Lying on the Couch (42 page)

His fantasies both aroused and disgusted him—they offended the very foundation of the life of service to which he had dedicated himself. He understood perfectly that the sexual excitation in his fantasy was heightened by the sense of absolute power he wielded over Carolyn, by the forbiddenness of the clinical situation. Breaking sexual taboos was always exciting: Hadn't Freud pointed out, a century ago, that there would be no need of taboos if forbidden behavior were not so enticing? But such lucid understanding of the source of the excitement in his fantasies did little to diminish their power or allure.

Ernest knew he needed help. First, he turned again to the professional literature on erotic transference and found more there than he expected. For one thing, he was comforted by the knowledge that, for generations, other therapists had struggled with his dilemma. Many had pointed out, as Ernest had concluded on his own, that the therapist must not avoid the erotic material in therapy or respond in a disapproving or condemning fashion lest the material be driven underground and the patient feel that her wishes are dangerous and damaging. Freud had insisted that there was much to be learned from the patient's erotic transference. In one of his exquisite metaphors, he said that to fail to explore erotic transference would be analogous to summoning a spirit from the spirit world and then sending it away without asking it a single question.

It was sobering for Ernest to read that the great majority of ther-

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apists who had become sexually involved with patients claimed they were offering love. "But don't mistake this for love," many therapists had written. "This is not love—it is but another form of sexual abuse." It was also sobering to read that many offending therapists had felt, as he had, that it would be cruel to withhold sexual love from a patient who craved and needed it so much!

Others suggested that no intense erotic transference could persist for long if the therapist did not unconsciously collude. A well-known analyst suggested that the therapist attend to his own love life and ensure that his "libidinal and narcissistic budget be sufficiently positive." That rang true for Ernest and he set about balancing his libidinal budget by resuming a relationship with Marsha, an old friend with whom he had had a nonpassionate but sexually satisfying arrangement.

The idea of unconscious collusion troubled Ernest. It was not unlikely that he was, in some covert fashion, conveying his lustful feelings to Carolyn—confusing her by giving her one message verbally and an opposing message nonverbally.

Another psychiatrist, whom Ernest particularly respected, wrote that some grandiose therapists sometimes resort to sexual relationships when they are in despair about their inability to cure the patient, when their belief in themselves as an omnipotent healer is frustrated. That didn't fit him, Ernest thought—but he knew someone it did fit: Seymour Trotter! The more he thought about Seymour—his hubris, his pride in being thought of as "the therapist of last resort," his belief that, if he set himself the task, he could cure every patient—the more it clarified what had happened between Seymour and Belle.

Ernest turned for help to his friends, especially to Paul. Speaking to Marshal was out of the question. Marshal's reaction would have been entirely predictable: first censure, then outrage at Ernest's departure from traditional technique, and finally absolute insistence that he terminate therapy with the patient and reenter personal analysis.

Besides, Marshal was no longer in the picture. Last week Ernest had to terminate his supervision because of a curious set of events. Six months before, Ernest had accepted a new patient, Jess, who had abruptly terminated treatment with a San Francisco analyst whom he had been seeing for two years. When Ernest inquired about the circumstances of his termination, Jess described a peculiar incident.

Jess, an indefatigable runner, had one day, while jogging through Golden Gate Park, seen a strange disturbance deep in the branches of a scarlet weeping Japanese maple. When he approached, he saw it was his analyst's wife locked in a passionate embrace with a saffron-robed Buddhist monk.

What a dilemma. There was no doubt it was his analyst's wife: Jess had been taking training in ikebana, and she was a well-known master in the Sogetsu school, the most innovative of ikebana traditions. He had met her twice before at flower-arranging competitions.

What should Jess do? Though his analyst was a formal, distant man for whom Jess felt no great affection, still he was competent, decent, and had been so helpful that Jess was reluctant to hurt him by telling him the painful truth about his wife. Yet, on the other hand, how could he possibly continue his analysis while bearing such an enormous secret? Jess saw only one course of action: to terminate analysis under the pretext of some unavoidable scheduling conflict.

Jess knew he still needed therapy and at the recommendation of his sister, a clinical psychologist, began work with Ernest. Jess was the scion of a wealthy old San Francisco family. Exposed to the driving ambition of his father and the expectation that he would eventually enter the family banking business, Jess had rebelled on every front: flunking out of college, surfing for two years, abusing alcohol and cocaine. After the painful dissolution of a five-year marriage, he had slowly begun to put his life back together. First, a prolonged hospitalization and outpatient recovery program for substance abuse, then training in landscape architecture, a profession of his own choice, then two years of analysis with Marshal, and a rigorous physical conditioning and running regimen.

In his first six months of therapy with Ernest, Jess described why he had stopped therapy but refused to name his previous therapist. Jess's sister had told too many stories about how therapists love to gossip about one another. But, as the weeks went by, Jess grew to trust Ernest and, one day, suddenly divulged the name of his previous therapist: Marshal Streider.

Ernest was stunned. Not Marshal Streider! Not his impregnable. Rock of Gibraltar supervisor! Ernest was plunged into the same dilemma Jess had faced. He could neither tell Marshal the truth—he was bound by professional confidentiality—nor continue supervision with Marshal while possessing this burning secret. The incident

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was not entirely inconvenient, however, since Ernest had been building the resolve to terminate supervision and Jess's revelation provided the necessary impetus.

And so, with much trepidation, Ernest told Marshal of his decision. "Marshal, for some time now I've been feeling it's time to cut the cord. You've brought me a long way and now, finally, at age thirty-eight, I've decided to leave home and be on my own."

Ernest braced himself for a vigorous challenge from Marshal. He knew precisely what Marshal would say: Surely he would insist on analyzing his motives for such a precipitate termination. Without doubt, he would inquire about the timing of Ernest's decision. As for Ernest's pathetic desire to be on his own. Marshal would cut the ground out from under that in an instant. He would suggest it was more evidence of Ernest's juvenile iconoclasm; he might even intimate that this impetuousness suggested that Ernest lacked the maturity and the drive for self-knowledge so necessary for candidacy in the psychoanalytic institute.

Curiously, Marshal did none of these things. Appearing weary and distracted, he responded in a perfunctory fashion: "Yes, perhaps it's time. We can always pick up again in the future. Good luck to you, Ernest! My very best."

But it was not with relief that Ernest heard these words and ended his supervision with Marshal. Instead, puzzlement. And, yes, disappointment. Disapprobation would have been far preferable to such indifference.

After spending a half-hour reading a long article on therapist-patient sexual behavior faxed to him by Paul, Ernest picked up the phone.

"Thanks for 'Office Romeos and Lovesick Doctors'! Good God, Paul!"

"Ah, I see you got my fax."

"Unfortunately, yes."

"Why 'unfortunately,' Ernest? Wait a minute, let me switch to the cordless phone and into my comfortable chair. I've got a feeling this is going to be a histrionic conversation. . . . Okay . . . now again, why 'unfortunately'?"

"Because 'Office Romeo' is not what's happening. That article demeans something very precious, something of which it has no comprehension. Trivializing language can be used to vulgarize any finer sentiment."

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"That's the way it seems to you because you're too close to see what's happening. But it's important for you to see what it looks like from the outside. Ernest, since our last talk I've worried about you. Listen to all the things you're saying: 'being in deep truth, loving your patient, her being touch-deprived, you being flexible enough to give her the physical closeness she needs to work in therapy.' I think you're going off your fucking rocker! I think you're heading for serious trouble. Look, you know me—I've been ridiculing orthodox Freudians ever since we entered this field, right.^"

Ernest grunted assent.

"But when the doyen said 'finding a love object is always refind-ing one,' he was on to something. That patient is stirring up something in you that comes from elsewhere—far away and long ago."

No response from Ernest.

"Okay, Ernest, here's a riddle for you: What woman do you know who unconditionally loved every little molecule of your body? Three guesses!"

"Oh, no, Paul. You're not getting on the mother shtick again? I never denied I had a good nursing mother. She gave me a good start the first couple of years; I developed lots of good basic trust—that's probably where my promiscuous self-revealing comes from. But she wasn't a good mother when I started off on my own; never, till the day she died, could she forgive me for leaving her. So what's your point? That in the dawn of life I was imprinted like a young duckling and have been searching for my mother-duck look-alike ever since?

"And even so," Ernest continued—he knew his lines well; Paul and he had had similar conversations in the past—"I'll give you that. Part of it! But you're being so reductionistic—that I'm nothing but a grown-up still searching for the all-accepting mother. That is bullshit! I am, all of us are, so much more than that. Your mistake, and the mistake, too, of the entire analytic enterprise, is to forget that there's a real relationship in the present that's not determined by the past, that exists in the moment, two souls touching, influenced more by the future than by the early past—by the not-yet, by the destiny that awaits us. By our camaraderie, by our huddling together to face and endure the hard existential facts of life. And that this form of relationship—pure, accepting, mutual, equal—is redemptive and the most potent force we have for healing."

"Pure? Pure?" Paul knew Ernest too well to be intimidated or

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swayed by his oratorical flights. "A pure relationships If it were pure, I wouldn't be ragging on you. You're getting off on this woman, Ernest. For Chrissakes, admit it!"

"An asexual hug at the end of the session—that's it. And I've got this under control. Yes, I've got fantasies. I've admitted that. But I keep them in fantasy land."

"Well, I bet your fantasies and her fantasies are doing a moist minuet in fantasyland. But the truth, Ernest, reassure me. No other touching? The time sitting next to her on the couch? A harmless kiss?"

The thought of caressing Carolyn's fine hair as she leaned against him wafted through Ernest's mind. But he knew that wouldn't be understood, that Paul would vulgarize that as well. "No, that's it. No other contact. Paul, believe me, I'm doing good therapy with this woman. I'm handling this."

"If I thought so, I wouldn't be nagging you about it. There's something about this woman that I can't understand. To keep on coming after you like that hour after hour. Even after you are clear and firm about boundaries. Or you think you are. Now I'm not questioning that you're gorgeous—who could resist that cute little ass of yours? But something else is going on: I'm convinced you are unconsciously encouraging her . . . you want my advice, Ernest? My advice is to bail out. Now! To transfer her to a female therapist. And to abandon your self-disclosure experiment as well! Or confine it to male patients—at least for now!"

After he hung up, Ernest paced around his office. He always told Paul the truth, and this rare lapse left him feeling alone. To distract himself he turned to his correspondence. To renew his malpractice insurance, he had to fill out a questionnaire teeming with queries about his relationship with patients. It posed explicit questions. Did he ever touch patients? If so, in which way? Both sexes? For how long? Which part of the patient's body did he touch? Had he ever touched a patient's breast, buttocks, or other sexual body parts? Ernest had an impulse to rip the form to shreds. But he did not dare. No one dared, in these litigious days, to conduct therapy without malpractice insurance. He picked up the form again and checked "yes" to the question, "Do you touch patients?" To the question, "In which way?" he answered "To shake hands only." For all other questions he checked no.

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Ernest then opened Carolyn's folder to prepare for his upcoming hour. His thoughts wandered briefly back to his conversation with Paul. Transfer Carolyn to a female therapist^ She wouldn't go. Give up the experiment? Why? It's proceeding; it's in process. Give up being honest with patients? Never! The truth got me into this and the truth will get me out!

TWENTY