I, as did Jessica, now like Otto a great deal more than I did when Don presented his first session with Otto. This must mean that Don also liked Otto a great deal more because Jessica and I are resonating with Don's affect as he presents the second installment. I suspect that much went on in the relationship between Don and Otto while Otto was in the hospital. Otto must have felt helped, and it appears that he's had darn little help from others in his life, although I suspect we are going to find out about some childhood relationship that worked for him--maybe a grandmother or family friend--but more on that later. Otto seems to have dropped his defenses enough to allow an emotional connection with Don to take place. Don's presentation of the facts in this second installment has a much less rigid feel to it. Perhaps this is because Otto now feels more relaxed and trusting. Otto has dropped his shame-protective macho defense fairly rapidly, something that I have only seen in situations where the intensity of the affect(s) involved have made the person feel that everything has been exposed. Otto feels, for the moment, that he has nothing to hide from Don, and the man underneath the macho seems to be a rather nice fellow. Now we are hearing heart-felt facts about the person flowing from Otto rather than some formal litany of details. Furthermore, I also agree with Jessica that the intensity of the crisis faced by Otto with the simultaneous weakening of his defenses has propelled him into a new kind of relationship, one that, in the long run, may cause this episode to be the best thing that ever happened to Otto. Right now, he wants therapy in the worst way. I would not be surprised, however, if the macho defense returned and caused him to push Don away because Otto's therapy is going to expose him to a great deal of shame that he will have difficulty handling if Don is not on his toes and quite careful with him.
Everyone reading this response needs to know that Don and I have shared our interpretation and understanding of proverbs for many years.(And also that Don and I have a pact not to discuss this case in any fashion outside of this marvelous forum on Behavior Online.) I am, therefore, as startled and delighted as Don apparently was to hear Otto's interpretation of "a rolling stone gathers no moss." I was certain that this man's biography would cause him to find emotional intimacy to be disgusting, i.e., moss=dirty, bad, undesirable stuff and one should keep moving to avoid growing it. When I read of his interpretation, I was less suspicious of and worried about the rapid development of his relationship with Don because I believe he must have had a helpful, trusting, emotionally connected relationship with someone in his early life. I would, of course, be on the alert to find out who that person was and what Otto's relationship with her or him was like. This would provide the essentials of knowing how to summon positive interaffectivity (transference) with Otto during the difficult times in the therapy.
Otto's crisis reminds me of a wonderful episode of Star Trek, The Next Generation. Commander Data is an android who is without affect. (Not really because the directors mess things up from time to time and Data acts interested in things.) However, in this one episode Data has an "affect" chip installed in his positronic brain. Soon he begins wildly laughing at jokes heard years before because he suddenly "gets" them, but he is unable to control the laughter. He becomes terrified by several events which he normally would have handled without fear and then he is unable to control the fear and begs to be deactivated until the affect chip is removed. Before Otto heard what had happened to Sally, he was overloaded with what Tomkins calls "backed-up" affect but it was under control. Otto had every reason to learn not to express affect because of how dangerous it was for him as a child and because of how much he hated what his mother and father did to him. All he ever saw was affect out-of-control and used to destroy others. When this incident occurred in his current life, Otto's defenses broke down and, much like Commander Data, he was almost completely naive as to how to cope with it. It is not surprising that he had a psychotic episode faced with this flood of affect--a flood enhanced by his current affect triggering so much unresolved affect from memory--Don "deactivated" him momentarily by hospitalizing him after medication did not work.
Having already gone on too long, I will just add a bit on Don's report about Sally. She too seems disconnected from her affect. An "overly made up bleached blond" acting like a "shy little girl" is usually someone who is difficult to relate to, someone that one feels is either not in tune with their inmost self or is heavily disguising it from others. It is not a surprise that this is who Otto has picked as a girlfriend. I wonder if she is more a "trophy" because of her good looks than someone with whom he is interested in a long term relationship. Where I so often get people into couples therapy as early as possible, I would be hesitant to do so here until I learn something about Sally that tells me she is willing and able to seek a more intensive level of emotional intimacy. Of course, it is not clear that Otto is as yet ready for this either, but at least we have the feeling that Otto and Don are really beginning to get to know one another. This should bode well for what happens next.