Alvin obviously did not appreciate my inquiry and shook his head as I spoke. “Look, there’s a continuum from private to public. Some folks are extroverts by nature, and some simply prefer to remain private. I guess I’m just at the ‘private’ end of the continuum. I like being alone.”
There it was. In therapy lingo, resistance had made its entry. I persevered, though I knew he was digging in his heels. “Yet just a few minutes ago you talked about how comforting it was for you to speak intimately to me and to experience my interest in you.”
“That’s true, but I don’t need it all the time.”
The hour came to an end, and as we stopped, Alvin said, “I don’t think we’re getting anywhere.”
As I thought about our session, I marveled at how quickly things had changed. Until this session, Alvin and I had been allies in every way, yet now, suddenly, we seemed to be on opposing sides. No, as I thought more about what had happened, I knew that Alvin’s deep resistance wasn’t a complete surprise; I’d had a foreshadowing of it earlier when my exploration of his relationships with women had always fizzled out so quickly. I remembered his refusal to engage that question, and I recalled puzzling at his lack of curiosity about himself. In fact, a prominent lack of curiosity is generally a road sign telling a therapist that a patient may be unwilling to explore more deeply. I knew this was not going to be easy.
The struggle continued through the next session. The strength of his refusal to look at his social withdrawal convinced me that there were powerful forces in play. I’d seen many isolated, withdrawn individuals before, but rarely anyone with such competent social skills and capacity for intimacy. I was baffled. There was something odd going on.
“Let me share something, Alvin. In one of our first meetings, when you told me about your twenty-four-hour schedule, I felt some sadness for you. There seems so little warmth or human touch in your life. That somehow doesn’t fit with the Alvin I know, not with your forthrightness or your capacity for intimacy. And it doesn’t fit with the type of home life you had growing up. I know there were problems with your brother; still, you describe your parents as caring and nurturing and modeling a loving relationship and partnership. Individuals with your kind of background don’t cut themselves off from others in adulthood.”
“I’ll grant there are changes I should make, and I will get around to them.”
I kept trying to chip away, “Yet time keeps flowing on. I recall your saying that, ten years ago, when your parents died, you felt regret that they’d never seen you married or known their grandchildren. What about those regrets? And what are your regrets for yourself? Are you living the life you’ve hoped to live?”
“As I say, I will get around to making changes. But it’s not front and center for me now. Remember why I came to you. I came because of my anxiety following my brother’s death. My social life has got nothing to do with that.”
I took the last arrow out of my quiver, “I don’t agree. There’s a strong connection between the two. Let me try to explain. I’ve observed again and again that the amount of death terror experienced is closely related to the amount of life unlived. And that’s the reason that I’m trying to focus on the quality of your life now.”
As though I had hit a resonant chord, Alvin sank into deep thought for a minute, but then he responded, “Perhaps at some later time. I’m doing OK at present and feel disinclined to pursue it now.”
Analyze the resistance, analyze the resistance—that’s my mantra when I encounter such an impasse. I persisted: “During our first several hours together I was so impressed with your willingness to examine your responses to your brother’s death, and by your courage in sharing intimate aspects of your life. I had a sense of our working well together. But in these last sessions, we’ve really hit a wall. You’re balking at going further, but I’m absolutely convinced that you know there’s more to do. It’s as though you no longer trust me.”
“No, that last part’s not true.”
“Then help me understand what’s happened. At what point do you feel things changed here?”
“It’s not you, Irv; it’s me. Look, there are just some things I’m not ready to discuss.”
“I know this feels like badgering, but indulge me a bit further. Let me make one last inquiry. I have a hunch that the blockage you’re feeling is related to your relationships with women. Earlier you described your relationships as just fizzling out. I’m wondering if that had to do with the sexual aspect of those relationships.”
“No, that’s not the issue.”
“Then what is the issue?” I knew I was out of line. I was almost battering my patient, but I couldn’t stop. My curiosity was aflame and had taken on a life of its own.
To my surprise, Alvin opened the door a crack. “I meet a lot of terrific women, and the same thing happens every time. We go out, have dinner, sex is great, we like one another, and then sooner or later, after a few dates, the women come to my house. And then it ends.”
“Why? What happens?”
“Once they see my house, I never see them again.”
“Why? What do they see?” I was still clueless and feeling oddly slow on the uptake.
“They get upset. Don’t like what they see. Don’t like the way I take care of my house.”
Alvin and I both looked at the clock. We had run over a few minutes. He wanted out of the office, and I had a patient waiting. I took a risk.
“I’m really glad you’re trusting me with this. I’m going to make an unusual proposal that I think might be tremendously important for your therapy. I’d like to hold our next session at your house. Can you make it a week from today at six pm?”
Alvin took a deep breath and tried to relax. “I’m not sure. I need to think about it. Let me sleep on it and phone you tomorrow.”
“Sure, call me here between seven and ten in the morning.” That was my writing time, which I ordinarily hold inviolate. But this was really important.
At one minute past seven the next morning, Alvin called: “Irv, I can’t handle this. I was up all night stewing. I just can’t deal with your visiting me at home, and I can’t deal with more sleepless nights waiting for next week. I want to stop therapy.”
A lot of things flashed through my mind. I’d been around long enough to know that many patients require repeated courses of therapy. They do some work, make some changes, and then terminate. After therapy stops, they consolidate their gains for months or years, and then, at some future point, they return for additional, often more comprehensive work. Any mature therapist would recognize that pattern and show restraint. But I wasn’t feeling particularly mature.
“Alvin, I feel certain that you’re upset by envisioning my response to your home. Perhaps you feel a lot of shame; perhaps you worry about my feelings toward you?”
“I can’t deny that’s part of it.”
“I have a sense your thought is divided. You’ve alluded to one part, the part overwhelmed by shame. But there is also the part that wants to change. That’s the part that decided to tell me about the nature of your problem, the part that really wants to live in a different way. And that’s the part of you I want to engage. You don’t have to wait a week. Let’s meet today. What’s your schedule this morning? I could come right now.”
“No, it’s too much for me.”
“Alvin, you’re turning down an opportunity to set your life on a different, more satisfying course, and I think you’re rejecting that option because of your fears of my judging you. But you’ve already learned those fears are unfounded. And, second, let me ask you to take a cosmic perspective: you’re allowing a fear of some fleeting feeling passing through my mind to influence the entire course of your one and only life. Does that make sense?”
“Okay, Irv, you’re wearing me down. But I can’t do it now. I’m just leaving for work, and I’m scheduled wall-to-wall today.”
br />
“What time are you done?”
“About seven this evening.”
“How about I come over at seven thirty for a session?”
“Are you sure this is the right thing?”
“Trust me. I’m sure.”
Promptly at seven thirty, I arrived at his attractive small home in Sunnyvale, a few miles from my Palo Alto office. The front door was ajar, and scotch-taped to it was a note that read, “Come right in.” I rang the doorbell and entered. At the far end of the living room, in a large lounge chair, Alvin sat facing a window. I could see only the back of his head. He did not turn toward me.
I wanted to go to Alvin, but I wasn’t sure how to reach him. I could not see more than a few, very small sections of bare floor. The remainder of its surface was covered entirely by tall stacks of old telephone books—where had he gotten them all?—large art books, books of train schedules, stacks of yellowed newspapers, and piles of old science fiction books. I love science fiction and restrained myself from sitting down on a New York Times tumulus to start browsing. The only places I could see the hardwood floor were narrow, perhaps ten-inch-wide trails, one leading to the adjoining kitchen, another to Alvin’s chair, and a third to a large sofa covered with more dusty books and heaps of old x-ray films and medical charts.
The year was 1982, and hoarding had yet appeared as a familiar topic in psychiatry or on daytime television. I had never before seen or imagined anything like the inside of Alvin’s home. Feeling too overcome to manage a foray into other rooms, I cautiously weaved my way over to the chair nearest Alvin and sat down, facing his back.
“Alvin,” I spoke loudly, the chairs being fifteen feet apart, “thank you for meeting with me here. It is important that you’ve allowed me to see your home, and I feel now, more than ever, that we need to continue to meet. I know how hard this is for you, and I appreciate your allowing me into your life and your home.”
Alvin nodded but remained silent.
I was at a loss for words. I knew that eventually we would attempt to understand the hoarding by working on its meaning and its genesis, but at this moment, it was imperative that we examine our relationship, now roiling with humiliation and anger.
“Alvin, I’m so sorry to put you through this, but there is no other way. We have to face this together. I know this is hard for you, but it’s a big step forward—a huge step—and we need to talk it through. I’m wondering if there’s a place where we can sit closer to talk.”
Alvin shook his head.
“Or perhaps we can stroll around the block?”
“Not now, Irv, this is all I can do today, and I want to stop.”
“Well then, tomorrow. Can you make it at this same time, seven thirty, tomorrow evening, in my office?”
Alvin nodded. “I’ll phone you first thing in the morning.”
I sat for a few more minutes in silence and then left.
The next morning, Alvin phoned. I was not surprised by his words, “Irv, I’m sorry, but I simply can’t make it. Don’t think I don’t appreciate what you’ve done, but I can’t meet again. At least not now.”
“Alvin, I know I’ve pushed you hard—too hard perhaps—but look at what we’ve done. We’re on the brink of something crucial.”
“Nope. Not now. We’re done. Perhaps I’ll call you in the future. For now I can deal with it on my own. I’ll start to organize my home.”
I closed Alvin’s folder. Since that visit to his house I had not seen him or heard from him until the previous day at Molly’s funeral. And what was he doing there anyway? What was his connection with Molly? I recall that for some time after our last visit I thought about Alvin and wondered about what had happened to him, and while walking through the corridors or sitting in the hospital cafeteria, I scanned my surroundings looking for him. I remember, also, following my last session with him, speaking at some length with an old and close friend, also a psychiatrist, to help me deal with my own dismay at having so badly bungled a case. But now, after our meeting at Molly’s memorial yesterday, I had to reconsider. Had I bungled it? Alvin looked great and had two children and a lovely wife, who told me that I was responsible for their marriage. How had that all come about? I must have been more effective than I thought. My curiosity once again was aflame.
***
We met for coffee at a small café near the hospital, taking a corner table for privacy.
“Sorry,” I began, “that I was a bit slow to recognize you. As I mentioned, aging has taken its toll on my facial recognition. But don’t think I haven’t thought about you, Alvin. I’ve often wondered about how you’ve fared, especially since I thought our work together ended prematurely, leaving you with problems still to work on. I’d love a follow-up. You know, I think I didn’t recognize you at first yesterday because I hadn’t expected to see you at Molly’s funeral. How did you know Molly?”
A look of surprise appeared on Alvin’s face. “Don’t you remember? A day or two after our last session you called and gave me her name and suggested I contact her to help me get my house back in order.”
“Oh, my, I had entirely forgotten that. And you did contact her?”
Alvin nodded vigorously. “Oh yes. You mean, she never mentioned me to you?”
“She wouldn’t. She had her honor code: she was tight-lipped as a clam about identifying her clients. But I referred you to her over thirty years ago. You still remember her from back then?”
“No, that’s not quite it. What happened is that I called Molly immediately, and she took over. I mean took over completely. In a few days my house was neater than it had ever been, and she has taken care of my house and my bills, my taxes, and all my affairs ever since. I was her client right up till her death. I’ve often told Monica how grateful I am to you. You turned my life around. You gave me so much. But, most of all, you gave me Molly. All these years, the past thirty years, she’s come to my house once a week without fail and taken care of everything until just a couple of months ago, when she grew too ill. She was the best thing that ever came my way—except, of course, for Monica and my two wonderful children.”
After our conversation, my mind swirled with thoughts about the impossibility of ever learning how psychotherapy works. We therapists strive so fervently for precision in our work and aspire to be fine-tuned empiricists, trying to offer precise fixes for the broken elements in our patients’ attachment history or DNA sequences. Yet the realities of our work do not fit that model, and often we find ourselves improvising as we and our patients stumble together on the journey toward recovery. I used to be unnerved by that, but now, in my golden years, I whistle softly to myself as I marvel at the complexities and unpredictability of human thought and behavior. Now, rather than being rattled by uncertainty, I realize that it is pure hubris to posit specificity. Now, the one thing I’ve come to know with certainty is that if I can create a genuine and caring environment, my patients will find the help they need, often in marvelous ways I could never have predicted or even imagined. Thank you, Molly.
~ 5 ~
Don’t Fence Me In
Dear Dr. Yalom
I’m a seventy-seven year old (former) CEO and a year ago I moved into a retirement home in Georgia. Nice place but it’s not working out: I’m having severe and persistent adjustment problems. I’ve been seeing a therapist for the past year but our work has recently bogged down. Can you see me in consultation? I’m willing to fly to California at any time.
Rick Evans
Three weeks later Rick Evans strode confidently into my office appearing as though he had been there often. He looked the way I think a retired CEO should look: lean, attractive, relaxed. With his bronze golfer’s tan, his regal posture, his masterfully chiseled nose and chin, I could picture him on the brochure cover for any upscale retirement community. And his thick shock of straight, neatly parted, gleaming white hair was a wonder to be
hold. I ran my hand dolefully over my own balding scalp. Though I couldn’t catch his glance full on, I liked his intense yet slightly plaintive eyes.
Rick wasted no time, speaking even as he was taking his seat. “That book of yours, Staring at the Sun: Overcoming the Terror of Death is strong, very strong. Especially for someone my age. That book is why I’m here.”
He glanced at his watch as though checking that we were starting on time. “Let me get right to the point. As I mentioned in my email, I moved into Fairlawn Oaks a year ago. After my wife died, I first tried to make a go of it at my home. Tried like hell for eighteen months, but couldn’t do it, not even with a lot of household help. Just too damn much hassle with all the shopping, the cooking, the cleaning. And it was too damn lonely. So I made the move. But it’s not working out. Not that I’m knocking Fairlawn Oaks. The home is great. But I’m just not adapting.”
I was struck by all Rick had not done. He had not looked around at my office—not even for an instant—nor had he made any social gesture of greeting. He had come all the way across the country to see me and yet had not once cast his eyes in my direction. Perhaps he was more anxious than he appeared. Perhaps he was entirely task-oriented and intent only on making the most efficient use of his time. I’d get back to all that later. For now, I encouraged him to continue his story.
“Not adapting how?”
He flicked off my inquiry with a twitch of his wrist. “I’ll tell you about that. But first I want to say something about the therapist I’ve been seeing for a year and a half. She’s a good lady. She helped with my grief, no question about it. She got me up from the floor, sponged me off, and back into the ring, back into the world. But now we’ve stalled. Not blaming her, but in our therapy hours we’re wasting time and money, though she doesn’t charge your high-end rates. We’re just going around in a circle, covering the same stuff over and over again. Then, after reading your book, I read some of your others, too, and suddenly had the thought that a consultation with you could give my therapy a jump-start.” Even here he didn’t look at me. This felt odd, as he certainly was not a shy man. He just plowed right ahead. “Now, I know therapists are possessive and touchy about that sort of thing, so I decided to run it by her in a diplomatic fashion. Don’t get me wrong: I wasn’t asking her permission. I was going to contact you whatever she said. Turned out she was very positive. She grabbed at the thought: ‘Sure, sure, good idea. Contact him for a consultation. I’d welcome that. California’s a long way off, but what better use for your time and money?’ She offered to write you a note describing our therapy work, but I felt a bit miffed and told her I was a big boy and I could take care of filling you in.”