Heartsink relationships: paradox as paradigm

### A heartsink trio Alvin sat in the consulting room, crutches against the wall behind him, and picked ineffectively at a band-aid on his cheek. His physician entered the room, reluctantly. ‘I'd like you to look at this spot on my face’ . ‘OK, just remove the band-aid.’ ‘I can't. My finger nails are too short.’ Alvin giggled. The physician sighed. He approached (but not too closely), and removed the dressing with the extreme tips of his fingers. He washed his hands, approached again, and peered at the pimple from a distance. ‘I stuck a needle in it last night.’ The physician sighed, yet again. On closer inspection, (but still not too much closer), the pimple turned out to be a small, infected sebaceous cyst. Hands were washed again. ‘It looks like a small sebaceous cyst, that has got infected, Alvin.’ ‘A cyst! How would I get that?’ ‘Alvin, what's the big deal. It's only a cyst.’ ‘You sound just like my father!’ ‘What does that mean?’ Alvin's story was revealing. He was the son of an abusive father, and had left home and school at the age of 15. He approached life tentatively, and with good reason, He had spent various periods of time in psychiatric institutions and in jail, and was a client in a methadone clinic. His life was marked by drug-induced psychotic episodes, and conflicts with the police, with men, and with women. Inevitably, he fared poorly when these conflicts became physical. For example, 1 month prior to his latest office visit, Alvin had been ‘sent packing’ by his wife after a particularly fierce argument. In a fit of frustration, he had insisted on removing a small refrigerator from their apartment, had fallen while trying to negotiate a flight of stairs, and had sustained a broken leg when the appliance …