Monday, July 15, 1996	1 pm. Initial session with Anna Green. Anna is 26. She is quite attractive, presents herself with a great deal of care. She describes herself as shy, but is quite vivacious. Anna is quite scattered though. Her conversations flitters around like a butterfly, never really stopping on any particular topic. It seems that if she is talking about something important, she will get scared and flit away to another topic. She is using her verbal loquaciousness as a screen for insecurity. Anna seems like she might be setting herself up as a victim--she lets things happen to her. Anna complains of being unable to concentrate + sleep disorders. She says that she has been having long conversations in her mind with a boyfriend who evidently dumped her. My impression is that the dumping happened about a month ago, but I'm not sure. The facts of his actual departure are obviously painful to her, so she flits over it. She is looking forward to the time when he comes crawling back to her, so that she can scorn him. Apparently, she practiced fellatio on Bill for her first time, and she really liked the experience.
Thursday, July 18, 1996	4 pm. Second Session with Anna Green. She says that she cries four hours a day, clearly an exaggeration. But she is upset. She has been sleeping an estimated 5 hours a night. She describes herself as a victim of Bill and his lying. She fantasizes about having long conversations with him and also that someone will end up murdering him. I told her to start a journal. Monitor the sleep disturbances.
Monday, July 22, 1996	1 pm. Third Session with Anna Green. I found myself looking forward to the session with Anna and when she arrived, I greeted her heartily. She immediately brought me back to earth by noticing my attitude and telling me that she had a really bad weekend. I should strive to be more neutral in my affect shown to my patients. Anna sounded like she really felt bad over the weekend without having any precipitating crisis. She tried to write a journal but is having trouble with it. My guess is that Anna is of a hysterical personality type, but not overly pronounced. She describes her mind as racing ahead of herself. She talked a little about Bill and how she had been warned against him. Bill apparently liked to talk to Anna about multiple partners and Anna believes in encouraging a rich fantasy life. Anna played along and they talked about bringing another woman into their bed. But Anna wasn't seriously considering it. Anna believes that Bill was trying to "test the waters." Anna also thought that she was really in love with Bill. Martin, the guy who warned Anna about Bill, apparently had a crush on Anna himself. Anna describes herself as having an "indiscretion" with Martin during an out-of-town convention that never went beyond a kiss after Martin declared his feelings for Anna. At the end of the session, Anna was worried that she might have depressed or bored me.
Thursday, July 25, 1996	4 pm. Fourth Session with Anna Green. Anna said that she has been having conversations with her good friend Caren about our conversations. Caren believes Anna "has feelings" for me. Anna says that she likes me, but that Caren is crazy, although Anna admits that she is having long imaginary conversations with me, like she has been having with Bill since their breakup. Anna is obviously experiencing some transference. Anna talked about her sixth grade experiences. She was a "good girl" and an A student. She says that she was unpopular because she was good at math. She describes herself as an awkward, shy geek. Her father is and was a university mathematics professor who played math games with Anna, and both parents sound fairly supportive. Anna describes writing her papers in tiny tiny letters, somewhat obsessively. Anna also sounds like she felt like a victim throughout her school years. She describes being traumatized by some boys who destroyed a homework assignment. She also tells of agreeing to switch seats with another girl even though it meant that she lost her cherished seat next to a boy she really liked and had to move to a seat next to a boy she despised. Anna again was concerned about whether she was boring me. She said that in her conversations with me, she feels that she can tell me very private, embarrassing things. I asked whether she felt that it was true in my presence or only in her imaginary conversations. She said that if she told me about Caren, it would be a test. In questioning her further, Anna described a dinner engagement she had with Caren last night. Apparently, Caren turned the conversation to experimenting with new sexual experiences, and said that she wanted to make love to a woman. Anna agreed that it would be an interesting thing to try. Anna was shocked when she realized that Caren meant for the two of them to have sex together that evening. Even though she felt that Caren was not sexually attractive, Anna felt that it would hurt Caren's feelings too much to refuse. So Anna allowed Caren to perform cunnilingus on her. Anna simulated orgasm quickly to end the experience. Anna said that she is embarrassed that Caren's oral ministrations felt good, even though she said that she was "freaked" by her first homosexual experience. Anna said that she had often simulated orgasm in her sexual encounters with Bill. Actually, in this session, Anna spoke very little about Bill and since her distress seems markedly less, I reduced the frequency of the sessions to once a week. Anna Green's Personnel File shows that she was hired right out of college. While her programming skills were referred to as adequate, she was apparently really hired on the basis of her social skills. There is an approving reference to her baking cookies for the programming staff, and plenty of references to problems that SII is having with its programming contingent. Anna is described by her boss as a "great girl" and upbeat, positive, and well liked by everyone. Actually, the file struck me as patronizing, without much reference to her actual programming talents. Anna apparently tripped on the stairs outside the building and sprained her ankle in March, 1995. There is an "incident report" about Anna "necking" at night in the company lounge with Bill Torbett.
Friday, July 26, 1996	Took a look at the doodles that Anna Green brought in yesterday. They are a collection of very controlled little thumbnail sketches of representative objects--a bride, a bow, an eye and shoes, irises, a cute puppy dog character and maybe some coins. Near the eye are a pair of either needles or chopsticks. All of the images are crowded near the top of a piece of binder paper. Somehow they give the impression of someone who is very tightly wound inside.
Thursday, August 1, 1996	4 pm. Fifth Session with Anna Green. Anna came in talking about the possibility that she may be having medical problems. While saying that she was pleased that she was fixated a lot less on Bill, she described an anxious stomach, and difficulty falling asleep. She says that Bill became her addiction. I believe Anna is experiencing a grief reaction to her separation from Bill. She also seems to have placed me in a center spot through transference. I will fill the void until she can find another person whom she can trust in that role. Anna said that she can look in my windows and has actually recognized Ms. Bows inside my office. For the sleep disturbances, I suggested that she try melatonin and limit her caffeine intake. Anna then described how Caren and her boyfriend tried to pressure her into a threesome. Apparently, they all got naked and Anna left only after Caren and her boyfriend Greg began intercourse. Anna said that she smoked marijuana prior to this encounter. Anna agreed that we needed to work on her inability to say no to unwelcome sexual encounters. I believe that substance abuse is contributing to her weakness in this regard.
Thursday, August 8, 1996	4 pm. Sixth Session with Anna Green. Anna said that she has been having some success utilizing melatonin for her sleep disorders. She is getting nine hours of sleep a night now, although she still frequently feels tired. We started to talk about her capitulating to unwanted sexual advances, but we ended up talking about early sexual experiences. She told me about seeing her grandfather naked in the shower and not thinking much of it until her parents acted embarrassed about the incident. She discussed marrying with her father. She remembers explaining to her father her anatomical theory that her tongue continued through her body and stuck out of her vagina. She thought her clitoris was a little tongue. She said that she never talked to her parents about sex and that her mother thought that sex was dirty. At the commencement of her menses, Anna didn't tell her mother but used her mother's pads until her mother noticed. She describes herself as a late bloomer, saying that she didn't start dating until she was seventeen. She didn't have sex with her first boyfriend, thinking she was going to marry as a virgin. But she met Reed, a senior when she was a sophomore in college. At graduation, as he was getting ready to leave, she says "it sort of happened." Apparently, he ruptured her hymen, causing a great deal of pain and bleeding, but failed to consummate the act. She says that she was freaked out and ran away. She never saw him again, refusing to take his repeated phone calls and, because of her embarrassment, was glad that he was moving away. He was the only man with whom she'd had intercourse prior to Bill. She pretended to be a virgin to Bill because she says that it slowed down slightly the need for a sexual consummation of their relationship. She says with Bill it just sort of happened. In all of Anna's limited sexual experience, the act is never her idea, but "just sort of happens" to her. But Anna has been effective in fending off many advances from some boyfriends.
Thursday, August 15, 1996	4 pm. Seventh Session with Anna Green. Anna has decided that she is too smart and too beautiful to be disrespected by men. She was captivated by the chauffeur scene that Bruce Redot used to seduce Sylvia Bows. Apparently, most of SII knew about that showy seduction. Anna opened up a little and told me what happened with her and Bill. Anna decided that her encounter with Reed didn't count and that she was still a virgin. She told Bill that she wanted to wait until she was with the guy she was going to marry. Without Bill ever actually asking her to marry him, Anna went from feeling that he was a casual boyfriend to believing that she was going to marry him. Almost by surprise one night, when staying over at a friend's new apartment, Bill successfully initiated sexual contact. But they didn't use contraception. Contraception, for Anna, apparently gave the sex a reality to which she was unwilling to admit. So their contraceptive use was spotty at best. They finally settled on a withdrawal method which worked until Anna became pregnant. Bill insisted Anna have an abortion and Anna wasn't sure what she wanted. She asked for time to think. Bill became insistent, finally threatening her that if she wanted to raise the child, it would have nothing to do with him. Bill stopped talking to Anna. Anna confided her situation to Caren. Caren immediately insisted that she have an abortion and the procedure was done the next day. Anna believes that it was the right decision and says that she hardly ever regrets it. She told Bill that she had had an abortion by telling him that he was the father of a dead baby. Bill said that she was psychotic and needed psychiatric help and that he never wanted to speak to her again. They haven't spoken since.
Thursday, August 22, 1996	4 pm. Eighth Session with Anna Green. Anna went to Los Angeles on business with several other SII employees and met Tony. Tony listened to Anna's tale of woe about Bill with a great deal of apparent sympathy. Anna disclosed that she was embarrassed about the size of her nipples and Tony disclosed that his penis had a tendency to bend to one side when tumescent. These mutual disclosures led to mutual explorations and Anna ended up in a hot tub with Tony. She says that it was her idea to initiate sexual contact and she performed fellatio on Tony without allowing Tony to reciprocate, although Anna utilized the hot tub jets to induce an orgasm. Anna said that she hadn't had an orgasm for a long time during her relationship with Bill. It was my impression that Tony manipulated Anna into having sex with him, even though Anna didn't seem to see it that way. Anna missed her flight the next day, so she spent the night with Tony making love on a beach in Santa Monica. Anna told Tony that he was the best one-night stand ever, but Tony protested that they could carry on a long distance relationship and has already called her a couple of times at work today. Anna feels that her relationship with Tony could work out. I think that Anna is being set up for disappointment.
Monday, August 26, 1996	6:30 pm. Telephone Call from Anna Green. Anna called me, sobbing uncontrollably. Apparently Tony met another woman in record time and wants to marry her. Tony elaborately ducked Anna's call, finally getting a co-worker to give her the news, with his coaching overheard from the background. While Anna had originally been okay about Tony's role as a one-night stand (especially when it was Anna's idea), since Tony's expressed enthusiasm, she had developed an elaborate fantasy about a relationship with him. That fantasy was dashed suddenly, so Anna is at her most fragile right now. Anna says that she feels like she is being punished and wants to take a shower to wash "it" all off her. I asked her to come in, but Anna hung up the phone. Repeated calls to her message machine were to no avail.
Thursday, August 29, 1996	4 pm. Ninth Session with Anna Green. Anna came in saying that she felt emotionally numb. I decided to take more of an active role in this session than is my normal practice. We talked about Tony and elicited that she really wouldn't have suffered emotional pain if Tony had been a one-night stand. It was when Tony raised her expectations and then dashed them that she suffered. Anna again said that she would like to have people respect her in the way that she seems them respect Sylvia Bows. She thinks Sylvia is admirable because she doesn't let people push her around and she is in command. People want to be liked by her. Anna admitted that sometimes she lets people push her around. We talked about a Personal Bill of Rights, with a first article that Anna be free to say no to any sexual encounter that she isn't in favor of. Anna liked the rule, but said that she had already broken it by performing fellatio on David, a programmer at SII, on Tuesday. I suspect she wanted to feel valued by men after her experiences with Bill and Tony. She didn't copulate with David and said that she didn't want to continue her sexual relationship with him. She also told me that she prefers to be addressed by me as Anna.
Thursday, September 5, 1996	4 pm. Tenth Session with Anna Green. Anna began by insisting that I address her as Anna. She professed that she was completely over Tony and then proceeded to tell me about her elaborate fantasies of ruined romance and a marriage gone bad through the birth of twins. She later admitted that maybe she was just a little bitter. Anna feels powerful now that she had sex with David. She believes that he looks at her and remembers her sexual prowess each time they meet in the company. She also discussed how she justified certain items in Bill's personality when she was in the relationship and how she now looks upon them. Apparently, Bill was proud of having taken the virginities of six women. I discovered that, although not official, Anna and Bill lived together for a time. Bill's girlfriends were used to taking care of Bill by doing the cooking, cleaning and laundry. Anna now believes that she was in love with a person who really didn't exist--an imaginary person that she created by attributing characteristics to Bill that he didn't actually possess. I suggested a new article to the Anna Green Bill of Rights--"People can like and respect Anna Green even if she doesn't have sex with them." Anna said that she didn't want to use sex like that and she would consider the amendment.
Thursday, September 12, 1996	4 pm. Eleventh Session with Anna Green. Anna was about twenty minutes late for our session. She had been at the Seybold Conference doing work for SII. When I gently chastised her on being late, she took it rather personally, as if I was truly angry. She became effusive in her compliments towards me, concerned that I might still be angry. She's also worried again that I might be bored during her session, and I assured her that I was not. Anna said that she is surprised when men react to her openness and frankness as if she was coming on to them. She describes her work environment, which seems to have a lot of sexual content, and says that co-workers feel free to talk about sexually related topics and stories in front of her, since her relationship with Bill. Apparently she gives as good as she gets, so she is treated as one of the boys on that score. There is a ritual about staying late, eating pizza, and watching pornographic movies in the company conference room, that is sanctioned by Anna's immediate supervisor. Anna says that he goes to get the tapes! I'm surprised that they haven't been caught or sued. However, Anna is clearly okay with it (although she apparently feels uncomfortable about staying through pornographic movies) so it isn't my problem. David, upon whom Anna performed fellatio once, wants to repeat the experience. He trapped her in the copy room and suggested a purely sexual relationship where he could prove to Anna his sexual prowess by being allowed to reciprocate. Anna apparently angrily refused his advance, for which I was very proud of her. David used his HIV negative status as an inducement to initiate sexual congress. SII's HIV testing program is having some unintended side effects. Anna said that she utilizes a vibrator to masturbate to orgasm. She said that she has difficulty reaching orgasm during intercourse because there are too many things to think about. But during a masturbatory fantasy, it is all about her and her pleasure. She describes a sexual fantasy about surrendering to an unseen stranger who initiates and performs intercourse while she is standing in a crowd watching a fireworks display. She never turns to see the face of the stranger. This fantasy seems perfectly attuned to Anna's history of submitting to unwanted sexual advances.
Thursday, September 19, 1996	Letter to Bill Bennett respecting Anna Green. I mentioned my infatuation with Anna in my letter to Bill Bennett. 4 pm. Twelfth Session with Anna Green. I've been rereading my notes on Anna and my other patients. They are so dry. They don't begin to give a sense of what these people feel like--what they are about. My goodness, it's as if I'm writing these notes for some board of review or something. I'm trying so hard to stay impartial that I'm losing the sense of what these notes should convey. Well, with Anna it seems that it would be inappropriate to try to stay in that strangling mode. These notes are for my eyes only, so to speak, and I should try to get something of these people's souls into them. Anna--oh sweet Anna. I've tried to describe her in terms of what is happening to her life, but I find myself increasingly infatuated with her. I'm not sure why, actually. I have patients who are more attractive, although she is very attractive. I have patients who are smarter, although she is very intelligent. But there is something about Anna that makes me want to fold her up in my arms. And there is something, if I am going to be honest with myself, which excites my lust. Perhaps it is something in her voice. Perhaps it is a look in her eye. Whatever it is, I feel myself falling into an abyss relating to her charms. I stopped writing down my dreams because I thought they were getting out of hand, but denying them simply won't work any longer. I went back to the American Psychiatric Association rules of professional conduct and reread the section on sexual relationships with patients. The rule is harsh and absolute--once someone has been a patient, they can never be in a sexual relationship with their therapist. It doesn't matter whether they stop being treated by the therapist, it doesn't matter how seductive they may be, it doesn't matter whether the therapist marries the patient. Never, under any circumstances, can a patient or former patient ever be a sexual partner of their therapist. This is a good rule which I support. A patient can be so vulnerable to an unscrupulous therapist--they've laid themselves bare--that this rule must exist. But it can be hard to live by. This session was a good example. Anna came in and told me about how important I was to her. She told me that she is having long imaginary conversations with me reminiscent of her long imaginary conversations with Bill when she first started. She is clearly undergoing transference. Although she didn't explicitly say so, she seemed to be asking me if I was thinking about her outside of our sessions. I told her that, of course, as her therapist, I was thinking about all my patients, but she was clearly unsatisfied by that attempted diversion. She wanted to know my dreams as a man and not as a doctor. Oh, it would have been so inappropriate to tell her what she has inspired in me! I changed the subject again, and got her talking about a dream she had when she was thirteen--something about being an alien protector of the earth and flying over Europe. She remembers being carried through the catacombs of Paris by a character who she later recognized as Jean Valjean from Les Miserables. But the dream was important to her--even triggering sense memories. Although this dream was not explicitly sexual, it has strong similarities to the powerful stranger of her previously described sexual fantasy of being made love to in a crowd by an unseen stranger standing behind her.
Thursday, September 26, 1996	4 pm. Thirteenth Session with Anna Green. I had hoped that Anna had forgotten about quizzing me on my dreams, but she started off asking me about them again. She's thinking a lot about me and even made several overt sexual references. Apparently, I play with my pencil while she talks about sex. I never noticed before, but she caught me twice at it during this session so I guess it's true. Patients are so sensitive to every nuance of a therapist. As I'm getting to know them, they are getting to know me, and I should remember that. Anna talked about the intimacy that has developed between us as having sexual connotations for her. The goal, through therapy, is to try to turn this transference outwards towards others, showing the patient that she can trust others and not just the therapist. But with Anna, my own feelings lie heavily upon me. Despite myself, I enjoy her sexual interest in me. As a therapist I must turn her interest away from me and direct it to other people, but as a man, I enjoy the attention. I feel like I might not be willing to let go. Anna and I need to talk frankly about this. It may be that I am not the best therapist for her, my own needs and wants seem to be interfering with my duties as her doctor. Although painful, perhaps I should refer Anna to another doctor. Anna described a dream during this session--a metaphor for closeness, trust, and death. She is a rock, immobile at the ocean's shore and the tide is coming in, slowly submerging her, pleasuring her, and bringing her peace. She told me that she thinks of me as the water in this dream. Anna also described initiating a bath with Caren in a big old fashioned tub at Anna's apartment. Anna didn't think of it as initiating further sexual contact--apparently women do this kind of thing together. I can imagine my inviting Bill over for a bath! Anyway, she went into quite specific detail trying to get me to imagine a scene of herself and Caren (she went into some detail describing Caren's attributes) cavorting naked and suggested that it would have been good if I could have observed unseen. I'm afraid her descriptions worked and I was glad for the table top's protection from her gaze. Anna insisted she's not a lesbian and said that she would be glad to prove it to me! I declined her offer. But Anna will probably be successful in one of her aspirations. I'm sure I will be dreaming about her tonight.
Thursday, October 3, 1996	4 pm. Fourteenth Session with Anna Green. Anna made her sexual interest in me plain by starting with a story clearly designed to get a rise out of me. She went to a club in the East Bay and danced and drank until 2 am with Caren. They picked up some young college freshman and decided to go swimming in a lake that, needless to say, was closed at that hour. They all went swimming naked after nearly being caught and ended up in a ménage à trois on a platform in the middle of the lake. Finally, I confronted her. I told her that I thought it best if she switch therapists because I was only provoking a sexual response from her. Well, Anna lost it. I mean she really lost it. She couldn't breathe she was sobbing so hysterically. She frightened me with the violence of her reaction. Suffice it to say that it didn't go over well. She begged me not to "give her away." And she said that she knew she was a "bad girl" and promised "to be good." Of course I backed down--what was I to do? We'll see how it will work out.
Thursday, October 10, 1996	4 pm. Fifteenth Session with Anna Green. Anna looked terrible this session, as if she had spent a lot of time crying during the weekend. She said that she was feeling as if she had no energy, but it sounded like depression. Unfortunately, I was apparently the cause. Although I had thought our decision at the end of the last session to continue therapy despite our mutual sexual attraction had set her mind at ease, apparently Anna continued to be deeply upset by what she perceived as my rejection of her. As she put it, if she's rejected by her own therapist, who else is left? She's feeling insecure, rejected, and unloved. She has reevaluated her past relationships with men and now she has decided that they represent a continuing string of rejections up to and including me. Of course, although she doesn't know it, I could be counted as a conquest, if it weren't for our doctor/patient relationship. While my general policy would be to not reveal to a patient my own inappropriate sexual feelings, I had to reveal a little bit of how I felt about her. I had to make her understand that I was not rejecting her out of my heart but instead was insisting that our relationship remain pure due to professional ethics. She cheered noticeably and I think she actually understood. We talked about transference and how important it was for her to direct her feelings toward me more generally to others in her life and to make new, secure attachments. I hope she has decided to abandon her attempts at seduction because they were making my dreams troubling. Well, to be honest, I'm not sure that I really do want her to abandon her efforts--there's something nice about a desirable, intelligent, and beautiful woman attempting to seduce you through vivid descriptions of erotic activity. At any rate, during the rest of the session Anna described a party at SII involving pornographic videos and marijuana smoking in a conference room there after hours. Anna is admitted to this strange, all male sexual ribaldry that goes on in the programming department of SII. The men were describing, in their gender specific manner, their sexual preferences, fantasies, and desires. When it was Anna's turn, she opened up with a revelatory dream that she had, and she shocked them. It was not what they were expecting and they clearly didn't know how to react at the depth of Anna's sexuality revealed by the dream. So they ridiculed her as weird and perverted. Anna felt mocked by the group of males. As she was already depressed, Anna might have amplified their remarks, but in any case she left upset. The dream which brought on their derision involved Anna having a sexual relationship with an animator who donned a costume to become his famous animated character--a goofy, compassionate, and intelligent dog. I thought the choice of the dog as the animated animal is telling--a dog suggests absolute loyalty, devotion, and lifelong commitment.
Monday, October 14, 1996	6:15 pm. Telephone Call from Caren Patterson regarding Anna Green. This was a very interesting call. Caren wanted me to know that she has not had a lesbian liaison with Anna, despite what Anna might have told me. She went out of her way to explain that while she and Anna had talked about it, they had never actually engaged in any homosexual activity and that she had only had sexual relationships with two men and never with a woman. My sense was that Caren was telling the truth. So there are two possibilities--either Caren is lying and trying to suppress Anna's recounting of their tryst, which is possible I guess, or Anna is lying and she told me about a sexual encounter that never actually happened. And far from being the sexual encounter that a patient might fantasize about, this was an unsatisfactory encounter for Anna. So why would Anna make up a story about an unsatisfactory encounter? My conclusion is that it was for my benefit. Anna made up the story for my erotic amusement--to keep me interested (both sexually and professionally) in her and her problems. If that encounter is not true, then how many other of Anna's sexual escapades are false as well--little prurient stories developed for my libido. I must carefully go over the past sessions and try to separate fact from fiction.
Thursday, October 17, 1996	4 pm. Sixteenth Session with Anna Green. I really upset Anna today by cross examining her to figure out whether she was in fact telling me the truth about her various erotic encounters or whether she was representing her fantasies as truth. While I never got her to actually confess to lying about having sex with Caren, it was clear that she didn't represent the truth. I started out the session slowly, talking about fantasies in general--I wanted to give Anna an opportunity to tell me that she has been lying to me if she wanted to. But Anna never did. The sessions rapidly escalated when I forced Anna to admit that most of the story about skinny dipping in Lake Anza was in fact made up. She tried to defend her practice of telling me a rich mixture of fantasy and reality and representing it as truth by saying that this is what she was thinking about and it is how things should have been. This of course doesn't fly. When pressed, Anna became very upset and clearly felt trapped. Anna guessed correctly that Caren tipped me off and I believe she will confront Caren about this. It is unfortunate but couldn't be helped. I had to talk about the stories with Caren because if what Caren said was true, then these stories could not have been. About other stories I didn't have such a firm footing.
Thursday, October 24, 1996	4 pm. Seventeenth Session with Anna Green. Anna is still smarting over my interrogation during the last session. But I can tell that she has been doing some deep thinking about the nature of fantasy and reality. I don't think she'll be telling me her fantasies as if they were reality any time soon. She accused me of trying to trap her into admitting that she never slept with Caren when I just assumed that premise in our session--I wasn't as artful as they are in those old detective movies, I guess. But I do think it is clear that Anna and Caren did not consummate a sexual relationship, nor did Anna, Caren, and Caren's boyfriend engage in a ménage à trois, although I haven't touched on that issue. Anna professed her love for me yet again, and again I explained the obligations of a therapist to his patient. But Anna invented convoluted hypotheticals where she suffered amnesia after a plane crash and had plastic surgery and I didn't recognize her and then we both fell in love with each other, got married and had children before we discovered, a la Oedipus, what had happened. I guess if I say that this situation is okay, she will push me to have a relationship with her without all those conditions--I can just hear it now: "You don't want me to be in a plane crash, do you?" Anna explored her feelings around the time of her abortion. She waited until the end of her first trimester and then apparently had some problem with her progesterone level after the abortion which was improperly handled by the medical staff who were administering to Anna. Finally, she was placed on birth control pills as a means of stabilizing her menses. I should ask her if she is still taking those pills. She also mentioned that she knew that Helen was my patient. Previously, she had mentioned that she saw Sylvia in my office. Anna is obviously spying on me from her vantage point at SII. It makes me a little nervous about what she knows and doesn't know. Apparently part of Helen's paranoia at least is justified. Anna didn't know anything about Helen's whereabouts, but said that the police had been at SII asking questions.
Friday, November 1, 1996	4 pm. Eighteenth Session with Anna Green. Anna described a Halloween revel that she went to last night. She went over to Polk Street and went bar hopping with some undisclosed friends. She was dressed as an alien prostitute with two pairs of breasts, one of which was bare. She liked feeling anonymous and thought that she was much more uninhibited than normal--interacting with strangers and even getting involved in a public kissing performance with a leather-clad man acting the role of a policeman arresting the prostitute. She ended up back in an apartment with a number of other people and smoked some marijuana probably laced with PCP. She described having time dilation effects where she felt like she didn't want to move. People in the room were having sex in the corners while she watched. After about an hour, she found herself sexually excited and able to move so she sought release by discretely masturbating against the corner of a table. I tried to suggest that these stories might have more to do with fantasy than reality, but she insisted that they were true and that she could produce photographs if I demanded. Anna actually seemed quite happy and somewhat light hearted during this session. She seems to have made an adjustment away from Bill quite nicely through these sessions. I don't think he is a very big issue in her life anymore.
Thursday, November 7, 1996	4 pm. Nineteenth Session with Anna Green. Anna came in distressed that Bill has found a new love interest at SII. Before allowing Anna to talk about Bill again, however, I steered her to talk about how she copes with bad news. I just thought that it would be better for Anna to intellectualize a bit before wallowing in the emotions of loss that she felt prior to starting these sessions. So we talked about Anna's propensity to visualize difficult upcoming events in detail prior to experiencing them. She uses this as a method of familiarization, so when the dreaded event actually occurs, she feels as if she has already lived through it. But Bill and his new girlfriend finally came up again. Anna describes herself as emotionally fragile, although her upset over Bill carrying on with a new love interest seems more bruised pride than longing for a continuation of her relationship with Bill. He has become a symbol for her rather than a real person--a symbol of rejection. Anna has a distaste for Bill's new object of affection, Ethel, whom she describes as a bitch with herpes. Ethel is also a SII employee and Anna finds herself confronted periodically with glimpses of the budding romance between Ethel and Bill. Anna empathized with Suzie's ex-husband who worked at SII with his ex-wife and was visibly shaken when he saw his former wife flirting with other men at the company. Now Anna finds herself in a similar position. I pointed out that Anna had hoped that Bill would be likewise disturbed when she went out with David, but Anna refused to see the similarity.
Thursday, November 14, 1996	4 pm. Twentieth Session with Anna Green. I got the feeling that Anna is still trying to entertain me in my sessions, although she has taken a different tack. Now she is trying to demonstrate some insight into her own behavior--she is analyzing things utilizing a psychological framework. My impression is that it is for my benefit. Anna is still seeking my approval and praise. While this may be turned to her benefit perhaps, I must recognize it and be careful in how it influences our future sessions. Anna has given some thought about her feelings towards Bill and has decided that her primary feelings are motivated by jealousy and rejection. But she doesn't want Bill back, she merely wants him to pine for her, wallowing in his mistake in losing her, until his lonely death. Anna has an ability to take things to an extreme--fantasizing about ultimate consequences. She is afraid that the rest of SII is feeling her pain and loneliness when they look at Bill in the embrace of another, and she doesn't like feeling pitied. We talked about whether ex-lovers could ever be friends and she felt strongly that they could not. She thought that once the separation occurs, each wants the other to suffer or disappear from the face of the earth. She also mentioned Sylvia as a future single mother. I guess there is a lot of gossip and speculation at SII about Sylvia's current condition.
Thursday, November 21, 1996	4 pm. Twenty-first session with Anna Green. Anna was getting a cold during our session. It would be lovely to get her cold just in time for a flight back east. It would give me the ability to spread some special holiday cheer. Apparently Anna discovered John, a programmer who has worked in her department for years and one with whom she has had a friendly rapport. She mentioned early on in our sessions that he had a crush on her, but she seemed to indicate that she wasn't interested, that he wasn't even a candidate for consideration. I wonder what changed? Has Anna been feeling so unwanted that she is now considering any offer? Anna describes John somewhat charitably as socially challenged and clumsy, although she managed to convey the impression that he was also a sweet guy--tall, thin, and awkward. I have the feeling that Anna really has been affected by seeing Bill with Ethel and wants to be in a relationship as a reaction. A relationship would put a buffer between her and the pity of her co-workers--she described them as clucking over her when they saw Bill's demonstrative public behavior with Ethel. It's hard when all the relationships are within one company. Modern life seems to thrust people together in isolated situations where they can have romances with those they work with or not at all. Anna describes the situation as incestuous, and I get her point. Anna made numerous references to her feelings towards me during this session, but they seemed more playful and less intense than in sessions past. Perhaps when she stops completely, I will be a little disappointed if I'm honest with myself. But no matter. When it came to the end of the session, we decided to skip a session because of Thanksgiving. I sensed some separation anxiety--she kept wavering back and forth between having a session early Wednesday which would be inconvenient for both of us or not at all. We're going to try not at all, although I wouldn't be surprised to get a call in New York from Anna over the long weekend.
Friday, November 29, 1996	9 am. Telephone Conversation with Anna Green. Anna called me at my parent's house here in New York. It was 6 in the morning her time. Apparently she is suffering some separation anxiety due to my leaving town this weekend. She said that she wouldn't have felt so bad had she believed that I was in town, but since she knew that I was across the country she experienced severe anxiety. She said that she knew it was irrational and had tried to stop herself from calling, but she finally had to call. I told her to stay busy with her parents--she is staying with them over the long weekend--and that I'd be back soon. We're not scheduled to see each other until Thursday, but I suspect that she might want to come in earlier to convince herself that I'm really back. I didn't realize quite how dependent Anna is on me. I also believed that her romantic feelings for me had greatly subsided lately and that she was managing a successful transference back onto outside boyfriends. But apparently I was wrong. She has just been suppressing the expression of those feelings during our sessions because she is afraid that I will drop her as a patient, as I once "threatened" to do. Perhaps it isn't fair to force her to stop expressing how she feels, even if it does have to do with her sexual desire towards me. I mostly wanted her to stop because of how I felt. I could feel myself weakening in my resolve against becoming romantically involved with my patients. And I also was trying to push away the quite positive sensations which her obvious sexual interest was eliciting in me. It isn't seemly for me to be enjoying our sessions so much. But these sessions should be about how Anna feels and not about how I feel. Perhaps I am being selfish. Perhaps I should encourage Anna a bit more and allow her to be honest about her feelings towards me. I may be able to appropriately redirect those feelings towards others after they have been properly brought forth and explored. I should be willing to do this, even if I do find it somewhat pleasurable.
Thursday, December 5, 1996	4 pm. Twenty-Second Session with Anna Green. Anna described the anxiety that she felt when I was gone and said that it mostly dissipated when she saw that I was back. When I questioned her as to why she didn't come and see me as soon as I came back, she told me that she had tracked my movements through my service. She even told me that she was watching the front of the building and saw me come in and that she saw me through my windows. She seems very upset over the prospect of my leaving town during Christmas. I will have to try to prepare her for the next period of separation. Anna was sick over Thanksgiving, which she spent with her parents. She describes her relationship with them as close, but she clearly doesn't share any confidences with them or discuss with them what is really going on in her life. She says that she doesn't want to upset them. Anna was curious as to whether I had told my parents about her. I tried to explain that my parents know that I won't talk about my patients, so they don't press me on that, even when I get calls in their presence. Anna seemed disappointed that I hadn't told my mother about "the girl that I'm treating." Anna spoke about John in a quite perfunctory way. When I called her on it, she said that it was just because she was tired and sick. She then went on to say that she didn't feel any passion towards John and indicated that she doesn't really consider John a candidate for a long term relationship. She said that it feels good to be pursued and then turned the tables on me, asking me whether I liked the feeling of being pursued by her. I tried to ramble about how I'm only interested in what's good for my patient, but the truth is that it makes me feel very good to be pursued by someone as desirable as Anna. Anna described a series of dreams with sexual content regarding me that she has had and said that they made her reach orgasm. I'm afraid she's given me an image that will stick with me for awhile.
Thursday, December 12, 1996	4 pm. Twenty-Third Session with Anna Green. Anna just left and the blood is coming back to my head! She said something about torturing John by being naked around him and then suddenly she was taking off her clothes in the office! She calmly removed her blouse, while telling me that she was a sick patient that needed to be naked. I was totally staggered. I told her to put back on her shirt and then she removed her pants. She wasn't wearing any underwear, so I assume that this was planned, unless she doesn't usually wear underwear. Great. Something else to think about. While I tried to impress upon her that her scheme wasn't going to work, I have to say that I drank in the sight somewhat greedily. She really is breathtaking when naked. She crossed to the windows and probably could have been clearly seen by anyone casually looking in, not to mention by the contingent already peering into my windows--the FBI, Joseph Mazurka, Hal, The Irishman, and maybe the Faxer. They all got an eyeful. I used the desk as a defensive position. I was afraid if I got up and tried to leave the office, she would have put herself in my path and made it impossible for me to leave without touching her. Instead, I sat like a statue behind my desk, gripping the sides for support. They don't really cover this in medical school. Anna made a great show of bending over to recover her pants--and then looked straight back at me through her legs. When she left, she said that she would think of nothing else all week. Yeah right. Like I'm going to put this right out of my mind. I guess this officially makes Anna my favorite patient. Oh, she also talked about isolation, loneliness, using her sexuality to entrap men for the attention. But all that was driven out of my head somehow by the end of the session.
Thursday, December 19, 1996	4 pm. Twenty-Fourth session with Anna Green. I was very strict with Anna and tried to persuade her how outrageous her conduct was during our last session and to prevail upon her not to try such a stunt again. I think she understood, but she waxed poetic about how much she enjoyed standing naked in front of me and how important it was to her as a sexual thrill. I pointed out to her that what she was really describing was a thrill properly ascribed to latent exhibitionist tendencies--the thrill of possible discovery. She was appalled at the notion that the sexual sensation she experienced might not be as a result of her true love for me. I left her to think about that over the holidays. I also brought up the incident about her alleged skinny dipping in the lake at night. After my conversation with Caren, it was apparent that the incident never happened, but I used it as an example of her exhibitionism in any case. I was interested in how Anna would react--whether she would now disavow the incident. But instead she seemingly has incorporated it--she doesn't know what I know as a falsehood and what I don't know. She became slightly guarded and refused to meaningfully compare that incident to the one in my office, only saying that they were different. I have to say that I'm worried about the turn our sessions have taken over the last couple of weeks--first Anna revealed an almost pathological dependency on me--freaking out when I left San Francisco over Thanksgiving weekend. And then the stripping incident. How effective am I actually being with Anna. Having lost Joseph Mazurka, I'm especially concerned about my competence, I guess. I need to enable Anna to turn her attentions away from me and towards a more appropriate external relationship. So far, Anna's relationships are not the mature, stable, and emotionally healthy ones that I would wish for her.
Thursday, December 26, 1996	3:15 pm. Twenty-fifth Session with Anna Green. Anna made a special trip from Davis today to make her session. She arrived unannounced forty five minutes early and asked to be seen. I was able to accommodate her. Anna is an only child. Her parents take a strong interest in her social life. Anna complained briefly about her mother's friendship with Caren--apparently a back door source of information about Anna. She did not feel comfortable talking to her parents about her relationship with John, whom she now considers as irrelevant to her life. Instead she talked to her parents about me. Without giving out the defining characteristic of our relationship--that of a doctor and a patient--Anna talked to her parents at length about my looks, intelligence, and ability to understand her. She did tell them that we have not gone out on a date yet. But "yet" was the main point. Anna even told them a little about stripping for me in my office, although her version of the story was about me accidentally catching her naked. At some point I finally had to intervene and stop her. I am not sure whether she was telling me the truth or this was just another fabrication designed to get to me. When pressed, Anna retaliated by saying that she wouldn't tell a lie to her parents and that I was in fact the most important thing going on in her life currently. I am very disturbed that Anna has taken her infatuation with me outside these sessions and my office. By giving her parents the impression of me as a possible suitor, Anna gave even more reality to her fantasies of our possible life together. I am disappointed at my inability to channel Anna's emotions into a more constructive relationship. Since Anna seems to do better and be stronger emotionally when she is pursued or already in a relationship, I sincerely hope that she meets someone soon. But I also must be careful to make sure that I don't get her to inappropriately transfer her emotions from me to someone with whom she otherwise wouldn't make a commitment.
Thursday, January 2, 1997	4 pm. Twenty-sixth Session with Anna Green. The pitiable John showed up at least mostly uninvited to join Anna during her New Year's Eve festivities. She was planning on going out with Caren and her boyfriend Greg. So she brings John along. They were sitting in the back seat and John tried to put his hand on Anna's knee. Anna jumped in her seat. John decided to then accuse Anna of having an affair. The charge completely stunned Anna, not because it was true or false (apparently false) but because John would have the temerity to think himself in a position to accuse her of anything. Anna went off on John and John confessed his love for her and started to cry. Anna never actually dealt with John, though, because Greg stopped the car and went and had a long talk with John. Apparently he got through because John stopped crying and rejoined them in the car and for the rest of the evening, although nobody had a very good time. Anna is still furious with him. I urged her to not be too harsh with him, because he clearly had his heart broken. I was a bit harsh to Anna, telling her that she had led him on and then broken his heart, but it didn't seem to faze her--she's still so angry with him that she doesn't see his human side at the moment.
Thursday, January 9, 1997	4:35 pm. Twenty-seventh Session with Anna Green. Anna arrived quite late for her session today. She was at MacWorld and lost track of time. She described MacWorld as a place where the geeks come out and play together, but she was obviously flattered when I told her that she was far from a geek. Anna was in a very good mood and, when I questioned her on it, she told me that she had met Martin, a graduate student whom she had previously met and had a brief innocent flirtation with while she was seeing Bill. She spoke about him previously in our third session. Apparently, he's getting a lot of offers from software companies, but he still has to complete his graduate program. Anna is thrilled to renew her relationship with Martin--she seems completely prepared to change her life over a guy whom she met once for a few days and now met again for a few days. But I am glad to see Anna transferring some of the attention she's focused on me towards a relationship which at least has some chance of success. Anna accused me of sounding like her father at one point, and I guess she was right. I do feel protective--as if she's an ex-girlfriend or something. I must watch that proclivity I have towards her; it's inappropriate. I tested Anna a bit to see how much she cared about this guy by suggesting that I might come by MacWorld and hook up with her there. She was completely uninterested. Her focus is locked on Martin now. Martin was waiting in the lobby during our session and Anna hopes to spend the weekend with him prior to his returning to Michigan.
Thursday, January 16, 1997	4 pm. Twenty-Eighth Session with Anna Green. Anna spent a frustrating weekend with Martin trying to seduce him. She paraded around naked and received a series of massages, but he left her sexually frustrated. He said that he wasn't worthy of receiving her sexual favors. In fact, it sounds like our good friend Martin may have something of a foot fetish, combined perhaps with a masochistic tendency. And Anna is following her usual pattern of ecstasy in the first portion of her relationships followed by disillusionment as the reality takes over from her bloated expectations.
Thursday, January 23, 1997	Anna called and cancelled our session for today. She said that she had the flu, and was in bed with a temperature of 103.5. Sounding terrible, she seemed genuinely disappointed to be missing our session. I told her to drink plenty of fluids and contact her general practicioner. She said that she'd see me for our next regularly scheduled session.
Thursday, January 30, 1997	4 pm. Twenty-Ninth Session with Anna Green. Anna came in after being sick all last week. She said that she missed a full week of work and was finally treated with antibiotics. Even now, she said she still felt a bit weak. Mostly Anna and I spoke about Martin's impending visit. He is arriving tomorrow night to spend the weekend with her. She is still hurt that he spurned her direct sexual advances during his last visit, but he called frequently while she was sick and she was clearly touched by his concern. She said that he sent her a get well present of high heeled shoes with an extreme five inch heel. Anna thought they were funny and impractical, but I bet that Martin demands that she model them during their weekend. It seems obvious that Martin has a strong foot fetish. Anna said that she sensed something weird in their telephone conversations--when she was annoyed at him, he seemed to really become interested in their conversation, asking lots of questions to further draw her out. Anna is afraid that he might have a medical problem like AIDS or impotence which he is afraid to confide in her because they have only known each other a short time. I really don't think that's it, but this weekend will probably end the speculation. Although intending to be supportive, she intends to confront him about it in a very direct way.
Thursday, February 6, 1997	4 pm. Thirtieth Session with Anna Green. Anna told me about her weekend with Martin. It is quite clear that Martin is a full-blown masochist who has coopted Anna into his fantasies. Anna seemed to have a good time, dressing up like a post-apocalyptic motorcycle mistress is how she put it, and playing the master part. But Anna liked it in an acting out a fantasy kind of way. I don't think she appreciates that Martin is going to want this as a steady diet. Anna believes that the next time it is her turn to play the slave, but I don't think that Martin will easily switch roles. When I questioned her on how she would feel if Martin wouldn't switch, she said that she had played in his fantasy world and that he would just have to learn to play in hers. But from what I know of S&M, I don't think Anna's insistence on turn about is going to be all that successful. I wonder if it is my responsibility to warn her about how seriously most S&M advocates view their fantasy role-playing. Somehow I'd feel uncomfortable trying to give Anna unsolicited advice about her love life. But Anna doesn't realize that the fantasy, in many ways, sexually defines Martin. She assumes that he is like her: able to derive pleasure from many different roles--like dress-up games. Oh, and even Anna believes that Martin has a serious "foot thing" as she put it.
Thursday, February 13, 1997	4 pm. Thirty-First Session with Anna Green. Anna came in depressed because tomorrow is Valentine's Day and Martin is in Michigan. Anna wants to jump on a plane and go visit him. She is busy this weekend with work, but she is talking herself into going next weekend. Anna wants to just surprise Martin--showing up when she's not expected. For obvious reasons, I've always thought that type of surprise was a mistake, but I didn't think it was appropriate to plant seeds of doubt about Martin's fidelity to Anna--I would have sounded more like a jealous, churlish suitor than Anna's doctor. To prepare for her visit, Anna went to a leather, chains, and whip store somewhere to buy something "appropriate" to wear under her coat, a coat which she would shed immediately after surprising Martin. But Anna was surprised by what she saw at the leather store. Anna is really quite naive about the sadomasochistic community in San Francisco and their practices. She saw porno actors with nipple and penis clamps, and believed they couldn't be real. She understands exploring fantasies in sexual relationships, but doesn't appreciate how consuming the realization of a fantasy can become to some people. Most of the sadomasochistic patients that I've seen in the course of my practice have disdained what they referred to as "vanilla" sex and identified themselves as either a "top" or a "bottom." I think Martin's desire to be a "bottom" is going to run a collision course with the realization of Anna's fantasies. Anna described a recurrent sexual dream which results in nocturnal orgasms. In the dream, she is forced to have sex by a powerful stranger who overwhelms her. Anna is ashamed of this fantasy because she thought of it as a rape fantasy and believes that rape is a horror. I tried to reassure her that rape is about violence and her dream is not. Rather, her dream fantasy is about powerlessness and surrendor. In fact, it seems as if both Martin and Anna are going to want to occupy the role of "bottom" next week. I wonder how it will play out. I urged Anna to be as honest and direct as possible with Martin to try to avoid a whole predictable series of disappointments.
Thursday, February 20, 1997	Anna was off today, going to Michigan to spend the weekend with Martin. I find myself thinking a lot about Anna. I really have to keep it in check if I am to properly serve her as her doctor. And yet with her...it's so easy to be drawn off the track. I missed seeing her for her session.
Saturday, February 22, 1997	7:32 pm. Telephone Call with Anna Green. My service told me that Anna called and sounded hysterical so I called her back in Michigan. She was in the restroom of a restaurant which she had "escaped" to. Apparently Martin, the idiot, took her completely unprepared to an S&M club. Anna watched in horror in some basement dungeon as a girl was stripped naked and beaten with bamboo canes. She didn't take it well. Anna assumed that the girl was some sacrifice and that she was in the midst of some demonic cult. She started screaming and then fled from the place, found a telephone, called the police and then called me. I told her that I believed that the girl was acting on her own free will, but Anna believes that she was hypnotized or something. Actually, she thinks Martin was also hypnotized as well. I didn't realize that my time with Anna on the phone was limited, but suddenly she hung up when the police arrived at the restaurant. I tried calling back, but I just got some patron that told me that she had just walked out the front door with the police. It sounds like Anna got a glimpse of a world that she never knew existed.
Monday, February 24, 1997	9 am. Telephone Conversation with Martin Fleck respecting Anna Green. Martin Fleck gave me a call at exactly 9 am this morning. Martin is very sorry about taking Anna unprepared to the S&M club--he realizes it didn't go as well as he was hoping. I tried to make it clear how stupid it was, but I felt like I was beating him when he was already down. He'd already figured out that it wasn't a good move. I'm not sure if he came to that realization when she ran from the room screaming or if it was when the police arrived or maybe it was when she didn't show up back at his place later on...what an ass! Well, he begged me to try to make it right with Anna. He thinks he may be in love with her and doesn't want to blow it over a misunderstanding. I told Martin that I was planning on having a long talk with Anna about S&M and its practitioners and that I would try to undo some of the damage he'd done. Groveling, he expressed his gratitude. He told me that Anna is missing. Obviously she didn't want to have anything more to do with him that weekend, so I wasn't very concerned. But I called her work and her home today and I haven't been able to locate her. I'm sure she's okay, but it worries me that I can't find her.
Thursday, February 27, 1997	8:48 am. Anna cancelled her session today. She said that she doesn't want to face what happened in Michigan yet. She wants time to become "grounded in reality" again--spending time in commonplace activities with her parents. She's trying to use comfortable, familiar surroundings to help her repress her strong feelings generated by the S&M club. I urged her to come in and talk--sometimes when a person is in crisis, the session is all the more revealing--but she was firm in her resolve. She even admitted that she was hoping that she could talk to the answering service so that she wouldn't have to counter my arguments. When she said that, I knew that it would be pointless to continue so we rescheduled the appointment for next week.
Thursday, March 6, 1997	4 pm. Thirty-Second Session with Anna Green. Anna came in and we were finally able to talk about her night at the S&M club in Michigan. Anna has come to recognize that the girl who was undergoing the whipping was there of her own volition. But that night, Anna described the scene to the police in such a way as to give them cause to raid the house. Anna told the police that she believed the girl to be underaged and drugged, and that there might also be weapons on the premises, even though she admitted that she had seen neither firearms nor narcotics. The police clearly took advantage of the situation and had a ball. They dragged the naked and shivering girl, under a blanket, down to the police station, together with her hooded tormentor and a couple of others. The police delighted in humiliating the club members so that they awoke even Anna's sympathy. I would guess that Martin will be persona non gratis at the club from now on. Subsequently, Anna did some research about S&M and discovered that what she saw was not atypical. Although still incomprehensible to her, Anna no longer feels that she was watching some form of satanic ritual. But she still hasn't sorted out her feelings with respect to the incident and Martin. She still hasn't communicated with him, although he has used up all the tape in her answering machine leaving her messages. Anna's motto has become "repress, repress, repress," but repression is working less well than it did formerly--she is still going through her standard pattern of obsessively replaying the disturbing events over and over in her mind to the detriment of her sleep patterns. This mirrors her original complaint when she first saw me after her breakup with Bill.
Thursday, March 13, 1997	4 pm. Thirty-third Session with Anna Green. Anna is still having difficulty falling asleep after her experiences with the S&M club, but it seems that the trauma surrounding that event is slipping away. Anna had resolved not to talk to Martin for a time, but he flew out to San Francisco and was able to convince the painters of an apartment building across the street from Anna's home to use the as yet unpainted side of the building as a billboard to advertise his affection for Anna. Anna was embarrassed and pleased when she saw the building emblazoned with the message: "I LUV U ANNA." She was met by Martin at the front door to her apartment. She said that the neighborhood seemed to have gathered for the event, clapping and cheering. Martin and Anna only were able to talk briefly before Martin had to fly back to Michigan, but Anna admits that she is a sucker for romance. And she says that, sexual quirk aside, she still really likes Martin. So she is toying with the idea of satisfying Martin's desires by being his dominatrix. She professes to understand that, to its devotees, S&M is more than just a role playing diversion. I tried to explain that it is often an integral part of their personality structure. But Anna sees deeper into Martin than just his sexual persona and feels that he is capable of great love and affection. Anna has started to look at people in the street differently. She remembers the man in the leather mask who was screaming that he was a lawyer in the police station, and now imagines the secret sexual lives of the ordinary people that she sees in the street. She has come to the conclusion that there are a lot of strange people in San Francisco, and I found it hard to argue. She has decided to learn more about S&M, so with a helpful clerk at a dirty bookstore in North Beach, she has gotten some reading material and is preparing herself to undergo the lash in Martin's hands. Martin describes having a sexual rush while he is being abased. Anna says that she has to understand that before she can inflict pain on him. If I wasn't a psychiatrist, I'd say that she was out of her mind. But I am a psychiatrist, so all I can do is nod and say, "Hmm." I was afraid several times during this session that my personal feelings for Anna were going to interfere with my professional judgment. I really think it would be a lot better for Anna if she dumped Martin and tried to find someone else more compatible in body and spirit.
Thursday, March 20, 1997	4 pm. Thirty-Fourth Session with Anna Green. I really hate Martin, that submissive son of a bitch. He's going to hurt Anna, I can just feel it. He sent her a drawing which is undeniably brilliant, but completely twisted. Anna is depicted as a whip-wielding, leather-clad, bare-breasted woman without a head, and with nails hammered into her leg. He said it had something to do with a dream. Anna liked the image. She is malleable and she is trying to fashion herself into a dominatrix just to please Martin. But it doesn't resonate with her, so it is going to end badly for all concerned. And it's really not my personal feelings for Anna getting in the way of my therapeutic judgment. Well, not entirely. This Martin character is just all wrong for her. Anna said that she can intellectualize about her relationship with Martin now; the passion has cooled to the point where she could walk away if she wanted to. But I think that Anna is fooling herself. Her pattern is to idealize a partner, create fantasy expectations and then, when the relationship doesn't work out, to excoriate herself for imagined personal lapses or faults. In any case, Anna is now researching S&M by hanging out in dirty bookstores, striking up a friendship with a woman, Kathy, who works there and enlisting her assistance as a guide to the mysteries of S&M phone sex, and then practicing that phone sex with Martin. Apparently, Martin and Anna spent every night last week in torrid conversation, with Anna dominating Martin long distance. When I asked her whether she was prepared to act out in reality what she had been describing over the phone, Anna hesitated. She realizes that describing the infliction of punishment is much different from actually inflicting pain on someone, but I think Anna is steeling herself to really play the master in reality. Anna senses my hostility towards Martin. I really must not let her know how I feel about him. I'm afraid my instincts in this matter might not be strictly professional.
Thursday, March 27, 1997	4 pm. Thirty-Fifth Session with Anna Green. Anna describes herself as running an S&M radio play complete with sound effects all over the telephone for Martin's benefit. She seems to be proud of her abilities in this area. But I'm afraid that the reality is going to be far different from her telephone fantasies. Even Anna has found that just imagining the reality of a fantasy can be unpleasant. Martin described a fantasy where he ejaculated into one of her shoes at a restaurant. He wanted Anna to put her foot in it and walk home. Anna neatly summed it up: "Yeech!" But on the phone, to not destroy Martin's masturbatory experience, she pretends to be excited by the fantasy. Martin is not going to have a good sense of where Anna's passions really lie. Couples in this stage of sexual intimacy usually are attempting to find out what turns each other on. Well, Anna knows about Martin, but Martin doesn't have a clue about Anna. This is bound to lead to difficulties later on. Martin told Anna about what happened at the S&M club after she ran out that night. Apparently, Martin reassured the other club members that he would take care of Anna. So they were surprised when the police burst in on them. Martin is persona non gratis at the S&M club in Michigan and Anna believes that Martin has been ostracized from the S&M community nationwide, although I told her that it wasn't one organization with tight control over its affiliates. However, Anna is secretly pleased that Martin might have difficulty spending time at S&M clubs. While pretending that she doesn't want to change his sexual preferences, she doesn't think that they are good for him. At the end of the session, she showed me another drawing that Martin sent to her. This one also depicts a headless woman, now topless with spiked heels, needle-like fingernails, and a nipple clamp, high stepping with impossibly long legs in some flowing black garb. I'll say this for Martin--he is willing to put his sexual preferences right out there.

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Anna Green's Patient File
Charles Balis' Notes by Patient



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