Lying on the Couch ^ 83
"Yes, I remember that lecture—you did well, Ernest.I still think you should write that up for publication."
"Thanks. I've got a little will paralysis myself on finishing that paper. Right now it's stacked up behind two other writing projects. You may remember that in grand rounds I concluded that, if insight doesn't kick-start the will, then therapists have to find some other way to mobilize it. I tried exhortation: in one way or another, I began to whisper in his ear, 'You have to try, you know.' I understood, oh did I understand, Allen Wheelis's comment that some patients have to get their backs off the couch and their shoulders to the wheel.
"I tried visual imagery," Ernest continued, "and urged Justin to project himself into the future—ten, twenty years from now—and to imagine himself still stuck in this lethal marriage, to imagine his remorse and regret for what he had done with his own life. It didn't help.
"I became like a second in a boxer's corner, offering advice, coaching him, helping him rehearse declarations of marital liberation. But I was training a featherweight, and his wife was a cruiser-class heavyweight. Nothing worked. I guess the last straw was the great backpacking caper. Did I tell you about that?"
"Go on; I'll stop you if I've heard it."
"Well, about four years ago Justin decided it would be a great thing for the family to go backpacking—he's got twins, a boy and girl aged eight or nine now. I encouraged him. I was delighted with anything that had the aroma of initiative. He always felt guilty about not spending enough time with his children. I suggested he think of a way to change that, and he decided that a backpacking trip might be an exercise in good fathering. I was deHghted and told him so. But Carol wasn't delighted! She refused to go—no particular reason, just sheet perversity—and she forbade the kids to go with Justin. She didn't want them sleeping in the woods—she's phobic about everything, you name it: insects, poison oak, snakes, scorpions. Besides, she has problems staying home alone, which is strange since she has no problem traveling alone for business—she's an attorney, a tough trial lawyer. And Justin can't stay home alone, either. A folie a deux.
"Justin, with my vehement urging, of course, insisted that he would go camping and he would go with or without her permission. He was putting his foot down this time! 'Atta boy, 'atta boy, I whis-
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pered. Now we're moving. She raised hell, she wheedled, she bargained, she promised that if they all went to Yosemite and stayed in the Ahwahnee Hotel this year, then next year she'd go camping with them. ''No deal," I coached him, "hold firm."
"So, what happened?"
"Justin stared her down. She caved in and invited her sister to come stay with her while Justin and the kids went camping. But then . . . twilight zone set in . . . odd things began to happen. Justin, dazzled by his triumph, became concerned that he was not in good enough physical shape for such a venture. It would be necessary, first, to lose weight—he set twenty pounds for his goal—and then to strengthen his back. So he began working out, mainly by climbing forty stories to get to and from his office. During one workout he developed acute shortness of breath and got an extensive medical workup."
"Which was negative, of course," said Marshal. "I don't remember your telling me this story, but I think I can fill in the rest. Your patient became morbidly concerned about the camping trip, couldn't lose weight, grew convinced his back wouldn't hold up and that he wouldn't be able to take care of his children. Finally he developed full-blown panic attacks and forgot about backpacking. The family went off to the Ahwahnee Hotel, and everyone wondered how his idiot shrink ever came up with such a harebrained scheme."
"The Disneyland Hotel."
"Ernest, this is an old, old story. And an old, old error! You can count on this scenario whenever the therapist mistakes the symptoms of the family system for the symptoms of the individual. So that was when you gave up?"
Ernest nodded. "That's when I switched to a holding action. I assumed he was stuck forever in his therapy, his marriage, his life. That's when I stopped talking about him in our supervision."
"But now comes a major new development?"
"Yes. Yesterday he came in and, almost nonchalantly, told me he had left Carol and moved in with a much younger woman—someone he had hardly mentioned to me. Three times a week he sees me and he forgets to talk about her."
"Oh-ho, that's interesting! And?"
"Well, it was a bad hour. We were out of sync. I felt diffusely annoyed most of the session."
"Run through the hour quickly with me, Ernest."
Lying on the Couch ^ 85
Ernest recounted the events of the session, and Marshal went straight for the countertransference—the therapist's emotional response to the patient.
"Ernest, let's focus first on your annoyance with Justin. Try to rehve the hour. When your patient tells you he has left his wife, what do you begin to experience? Just free-associate for a minute. Don't try to be rational—stay loose!"
Ernest took the plunge. "Well, it was as if he were making light of, even mocking, our years of good work together. I worked like hell for years with this guy—I broke my ass. For years he was a dead weight around my neck . . . this is raw stuff. Marshal."
"Go on. It's supposed to be raw stuff."
Ernest searched his feelings. Plenty there, but which ones dare he share with Marshal? He wasn't in therapy with Marshal. And he wanted Marshal's collegial respect—and his referrals, and his sponsorship for the analytic institute. But he also wanted the supervision to be supervision.
"Well, I was pissed—pissed about his throwing the eighty thousand dollars in my face, pissed that he would just mosey out of that marriage without discussing it with me. He knew how much I had invested in his leaving her. Not even a phone call to me! And, let me tell you, this guy has phoned me about incredibly trivial stuff. Also, he had hidden the other woman from me, and that pissed me off, too. And also I was pissed about her ability, the ability of any woman, to simply crook her finger or twitch her little cunt and enable him to do what I had failed to do for four years."
"And what about your feelings about the fact that he actually left his wife?"
"Well, he did it! And that's good. No matter how he did it, it's good. But he didn't do it the right way. Why in hell couldn't he have done it the right way? Marshal, this is nuts—primitive stuff, practically primary process. I'm really uncomfortable verbalizing this."
Marshal leaned over and put his hand on Ernest's arm, a very uncharacteristic act for him. "Trust me, Ernest. This is not easy. You're doing great, Try to keep going."
Ernest felt encouraged. It was interesting for him to experience that strange paradox of therapy and supervision: the more unlawful, shameful, dark, ugly stuff you revealed, the more you were rewarded! But his associations had slowed: "Let's see, I'H have to dig. I hated it that Justin allowed himself to be led around by his pecker. I had
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hoped for better things from him, hoped he could leave that dragon the right way. That wife of his, Carol . . . she gets to me,"
"Free-associate to her, just for one or two minutes," Marshal requested. His reassuring 'just for one or two minutes' was one of Marshal's few concessions to a supervisory rather than a therapy contract. A clear and short time limit put boundaries around the self-disclosure and made the process feel safer to Ernest.
"Carol? . . . bad stuff . . . gorgon's head . . . selfish, borderline, vicious woman . . . sharp teeth . . . eye slits . . . evil incarnate . . . the nastiest woman I ever met. ..."
"So you did meet her?"
"I mean the nastiest woman I never met. I only know her through Justin. But after several hundred hours, I know her pretty well."
"What did you mean when you said he didn't do it the right way. What's the right way?"
Ernest squirmed. He looked out the window, avoiding Marshal's eyes.
"Well, I can tell you the wrong way: the wrong
way is to go from one woman's bed to another woman's bed. Let's see ... if I had my wish for Justin, what would it be? That, for once, just once, he'd be a mensch! And that he'd leave Carol like a mensch! That he would decide that this was the wrong choice, the wrong way to spend his one and only life, that he would simply move out—face his own isolation, come to terms with who he is, as a person, as an adult, as a separate human being. What's he's done is pathetic: shucking his responsibility, falling into a trance, swooning in love with some young pretty face—'an angel made in heaven,' he put it. Even if it does work for a while, he's not going to grow, not going to learn a goddamned thing from it!
"Well, there it is. Marshal! Not pretty! And I'm not proud of it! But if you want primitive stuff, there it is. Plenty of it—and it's patent. I can see through most of it myself!" Ernest sighed and leaned back, exhausted, awaiting Marshal's response.
"You know, it's been said that the goal of therapy is to become one's own mother and father. I think we could say something analogous about supervision. The goal is to become your own supervisor. Sooo . . . let's take a look at what you see about yourself."
Before looking inside, Ernest took a look at Marshal and thought, ''be my own mother and father, be my own supervisor —Goddamn he's good."
Lying on the Couch ^ 87
"Well, the most obvious thing is the depth of my feehngs. I'm overinvested, for sure. And this crazy sense of outrage, of proprietorship—of how dare he make this decision without consuhing me first."
"Right!" Marshal nodded vigorously. "Now juxtapose outrage with your goal of diminishing his dependency on you and cutting down his hours."
"I know, I know. The contradiction is glaring. I want him to break his attachment to me, yet I get angry when he acts independently. It's a healthy sign when he insists on his private world, even concealing this woman from me."
"Not only a healthy sign," Marshal said, "but a sign that you've been doing good therapy. Damn good therapy! When you work with a dependent patient, your reward is rebellion, not ingratiation. Take pleasure in it."
Ernest was moved. He sat in silence, holding back tears, gratefully digesting what Marshal had given him. A caregiver for so many years, he was not used to being nourished by others.
"What do you see," Marshal continued, "in your comments about the right way for Justin to leave his wife?"
"My arrogance! Only one way: my way! But it's very strong—I feel it even now. I'm disappointed in Justin. I wanted better things for him. I sound like a demanding parent, I know!"
"You're taking a strong position, so extreme you yourself don't believe it. Why so strong, Ernest? Where's the push coming from? What about your demands on yourself?"
"But I do believe it! He's gone from one dependent position to another, from wife-devil-mother to angel-mother. And the swooning, falling in love, 'angel from heaven' business—he's in bliss-merger, like an incompletely divided amoeba, he said . . . anything to avoid facing his own isolation. And it's the fear of isolation that's kept him in this lethal marriage all these years. I've got to help him see that."
"But so strong, Ernest? So demanding? Theoretically, I think you're right, but what divorcing patient can ever match up to that standard? You demand the existential hero. Great for novels but, as I think back over my years of practice, I cannot recall a single patient who left a spouse in that noble fashion. So let me ask you again, where's all that push coming from? What about similar issues in your own life? I know that your wife was killed in a car accident
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several years ago. But I don't know much else about your life with women. Did you remarry? Have you been through a divorce?"
Ernest shook his head and Marshal continued: "Let me know if I'm intruding too far, if we're crossing the line between therapy and supervision."
"No, you're on the right track. Never remarried. My wife, Ruth, has been dead six years. But the truth is that our marriage was over long before that. We were living separately but in the same house, just staying together for convenience. I had a lot of trouble leaving Ruth, even though I knew very early—we both knew—that we were wrong for each other."
"Sooo," Marshal persisted, "going back to Justin and your coun-tertransference ..."
"Obviously I've got some work to do and I've got to stop asking Justin to do my work for me." Ernest looked up at the ornate gold-plated Louis XIV clock on Marshal's mantel only to be reminded, once again, that it was purely decorative. He looked at his watch: "Five minutes left—let me discuss one other point."
"You mentioned something about a bookstore reading and a social encounter with a former patient."
"Well, first something else. The whole question of whether I should have owned up to my irritation to Justin when he called me on it. When he accused me of trying to bring him down from his love bliss, he was absolutely right—he was reading reality correctly. I think that, by not confirming his accurate perceptions, I was doing antitherapy,"
Marshal shook his head sternly. "Think about it, Ernest: What would you have said?"
"Well, one possibility was to have simply told Justin the truth— more or less what I told you today." That was what Seymour Trotter would have done. But of course Ernest did not mention that.
"Like what? What do you mean?"
"That I had become unwittingly possessive; that I may have been confusing him by discouraging his independence from therapy; and also that I may have permitted some of my own personal issues to have clouded my view."
Marshal had been staring at the ceiling and suddenly looked at Ernest, expecting to see a smile on his face. But there was no smile.
"Are you serious, Ernest?"
Lying on the Couch ^ 89
"Why not?"
"Don't you see that you're too much involved as it is? Whoever said that the point of therapy is to be truthful about everything? The point, the one and only point, is to act always in the patient's behalf. If therapists discard structural guidelines and decide instead to do their ow^n thing, to improvise willy-nilly, to be truthful all the time, why, imagine it—therapy would become chaos. Imagine a long-faced general walking among his troops wringing his hands on the eve of battle. Imagine telling a severe borderline that, no matter how hard she tries, she's in for another twenty years of therapy, another fifteen admissions, another dozen wrist slashings or overdoses. Imagine telling your patient you're tired, bored, flatulent, hungry, fed up with listening, or just itching to get onto the basketball court. Three times a week I play basketball at noon, and for an hour or two before I am flooded with fantasies of jump shots and spinning drives to the basket. Shall I tell the patient those things?
"Of course not!" Marshal answered his own question. "I keep these fantasies to myself. And if they get in the way, then I analyze my own countertransference or I do exactly what you're doing right now—and doing well, I want to add: working on it with a supervisor."
Marshal looked at his watch. "Sorry to go on so long. We're running out of time—and some of that is my fault for talking about the ethics committee. Next week let me give you the details about your beginning a term on the committee. But now, please, Ernest, take two minutes about the bookstore meeting with your former patient. I know that was part of your agenda."
Ernest started to pack his notes into his briefcase. "Oh, it was nothing dramatic, but the situation was interesting—the kind of thing that might generate a good discussion at an institute study group. In the beginning of the evening a very attractive woman came on to me very strongly and I, for a moment or two, reciprocated and flirted back. Then she told me that she had been my patient briefly, very briefly, in a group about ten years ago, in my first year of residency, that the therapy had been successful, and that she was doing extremely well in her life."
"And?" asked Marshal.
"Then she invited me to meet her after my reading, just for coffee in the bookstore cafe."
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"And wh
at did you do?"
"I begged off, of course. Told her I had a commitment for the evening."
"Hmm . . . yes, I see what you mean. It is an interesting situation. Some therapists, even some analysts, might have met with her briefly for coffee. Some might say, given that you saw her only in brief therapy and in a group, that you were being too rigid. But," Marshal rose to signify the end of their hour, "I agree with you, Ernest. You did the right thing. I would have done exactly the same."
FIVE
ith forty-five minutes to spare before his next patient, Ernest set off for a long walk down Fillmore toward Japantown. He was unsettled in many ways by the supervisory session, especially by Marshal's invitation, or rather edict, to join the State Medical Ethics Committee.
Marshal had, in effect, ordered him to join the profession's police force. And if he wanted to become an analyst, he could not alienate Marshal. But why was Marshal pushing it so hard? He must have known the role wasn't right for Ernest. The more he thought about it, the more anxious he grew. This was no innocent suggestion. Surely Marshal was sending him some kind of wry, coded message. Perhaps, "See for yourself the fate of incontinent shrinks."
Calm down, don't make too much of it, Ernest said to himself. Maybe Marshal's motives were entirely benign—probably serving on this committee would facilitate acceptance as a candidate for the analytic institute. Even so, Ernest didn't like the idea. His nature was
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to understand someone in human terms, not to condemn. He had acted as policeman only once before, with Seymour Trotter, and, though his behavior had been publicly impeccable on that occasion, he had resolved never again to sit in judgment of another,
Ernest checked his watch: only eighteen minutes before the first of his four afternoon patients. He bought two crisp fuji apples from a grocery store on Divisadero and devoured them as he rushed back to his office. Brief lunch breaks of apples or carrots were the latest in a long series of weight-losing strategies, each hugely unsuccessful. Ernest was so ravenous by the evening that he wolfed down the equivalent of several lunches during dinner.
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