Lying on the Couch (14 page)

"But so strong, Ernest? So demanding? Theoretically, I think you're right, but what divorcing patient can ever match up to that standard? You demand the existential hero. Great for novels but, as I think back over my years of practice, I cannot recall a single patient who left a spouse in that noble fashion. So let me ask you again, where's all that push coming from? What about similar issues in your own life? I know that your wife was killed in a car accident

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several years ago. But I don't know much else about your life with women. Did you remarry? Have you been through a divorce?"

Ernest shook his head and Marshal continued: "Let me know if I'm intruding too far, if we're crossing the line between therapy and supervision."

"No, you're on the right track. Never remarried. My wife, Ruth, has been dead six years. But the truth is that our marriage was over long before that. We were living separately but in the same house, just staying together for convenience. I had a lot of trouble leaving Ruth, even though I knew very early—we both knew—that we were wrong for each other."

"Sooo," Marshal persisted, "going back to Justin and your coun-tertransference ..."

"Obviously I've got some work to do and I've got to stop asking Justin to do my work for me." Ernest looked up at the ornate gold-plated Louis XIV clock on Marshal's mantel only to be reminded, once again, that it was purely decorative. He looked at his watch: "Five minutes left—let me discuss one other point."

"You mentioned something about a bookstore reading and a social encounter with a former patient."

"Well, first something else. The whole question of whether I should have owned up to my irritation to Justin when he called me on it. When he accused me of trying to bring him down from his love bliss, he was absolutely right—he was reading reality correctly. I think that, by not confirming his accurate perceptions, I was doing antitherapy,"

Marshal shook his head sternly. "Think about it, Ernest: What would you have said?"

"Well, one possibility was to have simply told Justin the truth— more or less what I told you today." That was what Seymour Trotter would have done. But of course Ernest did not mention that.

"Like what? What do you mean?"

"That I had become unwittingly possessive; that I may have been confusing him by discouraging his independence from therapy; and also that I may have permitted some of my own personal issues to have clouded my view."

Marshal had been staring at the ceiling and suddenly looked at Ernest, expecting to see a smile on his face. But there was no smile.

"Are you serious, Ernest?"

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"Why not?"

"Don't you see that you're too much involved as it is? Whoever said that the point of therapy is to be truthful about everything? The point, the one and only point, is to act always in the patient's behalf. If therapists discard structural guidelines and decide instead to do their ow^n thing, to improvise willy-nilly, to be truthful all the time, why, imagine it—therapy would become chaos. Imagine a long-faced general walking among his troops wringing his hands on the eve of battle. Imagine telling a severe borderline that, no matter how hard she tries, she's in for another twenty years of therapy, another fifteen admissions, another dozen wrist slashings or overdoses. Imagine telling your patient you're tired, bored, flatulent, hungry, fed up with listening, or just itching to get onto the basketball court. Three times a week I play basketball at noon, and for an hour or two before I am flooded with fantasies of jump shots and spinning drives to the basket. Shall I tell the patient those things?

"Of course not!" Marshal answered his own question. "I keep these fantasies to myself. And if they get in the way, then I analyze my own countertransference or I do exactly what you're doing right now—and doing well, I want to add: working on it with a supervisor."

Marshal looked at his watch. "Sorry to go on so long. We're running out of time—and some of that is my fault for talking about the ethics committee. Next week let me give you the details about your beginning a term on the committee. But now, please, Ernest, take two minutes about the bookstore meeting with your former patient. I know that was part of your agenda."

Ernest started to pack his notes into his briefcase. "Oh, it was nothing dramatic, but the situation was interesting—the kind of thing that might generate a good discussion at an institute study group. In the beginning of the evening a very attractive woman came on to me very strongly and I, for a moment or two, reciprocated and flirted back. Then she told me that she had been my patient briefly, very briefly, in a group about ten years ago, in my first year of residency, that the therapy had been successful, and that she was doing extremely well in her life."

"And?" asked Marshal.

"Then she invited me to meet her after my reading, just for coffee in the bookstore cafe."

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"And what did you do?"

"I begged off, of course. Told her I had a commitment for the evening."

"Hmm . . . yes, I see what you mean. It is an interesting situation. Some therapists, even some analysts, might have met with her briefly for coffee. Some might say, given that you saw her only in brief therapy and in a group, that you were being too rigid. But," Marshal rose to signify the end of their hour, "I agree with you, Ernest. You did the right thing. I would have done exactly the same."

FIVE

ith forty-five minutes to spare before his next patient, Ernest set off for a long walk down Fillmore toward Japantown. He was unsettled in many ways by the supervisory session, especially by Marshal's invitation, or rather edict, to join the State Medical Ethics Committee.

Marshal had, in effect, ordered him to join the profession's police force. And if he wanted to become an analyst, he could not alienate Marshal. But why was Marshal pushing it so hard? He must have known the role wasn't right for Ernest. The more he thought about it, the more anxious he grew. This was no innocent suggestion. Surely Marshal was sending him some kind of wry, coded message. Perhaps, "See for yourself the fate of incontinent shrinks."

Calm down, don't make too much of it, Ernest said to himself. Maybe Marshal's motives were entirely benign—probably serving on this committee would facilitate acceptance as a candidate for the analytic institute. Even so, Ernest didn't like the idea. His nature was

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to understand someone in human terms, not to condemn. He had acted as policeman only once before, with Seymour Trotter, and, though his behavior had been publicly impeccable on that occasion, he had resolved never again to sit in judgment of another,

Ernest checked his watch: only eighteen minutes before the first of his four afternoon patients. He bought two crisp fuji apples from a grocery store on Divisadero and devoured them as he rushed back to his office. Brief lunch breaks of apples or carrots were the latest in a long series of weight-losing strategies, each hugely unsuccessful. Ernest was so ravenous by the evening that he wolfed down the equivalent of several lunches during dinner.

The simple truth: Ernest was a glutton. He consumed far too much food and would never lose weight merely by shifting the proportions around during the day. Marshal's theory (which Ernest secretly considered analytic bullshit) was that he did too much mothering in therapy, permitted himself to be sucked so dry by his patients, that he gorged himself to fill his emptiness. In supervision, Marshal had repeatedly urged him to give less, and to say less, limiting himself to only three or four interpretations each hour.

Glancing about—Ernest would hate for a patient to see him eating—he continued to reflect on the supervisory hour. "The General wringing his hands before the troops on the eve of battle!" Sounded good. Everything Marshal said in that confident Bostonian accent sounded good. Almost as good as the Oxonian speech of the two British analysts in the Psychiatry Department. Ernest marveled at the way he and everyone else hung on their every word, even though he had yet to hear either of them express an original thought.

And so, too. Marshal sounded good. But what had he really said? That Ernest should conceal himself, that he should hide any doubts or uncertainties. And as for the general wringing his hands—what kind of analogy was that? What the hell did the battlefield have to do with him and Justin? Was there a war going on? Was he a general? Justin a soldier? Sheer sophistry!

These were dangerous thoughts. Never before had Ernest permitted himself to be so critical of Marshal. He reached his office and began scanning his notes in preparation for his next patient. Ernest permitted no slack time for personal reverie when he was about to see a patient. Heretical thoughts about Marshal would have to wait. One of Ernest's cardinal rules of therapy was to give each patient one hundred percent of his attention.

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Often he cited this rule when patients complained that they thought of him far more than he thought of them, that he was but a friend rented by the hour. He generally responded that when he was with them in the here-and-now of the therapy hour, he was entirely and fully with them. Yes, of course they thought more about him than he about them. How could it be otherwise? He had many patients, they only one therapist. Was it any different for the teacher with many students, or the parent with many children? Ernest often was tempted to tell patients that when he had been in therapy he had experienced the same feelings for his therapist, but that was precisely the type of disclosure that brought the severest criticism from Marshal.

"For Chrissakes, Ernest," he would say. "Keep something for your friends. Your patients are professional clients, not your friends." But lately Ernest was beginning to question more seriously the discrepancy between one's personal and professional personae.

Is it so impossible for therapists to be genuine, to be authentic in all encounters? Ernest thought of a tape he had heard recently of the Dalai Lama speaking to an audience of Buddhist teachers. One member of the audience had asked him about teacher burnout and the advisability of structured off-duty time. The Dalai Lama giggled and said, "The Buddha off duty} Jesus Christ off duty}''

Later that evening during dinner with his old friend, Paul, he returned to these thoughts. Paul and Ernest had known each other since the sixth grade, and their friendship had solidified during medical school and residency at Johns Hopkins when they had roomed in a small, white-stepped house on Mount Vernon Place in Baltimore.

For the past few years their friendship had been conducted largely by telephone since Paul, reclusive by nature, lived on a twenty-acre wooded lot in the Sierra foothills, a three-hour drive from San Francisco. They had made a commitment to spend one evening a month together. Sometimes they met halfway, sometimes they alternated the drive. This had been Paul's month to travel and they met for an early dinner. Paul never spent the night anymore; always misanthropic, he had grown more so as he aged and recently had developed a strong aversion to sleeping anywhere but in his own bed. He was unperturbed by Ernest's interpretations about homosexual panic or his gibes about packing his beloved blankee and mattress in his car.

Paul's growing contentment with inner journeys was a source of annoyance to Ernest, who missed his travel companion of earlier

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years. Though Paul was extremely savvy about psychotherapy—he had once spent a year as a candidate at the Jungian institute in Zurich—his preference for rural life limited his supply of long-term psychotherapy patients. He earned his living primarily as a psy-chopharmacologist at a county psychiatric clinic. But sculpting was his real passion. Working in metal and glass, he gave graphic form to his deepest psychological and existential concerns. Ernest's favorite piece was one that had been dedicated to him: a massive earthenware bowl containing a small brass figure who grasped a large boulder as he peered inquisitively over the lip. Paul had titled it Sisyphus Enjoying the View.

They dined at Grazie, a small restaurant in North Beach. Ernest came directly from his office, dressed nattily in a light gray suit with a black and green plaid vest. Paul's clothing—cowboy boots, checked Western shirt, and string tie clasped by a large turquoise stone—clashed with his pointed professorial beard and thick wire-rimmed spectacles. He seemed like a cross between Spinoza and Roy Rogers.

Ernest ordered an enormous meal while Paul, a vegetarian, displeased the Italian waiter by refusing all his entreaties and ordering only a salad and grilled marinated zucchini. Ernest wasted no time filling Paul in on the events of his week. Dipping his focaccia in olive oil, he described his bookstore encounter with Nan Carlin and proceeded to complain about striking out with three women he had approached that week.

"Here you are, horny as hell," said Paul, peering through his thick glasses and picking lightly at his radicchio salad, "and listen to yourself: a beautiful woman comes after you, and because of some cockamamie excuse of having seen her twenty years ago. ..."