Mind Matters
When you're the CEO of a company, everyone expects you to be invincible and to have all the answers--and there's no one you can talk to. Is it any wonder you feel so alone?

My patient, Jacob, came to me complaining of an extreme sense of isolation.

"A CEO has no peers," he'd said during our first session, many months before.

As the head of an aeronautics company, he had no coworkers with whom he could share the concerns of his stress-laden job. He felt it was his role to instill confidence in his employees, and he struggled to maintain a calm, self-assured facade. He could no more confide in his employees than he could in the various other people involved in the corporation--not the board members or the consultants, and least of all the customers. The closest thing to peers he had were other industry executives, many of them competitors, and there the need for secrecy was worst of all.

Added to his isolation was a recurring feeling that he was an impostor, lacking the qualifications to run this company. He was the son of uneducated immigrant parents and had been the first in his family to attend college, and though he had graduated with distinction, he was certain it was only a matter of time before the world of Ivy League M.B.A.'s exposed him as the fraud he was. "I came from a swamp," he told me once. "No foundations. Everything rests on sludge."

His fear of being found out was so extreme that, while he craved connection with others, all possibilities of intimacy became threatening. That dynamic invaded his personal life as well. He kept his wife at a distance. Though she had no background in aeronautics, he lived in dread that she might ask him highly technical questions about his work, forcing him to admit he didn't know all the answers. He had difficulty with the simple intimacies of married life: he refused to share a closet and was uncomfortable sleeping in the same bed with her. Even his children seemed threatening, as if they might suddenly quiz him on some matter and find his response wanting.

Although Jacob's case was particularly severe, painful isolation like his bedevils many successful businesspeople. In the hierarchical structure of most corporations, CEOs don't have peers, and their real need to maintain distance frequently breeds anxiety.

When I first saw Jacob in individual therapy, he was unwilling to open up with me for several months. It was as if he feared that I too would discover his inadequacies and judge him harshly. I then suggested he join a short-term, 20-session therapy group I had formed.

His behavior in the group was revealing. The other participants took to him quickly because he was very attentive to their problems and needs. Time and again, people told him how valuable they found his insights, how much they appreciated the energy and focus he brought to the meetings. Gradually, however, the feedback began to change. The comments shifted from words of appreciation to questions such as "Jacob, what about you?" and "What are your concerns?" The therapy-group members remarked that after months together, they still felt as if they barely knew Jacob.

Jacob's participation demonstrated a core principle of group psychotherapy, namely, that the group serves as a social microcosm. In the therapy setting, patients re-create the same type of interpersonal relations and problems that plague them elsewhere in their lives. Jacob, who possessed excellent problem-solving skills key to his professional success, was quite capable of assessing the problems of the other members. When it came to himself, however, he was unable to share his emotions. Just as he did in his work life, he kept himself sheltered from self-disclosure.

Rather than focusing on his accounts of the rest of his life, I focused on Jacob's actual behavior within the group. I made certain he heard what the others were telling him: that they didn't know him and that they wanted to be closer to him. I encouraged him to express his fears of opening up to other members--his fear of judgment, his fear of being found a fraud--and he made some halfhearted efforts to do so before the group ended.

This brief experience had a profound effect. Over the course of the next nine months in individual therapy, Jacob repeatedly referred to the group and the feedback he'd received there. Gradually, he began to reveal his insecurities to me and grew comfortable trusting me with his secrets. To his great surprise, he found that I did not judge him for what he saw as weaknesses. A new idea took root: in the group and in our relationship, he discovered the paradoxical effect of self-disclosure, that neither I nor the group saw him as less able and less interesting because of his vulnerabilities. We actually felt closer to him, more interested.

I urged Jacob to transfer some of the things he'd learned in my office to his life at home. He became adamant that he wanted his children to grow up closer to him than he had been with his father, and he made determined efforts to be more engaged with them emotionally. The greatest change was in his relationship with his wife. Where he had previously seen a source of intimidation, he began to see a friend.

I would have liked to tell Jacob many things during our work together, but ironically, I too must keep up an appearance of confidence. As a therapist, I understand all too well his isolation. Trust and confidentiality prevent me from discussing my patients--the most important elements of my professional life--with my friends. To talk or write about even the most enlightening cases, I must construct elaborate disguises for my patients, as I have done here.

What's more, I too am the son of uneducated immigrant parents; my sister and I were the first in our family to attend college. I understand the feeling of being an impostor, as I must constantly speak--to my patients, to students, to the public--with a voice of authority. As I've begun writing novels, this feeling has grown stronger. When I read reviews that praise my books, I feel relieved that once again I've pulled the wool over the reviewers' eyes. And each time a bad review appears, I shiver, thinking, "Ah, they've found me out at last!"

This enforced isolation is an occupational hazard in many professions. CEOs must, at all costs, appear to maintain a serene self-confidence. On the eve of a great battle, the general must not walk among his troops wringing his hands in fear. And yet...the general must have someone to talk to. In my own life I've found this to be the key--I, like everyone else, must have someone to talk to. Over the years I've developed my "circle of intimates," close friends and family members with whom I can be totally open, and an ongoing support group of several colleagues.

My task in therapy is to help individuals like Jacob find some place for intimacy in their lives. The first step is for us to establish our relationship as one small, safe space of intimacy--frequently, the only such space these patients have. Next we begin to push outward from that space to nurture other close friendships.

That does not mean a radical change in interactions with coworkers. Isolation is built into certain professional situations--mine as a psychiatrist, and perhaps this CEO's. Seeking wellsprings of intimacy in the workplace may be inappropriate. Generally, CEOs' isolation is best countered with careful attention to their personal and family spheres.

Irvin D. Yalom, M.D. is a best-selling novelist ( Lying on the Couch and When Nietzsche Wept) and a professor of psychiatry at Stanford University. Ben Yalom is the editor of The Yalom Reader: Selections from the Work of a Master Therapist and Storyteller.