Lying on the Couch (52 page)

"No, Carolyn, let me finish. . . . there's something more I want to say to you. . . . Before I even met you I had made a conscious decision that I was going to be totally self-revealing with my next new patient. I felt, and still feel, that the basic flaw in most traditional therapy is that the relationship between patient and therapist is not genuine. My feelings about this are so strong that I had to break with an analytic supervisor I greatly admired. It's for this very reason that I've recently made a decision not to pursue formal psychoanalytic training."

"I'm not sure what the implications of this are for our therapy."

"Well, it means my treatment of you has been experimental.

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Maybe, in my own defense, I should say that that's too strong a term since, over the past few years, I have tried to be less formal and more human with all my patients. But with you there's a bizarre paradox: I committed myself to an experiment of total honesty and yet never told you about that experiment. And now, as I take stock of where we are, I don't believe this approach has been helpful. I've failed to create the type of honest, authentic relationship that I know is necessary if you're going to grow in therapy."

"I don't believe that any of this is your fault—or the fault of your approach."

"I'm not sure what went wrong. But something has. I feel an enormous gulf between us. I feel great suspicion and distrust coming from you, which alternates suddenly with some expression of great affection and love. And I always feel baffled because most of the time I don't sense you feel warm or even positive to me. Surely, I'm not telling you something you don't know."

Carol, head bowed, stayed silent.

"So, my concern is growing: I have not done the right thing by you. In this case honesty may not have been the best policy. It would have been better if you had seen a more traditional therapist, someone who would foster a more formal therapist-patient relationship, someone who would keep clearer boundaries between a therapeutic and a personal relationship. Sooo, Carolyn, I guess that's what I wanted to say to you. Any response?"

Carol started to speak twice but fumbled for words. Finally she said, "I'm confused. I can't speak—don't know what to say."

"Well, I can guess what you're thinking. In the light of all I've said, I'd expect that you'd be thinking you'd be better off with another therapist—that it's time to bring this experiment to an end. And I think you may well be right. I'll support you in this, and I'll be glad to make suggestions for another therapist. You might even be thinking that I've improperly charged you for an experimental procedure. If so, let's talk about that; maybe returning your fees is the proper thing to do."

The end of the experiment — a certain lilt to that, Carol thought. And the perfect way out of this whole sticky farce. Yes, it's time to go, time to stop the lie. Leave Ernest to Jess and Justin. Perhaps you're right, Ernest. Perhaps it is time for us to stop therapy.

That's what she should have said; instead, she found herself saying something quite different.

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"No. Wrong on all counts. No, Ernest, it is not your therapy approach that's at fault. I don't like the idea of your changing it because of me . . . that troubles me ... it troubles me a great deal. Surely one patient is not enough for you to reach such a conclusion. Who knows? Maybe it's too early to tell. Maybe it's the perfect approach for me. Give me time. I like your honesty. Your honesty has done me no harm. Maybe a lot of good. As for returning your fees, that's out of the question—and, incidentally, as an attorney, I want to advise you against such statements in the future. Leaves you vulnerable to litigation.

"The truth?" Carol continued. "You want the truth? The truth is you've helped. More than you know. And, no, the more I think about it, I don't want to stop seeing you. And I won't see anyone else. Maybe we're over the tough period. Maybe, unconsciously, I was testing you. I think I was. And testing you severely."

"How did I do on the test?"

"I think you passed. No, better than that . . . top of your class."

"What was the test all about?"

"Well . . . I'm not sure I know ... let me think about it. Well, I know a few things about it, but could we save that for another time, Ernest? There's something I must talk to you about today."

"Okay, but are we clean—you and I?"

"Getting cleaner."

"Let's go on with your agenda. You said it involved a client."

Carol described her situation with Marshal, revealing he was a therapist but, in all other ways, carefully disguising his identity and reminding Ernest of her professional commitment to confidentiality so that he wouldn't ask leading questions.

Ernest was not cooperative. He didn't like turning Carolyn's therapy hour into a consultation and posed a string of objections. She was resisting her own work; she was not making good use of her time or her money; and her client should be seeing a therapist, not an attorney.

Carol countered each of these deftly. Money was no issue—she was not wasting her money. She charged the client more than Ernest charged her. As for her cHent seeing a therapist—^well, he just wouldn't and she couldn't explain further because of confidentiality. And she wasn't avoiding her own problems—she'd be willing to see Ernest more frequently to make up the hour. And since the client's problems mirrored her own, she was working indirectly on her issues by

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working on his. Her most powerful point was that by acting in a purely altruistic manner for her client, she was enacting Ernest's exhortation to break the cycle of selfishness and paranoia passed on to her by her mother and grandmother.

"You've persuaded me, Carolyn. You're a formidable woman. If ever I have to have a case argued, I want you as my counsel. Tell me about you and your client."

Ernest was an experienced consultant and listened carefully as Carol described what she was confronting in Marshal: rage, arrogance, loneliness, preoccupation with money and status, and withdrawal of interest in anything else in his life, including his marriage.

"What strikes me," Ernest said, "is that he's lost all perspective. He's so caught up by these events and these feelings that he's become identified with them. We need to find a way to help him take a few steps back from himself. We need to help him see himself from a more distant perch, even from a cosmic perspective. That's exactly what I was trying to do with you, Carolyn, whenever I asked you to consider something from the long skein of your life events. Your client's become these things—he has lost the sense of a persisting self who is experiencing these events for some small fraction of his existence. And what makes things worse is that your client is assuming that his present misery is going to be his permanent state—fixed for all time. Of course, that's the hallmark of depression—a combination of sadness plus pessimism."

"How do we break that up?"

"Well, there are many possibilities. For example, from what you've said, it's clear that accomplishment and effectiveness are central to his identity. He must feel absolutely helpless now, and terrified of that helplessness. What's happened is that he may have lost sight of the fact that he has choices and that these choices give him the power to change. He has to be helped to understand that his predicament is not the result of a predetermined destiny, but the result of his own choices—for example, his choice to revere money. Once he accepts that he is the creator of his situation, he can also be brought to the understanding that he has the power to extricate himself: his choices got him into this; his choices can get him out.

"Or," Ernest continued, "he probably has lost sight of the natural evolution of his present distress—that it exists now, that it had a beginning and will have an end. You might even review times in the past when he's felt this much rage and distress and help him remem-

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ber how that pain has faded away—just as his current pain will, at some point, become a bleached memory."

"Good, good, Ernest. Terrific." Carol hastily scribbled notes. "What else?"

"Well, you say he's a therapist. There's some additional leverage there. When I treat therapists, I often find that I can use their own professional skills to good advantage. It's a good way to move them back from themselves, to look at themselves from a more distant perspective."

"How do you do that?

"One simple way might be to ask him to imagine a patient with the same concerns as his walking into his office. How might he approach that patient? Ask him, 'What would you feel about this patient? How might you help him?'"

Ernest waited as Carol turned a page and continued her note taking.

"Be prepared for him to be annoyed at this; usually when therapists are in deep pain, they're like anyone else: they want to be taken care of, not to have to be their own therapist. But be persistent . . . it's an effective approach, it's good technique. In the business, it's what you call 'hard love.'

"Hard love is not my strong suit," Ernest continued. "My former supervisor used to tell me that I generally opted for the immediate gratification of my patients loving me, rather than the more important gratification of watching them get better. I think—no, I know — he was right. I owe him a lot for that."

"And arrogance?" asked Carol, looking up from her notes. "My client is so arrogant and grandiose and competitive that he has no friends at all."

"Usually 'upside down' is the best approach: his grandiosity is probably covering a self-image that is full of doubt and shame and self-derogation. Arrogant, hard-driving people usually feel they have to overachieve just to stay even. So I wouldn't think of exploring his grandiosity or self-love. Focus instead on his self-contempt—"

"Shh." Carol held up her hand to slow him down while she wrote. When she stopped he asked, "What else?"

"His preoccupation with money," Carol said, "and with insider status. And his isolation and narrowness. It's as though his wife and family play no role in his life."

"Well, you know, no one enjoys being swindled, but I'm struck by

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your client's catastrophic reaction: such panic, such terror . . . it's as though his very hfe is at stake, as though, without money, he would become nothing. I'd be inclined to wonder about the origins of that personal myth—and, incidentally, I'd deliberately and repeatedly refer to it as a 'myth.' When did he create this myth? Whose voice guided him? I'd like to know more about his parents' attitudes toward money. It's important because, from what you tell me, his reverence for status is what did him in—sounds like a clever con man who must have picked up on this and used it to entrap him.

"It's a paradox," Ernest continued. "Your client—I almost said patient —considers his loss as his ruination, yet, if you can guide him properly, the swindle may be his salvation. It may be the best thing that ever happened to him!"

"How do I make that happen?"

"I'd ask him to look very deep within himself and examine whether his essence, his very center, believes that the purpose of his existence is to compile money. Sometimes I've asked such patients to project themselves into the future—to the point of their death, to their funeral—even to imagine their grave and to compose an epitaph. How might he feel, your client, to have an account of his preoccupation with money chiseled on his gravestone? Is that the way he'd like his life summed up?"

"Scary exercise," said Carol. "Reminds me of that lifeline exercise you once asked me to do. Maybe I should tackle this one, too . . . not today, though . . . I'm not finished with questions about my client. Tell me, Ernest, what do you make of his indifference toward his wife? I've heard by sheer chance she may be having an affair,"

"Same strategy. I'd ask what he would say to a patient who is this indifferent to the person closest to him in all the world. Ask him to imagine life without her. And what's happened to his sexual self? Where has that gone? When did it vanish? And isn't it strange how he seems far more willing to understand his patients than his wife? You say that she's also a therapist but that he ridicules her training and her approach? Well, I'd confront that head-on, as hard as I could. What's the basis of his ridicule? I'm sure it's not based on hard evidence.

"Let's see, what else? As for his incapacitation—if that continues, then maybe a sabbatical of a month or two from practice would be good for him, both for his sake and for his patients'. Maybe the best way to spend it would be a retreat with his wife. Perhaps they could

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see a couples counselor and attempt some listening exercises. I think one of the best things that could happen would be if he permitted her, even with her despised methods, to help him."

"One last question—"

"Not today, Carolyn, we're running out of time . . . and I'm running out of ideas. But let's spend just one minute looking at our session today. Tell me, underneath the words we've been exchanging today, what have you been feeling? About our relationship? And today I want to hear the full truth. I've leveled with you. Level with me.

"I know you have. And I'd like to level . . . but I don't know how to say it ... I feel sobered, or humbled ... or maybe 'privileged' is the right term. And cared for. And trusted. And your honesty makes it hard for me to conceal."

"Conceal what?"

"Look at the clock. We're running over. Next time!" Carol rose to leave.

There was an awkward moment at the door. They had to invent a new mode of leave-taking.

"See you Thursday," said Ernest as he held out his hand for a formal handshake.

"I'm not ready for a handshake," said Carol. "Bad habits are hard to break. Especially cold turkey. Let's cut down slowly. How about a paternal hug?"

"Settle for 'avuncular'?"

"What's 'avuncular'?"

TWENTY-EIGHT

(/)^ had been a long day in the office. Marshal trudged jT"^^ home, lost in reverie. Nine patients seen that day. Nine ^.^__^ times one hundred seventy-five dollars. Fifteen hundred and seventy-five. How long to earn back the ninety thousand dollars? Five hundred patient hours. Sixty full days at the office. Over twelve work weeks. Twelve weeks yoked to the plow, working for that fucking Peter Macondo! Not to mention the overhead during this time: the office rental, professional dues, malpractice insurance, medical license. Not to mention the fees lost when he canceled patients during the first couple of weeks after the swindle. Nor the five hundred the detective ripped off. Not to mention that Wells Fargo rallied last week and is four percent higher than when he sold it! And the attorney's fees! Carol's worth it. Marshal thought, even though she doesn't understand that a man can't just drop this. I am going to string up that bastard if it takes the rest of my life!