Lying on the Couch (32 page)

"You look at your watch, Carolyn. Can you put that into words?" Ernest smiled slightly as he recalled the supervisory session in which Marshal confronted him with the identical words.

"Well, our time is almost up," said Carol, dabbing at her eyes, "and there are other things I wanted to talk about today."

Ernest was chagrined to think he had been so directive that his patient had not been able to address her own agenda. He moved quickly. "A few minutes ago, Carolyn, you mentioned the sexual pressure you were experiencing. Is that one of the things?"

"It's the main thing. I'm out of my mind with frustration—I'm sure it's the root of all this anxiety. Our sex life was not much before but, since Wayne had his prostate surgery, he's been impotent. I understand that's not uncommon after surgery." Carol had done her homework.

Ernest nodded. And waited.

"So, Ernest . . . you sure it's okay to call you Ernest?"

"If I call you Carolyn, you must call me Ernest."

"All right, Ernest it is. So, Ernest, what should I do? Lots of sexual energy and nowhere to direct it."

"Tell me about you and Wayne. Even though he's impotent, there are still ways for you and him to be together."

"If by 'being together' you're thinking of some way for him to get me off, forget it. There's no solution there. Our sex life was over long before the surgery. That was one of the reasons I wanted to leave him. Now I'm completely turned off by any kind of physical contact with him. And he couldn't be less interested himself. He's never found me attractive—said I'm too thin, too bony. Now he tells me to go out and get laid somewhere."

"And?" asked Ernest.

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"Well, I don't know what to do and how to do it. Or where to go. I'm in a strange city. I know no one. I'm not about to go into a bar to get picked up. It's a jungle out there. Dangerous. I'm sure you'd agree that the last thing in the world I need is to be abused again by a man."

"That's for sure, Carolyn."

"Are you single, Ernest.' Divorced? The jacket of your book mentions no wife."

Ernest drew a breath. He had never talked about his wife's death to a patient. Now his commitment to self-disclosure was going to be put to the test. "My wife was killed six years ago in an auto accident."

"Oh, I'm sorry. That must have been hard."

Ernest nodded. "Hard . . . yes."

Dishonest. Dishonest, he thought. Though it's true that Ruth was killed six years ago, it's also true that my marriage would never have lasted anyway. But does she need to know thatf Stay with what will help the patient.

"So, you're also struggling in the singles world now?" Carol asked.

Ernest felt jammed. This woman was unpredictable. He had not anticipated such rough sailing for his maiden voyage of total disclosure, and was strongly tempted to head for the calm waters of analytic neutrality. He knew that course by rote: it would be simple enough to say, "I wonder why you're asking these questions," or "I wonder what your fantasies are about my being in the singles world." But such devious neutrality, such inauthenticity, was precisely what Ernest had vowed to avoid.

What to do? He wouldn't be surprised if next she inquired into his dating strategies. For a moment he imagined Carolyn, a few months or years hence, telling some other therapist about Dr. Ernest Lash's approach to therapy: "Oh yes, Dr. Lash often discussed his personal problems and his techniques of meeting single women."

Yes, the more Ernest thought about it, the more he realized that herein lay a major problem of therapist self-disclosure. The patient has confidentiality, but the therapist has none! Nor can a therapist demand it: if patients enter therapy in the future with someone else, they absolutely must have the freedom to discuss everything, including the quirks of their former therapists. And though therapists can

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be trusted to protect the confidentiality of the patient, they often gossip among themselves about the foibles of colleagues.

Several weeks ago, for example, Ernest referred the wife of one of his patients to another therapist, a friend named Dave. Recently the same patient requested another referral for his wife; she had terminated therapy with Dave because of his habit of smelling her as a way of apprehending her mood! Ordinarily Ernest would have been horrified at this behavior and would never again have referred a patient to him. But Dave was such a good friend that Ernest asked him what had happened. Dave said that the patient had left therapy because of her anger at him for refusing to prescribe Valium, which she had secretly been abusing for years. "And what about smelling?" Dave was at first bewildered but, a few minutes later, remembered one occasion when, early in therapy, he made a casual compliment about a new, particularly heavy perfume she was wearing.

Ernest added another item to his rules of disclosure: reveal yourself to the extent that it will be helpful to your patient; but if you want to stay in practice, have a care about how your self-disclosure will sound to other therapists.

"So you too are struggHng in the singles world," Carol repeated.

"I'm single but not struggling," Ernest responded. "Not at the moment, at least." Ernest strove for an engaging, yet nonchalant smile.

"I wish you would tell me more about how you deal with the singles life in San Francisco."

Ernest hesitated. There's a difference between spontaneity and impulsivity, he reminded himself. He must not, willy-nilly, respond to every question. "Carolyn, I'd like you to tell me more about why you're asking this question. I made you a couple of promises: to be as helpful as I possibly can—that's primary—and, in the service of that, to be as honest as possible. So now, from the standpoint of my primary objective—being helpful to you—let's try to understand your question: tell me, what is it that you're really asking me? And why?"

Not bad, Ernest thought, not bad at all. To be transparent does not mean to be a slave to all the patient's whims and flights of curiosity. Ernest jotted down his response to Carolyn; it was too good to lose—he could use it in his journal article.

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Carol was prepared for his question and had silently rehearsed this sequence, "I would feel more completely understood by you if I knew that you were dealing with similar issues. And especially if you have passed through them successfully. I can experience you as more like me."

"That makes sense, Carolyn. But there must be more to your question, since I've already said that I'm dealing—and dealing satisfactorily—with being single."

"I was hoping you could give me direct guidance—point me in the right direction. I'm feeling really paralyzed—to be honest, I'm horny and terrified at the same time."

Ernest looked at his watch. "You know, Carolyn, we're out of time. Before our next session, let me suggest you work on developing a series of options to meet men and then we'll consider the pros and cons of each. I'm very uncomfortable giving you concrete suggestions or, as you put it, 'pointing you in the right direction.' Take my word for it—I've been through it countless times: that type of direct guidance rarely proves helpful to the patient. What's good for me or someone else may not be good for you."

Carol felt thwarted and angry. You smug, self-righteous bastard, she thought. I'm not going to end this hour without some definite progress. "Ernest, I'm going to have a hard time waiting for another whole week. Could we schedule something earlier; I need to see you more often. Remember, I'm a good cash customer." She opened up her purse and counted out a hundred and fifty dollars.

Ernest was disconcerted by Carol's comment about money. Customer seemed a particularly ugly word: he disliked facing any part of the commercial aspect of psychotherapy. "Oh . . . ah . . . Carolyn, that's not necessary ... I know you paid cash at the first session, but from now on I'd prefer sending you a bill at the end of each month. And actually I'd prefer a check to cash—easier for my primitive bookkeeping methods. I know a check is less convenient because you don't want Wayne to know that you're seeing me, but perhaps a cashier's check?"

Ernest opened up his appointment book. The only time slot available was Justin's newly vacated eight a.m. hour which Ernest wanted to reserve for writing. "Let's play this by ear, Carolyn. I'm pressed for time at the moment. Wait a day or so and if you feel like you absolutely must see me before next week, give me a call and I'll

make time. Here's my card; leave a message on my voice mail and I'll call back and leave an appointment time."

"It's awkward if you call. I'm still not working and my husband's always home ..."

"Right. Here, I'll write my home number on the card. You can generally reach me there between nine and eleven in the evening." Unlike many of his colleagues, Ernest had no concerns about giving out his home number. He had learned long ago that, in general, the easier it was for anxious patients to reach him, the less likely they were to call.

As she was leaving the office, Carol played the last card in her hand. She turned to Ernest and gave him a hug, a little longer, a little tighter, than the last one. Sensing his body tensing up, she commented: "Thank you, Ernest. I needed that hug if I'm going to get through another whole week. I need to be touched so bad I can hardly stand it."

As she descended the stairs Carol wondered, Is it my imagination or is my pigeon taking the bait? He got into that hug just a bitf She was halfway down when the ivory-sweatered jogger came flying up the stairs, almost knocking her over. He grasped her arm firmly to steady her, lifted his white yachting cap by the bill, and flashed a brilliant smile at Carol. "Hey, we meet again. Sorry for almost running you over. I'm Jess. We seem to share a shrink. Thanks for keeping him over the hour; otherwise he'd be interpreting my lateness half the session. He in good form today?"

Carol stared at his mouth. Never had she seen such perfect white teeth. "Good form? Yeah, he's in good form. You'll see. Oh, I'm Carol." She turned to watch Jess bound up the remaining stairs two at a time. Great buns!

TWELVE

/?:.

Thursday morning a few minutes before nine, Shelly closed his racing form and tapped his foot impatiently in \^_y^ Marshal Streider's waiting room. Once he was finished with Dr. Streider, he had a good day ahead of him. First, some tennis with Willy and his kids, who were home for Easter break. Willy's kids played so well now that it felt less like coaching and more like competitive doubles. Then lunch at Willy's club: some of those lan-goustines grilled with butter and anise or perhaps that soft shell crab sushi. And then to Bay Meadows with Willy for the sixth race. Ting-a-ling, Willy and Arnie's horse, was running in the Santa Clara stakes. (Ting-a-ling was the name of Shelly's favorite poker game: a high-low five-card stud game where a sixth card could be bought at the end for two hundred and fifty dollars.)

Shelly had little use for shrinks. But he felt well disposed to Streider. Though he had yet to meet him, Streider had already served him well. When Norma—who, despite everything, really loved him—

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came home the night after receiving his faxes, she was so grateful not to have to end the marriage that she leaped into Sheliy's arms and tugged him into the bedroom. They pledged vows again: Shelly to make good use of therapy for help with his gambling habit, and Norma to give Shelly an occasional day of rest from her voracious sexual demands.

Now, thought Shelly, all I have to do is go through the motions with this Dr. Streider and I'm home free. But maybe there's an angle. There's got to be something. As long as I've got to put in the time, probably several hours, to humor Norma — and to humor the shrink, too — maybe there's some real use I can make of this guy.

The door opened. Marshal introduced himself, shook hands, and invited him in. Shelly buried his racing form in his newspaper, entered the office, and began appraising its contents.

"Quite a collection of glass you got there, Doc!" Shelly gestured toward the Musler pieces. "I like that big orange guy. You mind if I touch it?"

Shelly had already risen and at Marshal's be-my-guest gesture stroked the Golden Rim of Time. "Cool. Very soothing. I bet you have patients who'd like to take that home. And that jagged rim— you know, it looks something like the Manhattan skyline! And those glasses? Old, eh?"

"Very old, Mr. Merriman. About two hundred and fifty years. You like them?"

"Well, I like old wine. I don't know about old glasses. Valuable, eh?"

"Hard to say. There's hardly a booming market in antique sherry glasses. Well, Mr. Merriman ..." Marshal adopted his formal, session-opening voice, "please take a seat and let's begin."

Shelly caressed the orange globe one last time and took his chair.

"I know little about you except that you were once a patient of Dr. Pande's and that you told the institute's secretary that you had to be seen immediately."

"Well, it's not every day you read in the newspapers that your therapist is a fuck-up. What's the charge against him? What is it he did to me?"

Marshal took firmer control of the session: "Why don't we begin with your telling me a bit about yourself and why you began treatment with Dr. Pande."

"Whoa, Doc. I need more focusing. General Motors doesn't put

Lying on the Couch

a notice out saying there's something seriously wrong with your car and then let the owner guess what it is, do they? They say there's some something wrong with your ignition system or fuel pump or automatic transmission. Why don't we begin with your telling me about the defect in Dr. Pande's therapy?"

Startled for a moment, Marshal quickly regained his balance. This was no ordinary patient, he told himself: this was a test case—the first recall treatment case in psychiatric history. If flexibility were necessary, he could be flexible. Ever since his linebacker days he took pride in his ability to read the opposition. Respect Mr. Merri-man's need to know, he decided. Give him that . . . and nothing more.