Lying on the Couch

by Irvin D. Yalom

  And perhaps priestly consolation was exactly what he should be offering. Surely there was something to be learned from the church's two thousand years in the therapy business. Ernest had always wondered about priests' training. How good were they really at providing consolation.' Where did they learn their technique? Courses in consolation? Courses in confession-booth counseling? Ernest's curiosity had once led him to do a literature search at the library on Catholic confession counseling. He had come up with nothing. Another time he had inquired at a local seminary and learned that the curricula offered no explicit psychological training. Once, while visiting a deserted cathedral in Shanghai, Ernest sneaked into the confessional booth and, for thirty minutes, sat in the priest's seat, inhaling the Catholic air and murmuring, again and again, "You are forgiven. My child, you are forgiven!" He emerged from the booth full of envy. What powerful Jovian weapons against despair the priests wielded; in contrast, his own secular armamentarium of interpretations and creature comforts seemed puny, indeed.

  A widow whom he had guided through bereavement and who still returned now and then for a tune-up session once referred to his role as that of a compassionate witness. Maybe, Ernest thought, compassionate witnessing is all I'll be able to offer Carolyn Leftman.

  But maybe not! Maybe there are some openings for real work here.

  Ernest silently formulated a checklist of areas to explore. First of all, why such a poor relationship with her husband before he got cancer? Why stay for ten years with someone you don't love? Ernest mused about his own loveless marriage. If Ruth had not been crushed to death in her automobile, would he have been able to make the break? Perhaps not. Still, if Carolyn's marriage were so bad, why no attempts at marital therapy? And should her assessment of the marriage be accepted at face value? Perhaps there was still a chance to salvage the relationship. Why move to San Francisco for cancer treatment? Plenty of patients come to the cancer center for treatment for brief periods and then return home. Why so meekly give up her career and her friends?

  "You've been feeling trapped for a long time, Carolyn, first maritally, now maritally and morally," ventured Ernest. "Or maritally versus morally."

  Lying on the Couch ^^ ^°9

  Carol tried to nod in rapt agreement. Oh, how brilliant, she thought. Shall I genuflect^

  "You know, I'd Hke you to fill me in, to tell me everything about yourself, everything you think I should know to help us make sense of your life predicament."

  Us, Carol thought, hmm, interesting. They are so slick. They get the hook in so deftly. Fifteen minutes into the session and already it's "us," it's "tell me everything"; already "we" seem to have agreed that making sense of my "predicament" will offer salvation. And he needs to know everything, everything. There's no rush. Why should there be, at a hundred and fifty dollars an hourf And that's a hundred and fifty clear — no fifty percent overhead, no law clerks, no conference room, no office library, no paralegals, not even a secretary.

  Swiveling her attention back to Ernest, Carol began to recount her personal history. Safety lay in truth. Within limits. Surely, she reasoned, Justin was too self-centered to have talked much about the details of his wife's life. The fewer lies she told, the more convincing she would be. Hence, aside from shifting her education from Brown and Stanford Law School to Radcliffe and Chicago Law, she merely told Ernest the truth about her early life, about a frustrated and bitter mother who taught elementary school and never recovered from her husband's abandoning her.

  Memories of her father? Left when she was eight. According to her mother, he went crazy at age thirty-five, fell in with a grubby flower child, left everything, followed the Grateful Dead for a few years, and stayed stoned in a San Francisco commune for the next fifteen years. He sent her birthday cards (with no return address) for a few years and then . . . nothing. Until her mother's funeral. Then he suddenly reappeared, dressed, as though in a time warp, in a threadbare Haight-Ashbury uniform with rotting sandals, faded, shredded jeans, and a tie-dyed shirt, and claimed that only his wife's presence had stood in the way, all these years, of his assuming his natural paternal role. Carol desperately wanted and needed a father but began to suspect his judgment when he whispered to her at the cemetery service that she shouldn't delay in getting out all her anger toward her mother.

  Any remaining illusion of a father's return evaporated the following day when, stuttering, scratching his lice-filled hair, and filling the room with the stench of his hand-rolled cigarettes, he presented a business proposition that consisted of her turning over to him her

  11 o ^ Lying on the Couch

  small inheritance to invest in a Haight Street head shop. When she refused, he countered by insisting that her mother's house "properly" belonged to him—by "human law" if not "legal law"—since he had paid the down payment twenty-five years before. Naturally she had suggested he leave (her words, which she didn't tell Ernest, had been, "Hit the road, creep"). She'd been lucky enough never to have heard from him again.

  "So you lost your father and mother at the same time?"

  Carol nodded, bravely.

  "Siblings?"

  "One brother, three years older."

  "His name?"

  "Jeb."

  "Where is he?"

  "New York or New Jersey, I'm not sure. Somewhere on the East Coast."

  "He doesn't call you?"

  "He better not!"

  Carol's answer was so sharp and bitter that Ernest involuntarily winced.

  "Why had he 'better not'?" he asked.

  "Jeb got married at nineteen and joined the navy at twenty-one. At thirty-one he sexually molested his two young daughters. I went to the trial: he only got a three-year prison sentence and a dishonorable discharge. He's under court injunction not to live within a thousand miles of Chicago, where his daughters live."

  "Let's see." Ernest consulted his notes and calculated, "he's three years older . . . you must have been twenty-eight... so all this happened ten years ago. You haven't seen him since he was sentenced to prison?"

  "A three-year term is short. He got a longer sentence from me."

  "How long?"

  "Life!"

  A chill ran through Ernest. "Life is a long sentence."

  "For a capital offense?"

  "How about before the offense? Did you have much anger toward your brother then?"

  "His daughters were eight and ten when he abused them."

  "No, no, I mean anger toward him that existed before the offense."

  Lying on the Couch . ^^ m

  "His daughters were eight and ten when he abused them," Carol repeated through clenched teeth.

  Whoa! Ernest had stumbled into a land mine. He knew he was doing a "wildcat" session—one he could never describe to Marshal. He could anticipate the criticism, "What in hell are you doing by pressing her about her brother before even taking a decent systematic past history? You haven't even explored her marriage, the manifest reason for her coming." Yes, he could hear Marshal's words, "Sure, there's something there. But, for Chrissakes, can't you wait? Store it; come back to it at the appropriate time. You're incontinent again."

  But Ernest knew he had to put Marshal out of mind. His resolution to be entirely open and honest with Carolyn demanded that he be spontaneous, that he share what he felt when he felt it. No tactics, no storing ideas with this patient! The object today was "Be yourself. Give yourself."

  Besides, Ernest was fascinated by the suddenness of Carolyn's rage—so immediate, so real. Earlier he had had trouble reaching her: she seemed so bland, matter of fact. Now there was juice: she had come alive; her face and her words were in sync. To reach this woman he had to keep her real. He decided to trust his intuition and go where the emotion was.

  "You're angry, Carolyn, and not only at Jeb, but at me, too."

  Finally, jerk — you got something right, Carol thought. Christ, you're worse than I imagined. No wonder you never thought twice about what you and Justin were doing to me. You don't
even flinch at the thought of an eight-year-old girl being violated by her father!

  "I'm sorry, Carolyn, to have poked so hard into such a tender area. Perhaps I was premature. But let me be up front with you. What I was getting at was this: if Jeb could be so barbarous as to do that to his own young daughters, what might he have done to his younger sister?"

  "What do you mean . . . ?" Carol put her head down; she suddenly felt faint.

  "Are you all right . . . some water?"

  Carol shook her head and quickly regained her composure. "Sorry, I suddenly felt faint. Don't know what it was."

  "What do you think?"

  "Don't know."

  "Don't lose the feeling, Carolyn. Stay with it just for another cou-

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  pie of minutes. It happened when I asked about Jeb and you. I was thinking of you as a ten-year-old and what your life was like with an older brother like that."

  "I've been the counsel in a couple of lawsuits involving childhood sexual abuse. It's the most brutal process I've ever witnessed. Not only the awful recovered memories but the violent upheaval in the families and all the controversy about implanted memories—it's brutal for everyone. I guess I blanched at the thought of going through all this stuff myself. I'm not sure if you were steering me in that direction. If you were, I've got to tell you that right now I remember no particular trauma involving Jeb: my recollection is only of the typical amount of brother-sister torment. But it is also true that I remember very little of my early childhood."

  "No, no—I'm sorry, Carolyn, I wasn't clear. I wasn't thinking about some major childhood trauma and subsequent post-traumatic stress. Not at all, although I agree with you about that type of thinking being very much in fashion today. What I had in mind was less dramatic, more insidious, more ongoing. Something like this: What might it have been like for you to have grown up, to have spent considerable part of every day with an uncaring or even abusive brother?"

  "Yes, yes, I see the difference."

  Ernest glanced at the clock. Dammit, he thought, only seven minutes left. So much to do! I've got to start examining her marriage.

  Though Ernest's glance at the clock was sly, Carol caught it. Her first reaction was inexplicable. She felt hurt. But that passed quickly and she thought. Look at him — the sneaky, greedy bastard — figuring out how many minutes are left before he can chuck me out and start the meter clicking for the next hundred and fifty dollars.

  Ernest's clock was deep in a bookshelf out of the patient's view. In contrast. Marshal placed his clock in plain view on the small table between himself and the patient. "Only being honest," Marshal said. "It's open knowledge that the patient pays for fifty minutes of my time, so why keep the clock secret? To hide the clock is to collude in a pretense that you and the patient have a personal, not a professional, relationship." Typical Marshal: solid, irrefutable. Just the same, Ernest kept his clock obscured.

  Ernest tried to devote the remaining few minutes to Carolyn's husband: "I'm impressed that all the men you've mentioned, the pivotal men in your life, have badly disappointed you, and I know 'dis-

  appointment' is too tepid a word: your father, your brother, and, of course, your husband. But I really don't know much about your husband yet."

  Carol ignored Ernest's invitation. She had her own agenda.

  "While we're talking about men in my life who have disappointed me, I should mention one important exception. When I was an undergraduate student at Radcliffe, I was in a dangerous psychological place. I've never been worse: down on myself, depressed, feeling inadequate, ugly. And then, the last straw: I was dumped by Rusty, my boyfriend since junior high. I really hit bottom, drinking, using drugs, considering dropping out of college, even suicide. Then I saw a therapist, a Dr. Ralph Cooke, who saved my life. He was extraordinarily kind and gentle and affirming."

  "How long did you see him.^"

  "About a year and a half, as a therapist."

  "There's more, Carolyn?"

  "I'm a little hesitant to go into it. I really value this man and don't want you misunderstanding." Carol reached for a Kleenex and squeezed out a tear.

  "Can you go on.'"

  "Well . . . I'm very uncomfortable talking about this. . . . I'm afraid you'll judge him. I should never have mentioned his name. I know therapy is confidential. But . . . but ..."

  "Is there a question in there for me, Carolyn.'" Ernest wanted to waste no time letting her know that he was a therapist whom she could question and who would answer all questions.

  Dammit^ Carol thought, squirming with irritation in her chair. "Carolyn, Carolyn, Carolyn." Every goddamned sentence he has to say "Carolyn"!

  She continued, "A question . . . well, yes. More than one. First, is this entirely confidential? Not to be shared with anyone? And, second, will you judge or stereotype him?"

  "Confidential? Absolutely. Count on me."

  Count on you^ Carol thought. Yeah, like I could count on Ralph Cooke.

  "And as for judging, my task here is to understand, not to judge. I'll do my best and I'll promise to be open with you about it. I'll answer any of your questions," said Ernest, weaving his truth-telling resolve tightly into the fabric of this first session.

  "Well, I'll just spit it out. Dr. Cooke and I became lovers. After I

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  had seen him for a few sessions, he began to hug me from time to time to comfort me, and then it just happened—there on that glorious Persian rug in his office. It was the best thing that ever came my way. I don't know how to talk about it except to say it saved my life. Every week I saw him and every week we made love, and all the pain and all the misery just vanished. Finally he didn't think I needed any more therapy, but we kept on being lovers for another year. With his help I graduated college and got into law school. The best: University of Chicago Law."

  "Your relationship ended when you went to law school?"

  "For the most part. But a few times when I needed him I flew into Providence, and every time he was there and he gave me the comforting I needed."

  "He still in your life?"

  "Dead. He died young, about three years after I graduated law school. I think I've never stopped looking for him. I met my husband, Wayne, shortly afterward and decided to marry him. A hasty decision. And a bad one. Maybe I wanted Ralph so much I imagined I saw him in my husband."

  Carol grabbed more Kleenex, emptying Ernest's box. She didn't have to squeeze tears out now; they flowed of their own accord. Ernest reached into a desk drawer for another box of tissues, tore off the plastic cover, and started the paper flow by pulling out the first tissue, which he handed to Carol. She was astounded at her tears: a tragic and romantic view of her own life swept over her as her fiction became her truth. How sublime to have been loved so much by this all-giving, magnificent man; and how awful, how unbearable—here Carol wept harder—never to have seen him again, to have lost him forever! When Carol's sobbing subsided, she put away the Kleenex and looked up expectantly at Ernest.

  "Now I've said it. Aren't you judging? You said you'd tell me the truth."

  Ernest was in a jam. The truth was that he felt little charity toward this dead Dr. Cooke. He quickly considered his options. Remember, he reminded himself: total disclosure. But he balked. Total disclosure in this instance would not have been in his patient's best interests.

  His interview with Seymour Trotter had been his first exposure to therapist sexual abuse. In the ensuing eight years he had worked with several patients who had been sexually involved with previous

  Lying on the Couch ^ 115

  therapists, and in every case the resuh had been calamitous for the patient. And, despite Seymour's photograph, despite his arm raised jubilantly toward the sky, who can say what the outcome was for Belle? Of course there was the money she was awarded at the trial, but what else? Seymour's cerebellar deterioration was progressive. Probably after a year or two she had been trapped into full-t
ime caretaking for the rest of his life. No, no way one could say the outcome was good, in the long run, for Belle. Nor for any patient he had ever heard of. And yet, here today, Carolyn says that she and her therapist had an ongoing sexual relationship and it saved her life. Ernest was stunned.

  His first impulse was to discredit Carolyn's claim: maybe the transference to this Dr. Cooke was so strong that she hid the truth from herself. After all, it was clear that Carolyn wasn't home free. Here it is, fifteen years later, and she is still sobbing about him. Furthermore, as a result of her Dr. Cooke encounter, she made a bad marriage, which has plagued her since.

  Careful, Ernest warned himself, don't prejudge this. Take a moralistic, righteous stand and you'll lose your patient. Be open; try to enter Carolyn's experiential world. And above all, don't bad-mouth Dr. Cooke now. Marshal had taught him that. Most patients feel a deep bond toward the offending therapists and need time to work through the remnants of their love. It is not unusual for sexually abused patients to go through several new therapists before they find one with whom they can work.

  "So your father and brother and husband ended up abandoning or betraying or trapping you. And the one man you really cared for died. Sometimes death feels like abandonment, too." Ernest was disgusted with himself, with this therapy cliche, but under the circumstances it was the best he could do.

  "I don't think Dr. Cooke was too happy about dying."

  Carol immediately regretted her words. Don't be stupid! she chastised herself. You want to seduce this guy, to suck him in, what in hell are you doing getting testy and defending this wonderful Dr. Cooke, who is a sheer figment of your imagination^

  "Sorry, Dr. Lash ... I mean, Ernest. I know that wasn't what you meant. I guess I'm missing Ralph a lot now. I'm feeling pretty much alone."

  "I know that, Carolyn. That's just why it's important for us to be close."

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  Ernest noted Carolyn's eyes widen. Careful, he warned himself, she could see that statement as seductive. In a more formal voice, he continued: "And that's precisely why the therapist and patient must examine all the things that get in the way of their relationship—like, for example, your irritation at me a couple of minutes ago." Good, good, much better^ he thought.