Lying on the Couch

by Irvin D. Yalom

  "Hard to say. I had my suspicions within the first couple of years, but there was an incident—the great camping debacle—that removed even the shadow of a doubt. That was about five years ago."

  "Tell me about that."

  "Well, Wayne decided the family should indulge in America's favorite pastime: a camping trip. I once almost died, in my teens, from a bee sting—anaphylactic shock—and I have malignant poison-oak reactions; so there was no way I could go camping. I suggested a dozen other trips: canoeing, snorkeling, inland waterway trip to Alaska, sailing in the San Juans, Caribbean, or Maine—I'm a good sailor. But Wayne decided his whole manhood was at stake and would have nothing else but a camping trip."

  "But how could he expect you to go camping with a bee sting sensitivity? He expected you to put your life at risk?"

  "He could only see that I was trying to control him. We fought pitched battles, I told him I would never go, and then he insisted on taking Mary without me. I had no problem with his going backpacking and urged him to go with some male friends—but he had no friends. I felt it was unsafe for him to take Mary—she was only four. He's so inept, so cowardly, that I feared for her safety. I believe he wanted Mary there for his protection rather than vice versa. But he wouldn't budge. Finally he wore me down and I agreed.

  "And that's when things got bizarre," Carol continued. "First he decided he had to get in shape and lose ten pounds—thirty pounds would have been more to the point. Incidentally that's the answer to your question about good looks: he blimped up soon after our wedding. He started going to the gym daily to lift weights and lose weight, which he did, but then he threw out his back and gained the weight back. He'd get so anxious he'd often hyperventilate. Once, at the dinner honoring me when I made full partner in our firm, I had to leave to take him to the emergency room. So much for the macho camping trip. That's when the horror of my mistake fully dawned on me.

  "Whew, what a story, Carolyn." Ernest was struck by the similarities between this account and Justin's story about his backpack-

  Lying on the Couch ^ 2,01

  ing fiasco with his wife and twins. Fascinating to hear two such similar stories—but from very different perspectives.

  "But tell me, when you really realized your mistake—let's see, how long ago was that camping trip? You say your daughter was four?"

  "About five years ago." Every few minutes Carol pulled herself up short; despite loathing Ernest, she found herself engaged in his inquiry. Amazing, she thought, how bewitching the therapy process becomes. They can hook you in an hour or two, and once they have you they can do as they wish — get you coming every day, charge you what they wish, fuck you on their rug and even charge you for that. Maybe it's too dangerous to play myself honestly. But I have no other option —// 1 invented a persona, I'd be tripped up time and again by my own lies. This guy's a prick, but he's no dummy. No, I have to play myself. But careful. Careful.

  "So then, Carolyn, five years ago you realized your mistake—yet you stayed in the marriage nonetheless! Maybe there were more positive parts of the marriage you haven't discussed yet."

  "No, it was a hideous marriage. I had no love for Wayne. Nor respect. Nor he for me. I got nothing from him." Carol dabbed at her eyes. "What kept me in the marriage? Christ, I don't know! Habit, fear, my daughter—though Wayne has never bonded to her— I'm not sure . . . the cancer and my promise to Wayne . . . nowhere else to go—I've had no other offers."

  "Offers? From men, you mean?"

  "Well, no offers from men, for sure, and, please, Ernest, let's talk about that today—I've got to do something about my sexual feelings—I'm starving, I'm desperate in that area. But that's not what I meant just then—I meant no interesting professional offers. Not like those golden offers I had when I was young."

  "Yes, those golden offers. You know, I'm still thinking of your tears a few minutes ago when we talked about being first in your class and about the unlimited career vista ahead of you ..."

  Carol steeled herself. He's trying to get back in., she thought. Once they find the vulnerable area, they keep drilling into it.

  "There's a lot of pain in there," Ernest continued, "about what your life could have been. I was thinking of that wonderful Whittier lyric: 'of all sad words of tongue or pen, the saddest are these: it might have been.'"'

  Oh no, Carol thought. Spare me. Now it's poetry. He's pulling out all the stops. Next, he'll tune up the old guitar.

  ^•Oi Si-, Lying on the Couch

  "And," Ernest continued, "you gave up all those possibilities for a life with Wayne. A bad bargain—no wonder you try not to think about it . . . you see the pain that comes up when we face it head-on? I think that's why you haven't left Wayne—it would have put the stamp of reality on it. There would have been no denying any longer that you gave up so much, your whole future, for so little."

  Despite herself, Carol shivered. Ernest's interpretation rang true. Goddammit, get off my case, will youf Who asked you to pontificate on my lifef "Maybe you're right. But that's over; how can this help now? This is exactly what I meant by rummaging around in the past. What's past is past."

  "Is it, Carolyn? I don't think so. I don't think it's just that you made a bad decision in the past: I think you're still making bad choices. Right now in your life today."

  "What choice do I have? Abandon a dying husband?"

  "It feels stark like that, I know. But that's the way bad choices are always set up—by convincing yourself that's there's no other choice to be made. Maybe that might be one of our goals."

  "What do you mean?"

  "Helping you to understand that maybe there are more possible choices, a wider range of choices."

  "No, Ernest, it still comes down to the same thing. There are only two choices: I either abandon Wayne or stay with him. Right?"

  Carol regained her composure: this invented Wayne was far removed from Justin. Still, watching Ernest try to help her leave him revealed his methods of brainwashing Justin into leaving her.

  "No, not at all. You're making a lot of assumptions that aren't necessarily true. For example, that you and Wayne will always have contempt for each other. You've omitted the possibility that people may change. The confrontation with death is a great catalyst for change—for him, possibly for you. Possibly marital couple therapy might help—you mentioned you haven't tried that. Maybe there's some buried love that you or he might rediscover. After all, you have lived together and raised a child for nine years. How would it be for you if you left him or if he died and you knew you might have tried harder to improve things in your marriage? I'm certain you'd be better off feeling that you've left no stone unturned.

  "And another way to look at it," Ernest continued, "is to question your basic assumption that accompanying him to the very end of his life is a good thing. Is that necessarily true? I wonder."

  Lying on the Couch .-^^ ^°3

  "It's better than for him to die alone."

  "Is it?" Ernest asked. "Is it a good thing for Wayne to die in the presence of one who holds him in contempt? And still another possibility is to keep in mind that divorce need not be synonymous with abandonment. Is it not possible to imagine a scenario in which you build a different life for yourself, even with another man, and still do not abandon Wayne? You might even be able to be more present with him if you didn't resent him so much for being part of the trap. You see, there are all sorts of possibilities."

  Carol nodded, wishing he would stop. Ernest looked like he could go on forever. She looked at her watch.

  "You look at your watch, Carolyn. Can you put that into words?" Ernest smiled slightly as he recalled the supervisory session in which Marshal confronted him with the identical words.

  "Well, our time is almost up," said Carol, dabbing at her eyes, "and there are other things I wanted to talk about today."

  Ernest was chagrined to think he had been so directive that his patient had not been able to address her own agenda. He moved quickly. "A few m
inutes ago, Carolyn, you mentioned the sexual pressure you were experiencing. Is that one of the things?"

  "It's the main thing. I'm out of my mind with frustration—I'm sure it's the root of all this anxiety. Our sex life was not much before but, since Wayne had his prostate surgery, he's been impotent. I understand that's not uncommon after surgery." Carol had done her homework.

  Ernest nodded. And waited.

  "So, Ernest . . . you sure it's okay to call you Ernest?"

  "If I call you Carolyn, you must call me Ernest."

  "All right, Ernest it is. So, Ernest, what should I do? Lots of sexual energy and nowhere to direct it."

  "Tell me about you and Wayne. Even though he's impotent, there are still ways for you and him to be together."

  "If by 'being together' you're thinking of some way for him to get me off, forget it. There's no solution there. Our sex life was over long before the surgery. That was one of the reasons I wanted to leave him. Now I'm completely turned off by any kind of physical contact with him. And he couldn't be less interested himself. He's never found me attractive—said I'm too thin, too bony. Now he tells me to go out and get laid somewhere."

  "And?" asked Ernest.

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  "Well, I don't know what to do and how to do it. Or where to go. I'm in a strange city. I know no one. I'm not about to go into a bar to get picked up. It's a jungle out there. Dangerous. I'm sure you'd agree that the last thing in the world I need is to be abused again by a man."

  "That's for sure, Carolyn."

  "Are you single, Ernest.' Divorced? The jacket of your book mentions no wife."

  Ernest drew a breath. He had never talked about his wife's death to a patient. Now his commitment to self-disclosure was going to be put to the test. "My wife was killed six years ago in an auto accident."

  "Oh, I'm sorry. That must have been hard."

  Ernest nodded. "Hard . . . yes."

  Dishonest. Dishonest, he thought. Though it's true that Ruth was killed six years ago, it's also true that my marriage would never have lasted anyway. But does she need to know thatf Stay with what will help the patient.

  "So, you're also struggling in the singles world now?" Carol asked.

  Ernest felt jammed. This woman was unpredictable. He had not anticipated such rough sailing for his maiden voyage of total disclosure, and was strongly tempted to head for the calm waters of analytic neutrality. He knew that course by rote: it would be simple enough to say, "I wonder why you're asking these questions," or "I wonder what your fantasies are about my being in the singles world." But such devious neutrality, such inauthenticity, was precisely what Ernest had vowed to avoid.

  What to do? He wouldn't be surprised if next she inquired into his dating strategies. For a moment he imagined Carolyn, a few months or years hence, telling some other therapist about Dr. Ernest Lash's approach to therapy: "Oh yes, Dr. Lash often discussed his personal problems and his techniques of meeting single women."

  Yes, the more Ernest thought about it, the more he realized that herein lay a major problem of therapist self-disclosure. The patient has confidentiality, but the therapist has none! Nor can a therapist demand it: if patients enter therapy in the future with someone else, they absolutely must have the freedom to discuss everything, including the quirks of their former therapists. And though therapists can

  Lying on the Couch ^ 2.05

  be trusted to protect the confidentiality of the patient, they often gossip among themselves about the foibles of colleagues.

  Several weeks ago, for example, Ernest referred the wife of one of his patients to another therapist, a friend named Dave. Recently the same patient requested another referral for his wife; she had terminated therapy with Dave because of his habit of smelling her as a way of apprehending her mood! Ordinarily Ernest would have been horrified at this behavior and would never again have referred a patient to him. But Dave was such a good friend that Ernest asked him what had happened. Dave said that the patient had left therapy because of her anger at him for refusing to prescribe Valium, which she had secretly been abusing for years. "And what about smelling?" Dave was at first bewildered but, a few minutes later, remembered one occasion when, early in therapy, he made a casual compliment about a new, particularly heavy perfume she was wearing.

  Ernest added another item to his rules of disclosure: reveal yourself to the extent that it will be helpful to your patient; but if you want to stay in practice, have a care about how your self-disclosure will sound to other therapists.

  "So you too are struggHng in the singles world," Carol repeated.

  "I'm single but not struggling," Ernest responded. "Not at the moment, at least." Ernest strove for an engaging, yet nonchalant smile.

  "I wish you would tell me more about how you deal with the singles life in San Francisco."

  Ernest hesitated. There's a difference between spontaneity and impulsivity, he reminded himself. He must not, willy-nilly, respond to every question. "Carolyn, I'd like you to tell me more about why you're asking this question. I made you a couple of promises: to be as helpful as I possibly can—that's primary—and, in the service of that, to be as honest as possible. So now, from the standpoint of my primary objective—being helpful to you—let's try to understand your question: tell me, what is it that you're really asking me? And why?"

  Not bad, Ernest thought, not bad at all. To be transparent does not mean to be a slave to all the patient's whims and flights of curiosity. Ernest jotted down his response to Carolyn; it was too good to lose—he could use it in his journal article.

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  Carol was prepared for his question and had silently rehearsed this sequence, "I would feel more completely understood by you if I knew that you were dealing with similar issues. And especially if you have passed through them successfully. I can experience you as more like me."

  "That makes sense, Carolyn. But there must be more to your question, since I've already said that I'm dealing—and dealing satisfactorily—with being single."

  "I was hoping you could give me direct guidance—point me in the right direction. I'm feeling really paralyzed—to be honest, I'm horny and terrified at the same time."

  Ernest looked at his watch. "You know, Carolyn, we're out of time. Before our next session, let me suggest you work on developing a series of options to meet men and then we'll consider the pros and cons of each. I'm very uncomfortable giving you concrete suggestions or, as you put it, 'pointing you in the right direction.' Take my word for it—I've been through it countless times: that type of direct guidance rarely proves helpful to the patient. What's good for me or someone else may not be good for you."

  Carol felt thwarted and angry. You smug, self-righteous bastard, she thought. I'm not going to end this hour without some definite progress. "Ernest, I'm going to have a hard time waiting for another whole week. Could we schedule something earlier; I need to see you more often. Remember, I'm a good cash customer." She opened up her purse and counted out a hundred and fifty dollars.

  Ernest was disconcerted by Carol's comment about money. Customer seemed a particularly ugly word: he disliked facing any part of the commercial aspect of psychotherapy. "Oh . . . ah . . . Carolyn, that's not necessary ... I know you paid cash at the first session, but from now on I'd prefer sending you a bill at the end of each month. And actually I'd prefer a check to cash—easier for my primitive bookkeeping methods. I know a check is less convenient because you don't want Wayne to know that you're seeing me, but perhaps a cashier's check?"

  Ernest opened up his appointment book. The only time slot available was Justin's newly vacated eight a.m. hour which Ernest wanted to reserve for writing. "Let's play this by ear, Carolyn. I'm pressed for time at the moment. Wait a day or so and if you feel like you absolutely must see me before next week, give me a call and I'll

  make time. Here's my card; leave a message on my voice mail and I'll call back and leave an appointment time."
/>   "It's awkward if you call. I'm still not working and my husband's always home ..."

  "Right. Here, I'll write my home number on the card. You can generally reach me there between nine and eleven in the evening." Unlike many of his colleagues, Ernest had no concerns about giving out his home number. He had learned long ago that, in general, the easier it was for anxious patients to reach him, the less likely they were to call.

  As she was leaving the office, Carol played the last card in her hand. She turned to Ernest and gave him a hug, a little longer, a little tighter, than the last one. Sensing his body tensing up, she commented: "Thank you, Ernest. I needed that hug if I'm going to get through another whole week. I need to be touched so bad I can hardly stand it."

  As she descended the stairs Carol wondered, Is it my imagination or is my pigeon taking the bait? He got into that hug just a bitf She was halfway down when the ivory-sweatered jogger came flying up the stairs, almost knocking her over. He grasped her arm firmly to steady her, lifted his white yachting cap by the bill, and flashed a brilliant smile at Carol. "Hey, we meet again. Sorry for almost running you over. I'm Jess. We seem to share a shrink. Thanks for keeping him over the hour; otherwise he'd be interpreting my lateness half the session. He in good form today?"

  Carol stared at his mouth. Never had she seen such perfect white teeth. "Good form? Yeah, he's in good form. You'll see. Oh, I'm Carol." She turned to watch Jess bound up the remaining stairs two at a time. Great buns!

  TWELVE

  /?:.

  Thursday morning a few minutes before nine, Shelly closed his racing form and tapped his foot impatiently in ^_y^ Marshal Streider's waiting room. Once he was finished with Dr. Streider, he had a good day ahead of him. First, some tennis with Willy and his kids, who were home for Easter break. Willy's kids played so well now that it felt less like coaching and more like competitive doubles. Then lunch at Willy's club: some of those lan-goustines grilled with butter and anise or perhaps that soft shell crab sushi. And then to Bay Meadows with Willy for the sixth race. Ting-a-ling, Willy and Arnie's horse, was running in the Santa Clara stakes. (Ting-a-ling was the name of Shelly's favorite poker game: a high-low five-card stud game where a sixth card could be bought at the end for two hundred and fifty dollars.)