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Vivian’s fantasy world, the Atmosphere, is adaptive at first, because it provides the emotional support she isn’t getting elsewhere.
When does the Atmosphere become maladaptive?
What are some comparable “devices” other people use to cushion their world?

Over the course of many years, Vivian goes from wanting to feel better to wanting to get better.
What is the difference?

Thoughts of suicide allow Vivian to function: As long as she knows she has an out, she can endure what she is going through.
What are other examples of how something generally construed as negative can actually be helpful?

What role does forgiveness play in Vivian’s emotional healing?
What is the difference between forgiving and forgetting?

One of the books Vivian reads, Island of the Blue Dolphins, has a profound effect on her.
What about the book causes her to react?
If you read Island of the Blue Dolphins, what response did it evoke from you?

Vivian’s experiences may have been extreme, but her life is relatable on many levels.
What aspects of her story are universal?

Assuming time-travel was possible, what might the Vivian at the end of the book tell the Vivian at the beginning of the book?


Vivian reacts to her father’s constraints by escaping to a complex inner world, while outwardly she follows his strict rules. In contrast, her brother sometimes fights back.
One might assume children with the same parents are affected the same way, but in Vivian’s case, they aren’t. Why do you think this is?

Vivian belongs to a large, warm, Greek-Jewish clan that is the antithesis of her nuclear family.
In what ways do her nuclear and extended families shape her?

Vivian often relies on her mother to shield her from her father.
What is the role of one parent in protecting the child from the other parent?
What are the child’s expectations of the protector parent?

In the latter part of the book, Vivian’s mother becomes increasingly aware of the effect of her parenting and discusses it with Vivian.
Is this helpful for Vivian?
When and how should a parent have this kind of discussion with adult children?
Is it always/usually/sometimes appropriate or helpful?

The adult Vivian’s relationship with her parents changes as she comes to understand how their histories shaped them.
What prompted Vivian to seek this understanding?
How does the process evolve with her mother? Her father?


In therapy, the relationship between therapist and client is part of the healing.
How does this play out for Vivian?

What was the process of finding a therapist like in Vivian’s time?
What is it like today?
How do you go about finding a therapist when you don’t know what’s wrong?

Vivian sees seven therapists, each for many years. They are helpful (or not) in different ways, but only the last is able to pinpoint the problem and help her overcome it.
Why might Vivian, or anyone, stay with a therapist even if the therapist doesn’t “get” them?

Structure of the book

Vivian tells her story chronologically, as it unfolds for her. The reader doesn’t know anything before she knows it. There are no observations along the way from an older, wiser Vivian looking back, layering meaning onto what happened.
How did you feel about this structure?
What effect did it have on your involvement with the story?

There are no clinical explanations in the body of the memoir. They come at the end, in the Afterword, where Vivian’s therapist explains the theories and concepts of attachment and dissociation and shows how they apply to Vivian.
Did you find the explanations helpful?
Would you have wanted them placed elsewhere?

Questions for clinicians

How might Vivian’s mental health trajectory have been different if she had been born today, when there is more awareness of adverse childhood experiences (ACEs), relational trauma (betrayal by people you love, trust, or rely on), and attachment?

Dissociation allows Vivian to function well at work, no matter what is going on inside her.
In what ways can dissociation be positive? Negative?

Dissociation is what differentiates Vivian’s internal child parts from the popular concept of “inner child.”
What roles do her child parts play in advancing her healing? In holding her back from healing?

What role does therapy play in Vivian’s healing?
What other factors play a part in her healing?

Early attachment trauma caused the adult Vivian to rely more on fantasy Atmosphere people for connection than on real people.
What enabled her to eventually reverse that?

Not all therapists are trained/qualified/able to treat all conditions.
After therapy has begun, what is the responsibility of the therapist in evaluating whether it is a good fit?
How can the client determine this?
What might either of them do if they feel it isn’t working?

A trauma-informed therapist is aware of the impact childhood trauma can have on adult clients. A trauma-competent therapist is a trauma-informed therapist who is skilled in treating those clients.
What goes into the making of a trauma-competent therapist?
Consider the role of experience, training, relational style, comfort level of the therapist with the material, and other factors.