Lying on the Couch

by Irvin D. Yalom

  "How do we break that up?"

  "Well, there are many possibilities. For example, from what you've said, it's clear that accomplishment and effectiveness are central to his identity. He must feel absolutely helpless now, and terrified of that helplessness. What's happened is that he may have lost sight of the fact that he has choices and that these choices give him the power to change. He has to be helped to understand that his predicament is not the result of a predetermined destiny, but the result of his own choices—for example, his choice to revere money. Once he accepts that he is the creator of his situation, he can also be brought to the understanding that he has the power to extricate himself: his choices got him into this; his choices can get him out.

  "Or," Ernest continued, "he probably has lost sight of the natural evolution of his present distress—that it exists now, that it had a beginning and will have an end. You might even review times in the past when he's felt this much rage and distress and help him remem-

  Lying on the Couch .""^ 34 3

  ber how that pain has faded away—just as his current pain will, at some point, become a bleached memory."

  "Good, good, Ernest. Terrific." Carol hastily scribbled notes. "What else?"

  "Well, you say he's a therapist. There's some additional leverage there. When I treat therapists, I often find that I can use their own professional skills to good advantage. It's a good way to move them back from themselves, to look at themselves from a more distant perspective."

  "How do you do that?

  "One simple way might be to ask him to imagine a patient with the same concerns as his walking into his office. How might he approach that patient? Ask him, 'What would you feel about this patient? How might you help him?'"

  Ernest waited as Carol turned a page and continued her note taking.

  "Be prepared for him to be annoyed at this; usually when therapists are in deep pain, they're like anyone else: they want to be taken care of, not to have to be their own therapist. But be persistent . . . it's an effective approach, it's good technique. In the business, it's what you call 'hard love.'

  "Hard love is not my strong suit," Ernest continued. "My former supervisor used to tell me that I generally opted for the immediate gratification of my patients loving me, rather than the more important gratification of watching them get better. I think—no, I know — he was right. I owe him a lot for that."

  "And arrogance?" asked Carol, looking up from her notes. "My client is so arrogant and grandiose and competitive that he has no friends at all."

  "Usually 'upside down' is the best approach: his grandiosity is probably covering a self-image that is full of doubt and shame and self-derogation. Arrogant, hard-driving people usually feel they have to overachieve just to stay even. So I wouldn't think of exploring his grandiosity or self-love. Focus instead on his self-contempt—"

  "Shh." Carol held up her hand to slow him down while she wrote. When she stopped he asked, "What else?"

  "His preoccupation with money," Carol said, "and with insider status. And his isolation and narrowness. It's as though his wife and family play no role in his life."

  "Well, you know, no one enjoys being swindled, but I'm struck by

  3 44 '' Lying on the Couch

  your client's catastrophic reaction: such panic, such terror . . . it's as though his very hfe is at stake, as though, without money, he would become nothing. I'd be inclined to wonder about the origins of that personal myth—and, incidentally, I'd deliberately and repeatedly refer to it as a 'myth.' When did he create this myth? Whose voice guided him? I'd like to know more about his parents' attitudes toward money. It's important because, from what you tell me, his reverence for status is what did him in—sounds like a clever con man who must have picked up on this and used it to entrap him.

  "It's a paradox," Ernest continued. "Your client—I almost said patient —considers his loss as his ruination, yet, if you can guide him properly, the swindle may be his salvation. It may be the best thing that ever happened to him!"

  "How do I make that happen?"

  "I'd ask him to look very deep within himself and examine whether his essence, his very center, believes that the purpose of his existence is to compile money. Sometimes I've asked such patients to project themselves into the future—to the point of their death, to their funeral—even to imagine their grave and to compose an epitaph. How might he feel, your client, to have an account of his preoccupation with money chiseled on his gravestone? Is that the way he'd like his life summed up?"

  "Scary exercise," said Carol. "Reminds me of that lifeline exercise you once asked me to do. Maybe I should tackle this one, too . . . not today, though . . . I'm not finished with questions about my client. Tell me, Ernest, what do you make of his indifference toward his wife? I've heard by sheer chance she may be having an affair,"

  "Same strategy. I'd ask what he would say to a patient who is this indifferent to the person closest to him in all the world. Ask him to imagine life without her. And what's happened to his sexual self? Where has that gone? When did it vanish? And isn't it strange how he seems far more willing to understand his patients than his wife? You say that she's also a therapist but that he ridicules her training and her approach? Well, I'd confront that head-on, as hard as I could. What's the basis of his ridicule? I'm sure it's not based on hard evidence.

  "Let's see, what else? As for his incapacitation—if that continues, then maybe a sabbatical of a month or two from practice would be good for him, both for his sake and for his patients'. Maybe the best way to spend it would be a retreat with his wife. Perhaps they could

  Lying on the Couch ^ 3 4 5

  see a couples counselor and attempt some listening exercises. I think one of the best things that could happen would be if he permitted her, even with her despised methods, to help him."

  "One last question—"

  "Not today, Carolyn, we're running out of time . . . and I'm running out of ideas. But let's spend just one minute looking at our session today. Tell me, underneath the words we've been exchanging today, what have you been feeling? About our relationship? And today I want to hear the full truth. I've leveled with you. Level with me.

  "I know you have. And I'd like to level . . . but I don't know how to say it ... I feel sobered, or humbled ... or maybe 'privileged' is the right term. And cared for. And trusted. And your honesty makes it hard for me to conceal."

  "Conceal what?"

  "Look at the clock. We're running over. Next time!" Carol rose to leave.

  There was an awkward moment at the door. They had to invent a new mode of leave-taking.

  "See you Thursday," said Ernest as he held out his hand for a formal handshake.

  "I'm not ready for a handshake," said Carol. "Bad habits are hard to break. Especially cold turkey. Let's cut down slowly. How about a paternal hug?"

  "Settle for 'avuncular'?"

  "What's 'avuncular'?"

  TWENTY-EIGHT

  (/)^ had been a long day in the office. Marshal trudged jT"^^ home, lost in reverie. Nine patients seen that day. Nine ^.^__^ times one hundred seventy-five dollars. Fifteen hundred and seventy-five. How long to earn back the ninety thousand dollars? Five hundred patient hours. Sixty full days at the office. Over twelve work weeks. Twelve weeks yoked to the plow, working for that fucking Peter Macondo! Not to mention the overhead during this time: the office rental, professional dues, malpractice insurance, medical license. Not to mention the fees lost when he canceled patients during the first couple of weeks after the swindle. Nor the five hundred the detective ripped off. Not to mention that Wells Fargo rallied last week and is four percent higher than when he sold it! And the attorney's fees! Carol's worth it. Marshal thought, even though she doesn't understand that a man can't just drop this. I am going to string up that bastard if it takes the rest of my life!

  Marshal stomped into the house and, as always, dropped his brief-

  Lying on the Couch ^ 3 47

  case in the doorway
and rushed to his new phone Hne to check messages. Voila! Sow and ye shall reap! There was a voice mail message.

  "Hello, I saw your ad in the APA monitor—well, not your ad, your warning. I'm a psychiatrist in New York City and I'd like more information about the patient you describe. Sounds like someone I'm treating. Please call me at home at 212-555-7082 this evening. Very late is okay."

  Marshal dialed the number and heard a "hello" on the phone, a "hello" that, God willing, would lead him directly to Peter. "Yes," Marshal replied, "I got your message. You say you're treating someone like the person I describe in the ad. Can you describe him to me?"

  "Just a minute, please," said the caller. "Let's back up. Who are you? Before I tell you anything, I need to know who you are."

  "I'm a psychiatrist and an analyst in San Francisco. And you?"

  "A psychiatrist in practice in Manhattan. I need more information about your ad. You use the term danger.'"

  "And I mean danger. This man is a swindler, and if you're treating him, you're in danger. Does he sound like your patient?"

  "I'm not at liberty—professional rules of confidentiality—simply to talk to a stranger about my patient."

  "Trust me, forget the rules—this is an emergency," said Marshal.

  "I'd prefer that first you tell me what you can about this patient."

  "No problem with that," said Marshal. "About forty, good-looking, mustache, went by the name of Peter Macondo—"

  ""Peter Macondo!" the voice on the phone interrupted. "That's my patient's name!"

  "That's incredible!" Marshal fell into a chair, astounded. "Using the same name! That I never expected. The same name? Well, I saw this guy, Macondo, in brief individual therapy for eight hours. Typical problems of the mega-wealthy: estate issues with his two children and ex-wife, everyone wanted a piece of him, generous to a fault, wife alcoholic. You got the same script?" said Marshal.

  "Yep, he told me he sent her to the Betty Ford Center too," Marshal replied. "And then I saw him and his fiancee together . . . That's right, tall, elegant woman. Name Adriana . . . She used the same name, too? . . . Yeah, that's right, to work on a prenuptial agreement. . . sounds like a carbon copy. You know the rest. . . successful therapy, wanted to reward me, complained about my low fee, endowed lectureship at University of Mexico—"

  3 4 8 -^ Lying on the Couch

  "Oh, Buenos Aires? Well, nice to hear he is still improvising. He's brought up his new investment? Bicycle helmet factory?

  "That's right—the chance of a lifetime—you're absolutely guaranteed against loss. No doubt you got the great moral dilemma? How he gave a bad financial tip to the surgeon who saved his father's life? How he flagellated himself for that? Couldn't deal with the guilt of injuring a benefactor. How he would never again allow that to happen?

  "That's right ... a heart surgeon ... he spent a whole hour with me, too, working that through. A detective I saw ... a pain in the ass . . . really got off on that part—called it an inspired ploy.

  "So, how far along are you? Given him a check for the investment yet?"

  "Lunch next week at the Jockey Club—just before he leaves for Zurich? Sounds familiar. Well, you saw my ad just in time. The rest of the story will be short and bitter. He sent me a Rolex watch, which of course I refused to accept, and I suspect he'll do the same with you. Then he'll ask you to treat Adriana and pay you generously in advance for her therapy. You may see her a time or two. And then—poof—gone. Both will vanish from the face of the globe.

  "Ninety thousand. And believe me I can't afford it. How about you? How much were you planning to invest?

  "Yeah, only forty thousand? I know what you mean about your wife—I had the same problem with mine. Wants to bury gold coins under the mattress. In this case she was right—first time. But I'm surprised he didn't push for more.

  "Oh, he offered to lend you another forty, interest-free, while you freed up more money over the next few weeks? Cute twist."

  "I can't thank you enough for your warning," replied the caller. "In the nick of time. I'm in your debt."

  "Yes—in the nick of time, all right. You're very welcome. Glad to be of help to a fellow professional. How I wish someone had done that for me.

  "Whoa, whoa, wait, don't hang up. I can't tell you how glad I am to have saved you from a swindle. But that's not why ... or only why ... I placed the notice. This bastard's a menace. He's got to be stopped. He'll just go on to another psychiatrist. We've got to get this guy put away."

  "APA? Well, I agree: Getting the APA lawyers involved would be one way to go. But we don't have the time. This guy only surfaces

  Lying on the Couch r ^^ 349

  briefly and then vanishes. I've had a private investigator working on it and, let me tell you, when Peter Macondo disappears, he disappears. Untraceable. You have any information, any clues, that might lead to his real identity? A permanent address? Ever seen a passport? Credit cards? Checking account?

  "Yeah, cash for everything? Did that with me too. How about car license plates?

  "Great—if you can get the car plates—great. So, that's how you met him? He rented the house down the street from your summer house on Long Island and gave you a ride in his new Jaguar? I know who paid for that Jag. But yes, yes, get that license number, any way you can. Or the dealer's name if it's still on the car. No reason at all we shouldn't be able to trap him."

  "I agree completely. You should see a private investigator—or maybe a criminal attorney. Everyone I've consulted has gone out of their way to let me know what a pro this guy is. We need professional help. . . .

  "Yes, much better to let the detective gather the information, not you. If Macondo sees you snooping around his house or car, he's off."

  "Fees? My detective charged five hundred a day—the attorney two hundred-fifty an hour. In New York they'll rip you off for more.

  "I don't follow you," said Marshal. "Why should / should pay the fees?"

  "Neither do I have anything to gain. We're in the same boat— everyone has guaranteed me that I will never get a penny of my money back—that when Macondo's caught he'll have no assets and a mile-long string of claims against him. Believe me—my motives here are the same as yours: justice and the protection of others in our field. . . . Revenge? Well, yes, there's some of that—I'll own up to it. Okay, well, how about this? Let's go fifty-fifty with any expenses you run up. Remember, it's tax-deductible."

  After a bit of a haggle. Marshal said, "Sixty-forty? I can live with it. So we're agreed? Next step is to see a detective. Ask your attorney for a recommendation. Then let the detective help us develop a plan to trap him. One suggestion, though: Macondo will offer to give you a secured note of your choice—ask him for a bank-guaranteed note; he'll produce one with a forged signature. And then we can nail him for bank fraud—a more serious offense. That can get the FBI involved No, I didn't. Not with the FBI. Not with the police. I'll

  3 5° ^ Lying on the Couch

  square with you; I was too scared of bad publicity, of censure for boundary violations—for investing with a patient, or an ex-patient. A mistake—I should have gone after him with everything I had. But, see, you're not in that quandary. You have not yet invested, and when you do it will be only in order to trap Macondo."

  "Not sure you want to get involved?" Marshal began pacing as he talked. He realized he could easily lose this precious opportunity and chose his words carefully.

  "What do you mean? You are involved! What are you going to feel when you hear about other psychiatrists, maybe buddies of yours, getting stung and you know you could have stopped it? And how will they feel when they learn you were a victim and remained silent? Don't we tell our patients that? About consequences for actions—or inactions?

  "What do you mean—'you're going to think about it'? We've no time. Please Dr. . . . you know, I don't know your name.

  "That's true, you don't know mine. We're in the same predicament—we're both afraid of exposure. We need to con
fide in one another. My name is Marshal Streider—I'm a training analyst in practice in San Francisco—psychiatric training at Rochester, Golden Gate Analytic Institute. That's right—when John Romano was chairman at Rochester. You?

  "Arthur Randal—sounds familiar—St. Elizabeth's in Washington? No, don't know anyone there. So you've got mainly a psy-chopharm practice?"

  "Well I'm starting to do more brief therapy, too, and a little couples work. . . . But please, Dr. Randal, back to what we were saying—there's no time for you to think about it—are you willing to participate?

  "Are you kidding? Of course, I'll fly to New York. I wouldn't miss it. I can't come for the whole week—I've got a full schedule. But when the crunch time comes, I'll be there. Call me after you've seen the detective—I want to be involved with every part of this. You calling from home? What's the best number to reach you at?"

  Marshal wrote down several numbers—home, office, and weekend number on Long Island. "Yeah, I'll call about this time at home. It's pretty impossible to reach me at my office, too. You break on the half hour? I usually break ten till the hour—we'll never connect during the day."

  He hung up the phone feeling a mixture of relief, exhilaration, and

  Lying on the Couch . ^^ 3 5 i

  triumph. Peter behind bars. Peter's drooped head. Adriana, downcast, in prison grays. The new Jag, good resale value, parked in his garage. Vindication at last! No one fucks over Marshal Streider.