She smiled even as a tear escaped her eye. She wiped it away. "Not a lot — which is kind of the problem. We're ... existing." She shook her head as though trying to stop herself from saying more. The impulse to keep one's truth — especially one's pain — secret is among the most common, powerful, and toxic elements of human nature. "Grant is a wonderful person," she said. "He's been a great provider for almost twenty years. He's never hurt me."

If all my years as a practicing psychiatrist have taught me one thing, it's this: listen for what people do not say. All Nicole could come up with at the moment about Grant was that he made money and wasn't abusive. That left out a lot of other desirable qualities.

I knew Nicole needed permission to tell me what she was really feeling. And since she had already hinted at her reality, I gave her an opening. "He's wonderful, but ..."

A new look came into her eyes, a kind of sudden, unblinking focus I had seen take hold in other patients once they became convinced I really wanted to hear their truths and would not judge them. "But I'm bored to tears," she said flatly.

"And have been for how long?"

"Honestly?"

I waited.

"Probably since I've known him."

Nicole had come in asking for a prescription, maybe thinking that she had slid into a depression over the course of a few months, and we were already journeying back twenty-three years, to when she first met Grant. "What did you think of him when you met him?" I asked.

"That he was a real gentleman," she said. "That he would make a good husband and father — even if he was pretty, well, predictable." She squinted as if looking back all those years — which, in fact, she was. "I'd been through a really bad breakup just before I met him," she said. "I wanted someone stable."

"Who had you broken up with?" I asked.

"Oh, God." She laughed and actually blushed — more than twenty years later. So much for those who would deny the power of the past. "He was a complete mess."

A complete mess. Those were the same words Nicole had used to describe herself just moments before. And that was no coincidence. Listening carefully to Nicole had led me to my questions, which had led directly to the unconscious connection she now felt with her lover from decades before. "What kind of mess?" I asked.

"The worst kind," she said. Her expression brightened, and she suddenly looked ten years younger. "A troubled artist. Your typical bad boy."

" 'Bad,' meaning ... ?"

"You know. Wine, women. Not to mention the fact that he was broke."

"You weren't about to go there," I said.

She chuckled, shook her head. "I'd already been there."

"How so?"

"With my dad."

Nicole had come in for what she thought would be a quick fix — Zoloft — and come face-to-face with unresolved feelings about her father. We had traveled thirty or more years in about thirty minutes.

"Your dad?" I asked.

"Ancient history," she said. She looked away again.

"Doesn't sound like it," I said. "Here we are, talking about him."

"What can I say? He was a lot more interested in his scotch, the track, and other women than he was in my mother, my sister, or me."

Little Brown Book cover of Dr.Keith Ablow's book "Living the Truth", published by Little Brown.

It was worse than that one-liner might indicate, though, and Nicole told me the rest during a few more sessions. Her father would disappear for days at a time. Other women would call the house, setting the stage for screaming matches and occasionally even physical fights between her parents. Sometimes her dad gambled away everything he made as a laborer, leaving the family without food.

Once I knew that "ancient history," I knew why it seemed so important to Nicole to look perfect. She felt anything but perfect inside. Part of her was still the little girl whose father might be sober one night, drunk the next, smiling and generous when he came home from the track a winner, violent when he had lost everything. No wonder Nicole would have traded passion with a troubled artist for the predictability and stability Grant offered. She couldn't risk that her artist-lover would turn out to be no different from her dad. And that's one reason she would have felt somber after exchanging marriage vows — those vows were motivated partly by fear. They were partly about living life and partly about avoiding it.

"It doesn't help anything," Nicole said, "that I work with Grant and live with him. We're together 24-7."

"Why did it turn out that way?" I asked.

She shrugged. "He needed the help, and I didn't have much of a plan," she said. "I mean, I had fantasies about interior design or whatever, but I had no training or anything." She laughed. "I figured I'd at least know where he was all the time."

"Unlike your father," I said.

She stopped laughing. "I suppose," she replied.

"Did you ever pursue your love of design?"

"Just stuff in our house," she said. "I'll leave the rest to Kelley."

My skin turned to gooseflesh, as it does whenever the past becomes palpable in the present. It was clear to me now why Kelley leaving for design school had triggered Nicole's depression. Kelley was living out dreams that Nicole had once had for herself, dreams she had buried in order to create the safe family life she craved. Now, with her daughter off to design school, where she might even fall head over heels for an artistic, romantic, unpredictable man, Nicole was feeling the loss of what she had given up in exchange for stability — pieces of herself.

Why did it take Nicole almost losing herself entirely — thinking she might not want to live — before she gathered the courage to begin to find herself again? Because she thought she could avoid her pain. She had decided — partly consciously, partly unconsciously — to use alcohol, material possessions, great attention to her physical appearance, and even her commitment to her marriage vows to avoid thinking about why she had opted out of passion and why she had traded her own professional goals for the chance to keep an eye on her husband.

The reason was obvious to me, but I wanted to make it obvious to Nicole. I wanted to bring her face-to-face with the truth she had run from her whole life. Only that kind of reckoning with the early chapters in her life story could leave her free to imagine, and then live, wonderful chapters in the future. "So what do you think your dad loved more," I asked her, "the gambling, girls, and booze ... or you?"

She sat in silence for several seconds. Her eyes filled with tears again. "Not me," she said finally. "I guess I never really wanted to admit that. I mean, I was the one by his bedside every day for six months after he was diagnosed with cancer. I think I just wanted to hear him say ..." She stopped herself.

"... that he loved you," I said.

Tears ran down her cheeks.

"Had he ever told you that?" I asked.

She swallowed hard. "No," she said. "And he never did."

She looked down as though ashamed.

I let a few moments pass. "You know the worst part?" I asked Nicole.

She looked at me.

"Part of you still thinks he was right — that you're not lovable. That's what any little girl would think, growing up with a father who was incapable of caring about her. And that's the same part of you, by the way, that tells you that you have to keep tabs on your husband to keep him honest, instead of challenging him to grow if he wants to keep you around. It's the same part of you that won't express your passion for design. There's always that little voice in the back of your head saying maybe you're not worthy of love — not even your own."

"So how do I get that voice to stop?" she asked.

I smiled. "By listening to absolutely everything it has to say."

Excerpted from “Living the Truth: Transform Your Life Through the Power of Insight and Honesty” by Keith Ablow, M.D. Copyright © 2007 by Keith Ablow. Published in May 2007 by Little, Brown and Company. All rights reserved.

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