My work with Dr. Payne can be divided into two segments, the first of which will be presented in this post, and the follow-up in the next. As most of you have noticed, Dr. Payne lived in a personal world that was more cognitive than affective. He could think quickly, assess information of great complexity, plan therapeutic strategy with ease. But at no time was he comfortable with his own emotions or with the intense feelings of those he helped so well in therapy. We came to "joke" about the "circuit breaker" or fuse that blew every time the intensity of his emotions threatened to rise about some pre-set level neither of us ever understood. My report on this case is being written nearly 15 years after our first encounter, and he still works the same way—Harold will pile work on work, responsibility on responsibility, for several weeks or months, and then go away to a resort for a few days. There he will play golf, imbibe great expensive wines, live as he feels his hard work entitles him, and then return to the same sort of schedule.
Things were rocky for the first three months after we began to work at a twice-a-week pace. He came to understand the two unacceptable choices facing him. The thought of leaving the structure represented by his wife and children triggered intense guilt and shame, whereas the thought of leaving the lover who provided more warmth than he had ever known triggered intense distress. We began to get the idea that he expected marriage to be something like a suit of clothes into which he stepped to do his work, a role to be assumed rather than a dynamic relationship. His concept of the work of marriage had more to do with his role as a provider than the need for him to be a real person with real feelings who dealt with the feelings of his wife and children.
Complicating this script were the actual personalities of the women with whom he had become involved. In one powerful session he said: "For centuries, people have been assigned a spouse by their families or a marriage broker. I took for granted that any two adults could make a marriage work, but I did not take into consideration the idea that both of them had to know something about negotiating with each other." His wife (who I met on several occasions as we tried to work in couples therapy) believed similarly that the work of marriage had nothing to do with pleasure or fun, but only with the tasks associated with home and hearth. Like Harold, Martie could feel neither her own emotions nor those of her husband. Eventually, all three of their sons developed a relationship with a psychotherapist who became their primary source of nurturance, what Kohut called a selfobject relationship. Harold could figure out the meaning and derivation of nearly everything he learned about a patient in therapy, even though little affected him deeply enough to make him feel the other person's discomfort. In therapy as in his marriage, he painted by numbers.
On the other hand, Meg, his paramour, was not only nurturant, but a mind reader. With uncanny accuracy, she was able to discern his unspoken needs and figure out how to solve them, much as Harold was able to solve the "problems" of those who consulted him for treatment. In her company, Harold felt simply wonderful, even though he could not "understand" why. One woman demanded of him only that he fulfil her role expectations, while the other asked nothing more than that he validate her sense of herself as a caregiver. In neither relationship did he deal with his own feelings, and what he learned from neither woman helped him decide how to resolve his dilemma.
Therapy progressed, or at least continued. In a previous post about Harold, I mentioned that a few years earlier he had seen a number of physicians for a series of medical complaints involving heart and gut, all of which turned out to be "psychosomatic." In one session he talked about the emotional climate of his house during the period that he was so sick, and came to the realization that Martie had at that time been particularly cold and emotionally unavailable. It was six months after his recovery from the "medical" disease of the heart that he and Meg began the involvement that eventually ripened into a love affair. In a session only two weeks after that disclosure, Harold mentioned in an almost off-handed manner that he had been 9 years old when the last of his brothers left the family home to get married, an event to which he had responded with great sadness accompanying a sense of isolation. The departure of his last brother altered his relationship with his mother, who now turned to him as the most important source of joy in her life. Swiftly, we began to understand that the act of leaving Martie was analogous to his wish to leave a mother who "was all over" him, a wish conflicted by the perceived need to help father by "taking care of her." In his adult life, Harold is useful, clever, and highly intelligent, even though nobody gets more than a little piece of him.
As this phase of our therapy continued, it became clear that Meg was the only source of empathic relatedness in his life, and that Martie represented a continuation of his life with his mother. Slowly, inexorably, he moved away from Meg and toward Martie, almost as if he felt far safer when he could remain free from love. Although Meg continued to work for him, their love affair was terminated. Harold moved from the small apartment he had taken on the block where his office is situated, returned to his wife, and for a period of time both Martie and Harold came to see me for couples therapy. One interesting convention of this marriage was Martie's complete disavowal of all evidence that her husband might be involved with someone else, and Harold's absolute refusal to tell her about his affair.
There were, of course, two Marties—the one Harold saw and the one Martie experienced. The three of us noted that she was nearly incapable of admitting any emotional discomfort and thereby allowing another person to assist her. Rather, she would clam up (Harold said that this behavior "drives me wild") or get angry at one of the children. Harold's characterologic need to keep everything calm drove her similarly "wild." In a subsequent session Martie was unable to attend, Harold noted that of his five brothers, four had married "shrews." Unwilling to participate in any form of therapy that focused on her emotions or his reaction to them, Martie dropped out of treatment. Now Harold began to tell stories about her "clenched anger," as if suddenly it was visible to him. He began to deal differently with her anger (which actually was little more than the only method she knew to resolve any unpleasant emotion) and (to her great surprise) actually himself got angry at one of the children (rather than protect them from her anger). And to Harold's great surprise, Martie supported, rather than undermine, him. Now she returned to couple therapy.
As things improved more and more with Martie, Harold struggled with his wish to do the honorable thing and tell Meg what was happening. It took some weeks for him to do this, and when he did, she "gave up" and resigned her position in his office. Harold missed the next few sessions and for a short time could only work with me on the telephone; we learned that he regarded my consultation room as the place that had caused him to lose Meg. In Meg's name he made it increasingly difficult for Martie to get close to him. For one of the psychotherapy sessions he missed, he told me he had gone out to play golf and said "This makes me feel better than therapy."
His condition worsened steadily as he drifted more and more into a clinical depression. Medication helped a little, although he developed a sleep disturbance and became almost unable to work. Crushing fatigue assaulted him daily. Finally he was able to say that he felt most secure when he could have Martie and the boys in one house, and Meg available to him in another. Over the period of the next full year in therapy, Harold drifted back and forth between these two poles of his emotional existence. Miserably sick with the sadness associated with his separation from Meg, miserably unhappy with Martie's tight rein on her own emotions, and able to feel competent only in his own office, his life was simply awful. Slowly, quietly, he encouraged Meg to come back into his office, then into their love relationship, and (after he announced to Martie that he was moving out) into their own apartment.
Asked to describe how he felt around Meg, he talked of "fresh, clean, cool Autumn air, fresh coffee, fresh tomatoes, cucumbers and herring" as the symbols of everything that could represent contentment to him. And yet, all of this happiness was counterbalanced by his guilt that his departure from the home he and Martie had built was causing an equal amount of discontent for his children. Now he told his children that he was involved with Meg (who, of course, knew and loved her from the office) and found to his surprise that they were happy for him. It became clear to both Harold and me that no amount of "understanding" of his situation would provide an adequate "reason" to go through the horror of a divorce. After a year of this ambivalence, Meg found her own apartment, and he was left to contemplate life at neither pole.
It was soon after this that I made a move unlike anything I had ever done before in psychotherapy. Recognizing that he loved Meg, had no relationship with Martie, felt little or no residual connection to the house where Martie and the boys lived, and was truly paralyzed, I considered the possibility that only dynamite might shift him in one direction or the other. In the discipline I represent, dynamite is a metaphor for intense affect, and I developed a strategy that might do the job.
In one session in the 5th year of our work, when nothing else seemed to be going on but his complaints about how things were stuck, I took out a 3 X 5 card on which I had scribbled a few notations. "On this card," I told Harold, "I have written the names of the five single men to whom I am going to give Meg's telephone number. Each of them is a successful businessman who has been in enough therapy that I can guarantee their stability, and all of them are fine people I am sure both you and she might like." "You bastard," he said with a smile. "You really do mean that, don't you? You really do have five names on that card." He paused for a moment and said "OK. Its over." Laughing, he left the session to propose marriage to Meg. They did marry, now have a little girl, and have become one of the best loved couples in their network. Harold's practice of psychotherapy has changed greatly as he has become very interested in the emotional world of his patients, in his own emotional reaction to them, and in new areas of our field. These many years later, Meg tells me that she is still laughing about the day I pretended to give Harold those five names, and that any time "Harold starts to become impossible," she reminds him that I probably still have the 3 X 5 card.