This is an unedited
transcription of a demonstration of various stages of individual
adult psychotherapy. It was presented at the Cape Cod Seminars in
June of 1997. Henry T. Stein, Ph.D. worked with Martha E. Edwards,
Ph.D. who played her client. This material is protected by copyright
and may not be reproduced, in whole or part, without the expressed
consent of Dr. Stein.
explanation) We’re assuming now that I met Liz in the waiting
room and (inaudible) and I’m just sitting down at this point.
Whoever -- that, diagnostically, that would have been very important
because the initial greeting of a client in the waiting room,
according to Adler, the person cannot avoid revealing their life
style in the initial greeting. So if you’re sensitive to how
you interpret that, that’s the first clue you have -- actually,
the second. The first clue is the telephone call, where life style
issues begin to emerge. The greeting is the next one. The third
thing is as we walk down to the office, I would be observing how
she’s (inaudible) walking (down), which is another issue, going
into a new place never having been before, how she approaches it, and
then the taking of the seat, all of this I log in casually but I
remember it because these are golden moments of the first contact.
(Adler said this is very important.) And the person, after that,
they don’t realize what they’ve revealed, but then we sit
down, ok? And we start.
H - Can I have your
full name please?
M - Liz Osterman.
H - Would you spell
that for me?
M - O-S-T-E-R-M-A-N.
H - Ok. And I have
your telephone number and I have your address, which you gave me.
Thank you. Ok. What is your age, Liz?
M - 42.
H - 42. What is your
M - Married.
H - Your occupation?
M - Uh, right now I’m,
um, a special events coordinator for the center.
H - Ok. And is your
M - Yeah, he’s a
lighting designer. He freelances.
H - Do you have any
M - No.
H - How long have you
M - Um, we’ve
been married for 6 years and we lived together 2 years before that.
H - What is your state
M - Oh, I mean, other
than the fact I’m a little overweight, um, it’s fine.
H - A little meaning
M - Um, 5-10 lbs.
H - Are you taking any
M - Yeah, I’m on
H - How much Prozac?
M - Um, I don’t
know, a pill a day.
H - Do you know the
dosage? Who’s prescribed this for you?
M - My GP.
H - How long have you
been taking Prozac?
M - Um -- how long has
it been -- uh, I think it’s been about 6 months?
H - Ok. Do you smoke?
M - Yeah.
H - What (inaudible)
M - Oh, I’m
trying to quit, but a pack a day maybe. Half a pack to a pack.
H - Ok.
M - Half a pack.
H - Do you use alcohol?
M - Oh, you know, beer,
H - Um, how often and
M - You know, when we
go out, I have a glass or two, a couple of glasses.
H - Do you use any
M - Nah.
H - Ok. Thank you.
Now, how can I help you?
M - Oh, um, I don’t
know where to begin. Um, I just don’t feel very happy. I
don’t know how to be happy.
H - How unhappy are
M - I mean, it varies.
Um, I mean I -- part of it, I think I’m -- you know, I can be
really, really, really happy, but it never lasts and then I get
depressed. I think I’ve been cyclically depressed all my life.
H - Where did you get
that term cyclically?
M - Um, another
therapist I had told me.
H - When did you see
M - Um, I was in
therapy for a couple of years, um, individual and group, and I quit
about 4 months ago.
H - Why did you quit?
M - I don’t think
anyone understood me. I don’t think my group was very helpful.
H - Did you get
anything from the experience, anything positive?
M - Oh, I would say,
you know, mostly to understand that my problems are very complex.
H - When did you first
start feeling these symptoms as depression?
M - You know, I think
I’ve been depressed all my life, and -- even as a kid.
H - Even as a child.
M - Yeah. I would say
maybe real depression when my parents split up. I was 14.
H - When you said real
depression, what do you mean?
M - Uh, sad, crying.
H - But you also think
that you were depressed before that.
M - Well, I was never
H - Do you have any
idea of what was going on earlier that led to your unhappiness?
M - Well, my parents
never got along, there was always fighting. Um, I think my mother
has incredibly low self-esteem, my father, you know, he’s a
lying sonofabitch, um...
H - Tell me a little
more about your mother. From your childhood, what do you remember
her being like?
M - Um, she was a
nurse, she always -- she supposedly was a fantastic nurse, she took
great care of her patients, I think much better care of her patients
than of me. I think she cared more about her patients than she cared
H - Did that bother
M - Yeah.
H - How much?
M - Well, I just felt
very -- you know, like I didn’t matter. I mean -- and
sometimes she’d be very nice to me. Sometimes she would be
wonderful to me. And sometimes I didn’t -- I didn’t
exist, you know. I think she might have been depressed. I used to
have to kind of, you know, entertain her, kind of get her up, because
she’d come home and she’d just, you know, go to sleep.
H - So it went from a
high to a kind of low with your mother, yes? What was the high point
with your mother? What was -- what did you like so much about what
M - She was funny.
She’d make up stories for me. She would sing to me. She would
-- yeah, those are the -- yeah.
H - And then what was
at the bottom, what -- when did it get really bad? What was the
worst that you remember (voice fades out)?
M - Um, she would just
-- you know, like I wouldn’t be there. And I would kind of try
to get her attention and she would just act as if I didn’t
H - And that’s
when you felt really bad? What about your father? Tell me about
M - Um, like what I
what I know about him now, or...
H - No from -- the
impression of your -- from your childhood, as you remembered him?
M - Well, he, you know
-- sometimes -- sometimes I thought he loved me and sometimes I
thought he didn’t. You know, he could be fun, but he could be
H - What do you mean,
M - If he was made at
something I did, he would hit me, um...
H - Hit you how?
M - Spank me.
H - Spank you?
M - Hard.
H - Very hard?
M - Hard.
H - Did it leave any
bruises, do you know?
M - Maybe -- probably,
yeah. It hurt, it hurt.
H - Do you remember how
you felt when he did this?
M - I was so mad at
H - What were you like
as a child?
M - I suppose I was a
little bit of a handful.
H - How so?
M - I remember, um,
when I was about 2 or 3, I flushed my -- or tried to flush my
father’s slippers down the toilet. And I got in trouble. And
they told me not to do it again. But I did it again.
H - You did it again?
M - I did, and um --
um, I got in trouble again and I got spanked that time, um, and I did
it again. And nothing they could do would stop me.
H - You were very
determined, (weren’t you)?
M - I was.
H - Are you still a
very determined person?
M - Sometimes.
H - Sometimes. Do you
have any brothers and sisters?
M - Mm mm. Well, I
have -- I have a half-brother. I’ve never met him.
H - Did you hear
anything about him? Do you know anything about him?
M - No. I don’t
want to know.
H - You don’t.
Was that from your mother’s side or your father?
M - No, my father.
He’s, um, remarried, divorced.
H - Did anybody else
take care of you as a child?
M - Um, no one really
took care of me as a child.
H - Was anybody
assigned to you for your care?
M - No.
H - No. Did you have
any contact with your grandparents?
M - Yeah, I mean --
yeah, we had a lot of contact.
H - A lot of contact.
M - Yeah.
H - Who stands out?
M - I would say --
everybody. My, um, my father’s mother taught me to sew and
that was wonderful, although she could be pretty difficult at times,
she was -- and my mother’s mother was really a bitch on wheels.
But my grandfather was wonderful.
H - Your grandfather.
M - Yeah, my -- my
H - Your mother’s
father. In what way was he wonderful?
M - Oh, he was musical,
he would -- he taught me about music, he treated me like I was
special, he gave me lots of attention that I didn’t get at
home. And we -- I used to go spend summers with them a lot, um, and
-- in fact, I think my mother -- he gave to more to me than he gave
to my mother, and my mother was kind of jealous of that, but, um,
maybe that’s what grandfathers are for.
H - So he stands out as
a very wonderful person (inaudible). Was anybody else?
M - (No.)
H - How far back can
you remember into childhood? Can you go way, way back. Does
something specific that you kind of get a mental picture of and
describe to me?
M - Ok. Um, I guess
the thing I remember first is when I was, um, I -- when I was -- I
must have been 2, I think -- yeah, 2 -- and my mother used to sing me
a lullaby when I was at that age. And she brought in a little, like,
music box, um, stuffed animal music box and it played the lullaby.
And she said that she couldn’t sing the lullaby anymore and
that this would, you know, be my lullaby. And at first it was, you
know, it was neat. But then I realized she’s not going to be
H - What do you mean,
“not be here anymore”?
M - Well, I mean, my --
you know, she’s not going sing me my lullaby.
H - Sing again. How
did you feel?
M - Horrible.
H - Horrible?
M - Alone, you know
(inaudible) I haven’t thought of this in years.
H - It’s
bothering you right now.
M - Yeah.
H - Sounds like a
pretty miserable feeling. This is not part of the memory, was there
a reason why your mother stopped singing a lullaby that you found out
later on, and why she gave you this little music box?
M - I never found out.
H - You never found
M - I mean, I never
really thought about it actually.
H - Oh, you haven’t
thought about it, that there might be a reason that we don’t
know of right now.
M - That’s true,
yeah, I suppose. I never thought about that.
H - Well, maybe, we can
think about this together later on. Is there any other memory that
you can recall that seems very early?
M - Well, you know, in
addition to that one with the flushing the slippers down the toilet,
um, I remember my father -- he had this cigarette lighter he used to
keep on his bedside table. And it was -- you know, he came and he
said, “Where’s my cigarette lighter?” And I said,
you know, I don’t know. And he -- he accused me of taking it.
And I kept saying, “I didn’t do it, I didn’t do
it.” I mean, you know, how many people were there? I didn’t
do it. And he didn’t believe me and so he spanked me, um, and
then later he found it on his bedside table.
H - How did you feel
about all of that?
M - It was really
H - Did that happen
more than once, the accusing you of things?
M - Well, yeah, I mean,
they accused me -- well, I did it that time, but you know, I did -- I
did flush the slippers down the toilet so they accused me of that.
H - Yeah, but did he
accuse you of things that do really didn’t do at other times?
M - I mean, no, because
I was an only child, so it’s hard -- I mean, if someone did it,
it probably was me. So most of the time I would say it was -- he
didn’t do it very well, but most of the time if he accused me,
I did it.
H - Are there any other
memories you have that are early?
M - Um, I remember
being at school. Is that early enough?
H - Oh, yeah, that’s
-- that’s ok. About what age, do you think?
M - It was after I was
fat, so -- I don’t know, second grade maybe -- 7.
H - What happened?
M - Um, we were on the
playground and we were choosing sides for the game and I didn’t
get chosen so I just went off. And I remember looking at the birds,
they were flying around and just feeling like I didn’t want to
be there anymore. So I gave myself an asthma attack and I got sent
H - You gave yourself
an asthma attack. How did you do that?
M - If you breathe
right, you know, or wrong, whatever, I could get it to come on. So I
used to make myself do that sometimes. And then I got to go home.
H - Can you still do
M - No, I don’t
think so. I -- I don’t think I have -- I don’t have
asthma in the way I used to.
H - Did you have any
other childhood illness?
M - Other than being
H - Well, how fat were
M - Fat. I was really
fat. I mean, you know, like getting clothes in the -- what do they
call it -- the fat girls...
H - Oversized. Ok. Was
that a reason for that? Was anything ever explained to you?
M - Why I got fat?
H - yeah.
M - I ate to much. I
mean, I ...
H - Well, that’s
one reason, yeah, but there may be other reasons.
M - What?
H - Well, nobody
explained anything to you. You never went to a doctor?
M - No, I mean, my
mother was a nurse, she -- she knew what she was doing. I just think
I was so unhappy -- I also got asthma -- asthma and fat at 5. And
you know, um...
H - Sounds like you
were pretty unhappy.
M - Yup.
H - Did anybody know
that and respond to it at all?
M - No.
H - Did you ever tell
either of your parents how you were feeling?
M - I don’t think
so. I don’t think it would have done any good, so...
H - You don’t
M - ...I don’t
H - But you didn’t
do it, though. You don’t remember?
M - No.
H - Let’s come
back to the current situation. You’re married and you’re
working. Tell me about your work. How do you feel about it?
M - Uh, it’s
really demanding. Um, you know, I run special events, lots of money,
we’re trying to get money into the place, so you know, we have
these big events, there are lots of rich people there, I have to have
everything on -- you know, absolutely perfect, um, but I have to make
it look like it’s effortless, and, um, so I don’t think
-- because it looks effortless, people don’t realize how much
work it is. I work 14 hour days, some nights, sometimes.
H - How many days a
M - During events
season? Sometimes 6 or 7.
H - 6 or 7 days.
M - And people don’t
see it, because I make it look -- I know I make it look easy.
H - You make it look
easy. Is it easy for you?
M - No! No!
H - It’s very
difficult for you.
M - It’s very
demanding. I’m good at it.
H - Why do you make it
look easy if it’s so difficult?
M - Because you’re
supposed to. You’re not supposed to...
H - Oh, you’re
M - I mean, if people
are at an event, they don’t want to see you looking like
you’re, you know, working hard. They want to see you looking
like, you know, everything is under control. Nothing ruffles you.
H - And you can do
M - Oh, yeah, I’m
good at it. I used to be an actress.
H - When were you an
M - When I was in high
school I was in the Virginia Community Theater and I lost weight and,
um, I did a lot of children’s theater.
H - You lost weight.
That takes discipline, doesn’t it? How did you do that?
M - I stopped eating.
H - You stopped --
well, you must have eaten something. Did you have a
medically-approved diet? You just did it on your own? Did your
mother advised you or...
M - No, I just stopped
eating, you know? I mean, it probably wasn’t all that healthy.
I drank a lot of bouillon, I remember, and ate a lot of apples. I
think that was -- that was it for a while.
H - So it may have been
not the best diet.
M - No, it wasn’t
the best diet.
H - But it had the
result you lost weight.
M - But I got -- I lost
H - Ok. And then you
were an actress in the theater and you performed in plays?
M - Uh huh.
H - Did you like doing
M - I loved it. I
H - You loved it. Why
didn’t you continue?
M - My junior year my
mother decides -- the Ouji Board told her that we should move, so she
ripped me out of school, she took me away from my theater, we moved
all the way from Virginia to Seattle with no job, no house, no
H - On the basis of a
M - The Ouji Board.
She took it from me. She couldn’t stand that I had something.
She had to take it away.
H - And you felt what?
M - Devastated.
H - Devastated. What
did you do about it?
M - Cried a lot. I
mean, eventually when I put myself through college, because neither
one of my parents, uh, did anything about it, but I got into dance,
um, and choreography. So I didn’t go back into acting but I
got back into performing and making dances.
H - Do you ever wish
that you would do that again, or have you left that behind you, the
(dancing and acting)?
M - I wish I could be
an actress. I mean, it’s too late for me to be a dancer, but I
would love to be an actress.
H - You would love to
be an actress. Do you do anything about that?
M - Other than wish?
H - Yeah.
M - I mean, living in
New York, I mean, what -- like, what is there to do? There’s
only about a million other actresses.
H - Who are also in the
M - No, they’ve
been doing it for 20 years. I haven’t.
H - All of them?
M - Most of them.
H - Some of them.
M - Maybe some for 30
H - Maybe some of them
for 1 week. Tell me about your marriage, your relationship with your
M - John is
exasperating sometimes, but he can also be very sweet. Um, I would
say it’s, you know, very -- like my best friend, um -- he’s
kind of a strong personality.
H - In what way strong?
M - Well, you know, has
his own views. Likes to get his own way.
H - You said he was
exasperating. What -- about what?
M - Exacerbating.
H - Oh, exacerbating.
M - Exasperating.
Exasperating. That’s what he is.
H - Exasperating. Ok.
What attracted you to him when you first met?
M - His sense of
spontaneity. I’d just come to New York. You know, he was one
of the first people I met. We wanted to have sex, so we did.
H - How is your sex
M - Depends on who you
H - I’m asking
M - I would say it
sucks. He wants it, I don’t. He’s not a very, um,
H - How long has he
been this way?
M - You know, if I were
honest, I would say maybe for the whole time we’ve been
together. I just didn’t notice it as much until, you know,
the last few years.
H - Does it bother you?
M - I would like to
have a sexual relationship, but with him I don’t know that it’s
H - Why not?
M - Because I think
he’s so insecure. He is -- sex is a real issue with him. He
thinks he has a small penis so he feels insecure about it.
H - Does that bother
M - What?
H - The size of his
M - No, no. Well, I
guess sometimes I want -- I’m not sure.
H - You’re not
sure. You say you’d like to have a better sex life, but you’re
not sure it’s possible with him. Have you investi -- explored
this at all with anybody, with a therapist?
M - Oh, here and there
but not -- nothing, you know, real -- a lot.
H - Is there much
affection between you?
M - When he wants it.
H - When he wants what?
M - Affection. You
know, mostly when we’re out he will put his arm around me and
hold my hand. It’s almost like, you know, his little show.
Like I’m his little -- I’m his wife and I’m -- I’m
so wonderful. But when we’re home, you know, there he is, he’s
on the computer, he’s watching television. You know, I don’t
really seem to matter much to him.
H - Does that bother
you that he is involved with his television and computer?
M - Well, yes and no.
Um, there are times when I want to be doing something and that’s
ok. But what really pisses me off is when, you know, on the outside
he wants one thing, he wants to make it look like (inaudible) but
when -- when it’s just me, I don’t matter enough to make
it -- you know, for him to -- to be affectionate to me.
H - Are you able to
talk with him about this? Have you tried?
M - I -- no. I mean,
we’ve had fights about it.
H - You have fights
about it. How’s -- what kind of fighting takes place? Just
M - Um, what...
H - When you say --
when you say you have fights, are they ever physical?
M - Um, mmm, you know,
I think he has grabbed me, uh, you know, a few times, but nothing...
H - Has he bruised you
M - Maybe.
H - Does he still do
M - I mean, (inaudible)
H - He’s grabbed
-- has he hurt you?
M - Well, it hurts if
someone grabs you. But, I mean, it’s not that big a deal or
H - Do you have
M - Um, not really. I
mean, you know, I have a few from college and I see them and, you
know, whatever, but I don’t -- I don’t really have that
many friends in New York.
H - What do you do in
your free time?
M - Um, what do I do?
I sew, um -- sew.
H - You like to sew.
M - Yeah, I make all my
-- all my own clothes. I go to theater, I go to movies, I read.
H - Do you sleep well?
M - Um, why do you ask?
H - Well, I want to
know if you have -- you know, always get to sleep, do you sleep
restfully, do you wake up refreshed?
M - Um, it depends. If
it’s -- if I’m really, you know, under heavy stress, I
wake up several times during the night, I keep a pad by my bed, I
write down ideas I have, things I need to do, um, so sometimes I
don’t get a whole lot of restful sleep.
H - Do you remember
M - Um, no, not
usually. Sometimes but not usually.
H - Not usually. Do
you recall any dreams from childhood? Like, especially dreams that
reoccurred in childhood?
M - I can’t
really -- I remember one -- I don’t know how far -- if it’s
from childhood or it’s just -- but my mother -- my mother is
naked, I think she jumps out my apartment building window. It’s
vague. I can’t remember too much (voice fades out).
H - Can you recall any
of the feeling that was at the end of that dream or within the dream?
M - No, um, no right
H - Now, you told me
one memory connected with school. But that wasn’t the
earliest. Can you remember the first day of school?
M - No, uh uh. I went
to -- how many -- I went to 3 different schools that first year, so
it’s kind of a big...
H - Nothing stands out.
Does any memory from adolescence stand out?
M - Um, the things that
stand out the most are, you know, being in, um, the theater, um, and
kind of feeling like I was with people who are -- who at least liked
H - Well, we’re
almost near the end of our session right now. Um, there is something
that would save us a little bit of interview time if you are willing
to do it. I have a questionnaire which you could take with you and
look it over, and if you fill it out and bring it back, it’s
simply to save us some interview time. Can I show it to you? This
is the questionnaire. Take it with you and fill out as much of it as
M - Should I bring it
back next time?
H - Bring it back as
soon as you can.
M - Ok. Sure.
H - I’ll see you
next week at the same time, will that be all right.
M - Sure, yeah. Yeah,
that would be great.
H - Ok.
M - Ok, thanks, bye.