Yalom states his reluctance to treat patients in love, since romantic enchantment resists the scrutiny that therapy requires. Nevertheless, he accepts Thelma, a 70-year-old woman, because her suffering seems to him not genuine love but a pathological variant worth investigating. In their first session, Thelma—showing him photographs of herself as a young professional dancer—reveals that she had an affair eight years ago with Matthew, a psychology intern who had been her therapist. They met by chance a year after treatment ended, drifted into a 27-day relationship, then Matthew abruptly ended contact. Thelma, receiving no explanation, grew increasingly despondent; six months later she stockpiled sleeping medication and overdosed. She was saved only because her husband, Harry, a former British commando officer who traveled constantly for the Boy Scouts of America, grew alarmed at a busy phone signal and sent police to their home. When Matthew visited her in the hospital, he remained cold and professional. For eight years since, Thelma has left messages on Matthew’s answering machine but received no reply, spending most of her waking life replaying their 27 days together. She protected Matthew by never mentioning him in the eight years of therapy she received from a series of therapists. She tells Yalom he is her last chance—she intends to find a way to live, or else seeks help dying with minimal harm to her family.

Yalom, angered by Matthew’s exploitation of a patient, is simultaneously fascinated by the obsession. He suspects its roots are more about Thelma’s terror of aging and isolation than genuine love, and he accepts her for treatment, funded by a geriatric research project, with some acknowledged hubris. They agree to a six-month contract; after significant resistance, Thelma makes a no-suicide promise for that period.

Early sessions are unrewarding. Thelma is ambivalent about therapy, and any progress is offset by her elaborate strategies for maintaining distance. Yalom challenges her core belief—that her well-being depends entirely on Matthew’s opinion of her—but rational argument fails. He shares his own experience of a love obsession that crowded out his actual life, hoping to demonstrate how such fixations drain the present of reality; Thelma is unmoved. When he asks her to role-play Matthew releasing her from the obsession, she performs it with surprising enthusiasm, inventing a scenario in which Matthew explains that he chose a woman named “Sonia”—a name Thelma then reveals was her own stage name as a young dancer. Yalom notes she needs to confront not her idealized Matthew but the real one.

By the fourth month, Thelma has an insight that she has never sustained genuine intimacy with anyone—but the recognition makes her withdraw further rather than engage. With only weeks left in their contract and no real therapeutic relationship established, Yalom plays his final card: He proposes a three-way session with Matthew himself. Thelma lists objections but agrees to consider it. The following week she arrives transformed—hair done, attractively dressed for the first time—and reveals that she preempted his plan by calling Matthew herself. He returned the call after eight years of silence and eagerly agreed to the joint meeting.

At the session, Matthew turns out to be an attractive, conservatively dressed man in his early forties. Asked directly how he feels about Thelma, he says he has thought of her every day for eight years and cares deeply. He then explains the truth of eight years prior: Shortly after finishing his training, he suffered a psychotic break following an intensive Buddhist meditation retreat in India. He was hospitalized, discharged, and met Thelma by chance the following day while still in a delusional state characterized by the loss of personal boundaries—a belief in total “oneness” with others. He gave her everything she wanted from within that psychosis. When his hallucinations returned weeks later, he was re-hospitalized; Thelma’s subsequent suicide attempt was catastrophic for him. His own psychiatrist advised complete silence as necessary for both of them. Matthew also discloses he is no longer practicing therapy, was married and divorced, and has become a fundamentalist Christian.

Yalom is stunned. His image of Matthew as a calculating predator is demolished; the man before him is more patient than offender. The session ends with Thelma sobbing: She cannot believe Matthew’s stated care for her is genuine, and she protests that she does not want to be merely one among many to him.

The following day, Thelma describes feeling as though an amputation has taken place—her fantasies have stopped but left only emptiness behind. Yalom delivers his harshest interpretation: Since their experiences were fundamentally different—Matthew’s a psychosis without real personal boundaries, hers a love—a genuinely shared romantic love never existed at all. Thelma goes silent.

The session after that, Thelma arrives disheveled and accompanied by Harry, her white-haired husband. She reports spending 12 hours a day sleeping and thinking about Matthew less than 20% of the time. She erupts in anger at Matthew’s callousness, shows Yalom a newspaper article suggesting suicides can be disguised homicides, and wonders aloud whether her overdose was really an impulse to kill Matthew. Then she announces she is stopping therapy. Yalom recognizes the termination as an act of retaliation against him—the “executioner” who stripped away her sustaining illusion without building anything in its place. Harry, meeting briefly with Yalom, pleads for the return of the wife he once knew.

Yalom is left in self-recrimination, concluding he was driven by intellectual curiosity and grandiosity and had ignored 20 years of evidence that Thelma was a poor candidate for deep therapy. Weeks later, a phone call from Thelma surprises him: She is feeling considerably better, and mentions offhandedly that she has met Matthew for coffee and they plan to do so monthly. He learns no more. Six months later, a research follow-up finds Thelma to be the most improved of 28 geriatric subjects in the study—significantly less depressed, and no longer considered a suicide risk. The research team attributes her improvement to a pragmatic approach and a “systems intervention” involving Harry and a longtime estranged friend. Yalom finds this characterization cold comfort.

Sarah, a psychiatric resident supervising a therapy group, storms into Yalom’s office to report she had called his patient Carlos a crude name in front of the group the previous night. She explains that a fragile group member named Martha had disclosed, for the first time, that she had been raped. To help Martha speak, Sarah then disclosed her own rape from three years earlier. Carlos responded by questioning both women with increasingly detailed and graphic inquiries that the group gradually recognized as serving his own sexual arousal. When confronted by the group, he grew more offensive and declared that he would welcome being raped by an attractive woman.

Yalom then provides Carlos’s history. Carlos is a 39-year-old Argentine financial analyst with an advanced, slow-growing lymphoma that has now invaded his lungs and is running out of treatment options. Emaciated, hairless from chemotherapy, and socially isolated, he grew up as an only child—his mother died at his birth, his father from the same cancer—and has never had a male friend or a sustained relationship with a woman. His stated life goal is to sleep with as many women as possible. His only genuine emotional response in their first meeting was fear that his two teenage children, living with his ex-wife in South America, would abandon him. He asked for help intensifying the imaginative imagery he used in his psychological battle against cancer. He could not get the bears and pigs he imagined to attack the armadillos that symbolized his tumors with sufficient ferocity. Despite his abrasive personality, Yalom accepted him for treatment, drawn by this flicker of vulnerability and the plaintive way Carlos took his hand.

In their session following the group incident, Carlos dismisses what happened, declaring the other group members are losers. He casually adds that he would commit rape if it were legal. Yalom first tries suggesting that Carlos’s coarseness in the group might mask unexpressed anguish about his illness; Carlos denies it. Yalom reflects privately that he can trace the course of Carlos’s disease through his behavior: when death looms near, Carlos becomes compassionate and wise; when cancer is quiescent, he reverts to shallowness. His current state signals remission.

Yalom then shifts tactics and asks Carlos to imagine his teenage daughter living in the society of legalized rape he advocates. Carlos flinches and says he would want a loving world for her. Yalom responds that if he wants his daughter to live in such a world, he must build it through his own conduct. Carlos is visibly shaken.

Yalom then revisits a nightmare Carlos had reported two weeks earlier, in which he could only rent a green Honda Civic—his least favorite car in his least favorite color—when he wanted a Maserati. Carlos himself once compared death and rebirth to trading in a car, and Yalom extends this imagery. The dream suggests that in his next life, Carlos will receive the existence his current behavior has earned. Carlos recognizes the implication immediately and admits the dream shows he is “not living right” (73).

Finally, Yalom confronts Carlos’s recurring fantasy about Ruth, a woman he spoke with for five minutes at a church social, whom he believed he had a real chance to marry. By walking Carlos through Ruth’s perspective—a young divorced mother seeking stability, faced with the reality of Carlos’s terminal prognosis—he brings Carlos to acknowledge that the chances are essentially nonexistent. Carlos asks quietly where that leaves him. Yalom advises him to stop seeking a wife and focus instead on deepening the connections he already has, beginning with the group.

The session is transformative. Carlos discloses his cancer to the group, and his behavior reverses so completely that other members begin to rely on him for support. He returns to Yalom with two named insights. The first, “Everybody has got a heart” (76), arose when he suddenly saw the women in the group not as objects but as fellow sufferers, and he began perceiving vulnerable humanity in everyone around him. The second, “I am not my shoes” (76), came from Yalom’s earlier work on helping Carlos separate his core self from peripheral attributes—his work, his body, his illness—allowing him to present at work without defensive aggression and to face his physical deterioration without losing his sense of self.

In his final months, Carlos organizes a cancer self-help group, leads interpersonal skills classes at his church, and becomes a devoted and transparent father to his children, who elect to live with him while enrolling for a semester at a nearby college. He faces his dying openly and with humor, teaching his children by example how to confront death with equanimity. Shortly before he dies, he raises himself in his hospital bed, squeezes Yalom’s hand, and expresses profound gratitude, telling Yalom he saved his life.