Lying on the Couch (3 page)

"What? Merely a transference cure? Something about this is really getting to you, Ernest. That's good—it's good to question. You have a sense for the real issues. Let me tell you, you're in the wrong place in your life—you're not meant to be a neurochemist. Well, Freud's denigration of 'transference cure' is almost a century old. Some truth to it, but basically it's wrong.

"Trust me: if you can break into a self-destructive cycle of behavior—no matter how you do it—you've accomplished something important. The first step has got to be to interrupt the vicious circle of self-hate, self-destruction, and then more self-hate from the

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shame at one's behavior. Though she never expressed it, imagine the shame and self-contempt Belle must have felt about her degraded behavior. It's the therapist's task to help reverse that process. Karen Horney once said ... do you know Horney's work, Ernest?

"Pity, but that seems to be the fate of the leading theoreticians of our field—their teachings survive for about one generation. Horney was one of my favorites. I read all of her work during my training. Her best book, Neuroses and Human Growth, is over fifty years old, but it's as good a book about therapy as you'll ever read—and not one word of jargon. I'm going to send you my copy. Somewhere, perhaps in that book, she made the simple but powerful point: 'If you want to be proud of yourself, then do things in which you can take pride.'

"I've lost my way in my story. Help me get started again, Ernest. My relationship with Belle .^ Of course, that's what we're really here for, isn't it? There were many interesting developments on that front. But I know that the development of most relevance for your committee is physical touching. Belle made an issue of this almost from the start. Now, I make a habit of physically touching all of my patients, male and female, every session—generally a handshake upon leaving, or perhaps a pat on the shoulder. Well, Belle didn't much care for that: she refused to shake my hand and began making some mocking statement like, 'Is that an APA-approved shake?' or 'Couldn't you try to be a little more formal?'

Sometimes she'd end the session by giving me a hug—always friendly, not sexual. The next session she'd chide me about my behavior, about my formality, about the way I'd stiffen up when she hugged me. And 'stiffen' refers to my body, not my cock, Ernest—I saw that look. You'd make a lousy poker player. We're not yet at the lascivious part. I'll cue you when we arrive.

"She'd complain about my age-typing. If she were old and wizened, she said, I'd have no hesitation about hugging her. She's probably right about that. Physical contact was extraordinarily important for Belle: she insisted that we touch and she never stopped insisting. Push, push, push. Nonstop. But I could understand it: Belle had grown up touch-deprived. Her mother died when she was an infant, and she was raised by a series of remote Swiss governesses. And her father! Imagine growing up with a father who had a germ phobia, never touched her, always wore gloves in and out of the home. Had the servants wash and iron all his paper currency.

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"Gradually, after about a year, I had loosened up enough, or had been softened up enough by Belle's relentless pressure, to begin ending the sessions regularly with an avuncular hug. Avuncular? It means 'like an uncle.' But whatever I gave, she always asked for more, always tried to kiss me on the cheek when she hugged me. I always insisted on her honoring the boundaries, and she always insisted on pressing against them. I can't tell you how many little lectures I gave her about this, how many books and articles on the topic I gave her to read.

"But she was like a child in a woman's body—a knockout woman's body, incidentally—and her craving for contact was relentless. Couldn't she move her chair closer? Couldn't I hold her hand for a few minutes? Couldn't we sit next to each other on the sofa? Couldn't I just put my arm around her and sit in silence, or take a walk, instead of talking?

"And she was ingeniously persuasive. 'Seymour,' she'd say, 'you talk a good game about creating a new therapy for each patient, but what you left out of your articles was "as long as it's in the official manual" or "as long as it doesn't interfere with the therapist's middle-aged bourgeois comfort." She'd chide me about taking refuge in the APA's guidelines about boundaries in therapy. She knew I had been responsible for writing those guidelines when I was president of the APA, and she accused me of being imprisoned by my own rules. She'd criticize me for not reading my own articles. 'You stress the honoring of each patient's uniqueness, and then you pretend that a single set of rules can fit all patients in all situations. We all get lumped together,' she'd say, 'as if all patients were the same and should be treated the same.' And her chorus was always, 'What's more important: following the rules? Staying in your armchair comfort zone? Or doing what's best for your patient?'

"Other times she'd rail about my 'defensive therapy': 'You're so terrified about being sued. All you humanistic therapists cower before the lawyers, while at the same time you urge your mentally ill patients to grab hold of their freedom. Do you really think I would sue you? Don't you know me yet, Seymour? You're saving my life. And I love you!'

"And, you know, Ernest, she was right. She had me on the run. I was cowering. I was defending my guidelines even in a situation where I knew they were antitherapeutic. I was placing my timidity, my fears about my little career, before her best interests. Really,

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when you look at things from a disinterested position, there was nothing wrong with letting her sit next to me and hold my hand. In fact, every time I did this, without fail, it charged up our therapy: she became less defensive, trusted me more, had more access to her inner life.

"What? Is there any place at all for firm boundaries in therapies? Of course there is. Listen on, Ernest. My problem was that Belle railed at all boundaries, like a bull and a red flag. Wherever— wherever —I set the boundaries she pushed and pushed against them. She took to wearing skimpy clothes or see-through blouses with no brassiere. When I commented on this, she ridiculed me for my Victorian attitudes toward the body. I wanted to know every intimate contour of her mind, she'd say, yet her skin was a no-no. A couple of times she complained about a breast lump and ask me to examine her—of course, I didn't. She'd obsess about sex with me for hours on end, and beg me to have sex with her just once. One of her arguments was that one-time sex with me would break her obsession. She'd learn that it was nothing special or magical and then be freed to think about other things in Hfe.

"How did her campaign for sexual contact make me feel? Good question, Ernest, but is it germane to this investigation?

"You're not sure? What seems to be germane is what I did —that's what I'm being judged for—not what I felt or thought. Nobody gives a shit about that in a lynching! But if you turn off the tape recorder for a couple of minutes, I'll tell you. Consider it instruction. You've read Rilke's Letters to a Young Poet, haven't you? Well, consider this my letter to a young therapist.

"Good. Your pen, too, Ernest. Put it down, and just listen for a while. You want to know how this affected me? A beautiful woman obsessed with me, masturbating daily while thinking of me, begging me to lay her, talking on and on about her fantasies about me, about rubbing my sperm over her face or putting it into chocolate chip cookies—how do you think it made me feel? Look at me! Two canes, getting worse, ugly—my face being swallowed up in my own wrinkles, my body flabby, falling apart.

"I admit it. I'm only human. It began to get to me. I thought of her when I got dressed on the days we had a session. What kind of shirt to wear? She hated broad stripes—made me look too self-satisfied, she said. And which aftershave lotion? She liked Royall Lyme better than Mennen, and I'd vacillate each time over which

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one to use. Generally I'd splash on the Royall Lyme. One day at her tennis club, she met one of my colleagues—a nerd, a real narcissist who's always been competitive with me—and as soon as she heard he had some connection to me, she got him to talk about me. His connection to me turned her on, and she immediately went home with him. Imagine, this schnook gets laid by this great-looking woman and doesn't know it's because of me. And I can't tell him. Pissed me off.

"But having strong feelings about a patient is one thing. Acting on them is another. And I fought against it—I analyzed myself continually, I consulted with a couple of friends on an ongoing basis, and I tried to deal with it in the sessions. Time after time I told her there was no way in hell I would ever have sex with her, that I wouldn't ever again be able to feel good about myself if I did. I told her that she needed a good, caring therapist much more than she needed an aging, crippled lover. But I did acknowledge my attraction to her. I told her I didn't want her sitting so close to me because the physical contact stimulated me and rendered me less effective as a therapist. I took an authoritarian posture: I insisted that my long-range vision was better than hers, that I knew things about her therapy that she couldn't yet know.

"Yes, yes, you can turn the recorder back on. I think I've answered your question about my feelings. So, we went along like this for over a year, struggling against outbreaks of symptoms. She'd have many slips, but on the whole we were doing well. I knew this was no cure. I was only 'containing' her, providing a holding environment, keeping her safe from session to session. But I could hear the clock ticking; she was growing restless and fatigued.

"And then one day she came in looking all worn out. Some new, very clean stuff was on the streets, and she admitted she was very close to scoring some heroin. 'I can't keep living a life of total frustration,' she said. 'I'm trying like hell to make this work, but I'm running out of steam. I know me, I know me, I know how I operate. You're keeping me alive and I want to work with you. I think I can do it. But / need some incentive! Yes, yes, Seymour, I know what you're getting ready to say: I know your lines by heart. You're going to say that I already have an incentive, that my incentive is a better life, feeling better about myself, not trying to kill myself, self-respect. But that stuff is not enough. It's too far away. Too airy. I need to touch it. I need to touch it!'

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"I started to say something placating, but she cut me off. Her desperation had escalated and out of it came a desperate proposition. 'Seymour, work with me. My way. I beg you. If I stay clean for a year—really clean, you know what I mean: no drugs, no purging, no bar scenes, no cutting, no nothing —then reward me! Give me some incentive! Promise to take me to Hawaii for a week. And take me there as man and woman—not shrink and sap. Don't smile, Seymour, I'm serious—dead serious. I need this. Seymour, for once, put my needs ahead of the rules. Work with me on this.'

"Take her to Hawaii for a week! You smile, Ernest; so did I. Preposterous! I did as you would have done: I laughed it off. I tried to dismiss it as I had dismissed all of her previous corrupting propositions. But this one wouldn't go away. There was something more compelling, more ominous in her manner. And more persistent. She wouldn't let go of it. I couldn't move her off it. When I told her it was out of the question. Belle started negotiating: she raised the good-behavior period to a year and a half, changed Hawaii to San Francisco, and cut the week first to five and then to four days.

"Between sessions, despite myself, I found myself thinking about Belle's proposition. I couldn't help it. I toyed with it in my mind. A year and a half— eighteen months —of good behavior? Impossible. Absurd. She could never do it. Why were we wasting our time even talking about it?

"But suppose —just a thought experiment, I told myself—suppose that she were really able to change her behavior for eighteen months? Try out the idea, Ernest. Think about it. Consider the possibility. Wouldn't you agree that if this impulsive, acting-out woman were to develop controls, behave more ego-syntonically for eighteen months, off drugs, off cutting, off all forms of self-destruction, she'd no longer be the same person}

"What? 'Borderline patients play games'? That what you said? Ernest, you'll never be a real therapist if you think like that. That's exactly what I meant earlier when I talked about the dangers of diagnosis. There are borderlines and there are borderlines. Labels do violence to people. You can't treat the label; you have to treat the person behind the label. So again, Ernest, I ask you: Wouldn't you agree that this person, not this label, but this Belle, this flesh and blood person, would be intrinsically, radically changed, if she behaved in a fundamentally different fashion for eighteen months?

"You won't commit yourself? I can't blame you—considering

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your position today. And the tape recorder. Well, just answer silently, to yourself. No, let me answer for you: I don't believe there's a therapist alive who wouldn't agree that Belle would be a vastly different person if she were no longer governed by her impulse disorder. She'd develop different values, different priorities, a different vision. She'd wake up, open her eyes, see reality, maybe see her own beauty and worth. And she'd see me differently, see me as you see me: a tottering, moldering, old man. Once reality intrudes, then her erotic transference, her necrophilia, would simply fade away and with it, of course, all interest in the Hawaiian incentive.

"What's that, Ernest? Would I miss the erotic transference? Would that sadden me? Of course! Of course! I love being adored. Who doesn't? Don't you?

"Come on, Ernest. Don't youf Don't you love the applause when you finish giving grand rounds? Don't you love the people, especially the women, crowding around?

"Good! I appreciate your honesty. Nothing to be ashamed of. Who doesn't? Just the way we're built. So to go on, I'd miss her adoration, I'd feel bereft: but that goes with the territory. That's my job: to introduce her to reality, to help her grow away from me. Even, God save us, to forget me.