important (or trivial) information about himself but do so in a coy or provocative way. The other group members would proceed to request and then demand more. Dave would respond by sharing less. The group would be angered and accuse him of playing games with them. Dave would feel hurt and trapped. His suspicions and fears of the group members would be confirmed, and he would drop out of the group, more isolated and discouraged than when he began.
It seemed to me that if I were to keep the letters, I would be colluding, in a countertherapeutic way, with his penchant for secrecy. Even before starting the group, he would have entered into a conspiracy with me that excluded the other members.
Weighing all these considerations, I finally chose my response.
“I understand why the letters are important to you, Dave, and I also feel good that I’m the one you’re willing to entrust with them. However, it’s my experience that group therapy works best if everyone in the group, and that includes the group leader, is as open as possible. I really want the group to be helpful to you, and I think it best that we do it this way: I’ll be glad to store the letters in a safe, locked place for as long as you wish, provided that you agree to tell the group about our bargain.”
Dave looked startled. He hadn’t anticipated this. Would he take the leap? He cogitated for a couple of minutes. “I don’t know. I’ll have to think about it. I’ll get back to you.” He left my office, his briefcase and homeless letters in tow.
Dave never did get back to me about the letters—at least not in anyway I could anticipate. But he did join the group and attended the first several meetings faithfully. In fact, I was astounded at his enthusiasm: by the fourth meeting, he told us that the group was the high point of his week, and he found himself counting the days till the next session. The reason behind the enthusiasm was, alas, not the lure of self-discovery but the quartet of attractive women members. He focused solely upon them and, we learned later, tried to arrange to meet socially with two of them outside the group.
As I had anticipated, Dave kept himself well concealed in the group and, in fact, received reinforcement for his behavior from another secretive member, a beautiful and proud woman who, like him, looked decades younger than her years. At one meeting, she and Dave were asked to state their ages. Both refused, offering the ingenious dodge that they didn’t want to be age-typed. Long ago (when genitals were referred to as “privates”), therapy groups were reluctant to talk about sex. In the last two decades, however, groups talk about sex with some ease, and money has become the private subject. In thousands of group meetings, whose members supposedly bare all, I have yet to hear group members disclose their incomes.
But in Dave’s group, the burning secret was age. Dave teased and joked about it but adamantly refused to state his age: he would not jeopardize his chances of scoring with one of the women in the group. In one meeting when one of the women members pressed him to tell his age, Dave offered an exchange: his secret, his age, for her home telephone number.
I grew concerned with the amount of resistance in the group. Not only was Dave not seriously working in therapy, but his bantering and flirtatiousness had shifted the entire discourse of the therapy group to a superficial level.
At one meeting, however, the tone turned deeply serious. One woman announced that her boyfriend had just learned he had cancer. She was convinced he was going to die soon, though the doctors claimed that his prognosis was not hopeless despite his debilitated physical condition and his advanced age (he was sixty-three).
I flinched for Dave: that man at the “advanced” age of sixty-three was still six years younger than he. But he didn’t bat an eye and, in fact, began to speak in a far more honest fashion.
“Maybe that’s something I ought to be talking about in the group. I am very phobic about illness and death. I refuse to see a doctor—a real doctor”—gesturing mischievously at me. “My last physical exam was over fifteen years ago.”
Another group member: “You look like you’re in great shape, Dave, whatever your age.”
“Thank you. I work at it. Between swimming, tennis, and walking, I exercise a minimum of two hours a day. Theresa, I feel for you and your boyfriend, but I don’t know how to help. I do a lot of thinking about aging and death, but my thoughts are too morbid to talk about. To be honest, I don’t even like to visit sick people or listen to talk about illness. The Doc”—again, gesturing at me—“always says I keep things light in the group—maybe that’s why!”
“What’s why?” I asked.
“Well, if I start being serious here, I’ll start talking about how much I hate about growing older, how much I fear death. Some day I’ll tell you about my nightmares—maybe.”
“You’re not the only one who has these fears, Dave. Maybe it would be helpful to find out everyone’s in the same boat.”
“No, you’re alone in your own boat. That’s the most terrible part about dying—you have to do it alone.”
Another member: “Even so, even though you’re alone in your boat, it’s always comforting to see the lights of the other boats bobbing nearby.”
As we ended this meeting, I was exceedingly hopeful. It felt like a breakthrough session. Dave was talking about something important, he was moved, he had become real, and the other members responded in kind.
At the next meeting, Dave related a powerful dream he had had the night after the previous session. The dream (recorded verbatim by a student observer):Death is all around me. I can smell death. I have a packet with an envelope stuffed inside of it, and the envelope contains some thing that is immune to dea
th or decay or deterioration. I’m keeping it secret. I go to pick it up and feel it, and suddenly I see that the envelope is empty. I feel very distressed about that and notice that it’s been slit open. Later I find what I assume was in the envelope on the street, and it is a dirty old shoe with the sole coming off.
The dream floored me. I had often thought about his love letters and had wondered if I would ever get a chance again to explore their meaning with Dave.
Much as I love to do group therapy, the format has one important drawback for me: it often does not permit the exploration of deeper existential issues. Time and again in a group, I gaze longingly at a beautiful trail that would lead me deep into the interior of a person, but must content myself with the practical (and more helpful) task of clearing away the interpersonal underbrush. Yet I couldn’t deny myself this dream; it was the via regia into the heart of the forest. Rarely have I ever heard of a dream that so transparently laid out the answer to an unconscious mystery.
Neither Dave nor the group knew what to make of the dream. They floundered for a few minutes, and then I supplied some direction by casually asking Dave whether he had any associations to the dream image of an envelope which he was keeping secret.
I knew I was taking a risk. It would be an error, probably a fatal error, either to force Dave into untimely revealing or for me to reveal information he had entrusted to me in our individual work before he started the group. I thought my question was within the margins of safety: I stayed concretely with the dream material, and Dave could easily demur by failing to have pertinent associations.
He gamely proceeded, but not without his usual coyness. He stated that perhaps the dream referred to some letters he had been keeping secret—letters of a “certain relationship.” The other members, their curiosity aroused, questioned him until Dave related a few things about his old love affair with Soraya and the problem of finding a suitable resting place for the letters. He did not say that the affair was thirty years over. Nor did he mention his negotiations with me and my offer to keep the letters for him if he agreed to share all with the group.