Lying on the Couch

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by Irvin D. Yalom


  There was no mystery about the dream. The events of the previous night made the meaning crystal-clear. Eva's death had hurled

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  him into a confrontation with his own death (represented in the dream by the pervasive dread, by his separation from his family, and by his long elevator ascent to a heavenly seashore). How annoying, Ernest thought, that his own dream-maker had bought into the fairy tale of an ascent to paradise! But what could he do? The dream-maker was its own master, formed in the dawn of consciousness, and obviously shaped more by popular culture than by volition.

  The power of the dream resided in the nightshirt with the bright Smokey the Bear emblem. Ernest knew that symbol was prompted by the discussion of how to dress Eva in preparation for cremation— Smokey the Bear representing cremation! Eerie, but instructive.

  The more Ernest thought about it, the more useful this dream might be in teaching psychotherapists. For one thing it illustrated a point of Freud's that a primary function of dreams was to preserve sleep. In this instance, a frightening thought—cremation—is transformed into something more benign and pleasing: the adorable, cunning figure of Smokey the Bear. But the dream was only partially successful: though it enabled him to continue sleeping, enough death anxiety seeped out to soak his entire dream in dread.

  Ernest wrote for two hours, until Justin arrived for his appointment. He loved writing in the early morning hours, even though it meant he'd be exhausted by early evening.

  "Sorry about Monday," said Justin, walking straight to his chair and avoiding eye contact with Ernest. "I can't believe I did that. About ten o'clock, I was on my way to the office, whistling, feeling in a pretty good mood, when suddenly it hit me like a ton of bricks: I'd forgotten my hour with you. What can I say? I have no excuses. None at all. Just flat-out forgot. It's never happened before. Do I get charged?"

  "Well..." Ernest hesitated. He hated to charge a patient for a missed hour, even when, as in this case, it was obviously because of resistance. "Well, Justin, being that, in all our years together, this is the first time you've ever missed, . . . uh, Justin, why don't we say that from today on, I'll charge you for missed sessions without twenty-four hours notice."

  Ernest could hardly believe his own ears. Did he really say that? How could he not charge Justin? He dreaded his next supervision session. Marshal was going to climb all over him about this! Marshal accepted no excuse—auto accident, illness, hailstorm, flash

  flood, broken leg. He would charge patients if they missed to attend their mother's funeral.

  He could hear Marshal now: "You in this to be a nice guy, Ernest? Is that the point? So your patients will one day say to someone, 'Ernest Lash is a nice guy'? Or are you still guilty because you were irritated at Justin for leaving his wife without telling you first? What kind of capricious, inconsistent frame are you providing for therapy?"

  Well, there was nothing to be done about it now.

  "Let's go into it further, Justin. There's more going on than just missing Monday's session. In our last session, you were a couple of minutes late, and also we've had some silences, long silences, in the last couple of sessions. What do you think is happening?"

  "Well," said Justin with uncharacteristic forthrightness, "there'll be no silence today. There's something important I want to talk about: I've decided to raid my home."

  Justin, Ernest noted, was speaking differently: he had more directness and less deference in his voice. However, he was still evading a discussion of their relationship. Ernest would come back to that later—for now he was awash in curiosity about Justin's words. "What do you mean, raid}''

  "Well, Laura feels I should take what belongs to me—no more, no less. Right now I've only got the stuff I crammed into one suitcase the night I left. I've got a huge wardrobe. I've always indulged myself when it comes to clothes—God, the beautiful ties I've got at home; it breaks my heart. Laura thinks it's stupid to go out and buy all kinds of new stuff when I own so much—besides, we need the money for about twenty other things, starting with food and shelter. Laura thinks I should just march right into my own house and take what's mine."

  "Big step. How do you feel about that?"

  "Well, I think Laura's right. She's so young and unspoiled—and unanalyzed—she brushes aside a lot of crap and sees right into the center of issues."

  "And Carol? Her reaction?"

  "Well, I've called her twice—about seeing the kids and about getting some of my stuff. I've got some of next month's payroll stuff on my home computer—my dad'll kill me. I didn't tell her about the computer data—she'd trash it." Justin fell silent.

  "And?" Ernest was getting in touch with some of the irritation he

  had felt toward Justin the previous week. After five years of treatment, he shouldn't have to work so goddamn hard tugging out every byte of information.

  "Well, Carol was Carol. Before I could say anything, she asked when I was coming home. When I told her I wasn't coming back, she called me a fucking asshole and hung up."

  "Carol was Carol, you say."

  "You know, it's funny, she's helping me by being her usual bitchy self. After she screamed and hung up, I felt better. Each time I hear her shriek on the phone, I'm more sure I was right to walk out. More and more, I've been thinking what an idiot I was to have thrown away nine years of my life in that marriage."

  "Yeah, Justin, I hear your regrets, but the important thing is not to look back, ten years from now, and be overcome with similar regrets. And look at the start you're making! How wonderful that you've left this woman. How wonderful that you've had the courage to take such a step."

  "Yeah, Doc, you said it all along: 'avoid future regrets,' 'avoid future regrets.' I used to say it in my sleep. But I couldn't really hear it before."

  "Well, Justin, just put it this way, you weren't ready to hear it. And now you're ready to hear it and act on it."

  "How wonderful," Justin said, "that Laura came along when she did. I can't tell you what a difference it is to be with a woman who actually likes me, who even admires me, who's on my side."

  Though Ernest was irritated that Justin continually invoked Laura, he had himself under good control—the supervisory session with Marshal had really helped. Ernest knew he had no other recourse than to ally himself with Laura. Still, he didn't want Justin to give away his power completely to her. After all, he had just taken his power back from Carol, and it would be a good thing for him to own it for a while.

  "It is wonderful that Laura's entered your life, Justin, but I don't want you to downplay yourself in this— you made the move, it was your feet that walked out of Carol's life. But earlier you said something about a 'raid'?"

  "Well, I took Laura's advice and drove over to the house yesterday to pick up my possessions."

  Justin noted Ernest's surprise and added: "Don't worry—I haven't completely lost my mind. I phoned first to be sure Carol had left for

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  work. Well, can you believe Carol locked me out of my own house? The witch changed the locks. All night Laura and I talked about what to do. She thinks I ought to pick up a crowbar from one of my dad's stores and go back, bust open the door, and just take what belongs to me. The more I think about it, the more I think she's right."

  "Many locked-out husbands have done such things," Ernest said, astounded at Justin's newfound power. He imagined, for a moment, Justin in a black leather jacket and ski mask, crowbar in hand, tearing apart Carol's new house locks. Delicious! Ernest was beginning to like Laura more. Still, reason prevailed: he knew he'd better cover himself because later he'd have to describe this interview to Marshal. "What about the legal consequences, though? Have you considered seeing an attorney?"

  "Laura's against any delay: looking for an attorney will just give Carol more time to pillage and destroy my things. Besides, her courtroom viciousness is well known—I'd have a hard time finding an attorney in this city who'd be willing to take h
er on. You know, this business of getting my things back is not optional: Laura and I are running out of money. I don't have money to pay for anything—and I'm afraid that includes your bill!"

  "All the more reason to seek professional legal help. You've told me that Carol earned far more than you—in CaUfornia that means you're entitled to spousal support."

  "You're joking! Can you see Carol paying me spousal support?"

  "She's like everyone else; she has to obey the laws of the land."

  "Carol will never pay me alimony. She'd take it to the Supreme Court, she'd flush the money down the toilet, she'd go to jail, before paying me."

  "Fine, she goes to jail, Justin, and you'd walk in, get your things, your kids, and your house back. Don't you see how unrealistically you view her? Listen to yourself! Listen to what you're saying: Carol's got supernatural powers! Carol inspires so much terror that no attorney in California would dare oppose her! Carol is beyond all law! Justin, we're talking about your wife, not God! Not Al Capone!"

  "You don't know her as I do—even after all these years of therapy, you still don't really know her. And my folks aren't much better. If they were paying me a fair salary, I'd be okay. I know, I know, you've been pushing me for years to demand a realistic salary. I

  should have done it long ago. But now's not the time—they're really pissed at me for all this."

  "Pissed? How come?" asked Ernest. "I thought you said they hated Carol."

  "Nothing would please them more than never to lay eyes on her again. But she's got them hamstrung: she's holding the kids for ransom. Since I left, she hasn't allowed them to see their grandchildren—not even to talk to them on the phone. She's warned them that if they aid and abet me now, they can kiss their grandchildren good-bye forever. They're quaking in their boots—afraid to do anything to help me."

  For the rest of the session, Justin and Ernest talked about the future of their therapy. Missing a session and coming late obviously reflected a diminishing commitment to treatment, Ernest commented. Justin agreed and made it clear that he could no longer afford therapy. Ernest counseled against stopping therapy in the midst of so much upheaval and offered to allow Justin to postpone payment until his finances had straightened out. But Justin, sporting his newly found assertiveness, disagreed because he couldn't foresee his finances straightening out for years—not until his parents died. And Laura felt (and he agreed) that it was not a good idea to begin their new life with a big debt.

  But it was not only money. Justin told Ernest that he no longer needed therapy. Talking to Laura provided all the help he needed. Ernest didn't like that, but was assuaged by remembering Marshal's words that Justin's rebellion was a sign of real progress. He accepted Justin's decision to end therapy but gently argued against stopping so suddenly. Justin was obstinate but finally agreed to return for two more sessions.

  Most therapists take a ten-minute break between patients and schedule appointments on the hour. Not Ernest—he was far too undisciplined for that, and often started late or ran over the fifty minutes. Ever since he started practice, he had arranged a fifteen- or twenty-minute break between sessions and scheduled patients at odd times: 9:10,11:20, 2:50. Naturally, Ernest kept this unorthodox practice secret from Marshal, who would have criticized his inability to maintain boundaries.

  Generally Ernest used the break time to enter notes in the

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  patient's chart or to jot down ideas in a journal for his current book project. But he made no notes after Justin left. Ernest simply sat quietly, contemplating Justin's termination. It was an incomplete ending. Though Ernest knew he had helped Justin, he had not taken him far enough. And, of course, it was irritating that Justin attributed his entire improvement to Laura. But somehow that no longer mattered as much to Ernest. His supervision had helped attenuate those feelings. He must be sure to tell Marshal that. Individuals as supremely self-confident as Marshal usually get few strokes—most people don't think they need anything. But Ernest had a hunch he would appreciate some feedback.

  Despite his wish that he might have taken Justin a bit further, Ernest was not displeased with the termination. Five years was enough. He was not made for holding chronic patients. He was an adventurer, and when patients lost the appetite to strike out for new, unexplored territory, Ernest lost interest in them. And Justin had never been the exploring kind. Yes, it was true that, finally, Justin had broken his chains and liberated himself from that abomination of a marriage. But Ernest gave Justin little credit for that move—that wasn't Justin but a new entity: Justin-Laura. When Laura vanished, as she was sure to, Ernest suspected Justin would be stuck with the same old Justin.

  ELEVEN

  he following afternoon, Ernest hastily scribbled some clinical notes before Carolyn Leftman arrived for her second session. It had been a long day, but Ernest wasn't tired: he was always invigorated by doing good therapy and, so far, he was satisfied with his day.

  At least satisfied with four of his five patient hours. The fifth patient. Brad, used the time, as he always did, to give a detailed, and boring, report of his week's activities. Many such patients seemed constitutionally unable to use therapy. After failing in every attempt to guide him to deeper levels, Ernest began to suggest that another approach to therapy, perhaps a behavioral one, might offer Brad more help for his chronic anxiety and crippling procrastination. However, each time he began to utter the words, Brad would gratuitously comment on how enormously helpful this therapy had been, how his panic attacks had subsided, and how much he treasured his work with Ernest.

  Ernest was no longer satisfied with containing Brad's anxiety. He had grown as impatient with Brad as he had been with Justin. Ernest's criteria of good therapy work had changed: now he was satisfied only if his patients revealed themselves, took risks, broke new ground, and, more than anything else, were willing to focus on and explore the "in-betweenness"—the space between patient and therapist.

  At their last supervisory session. Marshal had chided Ernest for his chutzpah in thinking that a focus on the in-betweenness was something original; for the last eight decades analysts had been focusing microscopically on the transference, on the patient's irrational feelings toward the therapist.

  But Ernest would not be squelched and doggedly continued to take notes for a journal article on the therapeutic relationship entitled In-betweenness — The Case for Authenticity in Therapy. Despite Marshal, he was convinced he was bringing something new into therapy by focusing not on the transference—the unreal, distorted relationship—but on the authentic, real relationship between himself and the patient.

  Ernest's evolving approach demanded that he reveal more of himself to patients, that he and the patient focus on their real relationship—the we in the therapy office. He had long thought that the work of therapy consists of understanding and removing all the obstacles that diminish that relationship. Ernest's radical self-disclosure experiment with Carolyn Leftman was simply the next logical step in the evolution of his new approach to therapy.

  Not only was Ernest pleased with his day's work, but he had received a special bonus: patients had described to him two chilling dreams that, with their permission, he might use in his book on death anxiety. He still had five minutes before Carolyn was due to arrive, and he turned on his computer to enter the dreams.

  The first was only a snippet:

  / came to your office for an appointment. You weren't there. I looked around and saw your straw hat on the hat rack — it was all filled with cobwebs. An oppressive wave of great sadness came over me.

  Madeline, the dreamer, had breast cancer and had just learned that it had spread to her spine. In Madeline's dream the target of

  death shifts: it is not she who is faced with death and decay but the therapist, who has disappeared and left behind only his cobweb-filled hat. Or, Ernest thought, the dream might reflect her sense of loss of world: if her consciousness is responsible for the form and shape and meani
ng of all "objective" reality—her entire, personally meaningful world—then the extinguishing of her consciousness would result in the disappearance of everything.

  Ernest was accustomed to working with dying patients. But this particular image—his beloved Panama hat encased in cobwebs— sent a shiver down his spine.

  Matt, a sixty-four-year-old physician, supplied the other dream:

  / was hiking along a high cliff on the Big Sur coast and came upon a small river running into the Pacific. As I got closer I was amazed to see that the river was flowing away from the ocean, running backwards. Then I saw an old stooped man, who resembled my father, standing alone and broken in front of a river cave. I couldn't get closer to him since there was no trail down, so 1 continued following the river from on high. A short while later I came upon another man, even more stooped, perhaps my grandfather. I couldn't find a way to get to him, either, and woke up unsettled and frustrated.

  Matt's greatest fear was not of death per se but of dying alone. His father, a chronic alcoholic, had died a few months previously and, though they had had a long, conflicted relationship. Matt could not forgive himself for allowing his father to die alone. He feared that his destiny, too, would be to die alone and homeless, as had all the men in his family. Often, when he was overcome with anxiety in the middle of the night. Matt soothed himself by sitting next to his eight-year-old son's bed and listening to him breathing. He was drawn to a fantasy of swimming in the ocean, far from shore, with his two children, who lovingly help him slip beneath the waves forever. But, since he had not helped his father or his grandfather die, he wondered if he deserved such children.

  A river flowing backward! The river, carrying pine cones and brown brittle oak leaves, running uphill, away from the ocean. A river flowing backward to the golden age of childhood and the reunion of the primeval family. What an extraordinary visual image

 

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