Yalom opens by defining countertransference—the therapist’s own irrational feelings toward a patient—as the chapter’s central problem. When Betty, a 27-year-old, 250-pound woman, enters his office, Yalom immediately recognizes a severe test. He confesses a lifelong revulsion toward obese women, tracing its roots speculatively to a family dominated by controlling overweight relatives and to his own ambition to leave that world behind. Throughout the first session he must continuously push away contemptuous thoughts.

Betty is single, isolated, and severely depressed despite antidepressant medication prescribed by her New York psychiatrist, Dr. Farber. She works 60 hours a week, has no social life in California, and eats compulsively; her blood pressure has reached dangerously high levels. She relates all of this with forced, chatty humor, which Yalom resists. He accepts her as a patient precisely to confront his countertransference, noting wryly that Dr. Farber—who Betty says regularly fell asleep during their sessions—likely started her on medication because he, too, could not get therapy moving.

Yalom finds the early sessions boring and struggles to remain present. He thinks switching to a harder chair might help him focus, and remembers his mentor and therapist, Rollo May, doing the same—claiming it was for a bad back. Yalom later discovered the bad back was invented. During his sessions with Betty, Yalom clock-watches while Betty resists all practical suggestions, externalizes blame for her unhappiness, and deflects personal questions. Her only date in years—a man named George, contacted through a newspaper personal ad—acknowledged her on sight but never called again; she often thinks about his courtesy. Unable to make headway on content, Yalom shifts to process. He identifies two deadening behaviors—Betty’s refusal to speak from the immediate present and her compulsive need to entertain. He asks her to rate her self-disclosure on a scale of 1 to 10; she gives herself a 10, while Yalom observes she has never once voiced a here-and-now feeling. He obtains her agreement to let him interrupt the entertaining behavior as it occurs. Within a few sessions, Betty’s forced gaiety disappears, she begins speaking with real seriousness, and acknowledges feeling empty inside. Yalom finds himself genuinely engaged and stops noticing her body.

Betty grows invested in therapy but anxious about dependency, since her work contract in California is temporary, and she will eventually return to New York. Yalom invokes the idea—attributed to Otto Rank—that refusing intimacy to avoid future loss is a refusal of life itself. He refers Betty to a group therapy program at his clinic, co-led by two psychiatric residents, to help build the social support she needs.

In the group, Betty encounters Carlos, a patient with terminal cancer. Because her own father died of cancer when she was 12, the contact triggers severe anxiety, physical symptoms, and an eventual revelation: she unconsciously believes that as her father wasted away, losing weight will make her susceptible to cancer and death. Carlos’s kindness helps her through the crisis. Once this obstruction is identified, Betty launches a methodically prepared campaign—purging her apartment of all food, joining a bowling league and a square-dancing group, buying a stationary bicycle, and beginning a liquid Optifast diet. She loses roughly 50 pounds in three months, then grinds through months of hunger and mood swings as the weight loss slows. Yalom’s respect for her grows steadily.

As Betty approaches 150 pounds—the weight she was when her father died—vivid emotional flashbacks begin: She re-experiences unresolved traumas in reverse chronological order as she reaches the weight she was when each occurred. Intensive work on her father’s death follows. She develops panic attacks and recurrent nightmares, including one in which she is being bricked alive into a closet, and another in which a candle representing her soul burns steadily smaller. After her father’s funeral, she recalls hearing a voice say, “You’re next”—the moment she first grasped her own mortality. Yalom connects the candle dream to her fear of losing weight: keeping the flame large means staying alive. Betty also learns from a gynecologist that an endocrine disorder will prevent her from having children, deepening her grief over her own future. She eventually identifies her core loss as a grief for lost love: Her father was the only person who ever held her and told her he loved her. She confesses she was also ashamed of his obesity and lack of education. Yalom reassures her—drawing on a phrase from his first analyst, Olive Smith—that such ambivalence is part of human nature.

When Betty’s California assignment ends, she has stabilized at around 160 pounds and stopped dieting. A dream about painters invading the entire interior of her house, when she had only wanted the exterior trim done, signals that therapy has gone deep enough and she is ready to stop. In the final sessions, Betty confronts Yalom directly, observing that he had barely looked at her for six months and had never once touched her, while she knows from Carlos that Yalom regularly embraced him. Yalom admits he was put off by her body. Asked why she stayed, Betty says she is used to such treatment—and, more pointedly, that she cannot stand obese people herself. They part with Betty refusing a handshake and demanding a hug; Yalom discovers, to his surprise, that his arms reach all the way around her.

Eight months into therapy, Elva, an elderly widow whose husband Albert died roughly 18 months earlier, arrives at Yalom’s office visibly deflated after weeks of steady progress. She was robbed: a thief snatched her purse outside a Monterey restaurant where she had paid the lunch bill for three elderly friends, fled by car, and police later found the empty purse discarded on a roadside.

Beyond the financial loss, the robbery destroys Elva’s deep-seated belief that misfortune happens to other people. It also forces her to feel Albert’s absence as irreversible. Over 41 years of marriage Albert had been the family’s tireless fixer—roofer, mechanic, carpenter, builder—and Elva had organized her entire sense of safety around the unconscious assumption that he was still out back in the workshop watching over things. The theft makes that illusion untenable.

Yalom’s early sessions with Elva were difficult. She was bitterly contemptuous of everyone around her, assigning scathing nicknames—including “Herr Doctor Professor” for Yalom (145)—and finding fault with all comers; her venom reminded Yalom of his own mother, making the sessions genuinely hard to endure. The turning point came when Elva gleefully announced she had beaten her 21-year-old nephew at golf; their shared laughter opened a real rapport. Over subsequent months her anger softened, relationships around her began to repair, and Yalom was approaching the question of termination when the robbery set her back.

In the current session, Yalom gently states that Albert is truly gone—remaining only in her memory. Elva sobs for the first time in their work together. To restore connection and ease the emotional weight, Yalom shifts attention to her conspicuously large purse, teasing her about its contents. Elva rises to the banter, and together they empty the bag item by item—three doggie bags, 12 pens, sourdough starter, a partial paperback novel whose already-read pages have been torn out, and more—quarreling warmly over each object’s necessity until the bag is fully empty. Yalom later reflects on it as one of his most effective hours of therapy.