“She’s twenty-eight years old, unmarried, had an abortion two or three years ago. Feels a lot of guilt about it,” he said, watching the milk create light swirls in his cup of black coffee. “Doesn’t feel like she’s attractive; thinks that men now view her with disdain.”

His colleague lazily loosened the knot of his necktie and unbuttoned the first button of his shirt. “Yeah, go on,” he said.

“Came to therapy looking for improvement in her self-esteem, to not feel so dirty, to feel more confident, regardless of who she is around,” he continued. After taking a sip from the cup, he murmured with satisfaction. “I’ve seen her… I don’t know, maybe for ten sessions. Got a lot of conflict about her identity; on the one hand, she is an adult woman: She’s a copy editor for a well-known magazine. Paid off all of her student loans from college. Lives independently and supports herself. She’s physiologically an adult, you know? And, on the other hand, she believes she’s still an adolescent: She punishes herself for impulsively having sex with this guy and getting pregnant… and then beats herself up for getting that abortion when she was an adult. As if only teenagers get abortions.”

The other fellow, looking out the window, snorted quietly in cynical amusement.

“And so she has doubts that she can handle adult responsibilities—never mind she helps edit this magazine and functions well in her life! She’s not thrilled with her relationships, though, because of this conflict: Is she a girl or is she a woman? Do men expect too much if they believe her to be a woman, when she is really a girl? And if they believe her to be a girl, aren’t they disrespecting her because she is actually a woman? Her sexuality is in a precarious balance,” he continued, slowly rotating the cup with his long, slender fingers.

“So, the work is strengthening her ego so that she can embrace adult responsibilities and fully integrate this abortion experience into her life?” the other fellow asked.

“Part of it, yeah,” the therapist said. “She really doesn’t believe that men find her attractive, even though she is a beautiful woman.” He took another sip of coffee and, after pulling the cup away from his mouth, licked his lips. “She’s gotten some benefit from concrete evidence that men appreciate her adult sexuality. It’s been therapeutic.”

His colleague, perplexed, looked at him. “What do you mean, ‘concrete evidence’?”

“She needs to know that she is an adult woman who can attract adult men because she is an adult. She needs to learn to accept—and tolerate—the responsibility that comes with the power she can have over men. This power is frightening to a little girl and our time together demonstrates to her that, one, she can handle this power and two, she can use it responsibly.”

The other fellow blinked. He opened his mouth to say something, then closed it again.

The two men looked at each other.

“So… you’re sleeping with her in session?” the other fellow finally asked.

“Look—this is her opportunity to develop confidence with me, an adult man. This is her opportunity to learn that she can attract men, that she can behave like an adult and not like a child, that she can move on with her life despite a past mistake. If she is able to engage in a sexual relationship with me, that increases the likelihood that she’ll be able to do the same thing outside of therapy. Her confidence will generalize,” he argued.

“Don’t you have another patient who’s got a similar story?” his colleague asked. “Isn’t she like in her fifties and believes she can’t attract men because she got maimed in a car accident and subsequently gained a lot of weight?”

He cocked his head to the side and impatiently replied, “Oh, no… no. That wouldn’t be therapeutic at all—that woman requires strict boundaries because she needs to learn how to construct her own identity without unnecessary contributions from external forces, such as the car accident.”

He took another sip of coffee.

“That woman absolutely would not benefit from this kind of clinical intervention,” he concluded.