Seven Advanced Lessons in the Therapy of Grief
Long ago Earl, my friend of many years, phoned to tell me that his closest friend, Jack, had just been diagnosed with a malignant, inoperable brain tumor. Before I could commiserate, he said, “Look, Irv, I’m not calling for me—but for someone else. A favor—something really important to me. Look, will you treat Jack’s wife, Irene? Jack’s going to die an ugly death—perhaps the hardest death life can deal. It doesn’t help matters that Irene is a surgeon: she’ll know too much, and it’ll be agonizing for her to stand and watch helplessly as his cancer eats away his brain. And then she’ll be left with a young daughter and a full practice. Her future’s a nightmare.”
As I listened to Earl’s request, I wanted to help. I wanted to give everything he asked. But there were problems. Good therapy requires crisp boundaries, and I knew both Jack and Irene. Not well, it’s true, but we’d been at a couple of dinner parties together at Earl’s home. I had also once watched a Super Bowl game with Jack and played tennis with him a few times.
All of this I told Earl and wound up, “Treating someone you know socially never fails to get messy. The best way for me to help is to find the best referral—someone who doesn’t know the family.”
“I knew you’d say that,” he replied. “I prepared Irene for that answer. I’ve been over it with her again and again, but she won’t see anyone else. She’s pretty strong-willed, and though in general she has little respect for the field of psychiatry, she’s got a fix on you. She says she’s followed your work and is convinced, God knows why, you’re the only psychiatrist smart enough for her.”
“Let me sleep on it. I’ll call you back tomorrow.”
What to do? On the one hand, friendship called: Earl and I had never refused each other anything. But the potential boundary leakage made me queasy. Earl and his wife, Emily, were two of my closest confidants. And Emily, in turn, was Irene’s closest friend. I could imagine the two of them in a tête-à-tête talking about me. Yes, no question: I heard alarm signals ringing. But I turned the volume knob way down. I would extract a pledge from both Irene and Emily to build a wall of silence around therapy. Tricky and complex. But if I were as smart as she thought I was, I could handle it.
After I hung up I wondered why I was so willing to ignore the alarm signals. I realized that Earl’s request at this particular juncture of my life seemed fateful. A colleague and I had just finished three years of empirical research on spousal bereavement, studying eighty men and women who had recently become widows and widowers. I had interviewed each at length and treated all of them in brief eight-person therapy groups. Our research team had followed their progress for a year, collected a mountain of information, and published several papers in professional journals. I had become persuaded that few people knew more than I about the subject. As a bereavement hotshot, how could I, in good conscience, withhold myself from Irene?
Besides, she had said the magic words—that I was the only one smart enough to treat her. The perfect plug for my socket of vanity.