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Tom showed me his diary. He reported several instances of being able to practice self-observation of well-being, to establish a relation between interruption of well-being and thoughts, and to challenge his assumptions, demonstrating that these assumptions were not correct. Two examples are reported in table 3.

Table 3. Fourth session

I was particularly impressed by what he wrote in the observer's interpretation of the second situation: ‘you seek distress’. I had the perception that people like him had a low tolerance for well-being and promptly develop thoughts that may lead them back to distress, the condition that they ultimately believe they deserve. I thought of the patient I had seen with George Engel and his description of ‘pain-prone personalities’ [7].

I thought of my high school studies in Italy. I had attended, like Tom, a ‘classic lyceum’ where Latin, ancient Greek, and philosophy were the main subjects. I was not particularly fond of Latin and Greek (why did we not study English?), but I have to admit that they provided a unique background. A Greek notion was that if things go very well, the gods may become envious and strike you. In many literary situations it was clear that this was because success can make you underestimate the situations, feel invulnerable, and force you into major mistakes. In other words, one can make gross mistakes at the top of success that would not be made before climbing the ladder (there are almost daily examples of these phenomena with politicians, actors, etc.). Other people, however, are not carried out by these feelings of well-being and indeed are convinced that their success cannot last. I also thought of the Roman philosopher Seneca and his idea that well-being was a learning process and that writing could be instrumental.

At this point I was curious to see what Tom would develop for the next time period. I praised his work and encouraged him to come back with more material. I also encouraged him to dedicate more time to studying and social activities. There was a clear-cut decrease in his obsessions: they had become less frequent and less intense.

Table 4. Sixth session