I admire Don's patience, tenacity, and consistent support of Harold for five years. Some clients need this long-term, absolutely reliable relationship before they can muster the courage to change their lives.
Although Don's "dynamite" effectively broke the impasse with Harold by provoking a choice, I wonder how much deep, positive, cognitive and affective change has taken place within him. Harold seems to have jumped--from exploiting two women, seeing a home as merely a family warehouse, and unable to empathize with his patients--to becoming a happy husband and caring therapist. Perhaps a lot has happened in therapy that has not been described, but the impression is given that after a long period of treading water, and a nose-dive into clinical depression, a magical intervention produced a rapid, miraculous psychological conversion.
Dramatic breakthroughs can set the stage for significant change, but they are only the beginning of a movement that needs to be vigrously stimlulated by cognitive, affective, and behavioral strategies that move fluidly between support, encouragement, insight, and challenge. From an Adlerian perspective, core personality change takes place when the hidden, fictional, final goal has been revealed and gradually modified or (ideally) dissolved. Symptom reduction and behavioral change may be signs of this progress, or they may simply signify a shift in the client's strategy (without a change in the goal).
Has Harold's earlier tendency to punish women been completely overcome? (He did use one against the other, repeatedly.) For a while, it looked like his underlying motive was not to move completely "toward" either woman, but only, alternately, to move "away" from each of them. Was he trying to compensate for his childhood feeling of being confused and trapped by a pampering but abusive mother, by choosing two women who represented those two sides of his mother? He could then luxuriate in Meg's warm indulgence, and repeatedly prove that he could get away from, and punish, the cold and angry Martie. Eventually, he then turned on Meg when he "tried" to make it work with Martie.
(Harold's depression could have been a period of self-punishment: a post-payment for the chronic punishment of Meg through his ambivalence; and a prepayment for the planned ultimate punishment of Martie--leaving her, after raising her hopes for a reconciliation.)
As a Classical Adlerian, I might have elected to challenge Harold earlier in treatment with a series of Socratic questions designed to stimulate his thinking about the purpose of his behavior and symptoms. I would have encouraged him to examine his motives and his impact on Martie and Meg--then compare these conclusions with his childhood wishes and fantasies that may be embedded in his earliest recollections.
When confronted with Don's list of names, Harold may have awakened to the "cost/benefit ratio" of his behavior and symptoms, prompting him to act rapidly and avoid the risk of losing Meg completely. I did not see a clear progression of Harold's insight, cooperation, and caring that would have convincingly prepared him for a healthier relationship with Meg. The fact that she still has to bring up the 3x5 card, even in humor, when he "starts to become impossible," suggests that Harold may not have fully overcome his old indulgent and aggressive tendencies--he may have learned how to act the right role to get what he wants, and exercise enough behavioral control to avoid major conflict or loss. I am concerned that he might be tempted to punish Meg, if she were to stop indulging him.
It would be fascinating to examine Meg's style of life, especially to discover how her fictional, final goal meshes with Harold's. We might find some hidden agenda that runs parallel to her desire to be "validated as a care giver." Or, has Meg's love and devotion transformed Harold into a more fully functioning human being?
Don, I'd appreciate gaining a deeper insight into your work. Generally, what is your main goal in treament, and specifically, to what extent did you achieve it with Harold? Are there stages or landmarks in your approach to psychotherapy? How did Harold develop his new empathy for clients?