When the session ended, Adam felt guilty for charging David. Normally Adam was extremely attentive and used his instincts to anticipate where a session was headed and find the right openings to challenge his patients’ behavior, but he felt like he hadn’t helped David as much as he could’ve. For example, instead of letting David go on with his self- loathing, Adam should have been tougher and said something like “It sounds like you’re ready to leave your marriage.” Adam knew that David had no desire to get a divorce, but this could have helped David begin to acknowledge his reasons for philandering. But today Adam had been so distracted with his own thoughts and self- doubt that he’d felt off, out of sync, like he’d missed all of the obvious openings.

He had two more morning sessions and, as with David, Adam felt out of sorts, off his game. He had no doubt that the shooting and related issues were seriously affecti night.”

Well, that explained the agitation; this was a major setback for David.

Wanting to keep his patient feeling reassured and at ease, Adam asked in a very normal, nonjudgmental tone, “Where did you meet her?”

“Online,” David said. He crossed his legs, then uncrossed them again. His forehead was glistening with sweat. “I mean, not online, I mean through an online service… Ashley Madison.”

Adam knew of Ashley Madison and other similar extramarital dating services. Several of his patients frequently met sex partners through these sites.

“Okay,” Adam said calmly, waiting for David to continue on his own.

David explained how he’d registered with Ashley Madison and then had arranged to meet a woman, Linda- who was married with two kids- at a hotel and had sex with her. When he described what had happened, and especially when he mentioned the sex and how “hot and raw” it was, David started talking faster and louder, and Adam could tell how exhilarating the whole experience had been for him. It was very similar to the way a drug addict would behave when describing the experience of doing drugs; in fact, in a previous session David had told Adam about the coke habit he’d kicked several years ago. This had hardly been surprising to Adam, since most sex addicts have other addictions and are frequently codependent. All in all, David was just about as textbook as they get.

As David finished telling the story, his lips started quivering, and then the tears came, flowing down his cheeks, and he said, “I don’t know why…” He was crying harder and had to get hold of himself. Finally he said, “I don’t know why I keep doing this. I don’t know… I don’t know what’s wrong with me.”

David had cried before during sessions- he was a sympathy seeker- and Adam gave him tissues and reassured him, saying things like “It’s okay” and “I know how hard it is.” David, as usual, was blaming himself for his behavior, playing the victim, saying, “I feel like such a piece of shit. I don’t know what the hell I’m doing with my life anymore.” Adam advised him not to beat himself up about it too badly and reminded him that the Internet could be very tempting for anybody and that these things happened, using the same tactics he’d employ in any similar therapy session, trying to support and reassure his patient. All the time, though, he couldn’t help feeling like a total fraud. Who the hell was he to counsel anyone when his own life had been such a mess lately? And trying to treat David for philandering was the biggest joke of all, what with David sitting on the very couch where Adam had screwed Sharon Wasserman. Adam was telling David, “You don’t have to feel like you always have to be perfect,” and meanwhile he couldn’t help imaging Sharon on top of him, riding him, his hands on her breasts. Adam told David, “Just because you want to have sex with another woman doesn’t mean you have to actually do it,” remembering how he’d said Sharon’s name again and again when he came.

When the session ended, Adam felt guilty for charging David. Normally Adam was extremely attentive and used his instincts to anticipate where a session was headed and find the right openings to challenge his patients’ behavior, but he felt like he hadn’t helped David as much as he could’ve. For example, instead of letting David go on with his self- loathing, Adam should have been tougher and said something like “It sounds like you’re ready to leave your marriage.” Adam knew that David had no desire to get a divorce, but this could have helped David begin to acknowledge his reasons for philandering. But today Adam had been so distracted with his own thoughts and self- doubt that he’d felt off, out of sync, like he’d missed all of the obvious openings.

He had two more morning sessions and, as with David, Adam felt out of sorts, off his game. He had no doubt that the shooting and related issues were seriously affecting his performance at work. If this continued and he couldn’t work through it, he’d have to take some time off to clear his head, maybe go down to Florida after all.

During a break in his schedule, he went around the corner to the deli to get a cup of coffee and a muffin, and on his way back he checked his voice mail and saw that he had three messages and four missed calls from Dana. She had called and left a message on his work voice mail as well. Jesus Christ, what was going on now?

He called her, and she picked up during the first ring and said, “I’ve been calling you.”

“I’ve been with patients all morning, what’s going on?”

“She’s HIV positive.”

He thought she was talking about Marissa. Feeling like he might pass out, he managed to say, “What the hell’re you talking about?”

“Detective Clements just called and told me they found out Gabriela had HIV. They found her medicine or whatever in her apartment.”

“Jesus,”he said, catching his breath.“I thought you meant…”

“What?” Dana said.

“Never mind,” Adam said, still light- headed.

“Can you believe it?” Dana continued. “Clements said even her sister didn’t know. She might’ve been infected for years.”

Adam didn’t understand why Dana was calling him so urgently to tell him about this. “So is that it?” he asked.

“Aren’t you shocked?” Dana asked.

Actually Adam wasn’t shocked. Her boyfriend had had HIV, so why was it out of the realm of possibility that Gabriela had been infected?

“Oh, and that’s not all,” Dana went on. “They found out she was a drug addict, too, heroin, just like her boyfriend. Can you believe it? She was a junkie and had AIDS while she was working for us.”

“Let’s not start with that again,” Adam said. “That’s not how AIDS, HIV, is transmitted.”

“I’m talking about the deceit,” Dana said. “That woman lied to our fucking faces for years. I can’t tell you how furious I am.”

“You have a right to be furious,” Adam said.

“Aren’t you furious?”

“Of course I’m furious.”

“You don’t sound furious.”

“I’m standing on the corner of Fifty- eighth and Madison,” Adam said. “Sorry, but there’s a limit to the amount of furiousness I can express right now.”

Dana didn’t seem amused and said, “Well, it was nice talking to you too,” and hung up.

Several minutes later, as he rode in the elevator back up to his office, he decided that although hanging up on him had been melodramatic and childish, Dana had made a good point. Being so wrapped up in what was going on with the police and the media, and then, on top of everything, receiving that threatening note, maybe he hadn’t been expressing his anger very effectively lately, and this was likely contributing to all the symptoms of anxiety and self- doubt he’d been experiencing.

His one o’clock appointment, Helen, didn’t show up. Helen had never missed an appointment before, and Adam assumed that it was related to the shooting and that he had permanently lost another patient. His two o’clock, Patricia, a banker with panic disorder, showed up, but Adam felt he was as ineffec tive and off the mark as he’d been with his earlier patients. Patricia didn’t seem pleased at the end of the session either, and when Adam asked her if she wanted to make an appointment for her next session now, she said in a somewhat distant tone, “I’ll call you,” even though she normally made her appointments in person. Adam knew that something had to change fast, because at this rate either all his patients were going to stop coming to see him on their own or he was going to drive them away.