red pencil a paragraph that claimed that suicides are, in actuality, double homicides.
“I saw that in last Sunday’s paper. Could that have been true for me? Maybe when I tried to commit suicide, I really wanted to kill Matthew? You know, it feels right. Right here.” She pointed to her heart. “I never thought of it that way before!”
I fought to keep my equilibrium. Naturally, I was concerned about her depression. And yet, of course, she was in despair. How could it be otherwise? Only the deepest despair could have generated an illusion with the strength and the tenacity to have endured for eight years. And if I eradicated the illusion, then I had to be prepared to encounter the despair it had concealed. So, bad as it was, Thelma’s distress was a good sign, a homing signal that we were on target. Everything was going well. The preparation was finally complete, and the real therapy could now begin.
In fact, it had already begun! Thelma’s surprising outbursts, her sudden eruption of anger toward Matthew was a sign that the old defenses were no longer holding. She was in a fluid state. Every severely obsessional patient has a core of anger, and I was not unprepared for its emergence in Thelma. All in all, I considered her anger, despite its irrational components, an excellent development.
I was so preoccupied with these thoughts and with plans for our future work that I missed the first part of Thelma’s next comment—but I heard the ending of the sentence all too clearly.
“ . . . and that’s why I have to stop therapy!”
I scrambled to respond. “Thelma, how can you even consider that? This is the worst possible time to stop therapy. Now is the time you can make some real progress.”
“I don’t want to be in therapy any more. I’ve been a patient for twenty years, and I’m tired of being treated like a patient. Matthew treated me like a patient, not a friend. You treat me like a patient. I want to be like everyone else.”
I no longer remember the sequence of my words. I only know that I pulled out all stops and placed the utmost pressure on her to reconsider. I reminded her of the six-month commitment, of which five weeks remained.
But she countered, “Even you would agree that that there’s a time when you have to protect yourself. A little more of this ‘treatment’ would be unendurable.” She added, with a grim smile, “A little more treatment would kill the patient.”
All of my arguments met a similar fate. I insisted that we had made real progress. I reminded her that she had originally come to see me to free her mind from her preoccupation, and we had made great strides toward that. Now was the time we could address the underlying sense of emptiness and futility that had fueled the obsession.
Her response was, in effect, that her losses had been too great—more than she could bear. She had lost her hope for the future (by that she meant she had lost her “one-percent chance” of reconciliation); she had also lost the best twenty-seven days of her life (if, as I had shown her, they weren’t “real,” then she had lost this sustaining memory of her life’s highest point); and she had also lost eight years of sacrifice (if she had been protecting an illusion, then her sacrifice had been meaningless).
So powerful were Thelma’s words that I found no effective way to counter them, other than to acknowledge her losses and say that there was much mourning that she had to do and that I wanted to be with her to help her mourn. I tried, also, to point out that regret was extraordinarily painful to endure once it was in place, but that we could do much to prevent further regret from taking root. For example, consider the decision facing her at this moment: Would she not—a month, a year from now—deeply regret her decision to stop treatment?
Thelma replied that, though I was probably right, she had made a promise to herself to stop therapy. She compared our three-way session to a
“I saw that in last Sunday’s paper. Could that have been true for me? Maybe when I tried to commit suicide, I really wanted to kill Matthew? You know, it feels right. Right here.” She pointed to her heart. “I never thought of it that way before!”
I fought to keep my equilibrium. Naturally, I was concerned about her depression. And yet, of course, she was in despair. How could it be otherwise? Only the deepest despair could have generated an illusion with the strength and the tenacity to have endured for eight years. And if I eradicated the illusion, then I had to be prepared to encounter the despair it had concealed. So, bad as it was, Thelma’s distress was a good sign, a homing signal that we were on target. Everything was going well. The preparation was finally complete, and the real therapy could now begin.
In fact, it had already begun! Thelma’s surprising outbursts, her sudden eruption of anger toward Matthew was a sign that the old defenses were no longer holding. She was in a fluid state. Every severely obsessional patient has a core of anger, and I was not unprepared for its emergence in Thelma. All in all, I considered her anger, despite its irrational components, an excellent development.
I was so preoccupied with these thoughts and with plans for our future work that I missed the first part of Thelma’s next comment—but I heard the ending of the sentence all too clearly.
“ . . . and that’s why I have to stop therapy!”
I scrambled to respond. “Thelma, how can you even consider that? This is the worst possible time to stop therapy. Now is the time you can make some real progress.”
“I don’t want to be in therapy any more. I’ve been a patient for twenty years, and I’m tired of being treated like a patient. Matthew treated me like a patient, not a friend. You treat me like a patient. I want to be like everyone else.”
I no longer remember the sequence of my words. I only know that I pulled out all stops and placed the utmost pressure on her to reconsider. I reminded her of the six-month commitment, of which five weeks remained.
But she countered, “Even you would agree that that there’s a time when you have to protect yourself. A little more of this ‘treatment’ would be unendurable.” She added, with a grim smile, “A little more treatment would kill the patient.”
All of my arguments met a similar fate. I insisted that we had made real progress. I reminded her that she had originally come to see me to free her mind from her preoccupation, and we had made great strides toward that. Now was the time we could address the underlying sense of emptiness and futility that had fueled the obsession.
Her response was, in effect, that her losses had been too great—more than she could bear. She had lost her hope for the future (by that she meant she had lost her “one-percent chance” of reconciliation); she had also lost the best twenty-seven days of her life (if, as I had shown her, they weren’t “real,” then she had lost this sustaining memory of her life’s highest point); and she had also lost eight years of sacrifice (if she had been protecting an illusion, then her sacrifice had been meaningless).
So powerful were Thelma’s words that I found no effective way to counter them, other than to acknowledge her losses and say that there was much mourning that she had to do and that I wanted to be with her to help her mourn. I tried, also, to point out that regret was extraordinarily painful to endure once it was in place, but that we could do much to prevent further regret from taking root. For example, consider the decision facing her at this moment: Would she not—a month, a year from now—deeply regret her decision to stop treatment?
Thelma replied that, though I was probably right, she had made a promise to herself to stop therapy. She compared our three-way session to a
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