Creatures of a Day: And Other Tales of Psychotherapy (7 page)

“Interesting,” I said. “I suspect that Ralph’s face remains so clearly etched in your memory because it’s linked to some strong subterranean thoughts about death.”

Alvin nodded. “Hard to argue with that. I’m sure that is so. In Sunday school, the grown-ups talked of heaven, and I remember asking Dad about it. He dismissed the thought. He called it a fairy tale. He was a materialist—like most physicians, I think. His view was that when the brain goes, the mind goes, and along with it all awareness and perception, everything. Death is simply ‘lights out.’ You agree?”

I nodded. “I’m with your dad on that: I can’t imagine a disembodied consciousness.”

We sat in silence for a while. It was a good moment. I felt close to Alvin. “What did your dad’s answer mean to you? Did it diminish your anxiety about death?”

“No, it offered no solace. The idea of everything ending, or at least ending for me, was something I just couldn’t get my mind around.”

Alvin and I worked through these issues for several sessions. We reviewed them from different angles, we considered additional confirmatory memories, we explored some new, relevant dreams, and we solidified our gains. Gradually, however, therapy began to slow down. I always think therapy is working well when patients take risks each session, but Alvin took no further risks, and we broke no new ground. Soon, right on schedule, Alvin began to question what we were doing.

“I’m puzzled about your approach. I’m losing sight of exactly where we’re going. Are we trying to help eliminate my death anxiety? After all, don’t we all dread death? Don’t you?”

“Of course I do. The fear of death is hardwired into all of us. It enables us to survive. Those who were wired without that trait were winnowed out eons ago. So, no, I’m not aiming at removing fear, but for you, Alvin, that fear has morphed into something greater, into a terror that haunts you in your recurring nightmares and intrudes into your daily work. Am I right?”

“Well, not exactly. I’m noticing that I am changing a bit. Maybe I’m better. No more nightmares; I’m OK at work now; I rarely think of Jason anymore. So what next? I wonder if we’re about finished?”

That question arises often in therapy when symptoms diminish and patients regain their previous equilibrium. Is it really time to stop? Is it enough simply to remove the symptoms? Or should we reach for more? Should we not try to alter the patient’s underlying character and lifestyle that have given birth to these symptoms? I tried to be tactful as I gently guided Alvin toward further exploration: “Ultimately, Alvin, the decision as to whether you’re finished and ready to stop rests with you. But I think we shouldn’t fail to take a closer look at what’s helped you to improve. If we can identify the helpful factors, you may be able to call upon them in the future.”

“What’s helped? Tough question. For sure, something about
talking to you has helped. But how? I’d be only guessing
. Maybe just getting things out, revealing some things for the first time. For sure, knowing you were genuinely interested helped me. I haven’t had that feeling with anyone since my dad died.”

“Yes, I sensed that. And I felt that you took some real risks and made good use of our time together.” So far, so good, I thought, and then attempted to go further. “But now I think we’re ready to do more. I think it’s important to explore why you’ve arranged your life in the way you have. You have good social skills, you seem comfortable in your skin, and you say you benefit from the intimacy with me. So my question is, why have you backed away from the possibility of intimacy with others? What’s the payoff in living in such isolation?”

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 to
morrow
.”

“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
.”

“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.”