Lying on the Couch

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Lying on the Couch Page 5

by Irvin D. Yalom


  When Ernest phoned a couple of weeks later. Dr. Trotter once again refused all offers of help. Within minutes he switched the conversation to Ernest's future and again expressed his strong conviction that, whatever Ernest's strengths as a psychopharmacologist, he was still missing his calling: he was a born therapist and owed it to himself to fulfill his destiny. He invited Ernest to discuss the matter further over lunch, but Ernest refused.

  "Thoughtless of me," Dr. Trotter had responded without a trace of irony. "Forgive me. Here I am advising you about a career shift and at the same time asking you to jeopardize it by being seen in public with me."

  "No, Seymour," for the first time Ernest called him by first name, "that is absolutely not the reason. The truth is, and I am embarrassed to say this to you, I'm committed already to serve as an expert witness at your civil suit trial for malpractice."

  "Embarrassment is not warranted, Ernest. It's your duty to testify. I would do the same, precisely the same, in your position. Our profession is vulnerable, threatened on all sides. It is our to duty to protect it and to preserve standards. Even if you believe nothing else about me, believe that I treasure this work. I've devoted my entire life to it. That's why I told you my story in such detail—I wanted

  you to know it is not a story of betrayal, I acted in good faith. I know it sounds absurd, yet even to this moment I think I did the right thing. Sometimes destiny pitches us into positions where the right thing is the wrong thing. I never betrayed my field, nor a patient. Whatever the future brings, Ernest, believe me. I believe in what I did: I would never betray a patient."

  Ernest did testify at the civil trial. Seymour's attorney, citing his advanced age, diminished judgment, and infirmity, tried a novel, desperate defense: he claimed that Seymour, not Belle, had been the victim. But their case was hopeless, and Belle was awarded two mil-hon dollars—the maximum of Seymour's malpractice coverage. Her lawT^ers would have gone for more but there seemed little point to it since, after his divorce and legal fees, Seymour's pockets were empty.

  That was the end of the public story of Seymour Trotter. Shortly after the trial he silently left town and was never heard from again, aside from a letter (with no return address) that Ernest received a year later.

  Ernest had only a few minutes before his first patient. But he couldn't resist inspecting, once again, the last trace of Seymour Trotter.

  Dear Ernest,

  You, alone, in those demonizing witch hunt days, expressed concern for my welfare. Thank you—it was powerfully sustaining. Am well. Lost, but don't want to be found. I owe you much—certainly this letter and this picture of Belle and me. That's her house in the background, incidentally: Belle's come into a good bit of money.

  Seymour

  Ernest, as he had so many times before, stared at the faded picture. On a palm-studded lawn, Seymour sat in a wheelchair. Belle stood behind him, forlorn and gaunt, fists clutching the handles of the wheelchair. Her eyes were downcast. Behind her a graceful colonial home, and beyond that the gleaming milky-green water of a tropical sea. Seymour was smiling—a big, goofy, crooked smile. He held onto the wheelchair with one hand; with the other, he pointed his cane jubilantly toward the sky.

  As always, when he studied the photograph, Ernest felt queasy.

  He peered closer, trying to crawl into the picture, trying to discover some clue, some definitive answer to the real fate of Seymour and Belle. The key, he thought, was to be found in Belle's eyes. They seemed melancholy, even despondent. Why? She had gotten what she wanted, hadn't she? He moved closer to Belle and tried to catch her gaze. But she always looked away.

  hree times a week for the past five years, Justin Astrid had started his day with a visit to Dr. Ernest Lash. His visit today had begun Uke any of the previous seven hundred therapy sessions: at 7:50 A.M. up the outdoor stairs of the Sacramento Street Victorian, handsomely painted in mauve and mahogany, through the vestibule, up to the second floor, into Ernest's dimly lit waiting room, permeated with the rich, moist aroma of Italian dark roast. Justin inhaled deeply, then poured coffee into a Japanese mug adorned with a hand-painted persimmon, and sat on the stiff green leather sofa and opened the San Francisco Chronicle sports section.

  But Justin could not read about yesterday's baseball game. Not on this day. Something momentous had happened—something that demanded commemoration. He folded his newspaper and stared at Ernest's door.

  At eight A.M. Ernest put Seymour Trotter's folder into his file cab-

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  Lying on the Couch ^ 3 5

  inet, glanced quickly at Justin's chart, straightened his desk, placed his newspaper in a drawer, put his coffee cup out of sight, rose, and, just before opening his office door, looked back to scan his office. No visible signs of habitation. Good.

  He opened his door and for a moment the two men looked at each other. Healer and patient. Justin with his Chronicle in hand, Ernest's newspaper hidden deeply in his desk. Justin in his dark blue suit and Italian striped silk tie. Ernest in a navy blue blazer and Liberty flowered tie. Both were fifteen pounds overweight, Justin's flesh spilling into chins and jowls, Ernest's belly bulging over his belt. Justin's mustache curled upward, stretching for his nostrils. Ernest's manicured beard was his tidiest feature. Justin's face was mobile, fidgety, his eyes jittery. Ernest wore large goggle spectacles and could go for long periods without blinking.

  "I've left my wife," Justin began, after taking a seat in the office. "Yesterday evening. Just moved out. Spent the night with Laura." He offered these first words calmly and dispassionately, then stopped and peered at Ernest.

  "Just like that?" Ernest asked quietly. No blinking.

  "Just like that." Justin smiled. "When I see what has to be done, I don't waste time."

  A little humor had entered their interaction over the past few months. Ordinarily, Ernest welcomed it. His supervisor. Marshal Streider, had said that the appearance of humorous byplay in therapy was often a propitious sign.

  But Ernest's "just like that" comment had not been good-natured byplay. He was unsettled by Justin's announcement. And irritated! He had been treating Justin for five years—five years of busting his ass trying to help him leave his wife! And today Justin casually informs him that he left his wife.

  Ernest thought back to their very first session, to Justin's opening words: "I need help getting out of my marriage!" For months Ernest had painstakingly investigated the situation. Finally he concurred: Justin should get out—it was one of the worst marriages Ernest had ever seen. And for the next five years Ernest had used every known psychotherapy device to enable Justin to leave. Every one had failed.

  Ernest was an obstinate therapist. No one had ever accused him of not trying hard enough. Most of his colleagues considered him too active, too ambitious in his therapy. His supervisor was forever remonstrating him with, "Whoa, cowboy, slow down! Prepare the

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  soil. You can't force people to change." But, finally, even Ernest was forced to give up hope. Though he never stopped liking Justin and never stopped hoping for better things for him, he gradually grew convinced that Justin would never leave his wife, that he was immovable, rooted, that he would be stuck for life in a tormented marriage.

  Ernest then set more limited goals for Justin: to make the best of a bad marriage, to become more autonomous at work, to develop better social skills. Ernest could do this as well as the next therapist. But it was boring. Therapy grew more and more predictable; nothing unexpected ever happened. Ernest stifled yawns and pushed his glasses up the bridge of his nose to keep himself awake. He no longer discussed Justin with his supervisor. He imagined conversations with Justin in which he raised the question of referring him to another therapist.

  And here, today, Justin saunters in and nonchalantly announces he has left his wife!

  Ernest tried to conceal his feelings by cleaning his goggle spectacles with a Kleenex yanked from the box.

  "Tell me about it, Jus
tin." Bad technique! He knew it instantly. He put his glasses back on and jotted on his notepad: "mistake— asked for information—countertransference?"

  Later, in supervision, he would go over these notes with Marshal. But he knew himself that it was nuts for him to be pulling for information. Why should he have to coax Justin to continue? He should not have given in to his curiosity. Incontinent —that's what Marshal had called him a couple of weeks earlier. "Learn to wait," Marshal would say. "It should be more important for Justin to tell you this than for you to hear it. And if he chooses not to tell you, then you should focus on why he comes to see you, pays you, and yet withholds information from you."

  Ernest knew Marshal was right. Yet he did not care about technical correctness—this was no ordinary session. The sleeping Justin had awakened and left his wife! Ernest looked at his patient; was it his imagination or did Justin appear more powerful today? No obsequious head bowing, no slouching, no fidgeting in his chair to adjust his underwear, no hesitancy, no apologies about dropping his newspaper on the floor next to his chair.

  "Well, I wish there were more to tell—it all went so easily. Like I was on automatic pilot. I just did it. I just walked out!" Justin fell silent.

  Again, Ernest couldn't wait. "Tell me more, Justin."

  "It's got to do with Laura, my young friend."

  Justin rarely spoke of Laura, but when he did she was always, simply, "my young friend." Ernest found that irritating. But he gave away nothing and remained silent.

  "You know I've been seeing her a lot—maybe I've minimized that a bit to you. I don't know why I've kept it from you. But I've been seeing her almost daily, for lunch, or a walk, or going up to her apartment for a romp in the hay. I've just been feeling more and more together, at home, with her. And then, yesterday, Laura said, very matter of factly, 'It's time, Justin, for you to move in with me.'

  "And you know," Justin continued, brushing away the mustache hairs tickling his nostrils, "I thought, she's right, it is time."

  Laura tells him to leave his wife and he leaves his wife. For a moment Ernest thought about an essay he had once read on the mating behavior of coral reef fish. Apparently marine biologists can easily identify the dominant female and male fish: they simply watch the female swim and observe how she visibly disrupts the swim patterns of most male fish—all but the dominant males. The power of the beautiful female, fish or human! Awesome! Laura, barely out of high school, had simply told Justin it was time to leave his wife, and he had obeyed. Whereas he, Ernest Lash, a gifted, a highly gifted therapist, had wasted five years trying to pry Justin out of his marriage.

  "And then," Justin went on, "at home last night Carol made it easy for me by being her usual obnoxious self, hammering at me for not being present. 'Even when you're present, you're absent,' she said. 'Pull your chair up to the table! Why are you always so far away? Talk! Look at us! When was the last time you made a single unsolicited comment to me or the children? Where are you? Your body's here—you're not!' At the end of the meal, when she was clearing the table and banging and clattering the dishes, she added, 'I don't even know why you bother to bring your body home.'

  "And then suddenly, Ernest, it came to me: Carol's right. She's right. Why do I botherf I said it again to myself, Why do I botherf And then, just like that, I said it out loud. 'Carol, you're right. In this, as in all other things, you are right! I don't know why I bother coming home. You're absolutely right.'

  "And so, without another word, I went upstairs and packed up everything I could in the first suitcase I found and walked out of the

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  house. I wanted to take more, to come back in for another suitcase. You know Carol—she'll slash and burn everything I leave behind. I wanted to come back for my computer; she'll take a hammer to it. But I knew it was then or never. Walk back into the house, I told myself, and you're lost. I know me. I know Carol. I didn't look to the right or the left. I kept on walking, and just before I closed the front door I leaned my head in and yelled, not knowing where Carol or the kids were, 'I'll call you.' And then I got the hell away!"

  Justin had been leaning forward in his chair. He took a deep breath, leaned back exhausted, and said, "And that's all there is to tell."

  "And that was last night.^"

  Justin nodded. "I went directly to Laura's and we held each other all night. God, it was hard to leave her arms this morning. I can hardly describe it, it was so hard."

  "Try," Ernest urged.

  "Well, as I started to unfold myself from Laura, I suddenly had an image of an amoeba dividing in two—something I hadn't thought about since high school biology class. We were like the two halves of the amoeba separating bit by bit until there was just one thin strand connecting us. And then, pop —a painful pop—and we were separate. I got up, got dressed, looked at the clock, and thought, 'only fourteen more hours until I'll be back in bed folded together again with Laura.' And then I came here."

  "That scene with Carol last evening—you've dreaded it for years. Yet, you seem high-spirited."

  "Like I said, Laura and I fit together, belong together. She's an angel—made in heaven for me. This afternoon we go apartment hunting. She has a small studio on Russian Hill. Great view of the Bay Bridge. But too small for us."

  Made in heaven! Ernest felt like gagging.

  "If only," Justin continued, "Laura had come along years ago! We've been talking about what rent we could afford. On my way here today I started to calculate what I've spent on therapy. Three times a week for five years—how much is that? Seventy, eighty thousand dollars? Don't take this personally, Ernest, but I can't help wondering what would have happened if Laura had come along five years ago. Maybe I would've left Carol then. And finished therapy, too. Maybe I'd be looking for an apartment now with eighty thousand dollars in my pocket!"

  Lying on the Couch .-^*^ 3 9

  Ernest felt his face flush. Justin's words clanged in his mind. Eighty thousand dollars! Don't take this personally, don't take this personally!

  But Ernest gave nothing away. Nor did he blink or defend himself. Nor point out that, five years ago, Laura would have been about fourteen and Justin couldn't have wiped his ass without asking Carol's permission, couldn't get to noon without calling his therapist, couldn't order from a menu without his wife's guidance, couldn't dress in the morning if she didn't lay out his clothes. And it was his wife's money, anyway, that paid the bills, not his—Carol earned three times as much as he did. If not for five years of therapy, he'd have eighty thousand dollars in his pocket! Shit, five years ago Justin couldn't have figured out which pocket to put it in!

  But Ernest said none of these things. He took pride in his restraint, a clear sign of his maturation as a therapist. Instead he innocently asked, "Are you high-spirited all the way down?"

  "What do you mean?"

  "I mean, this is a momentous occasion. Surely you must have many layers of feelings about it?"

  But Justin did not give Ernest what he wished. He volunteered little, seemed distant, distrustful. Finally Ernest realized that he must focus not on content but on process —that is, on the relationship between patient and therapist.

  Process is the therapist's magic amulet, always effective in times of impasse. It is the therapist's most potent trade secret, the one procedure that makes talking to a therapist materially different and more effective than talking to a close friend. Learning to focus on process—on what was happening between patient and therapist— was the most valuable thing he had gotten from his supervision with Marshal and, in turn, was the most valuable teaching he himself offered when he supervised residents. Gradually, over the years, he had come to understand that process was not only an amulet to be used in times of trouble; it was the very heart of therapy. One of the most useful training exercises Marshal had given him was to focus on process at least three different times during each session,

  "Justin," Ernest ventured, "can we take a look at what's happening
today between the two of us?"

  "What? What do you mean 'what's happening'?"

  More resistance. Justin playing dumb. But, Ernest thought, maybe rebellion, even passive rebellion, wasn't a bad thing. He remembered

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  those scores of hours they had worked on Justin's maddening obsequiousness—the sessions spent on Justin's tendency to apologize for everything and to ask for nothing, not even to complain about the morning sun in his eyes or to ask if the blinds could be lowered. Given that background, Ernest knew he should applaud Justin, support him for taking a stand. The task today was to help him convert this back-assed resistance into overt expression.

  "I mean, how do you feel about talking to me today? Something's different. Don't you think?"

  "What do you feel?" Justin asked.

  Whoops, another very un-Justin response. A declaration of independence. Be happy, Ernest thought. Remember Gepetto's glee when Pinocchio first danced without strings^

  "Fair enough, Justin. Well, I feel distant, left out, as though something important has happened to you—no, that's not right. Let me put it this way: as though you have made something important happen and you want to keep it separate from me, as though you don't want to be here, as though you want to exclude me."

  Justin nodded appreciatively. "That's accurate, Ernest. Real accurate. Yeah, I do feel that. I am staying away from you. I want to hang on to feeling good. I don't want to be brought down."

  "And I'll bring you down? I'll try to take it away from you?"

  "You've already tried," said Justin, uncharacteristically looking directly into Ernest's eyes.

  Ernest raised his eyebrows quizzically.

  "Well, isn't that what you were doing when you asked if I were high-spirited all the way down?"

  Ernest caught his breath. Whoa! A real challenge from Justin. Maybe he had learned something from therapy after all! Now Ernest played dumb. "What do you mean?"

 

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