Paul is on the phone leaving a message for his kids about a visit scheduled for the next week.

Walter arrives for a first appointment. A well-dressed man who comments on his “nice things” and then fusses with the pillow in the chair and lets Paul know he is a CEO. Paul asks him to tell him about himself but Walter wants to know what he already knows about him. Walter is surprised he knows nothing about him. He is surprised that Paul doesn’t read the business section and tells him that his daughter’s friends at college never read that section either — and he sounds very disapproving. Walter keeps impressing on Paul how important he is.

He tells Paul it was his wife’s idea that he seek therapy because he doesn’t sleep well. Paul notes he has mentioned his wife twice and that she takes good care of him. He says he has tried Xanax and Ambien and says they did not work for him. He says his doctor told him he has underlying anxiety and should talk to someone. Walter is distressed that his whole life he was able to sleep whenever he wanted but now he can’t. 

Paul tells him gently that the kind of therapy he does is not a quick fix. Walter is impatient with this because he wants things to be better now, no matter he cost. Paul tells him he needs to know more about Walter and what is going on before he can say what is wrong.

Paul keeps trying to find out when he began to have trouble sleeping and Walter says he doesn’t really know, that it happened gradually. He mentions his daughter and then he smiles as he talks about her — she is the youngest of his children and only daughter. He is delighted in her and now she is in Rwanda. Walter grabs that as the problem but Paul says he thinks there is more to it than this.

Paul tells him he can see he is suffering for some kind of anxiety and the only way he knows to deal with that is to talk. Paul suggests to him that yes, he should say whatever comes into his mind. 

Walter is fidgety and uncomfortable being asked to talk. Paul asks if he has anyone he can talk to about the pressures he experiences and he says no one at work and not his sons because they aren’t interested.He reads Paul an email he received from his daughter. He becomes visibly upset reading her account of how difficult it is there and how much she finds being there important. Walter thinks he should run to get her ought because of what she describes because he fears she will be kidnapped. Paul says he thinks Natalie can be trusted to take care of herself.

Walter is angry at this and wants a concrete solution to his insomnia and as he angrily gets up to leave he falls down holding his chest. He seems to recover and still wants to leave. And he does.

Walter, like April, promises to be very challenging patient. Walter wants concrete specific answers. He needs for Paul to know how important and busy he is. It is only when he talks about his daughter that we catch of glimpse of a man who loves deeply. Notice that from the beginning he  makes repeated references to his importance and success so that Paul will know he is not dealing with an ordinary man. The intensity of this repetition leads me to suspect he has some deep seated feelings of insecurity, inadequacy and anxiety. His refusal to think about or talk about it means these feelings have no place to go but into his body — in the form of insomnia and the anxiety attack we saw at the end. But somatizing in this way carries its own dangers and can be as deadly as April’s cancer.

Like April, Walter leaves without scheduling another appointment. And like April, Walter foreshadowed his leaving when he talked about the doctor who prescribed medication that didn’t work. Walter is telling us he will not wait long for results.

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