Dorothy was taking a shit at the library when her therapist called and she let it go to voice mail. For three years running they had been meeting every Tuesday (save a New Year’s holiday and the thirty-one days of August) in the stuffy fifteenth-floor studio on Central Park West, with its treetop view and standard-issue decor: African masks, Oriental rugs, Afghan throws, South American flutes. Dorothy was comforted by the therapist’s warmth and womanliness, her aging but elastic skin, the way she clucked and wiped her hands like someone who had seen it all and intended to save you the trouble of seeing it for yourself. Still, more and more it worried Dorothy to have entrusted her mental health to one who made such little effort against the tide of cliché. It was one thing for problems—even solutions—to be unoriginal; another for presentation.

When the worrying got too intense, Dorothy had a choice of palliatives arrayed in pouncing distance of the saggy patient sofa: stress balls, beads, figurines for rubbing and handling, various-size pillows for pounding and embracing, and the eternal tissue box, draped in its hand-knitted elephant-gray cover. The box was always full. The therapist must be keeping watch on the box’s levels. Dorothy respected her attention to detail. Fullness, plenitude, preparedness, a material well of empathy—excellent clinical values all. But where did the therapist hide the half-full boxes? Or did she cram new tissues into the same old box between sessions? How old was the box, and how old were the tissues at the deepest, most archaeological substratum, and what might happen if Dorothy had a particularly lachrymal session and made it all the way down to the bottom?

The therapist was calling because Dorothy, who at this moment was rereading the flyer for student health services taped to the wall above the receptacle for used feminine-hygiene products, had left a voice mail at eleven o’clock last night canceling today’s session. It wasn’t that the miscarriage was such a big deal or that she was broken up in grief about it; it was that she hadn’t told the therapist she was pregnant, and didn’t want to have a whole session about her tendency to withhold. In the asymmetrical warfare of therapy, secrets were a guerrilla tactic. Dorothy was not belligerent by nature. She almost certainly would have told the therapist everything, except a few weeks ago, when it was on her tongue to do so, the therapist had interrupted a story that she was telling about her boyfriend, Rog, to remark that Rog was “a keeper.” Dorothy saw at once that after the language of “keeping” had been introduced into the room, it would be impossible to keep it from becoming attached to the pregnancy, to define the pregnancy in terms of a keeping or a not-keeping, when in fact Dorothy was not ready to talk about retention, even as a future decision toward which she was inevitably hurtling, and so she, driven into a cul-de-sac by a linguistic overdetermination that would have been rich material if she only could have borne it, said nothing.

FINALS GOT YOU STRESSED? the flyer quizzed. DON’T DESPAIR. TEXT TO TALK IT OUT. A sad stick figure in one corner, a smiling stick figure in the other. KILL YOURSELF, someone had written in green ink above the smiler. STOP THE HATE, someone else had written alongside. Then the hand in green ink had returned to draw a drooling penis with a thick beard and a natty top hat. Dorothy wondered if she had taught any of these students. It was possible.

There were other things that Dorothy had kept from the therapist, questions that lingered unasked, doubts she had failed to articulate. She had never expressed her aversion to the decor, never raised the matter of the tissues. And why, Dorothy had often speculated, had she never once—never in three years running—seen another person in the therapist’s waiting room? Did the therapist never run behind schedule? Was the next patient never early? Who were these masters of time? What had begun as Dorothy’s private joke—that she was, in fact, the therapist’s only patient, that the tissue box was refilled for her benefit alone—had blossomed into a suspicion that had evolved into a conviction that was reaching maturity as full-blown fact.

The therapist naturally went to great lengths to put up a front that Dorothy was one of many, an item in a series that had no beginning and no end. There were, first of all, the references to other patients. “Some of my other patients find it useful to . . .” “When you’ve been in this game a long time you learn . . .” That kind of thing. There was the overstuffed appointment book that the therapist consulted if Dorothy needed to move her session time. There was the gentle, patient smile the therapist issued whenever Dorothy complained of being in “crisis,” a wordless sign intended to make plain that Dorothy was a model of normalcy compared with the mentally ravaged hordes that were beating down the therapist’s door all the live-long week, except during the precise times that Dorothy was traversing the hallways, elevator, and lobby of the doorman building on Central Park West. The upshot of all this was that Dorothy was sure she was the therapist’s only patient but had not yet determined why this was so. Was the therapist not good at her job? Was she lazy? Who paid the rent? Perhaps she was merely a hobbyist therapist, or—and this was a new theory, whose kinks Dorothy was still ironing out—perhaps she had retired just before Dorothy was referred to her, and for deep psychological reasons of her own had not been willing to admit that she was no longer taking new patients, and thus the farce had begun, and thus had spun, ever so slowly, out of control.

Not long ago Dorothy had started seeing a second therapist, on the side, in whom she confided her doubts about the first therapist, but this was only a temporary situation. Dorothy wasn’t a millionaire.