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.
“I don’t remember,” Thelma continued, “much about the rest of the evening, about how things happened, about who touched who first, about how we decided to go to bed. We didn’t make any decisions, everything just happened effortlessly and spontaneously. What I do remember most clearly was that lying in Matthew’s arms was transporting—one of the greatest moments in my life.”
“Tell me about what happened next.”
“The next twenty-seven days, June 19 to July 16, were magical. We spoke on the phone several times a day and saw one another fourteen times. I floated, I glided, I danced.”
Thelma’s voice had a lilt to it now, and she rocked her head in rhythm to a melody of eight years past. Her eyes were almost closed, sorely trying my patience. I don’t like to feel invisible.
“That was the peak of my life. I have never before or since been so happy. Whatever has happened since then can never erase what he gave me then.”
“What has happened since then?”
“The last time I saw him was at twelve-thirty p.m. on July 16. For two days I hadn’t been able to reach him on the phone, so I popped in unannounced at his office. He was eating a sandwich and had about twenty minutes before he had to lead a therapy group. I asked about why he hadn’t returned my calls and he said simply, ‘It’s not right, we both know it.’” She paused and wept silently.
A great time for him to discover that it’s not right, I thought. “Can you go on?”
“I asked him, ‘Suppose I call you next year or in five years? Would you see me? Could we take another walk across the Golden Gate Bridge? Would I be allowed to hug you?’ Matthew answered my questions by taking my hand, pulling me into his lap, and hugging me tightly for several minutes.
“I’ve called him countless times since and left messages on his tape machine. At first he returned some of my calls, but then I stopped hearing from him at all. He cut me off. Complete silence.”
Thelma turned away and looked out the window. The lilt was gone from her voice. She was speaking more deliberately, in a bitter, forlorn tone, but there were no more tears. I thought that now she was closer to ripping or gouging than to crying.
“I never could find out why—why it was over, just like that. In one of our last talks he said that we have to return to our real lives, and then added that he was involved with a new person.” I suspected, silently, that the new person in Matthew’s life was another patient.
Thelma wasn’t sure whether the new person was a man or a woman. She suspected Matthew was gay: he lived in one of San Francisco’s gay enclaves, and was beautiful in the way many gay men are, with his neatly combed mustache, boyish face, and Mercury-like body. This possibility occurred to her a couple of years later when, while taking an out-of-town guest sightseeing, she warily entered a gay bar on Castro Street and was astounded to see fifteen Matthews sitting at the bar—fifteen slim, attractive, neatly mustached young men.
To be suddenly cut off from Matthew was devastating; and not to know why, unbearable. Thelma thought about him continuously, not an hour passing without some prolonged fantasy about him. She became obsessed with why? Why had he rejected her and cast her out? Why then? Why would he not see her or even speak to her on the phone?
Thelma grew deeply despondent after all attempts to contact Matthew failed. She stayed home all day staring out the window; she could not sleep; her movements and speech slowed down; she lost her enthusiasm for any activities. She stopped eating, and soon her depression had passed beyond the reach of psychotherapy or antidepressive medication. By consulting three different doctors for her insomnia and obtaining from each a prescription for sleeping medication, she soon collected a lethal amount. Precisely six months after her chance meeting with Matthew in Union Square, she left a goodbye note to her husband, Harry, who was out of town for the week, waited until his goodnight phone call from the East Coast, took the phone off the hook, swallowed all the tablets, and went to bed.
Harry, unable to sleep that night, phoned Thelma back and grew alarmed at the continual busy signal. He called his neighbors, who banged, in vain, on Thelma’s door and windows. Soon they called the police, who stormed into the house to find her close to death.
Thelma’s life was saved only by heroic medical efforts. The first call she made upon regaining consciousness was to Matthew’s tape machine. She assured him she would keep their secret and pleaded with him to visit her in the hospital. Matthew came to visit but stayed only fifteen minutes and his presence, Thelma said, was worse than his silence: he evaded any allusions she made to their twenty-seven days of love and insisted on remaining formal and professional. Only once did he step out of role: when Thelma asked him how the relationship with the new person in his life was going, Matthew snapped, “You have no need to know that!”
“And that was that!” Thelma turned her face directly toward me for the first time and added, in a resigned, weary voice, “I’ve never seen him again. I call to leave taped messages for him on important dates: his birthday, June 19 (our first date), July 17 (our last date), Christmas, and New Year’s. Every time I switch therapists, I call to let him know. He never calls back.
“For eight years I haven’t stopped thinking about him. At seven in the morning I wonder if he’s awake yet, and at eight I imagine him eating his oatmeal (he loves oatmeal—he grew up on a Nebraska farm). I keep looking for him when I walk down the street. I often mistakenly think I see him, and rush up to greet some stranger. I dream about him. I replay in my mind each of our meetings together during those twenty-seven days. In fact, most of my life goes on in these daydreams—I scarcely take note of what’s happening in the present. My life is being lived eight years ago.”
My life is being lived eight years ago—an arresting phrase. I stored it for future use.
“Tell me about the therapy you’ve had in the last eight years—since your suicide attempt.”
“During that time I’ve never been without a therapist. They gave me lots of antidepressants, which don’t do much except allow me to sleep. Not much other therapy has gone on. Talking treatments have never helped. I guess you could say I didn’t give therapy much chance since I made a decision to protect Matthew by never mentioning him or my affair to any other therapist.”
“You mean
that in eight years of therapy you’ve never talked about Matthew!”
Bad technique! A beginner’s error—but I could not suppress my astonishment. A scene I hadn’t thought of in decades entered my mind: I was a student in a medical school interviewing class. A well-meaning but blustering and insensitive student (later, mercifully, to become an orthopedic surgeon) was conducting an interview before his classmates and attempting to use the early Rogerian technique of coaxing the patient along by repeating the patient’s words, usually the last word of the statement. The patient, who had been enumerating ghastly deeds committed by his tyrannical father, ended by commenting, “And he eats raw hamburger!” The interviewer, who had struggled hard to maintain his neutrality, was no longer able to contain his outrage, and bellowed back, “Raw hamburger?” For the rest of that year, the phrase “raw hamburger” was often whispered in lectures and invariably cracked up the class.
I, of course, kept my reverie to myself. “But today, you’ve made a decision to come to see me and to be honest about yourself. Tell me about that decision.”
“I checked you out. I called five former therapists and told them I was going to give therapy one last chance and asked them who I should see. Your name appeared on four of their lists—they said you were a good ‘last ditch’ therapist. So that was one thing in your favor. But I also knew they were your former students, so I checked you out some more. I went to the library and checked out one of your books. I was impressed by two things: you were clear—I could understand your writing—and you were willing to speak openly about death. And I’m going to be open with you: I’m almost certain I will eventually commit suicide. I’m here to make one final attempt in therapy to find a way to live with some iota of happiness. If not, I hope you’ll help me die and help me find a way to cause as little pain as possible to my family.”
I told Thelma that I thought we could work together, but I suggested we have another consultation hour to consider things further and also to let her assess whether she could work with me. I was going to say more when Thelma looked at her watch and said, “I see that my fifty minutes are up and, if nothing else, I’ve learned not to overstay my welcome in therapy.”
I was musing on the tone of this final comment—not quite sardonic, not quite coquettish—when Thelma got up, telling me on her way out that she would schedule the next hour with my secretary.
After this session I had much to think about. First, there was Matthew. He infuriated me. I’ve seen too many patients badly damaged by therapists using them sexually. It’s always damaging to a patient.
Therapists’ excuses are invariably patent and self-serving rationalizations—for example, that the therapist is accepting and affirming the patient’s sexuality. While plenty of patients may need sexual affirmation—those who are markedly unattractive, extremely obese, surgically disfigured—I have yet to hear of a therapist affirming one of them sexually. It’s always the attractive woman who gets chosen for affirmation. It is, of course, the offending therapists who are in need of sexual affirmation and lack the resources or resourcefulness to obtain it in their own personal lives.
But Matthew presented somewhat of an enigma. When he seduced Thelma (or permitted himself to be seduced—same thing), he had just finished graduate school and thus must have been in his late twenties or early thirties. So why? Why does an attractive, presumably accomplished young man select a sixty-two-year-old woman who has been lifeless and depressed for many years? I thought about Thelma’s speculation that he was gay. Perhaps the most reasonable hypothesis was that Matthew was working on (or acting out) some personal psychosexual issues—and using his patient(s) to do it.
It’s precisely for this reason that we urge trainees to be in prolonged personal therapy. But today, with brief training courses, less supervision, a relaxation of training standards and licensure requirements, therapists often refuse, and many patients have suffered from a therapist’s lack of self-knowledge. I feel little charity for the irresponsible professionals and have urged many patients to report sexually offending therapists to professional ethics boards. I considered, momentarily, what recourse I had with Matthew, but supposed he was beyond the statute of limitations. Still, I wanted him to know about the damage he had done.
I turned my attention to Thelma and dismissed, for the time being, the question of Matthew’s motivation. But I was to struggle with that question many times before the dénouement of this therapy, and could not have guessed then that, of all the riddles in the case of Thelma, it was the riddle of Matthew I was destined to solve most fully.
I was struck by the tenacity of her love obsession, which had possessed her for eight years with no external reinforcement. The obsession filled her entire life space. She was right: she was living her life eight years ago. The obsession must draw part of its strength from the impoverishment of the rest of her existence. I doubted whether it would be possible to separate her from her obsession without first helping her to enrich other realms of her life.
I wondered about the amount of intimacy in her daily life. From what she had so far told me of her marriage, there was apparently little closeness between her and her husband. Perhaps the function of the obsession was simply to provide intimacy: it bonded her to another—but not to a real person, to a fantasy.
My best hope might be to establish a close, meaningful relationship between the two of us and then use that relationship as a solvent in which to dissolve her obsession. But that would not be easy. Her account of therapy was chilling. Imagine being in therapy for eight years and not talking about the real problem! That takes a special type of person, someone who can tolerate considerable duplicity, someone who embraces intimacy in fantasy but may avoid it in life.
Thelma began the next session by telling me that it had been an awful week. Therapy always presented a paradox for her. “I know I need to be seen, I can’t manage without it. And yet every time I talk about what’s happened, I have a miserable week. Therapy sessions always just stir the pot. They never resolve anything—they always make things worse.”
I didn’t like the sound of that. Were these previews of coming attractions? Was Thelma telling me why she would ultimately leave therapy?
“This week has been one long crying jag. Matthew’s been on my mind nonstop. I can’t talk to Harry because I’ve got only two things on my mind—Matthew and suicide—and both topics are off limits.
“I will never, never talk about Matthew to my husband. Years ago I told him that I briefly saw Matthew once by chance. I must have talked too much because later Harry stated that he believed that Matthew was in some way responsible for my suicide attempt. If he ever were to know the truth, I honestly believe he would kill Matthew. Harry is full of Boy Scout honor slogans—the Boy Scouts, that’s all he thinks about—but underneath he’s a violent man. He was a British commando officer during the Second World War and specialized in teaching methods of hand-to-hand killing.”
“Tell me some more about Harry.” I was struck by the vehemence in Thelma’s voice when she said that Harry would kill Matthew if he knew about what had happened.
“I met Harry in the thirties when I was dancing professionally on the Continent. I’ve always lived for two things only: making love and dancing. I refused to stop dancing to have children, but I was forced to stop thirty-one years ago because I got gout in my large toe—not a good disease for a ballerina. As for love, when I was younger I had many, many lovers. You saw that picture of me—be honest, tell the truth, was I not beautiful?” She continued, without waiting for my response. “But once I married Harry, love was over. Very few men (though there were some) were brave enough to love me—everyone was terrified of Harry. And Harry gave up sex twenty years ago (he’s good at giving things up). We hardly ever touch now—probably my fault as much as his.”
I was about to ask about Harry being good at giving things up, but Thelma raced on. She wanted to talk, yet still without seeming to be talking to me. She gave no evidence of
wanting a response from me. Her gaze was averted. Usually she looked upward, as though lost in recollection.
“The other thing I think about, but can’t talk about, is suicide. Sooner or later I know that I will do it, it’s the only way out. But I never breathe a word of this to Harry. It almost killed him when I attempted suicide. He suffered a small stroke and aged ten years right before my eyes. When, to my surprise, I woke up alive in the hospital, I did a lot of thinking about what I had done to my family. Then and there I made some resolutions.”
“What sort of resolutions?” No real need for my question, since Thelma had been on the verge of describing the resolutions, but I had to have some exchange with her. I was getting plenty of information, but we were not making contact. We might as well have been in separate rooms.
“I resolved never to say or do anything which could possibly cause Harry pain. I resolved to give him everything, to give in to him on every issue. He wants to build a new room for his exercise equipment—O. K. He wants Mexico for vacation—O.K. He wants to meet people at church socials—O.K.”
Noticing my quizzical look about church socials, Thelma explained, “For the last three years, ever since I knew I would eventually commit suicide, I haven’t wanted to meet anyone new. New friends only mean more farewells to say and more people to hurt.”
I have worked with many people who have truly tried to kill themselves; but usually their experience is in some way transformational, and they ripen into new maturity and new wisdom. A real confrontation with death usually causes one to question with real seriousness the goals and conduct of one’s life up to then. So also with those who confront death through a fatal illness: how many people have lamented, “What a pity I had to wait till now, when my body is riddled with cancer, to know how to live!” Yet Thelma was different. Rarely have I encountered anyone who came so close to death yet learned so little from it. Those resolutions she made when she regained consciousness after her overdose: Could she really believe that she would make Harry happy by rubber-stamping his every request and keeping her own wishes and thoughts concealed? And what could be worse for Harry than for his wife to cry last week and share nothing with him? This was a woman steeped in self-deception.