by The Naked Lady Who Stood on Her Head: A Psychiatrist's Stories of His Most Bizarre Cases
“What are you thinking about?” I asked.
“I don’t understand why I can’t feel happy. All of my friends seem to be happy. I have the biggest house, and my girlfriends are all jealous that I got Eddie, but I can’t seem to have any fun anymore. What’s wrong with me? Do you think I’m depressed?”
I didn’t know about that yet. I was just glad she didn’t call me Doctor again.
“What do you think is wrong?” I asked, following Lochton’s advice by avoiding yes/no questions and instead asking open-ended ones that would encourage her to talk.
“I feel empty…It’s like I have a giant hole inside…here.” She wrapped her arms around her chest and rubbed her shoulders in what I could have sworn was a seductive gesture.
As Sherry continued her story, I got the feeling she was holding something back. She told me that she couldn’t have children and both she and Eddie were fine with that. Neither of them was really into kids. But the way she spoke seemed rehearsed, almost as if she knew the answers I wanted to hear. I started to wonder whether she was really just an anxious, bored, possibly depressed housewife who wanted to understand herself better or a sociopath who practiced her story after reading some psychotherapy text.
“Tell me about your marriage,” I said.
“I think I fell in love with Eddie the first time I looked into his dreamy blue eyes. We were both juniors at Boston College, and he was the first-string quarterback. My mother loved him, his family had big money, and he was great in bed…at least for the first few years.”
“So things have changed between you?” I asked.
“He works so hard now that he’s too tired for sex. I really miss that, you know?” She grinned mischievously.
It seemed like she was flirting with me. I had read about seductive patients in textbooks, but to actually experience one was strange and uncomfortable. She was a confusing case, but I did have some ideas about what might be going on. Sherry seemed to focus on appearances and possessions—her dreamy-eyed husband with the family money, her big new house, and her jealous friends. Perhaps she had a narcissistic personality disorder—a condition wherein the individual pursues superficial pleasures in attempts to fill an underlying emotional emptiness and insecurity. But she could also be depressed because of her husband’s frequent travel. Her flirtatious behavior could also reflect a histrionic personality, typical of people who seek attention through dramatic and emotional behavior.
I needed to know more about her before I could make a diagnosis and plan a therapeutic strategy. I continued to gently ask questions, but she was evasive about details and just kept returning to the angst she felt as a lonely housewife.
“You know, if you’re going to be my psychiatrist, I need to know more about you,” she said as if challenging me to go mano a mano.
“What would you like to know?” I asked.
“Where you’re from, how old you are, and whether you have a girlfriend,” she listed in quick succession.
Most patients are curious about their psychotherapist, but Sherry’s series of questions felt intrusive. All patients are entitled to know their doctor’s professional qualifications, fees, and treatment policies, but disclosure beyond that standard information can be a delicate matter and impede the therapeutic process.
Not all psychotherapists agree on how much self-disclosure is appropriate. Freud took the position that the therapist should be impenetrable to the patient. This Freudian approach encourages the patient to project his fantasies onto the therapist, who serves as a sort of mirror for the patient’s inner life. The process of working through those projections, or transferences, helps patients understand themselves better and diminishes their mental symptoms.
Some clinicians endorse a more humanistic approach and don’t mind revealing additional information about themselves—where they are vacationing, how many children they have, and so on. They view these disclosures as a way to enhance their therapeutic alliance with the patient, but it depends on the nature of the patient’s problems. Therapist self-disclosure can be a burden for patients, who might feel a need to care for the therapist, or get angry or jealous, which can interfere with their own progress.
I could have told Sherry my age and where I was from, but I felt that the question about a girlfriend was over-the-top. My instincts told me that if I answered any of her questions, it would only encourage her to ask more, and where would it end? I decided to deflect. “You know, Sherry, it’s natural to want to know about your therapist, but I can help you more if we focus on you.”
She looked stung. “Fine, if that’s how you want to play it.” Her body language changed from the seductive teenager to a hurt little girl.
“What do you remember about your childhood, Sherry?”
“Look, I’m thirty-three, I graduated Boston College, I’m married, and I feel like crap. Okay? There’s nothing else to tell,” she replied, annoyed.
“Did you get along with your parents? Your mother?” I asked.
“Yes. Everything was fine.”
“You mentioned that your parents really like your husband.”
This made her smile. “Everybody loves Eddie. He’s a real charmer. I just wish he was around more. I wouldn’t be so nervous all the time.”
As we continued, Sherry relaxed; it was as if she had forgiven me. We talked more about her marriage and her chronic anxiety. I ended the session by suggesting that we meet weekly. “This will give us an opportunity to understand your feelings and try to sort things out.”
“Finally, someone wants to understand me. Thank you, Dr. Small,” Sherry said, smiling, as she rose to leave. She grabbed my hand to shake it but held it so long that I eventually had to pull it away. It was an uncomfortable moment for me that she didn’t seem to notice.
The next day was my supervision meeting with Lochton. His office was on the first floor of his Beacon Hill brownstone, a short, steep, uphill walk from the hospital. By the time I got there, lugging my backpack, I was panting. Those long shifts in the clinic didn’t really motivate me to get out and jog very often, especially in the winter. I caught my breath before buzzing the intercom.
“Identify yourself,” an officious voice blasted through the little box.
“It’s Gary Small for supervision, Dr. Lochton.” He buzzed me in and I opened the door to his waiting room, which was a converted entry hall. It was old Beacon Hill style—white walls with wainscoting, hardwood floors, Stickley furniture, and old New Yorker magazines. He made me wait for ten minutes, probably while he added globs of Brylcreem to his hair.
Finally a door opened. “Come in, Gary,” Lochton said in his deep, radio-announcer voice. His wood-paneled office walls were covered with framed diplomas, awards, and journal covers. The bookshelves were jammed with medical and psychiatric texts. “Please sit down.”
“Thank you, Dr. Lochton,” I said as I took a seat. He was wearing a smoking jacket and holding an unlit pipe. He looked like an overweight, Freudian version of Hugh Hefner.
“Please, call me Herman,” Lochton said.
The name Herman Hefner popped into my mind, and I almost laughed out loud. “Yes, sir,” I managed to say with a straight face.
“So how is it going with your YAVIS, Gary?”
I pulled my copious notes out of my backpack and began. “She’s a thirty-three-year-old college-educated housewife from Belmont whose main complaint is chronic anxiety. I tried, but she wouldn’t give me much early history. She says she’s in love with her husband but keeps talking about feeling empty inside, especially when he travels for work, which he does often.”
When I said her husband traveled, Lochton lit up. “So he deserts her, over and over. Any kids?”
“She can’t have them, and they don’t seem to want to adopt.”
“Interesting,” he said as he lit his pipe, deep in thought.
As I continued to describe Sherry, I could see that Lochton was enthralled. His pipe smoke filled the room. I coughed and wave
d away some of the smoke. He was completely oblivious.
“So what we have here is an educated, verbal young woman with the capacity for a long-term relationship, but barren and probably so ashamed of her infertility that she’s unwilling to adopt, even though her life is empty, boring, and unfulfilled.” He leaned forward. “This will be an excellent case to help you learn about psychotherapy. I’m intrigued by the husband’s frequent travel.”
“Her symptoms do get worse when he’s away—”
“Yes, but why does he travel so much, and what does she do in private to cope with her anxiety? She must be sensitized to separation and loss because of some early life trauma. Her evasiveness about her childhood proves my point.”
I didn’t see how he had proven his point at all, but I knew Lochton had a reputation for being obsessed with early separation and loss. His primary psychodynamic explanation for nearly every patient’s problem was a psychological loss early in childhood—whether it was a death in the family, a traumatic divorce, or a beloved cat gone missing. He theorized that these types of childhood experiences made patients overly vulnerable to separations and losses later in life. Lochton believed that childhood losses explained most psychiatric symptoms, from anxiety and depression to obsessions and compulsions.
He encouraged me to get Sherry to talk about her childhood. He said I should delve into her past and start seeing her twice a week. Increasing the frequency of her sessions would intensify our explorations and help her to open up more quickly.
“Find out about her relationship with her father,” he said. “Did he also travel when she was a child? Or maybe he deserted the family and she felt abandoned just as she does now.”
When I told Lochton about Sherry’s seductiveness, his expression completely changed. “In what way was she flirting with you?” he asked.
“It wasn’t so much overtly flirting, but more her body language, the way she moved around on the sofa and how she looked at me, the lingering handshake at the end of the session. It felt intrusive.”
Lochton stared at me silently. Finally he said, “Go on…” His response was odd. He was talking to me as if I were a patient.
“She asked me personal questions like whether I had a girlfriend.”
“How did that make you feel?” he asked.
“Strange. It was a therapy session, not a pickup bar.”
“Did you answer the personal questions?”
“No. I told her we were there to talk about her feelings, not about my personal life,” I said, trying not to sound defensive.
“That’s good, Gary, but do you think you did anything that might have provoked her seductive behavior?”
“Absolutely not, Dr. Lochton. I was completely professional.” I was starting to get annoyed. Lochton hadn’t seen Sherry’s behavior, and he was insinuating that I was the seducer.
He looked at his clock and said, “Our time is up here.” Now he was really talking to me like I was a patient.
As I got up to leave, he added, “You know, Gary, a patient like this woman can stir up discomfort in her therapist. Be careful of that, and keep delving into her past. I’m sure you’ll find the trauma that’s driving her neurosis.”
Although Lochton’s theory seemed like a stretch, I followed his advice and started meeting with Sherry twice a week. I kept probing her past but didn’t seem to get anywhere. At the same time, what I perceived as her seductive behavior escalated. She began wearing heavy makeup, short skirts, and plunging necklines to her sessions, and I noticed a pattern—when her husband was out of town, Sherry’s outfits were more provocative than when he was home.
I discussed the possibility of confronting her about it, but Lochton told me to ignore it and press on about her early trauma. I was relieved because I sensed that if I pointed out the sexy-apparel pattern, she would take it as a rejection of her possible seductive overtures and perhaps stop therapy.
After about a month of my futile attempts to pry into her past, Sherry became exasperated with me and finally said, “Look, I had a normal childhood, okay? No abuse. My parents never went anywhere, and I did well in school. Your questions are making me uncomfortable.”
It was clear that if she was going to talk about it, I needed to take a different approach. “That’s fine, Sherry. I don’t want to make you uncomfortable.”
“Thank you, Dr. Small. Can I call you Gary?”
“I don’t have a problem with that.” After a long pause I asked, “Is there anything else making you uncomfortable?”
She stared at me. “Actually, yes. I need to confess something.”
“Go ahead,” I said.
“Ever since Eddie started traveling more, I’ve been going to this bar at night,” she said. “At first I would just stop in for a quick drink with a friend, but eventually I started going there on my own.” She stopped and looked away.
“Are you concerned that you might be drinking too much?” I asked.
“No, that’s not it. I only have one or two glasses of wine to relax me.” She paused and then continued, “One night I met this guy. We had a lot of laughs, and I took him home with me when the bar closed.”
“How did you feel about that?” I asked.
“When I woke up the next day he was gone. I felt dirty, disgusted, and I threw the sheets in the trash,” she said, looking down.
“Did you ever go back to that bar?”
“At first, no. I stayed away. But after a couple of weeks, I did go back. That’s part of my confession. I’ve done it more than once.”
“So you’re going to a bar and having affairs when your husband is out of town?” I asked, trying to keep the surprise out of my voice and face.
“They’re not really affairs; they’re just one-night stands. And I always feel dirty and hate myself the next day. I mean, I still love Eddie.”
“If it makes you hate yourself and you feel dirty afterward, why do you think you keep going back?” I asked.
She paused for a moment and then said, “I don’t really think about the dirtiness at the beginning. I just feel bored and empty, and I want to be with someone. It’s weird, when we’re having sex, it feels like these guys really love me; but once I orgasm, everything changes. I want these strange men to disappear.” She shuddered. “Eddie would die if he knew.”
“How long has this been going on, Sherry?”
“I don’t know, a year maybe, but it’s all different now that I started seeing you, Gary. You’re the first man who has shown that you really care about me. You always want to know how I feel, and I can see that look in your eyes. I know you mean it.” She smiled at me again in her provocative way.
It was odd that she would say I was the first man who really cared about her. What about her husband and her father?
Although I thought it was progress that Sherry trusted me enough to reveal this secret side of her life, I was concerned. Her behavior was dangerous and could not only destroy her marriage but expose her to physical harm. I needed some supervision—fast.
“I think we both have to understand this better, Sherry. Do you think you can keep from going back to that bar until we’ve had a chance to talk again on Friday?”
Her smile was a caricature of sexiness. “For you, Gary, I’d do anything.”
Later that afternoon I hiked up to Lochton’s office. He had a field day over my session with Sherry. He paced and puffed his pipe as he expounded excitedly. “She’s acting out sexually to compensate for her unmet emotional needs as a child. She must have been sexually abused as a girl. That’s why she feels unloved and keeps searching for it with these strange men.”
I tried to tell him that I wasn’t convinced there had been abuse, but it was like talking to a tornado. He kept whirling about the room saying that Sherry was repeating these demeaning sexual acts as an adult repetition compulsion. And now her seductive behavior with me was perfect. She was developing a classic transference. At least he finally believed me about her seductiveness.
I understood the lecture on transference, just as I had the first three times I’d heard it. And as for Lochton’s explanations about Sherry’s early-childhood losses, they were plausible—maybe she was still hiding something from me.
Before the next session on Friday, I had decided to focus on Sherry’s self-destructive barhopping behavior and try to help her to stop. I was taken aback when Sherry showed up dressed like a prostitute.
She struggled to sit down in her tight miniskirt and started talking. “I want to thank you, Gary, for listening to me on Wednesday and helping me to stop doing what I was doing. It was crazy, and I know that you really do care about me.”
“I’m relieved you’ve stopped. How are you feeling?” I asked.
“You know the answer to that. It’s our little secret.” She winked, as if there was some inside joke between us.
“What do you mean?”
She didn’t say anything, just smiled.
“I thought we were beyond secrets, Sherry. For psychotherapy to work, you have to try to tell me what’s on your mind.”
She finally said, “But you know what’s on my mind—every time you look into my eyes.” She reached into her purse. “Here’s a little thank-you for our last session. I hope you enjoyed it as much as I did.” She handed me a gift and darted out of the office before I could say anything.
