Rachel’s boyfriend could not believe that he was enough for her, that she actually was satisfied by him and with him. He needed her reassurance and he needed her to faithfully pick up the phone when he called. In my formulation, he was endeavoring to stave off debilitating feelings of inferiority that surfaced immediately when she was unavailable, feeding the need to cling to her all the more tightly. Right away, as if regressed to a childhood place, he imagined her with another lover. Rachel’s spontaneous cry, “What are you, twelve years old?” was off, in my view, by six or seven years.

That I was resorting to my own discursive thinking was an irony not lost on me. My advice to Beth, however well intentioned, was not able to conclusively penetrate the mental walls she had erected.

Loyalty to her mother has made Rebecca distance herself from her need for her father. Her sadness has become a secret even to herself.

But, as important as it is to understand the sources and details of one’s pain, understanding is rarely enough. My patients come to therapy wanting the burden of their accumulated experience lifted. Yes, they want to make sense of their lives, but that is not usually their fundamental or exclusive aim. First and foremost, they are trying to get over their accumulated trauma in order to feel less fearful, isolated, forlorn, helpless, alone, anxious, or depressed. They might not be able to say it so clearly, but they are reaching for things

beyond thought, trying to make contact with essential capacities that have been sacrificed in their efforts to adapt, adjust, comply, cope, or conform.

Jean had no doubts about who she was. Not only was she wrong to have written the forbidden prescriptions, she couldn’t even focus on her medical records. Nothing was working out the way she hoped. The fan in her life was definitely broken. Were I to focus

only on what was broken, I would be pulled into her suffering instead of pointing the way out. I wanted more uncertainty for Jean, more of that Zen doubt. Whatever conclusion she aggressively threw at me, I parried it back at her until we reached a truce. Surrender was Jean’s rhinoceros. It went against everything she thought.