Neil brought in a dream this week. He and his wife Ellen are somewhere exotic, on an island or maybe in a jungle. Everything has been carved in stone — buildings, statues — and he talked about the interesting rock faces and their angles.

“I dreamed it all in color,” he said, “and that’s unusual for me.” He and Ellen were holding hands, which even in the dream, he thought was odd (given their emotional distance). When I asked if the dream brought anything to mind, he told me that he and Ellen had gone to a gallery over the weekend and saw some interesting sculpture. He thought about buying something for their home, as they used to do, but then he felt, “Why bother?” It would only stir up trouble, meaning the struggle over whose taste would prevail. He didn’t want to go there.

I had many ideas about the dream but no conviction as to any of them. I waited. Neil went on to say he’d been very “self-destructive” this past week. It seemed an unlikely description — I don’t think of him as “self-destructive” — so I asked him to fill me in.

On impulse, Neil told me, he’d decided to fly to Las Vegas with a friend where he stayed up all night and drank so much he wound up vomiting. He surprised himself. He hadn’t stayed awake all night in many years; then to be in a public rest room, feeling the room spin, about to be sick. He felt much better after he’d thrown up. When I asked why he’d gone to Vegas, he told me he felt he just “had to get away.” He couldn’t stand it any more.

After the trip, he felt better able to go back to his routine.

In session with Naomi, we discussed her ongoing moral dilemma about whether to disclose. She vacillated between an agonizing sense of guilt for occasions in the past when she hadn’t been honest, to a dry-eyed cynicism in which she’d argue that she might as well go on hiding the truth because she couldn’t undo the past.

“I realize that I’m lying to myself. I can hear it, but I don’t know what else to do.”

I offered a couple of suggestions and she looked at me scornfully. “That’s never going to happen,” she scoffed. Her plight felt hopeless; no solution seemed possible.

I’ve been thinking all week about why some people emerge from a horrendous childhood with hope intact. Given the serial abandonment and sexual abuse, it’s astonishing that Adrienne has any hope whatsoever that someone might care about her.

Why do some people have the ability to recognize goodness when they see it, to cleave unto it for dear life? Why do others never seek help, or when they find it, so easily let go? From my experience, it doesn’t necessarily have to do with the degree of illness. Some of the most troubled clients I’ve worked with over the years have been the most able to value the work and stick to it, despite the hostile and destructive feelings they brought to session.