Alex 18 - Therapy

by Jonathan Kellerman

  One topic that had held her interest was prison reform. She’d given eight radio interviews last year in which she decried the shift from rehabilitation to punishment. In two of the talks, she’d been joined by a man named Albin Larsen, listed as a psychologist and human rights worker.

  The photos I found showed a pleasant-looking woman with short, shagged caramel hair. Her face was round with chipmunk cheeks and terminated in a sharp little off-center chin. Her neck was graceful but starting to loosen. Crisp, dark eyes. Wide, determined mouth. Gorgeous teeth, but her smile seemed posed. In every picture she wore red.

  Now I knew whom to look for.

  *

  I left for her office the next morning at eleven-forty-five, figuring my best bet was to catch her during her lunch break. Her office was in Beverly Hills but not Bedford Drive’s Couch Row or any of the other fashionable streets where high-priced therapists congregated.

  Dr. Mary Lou Koppel plied her trade in a two-story building on Olympic Boulevard and Palm Drive—a mixed-use stretch near the glitzy city’s southern border. Down the block were an auto-painting franchise and a private school housed in what had once been a residential duplex. Beyond those sat a florist and a pharmacy advertising discounts for seniors. Traffic on Olympic was nonstop and freeway-deafening.

  Koppel’s building had a windowless front, with brick facing painted the color of wet sand. No identifying marks other than black plastic address numerals too small to read from across the street. The front door was locked, and a sign said to enter through the rear. Behind the structures was a six-space parking lot backed by an alley. Three slots marked RESERVED were occupied by small, dark Mercedes sedans, not unlike Jerry Quick’s.

  I fed a meter on Palm and made my way over.

  The ground floor was a long, dim, red-carpeted corridor that ran along the east side of the building and had the popcorn smell of a theater lobby. One occupant: an outfit called Charitable Planning. An arrow painted on the wall directed me to the stairway and when I got there faux-bronze letters specified what awaited me on the second story.

  PACIFICA-WEST PSYCHOLOGICAL SERVICES

  Upstairs was pewter-colored industrial carpeting, blue-gray walls, better lighting. Unlike the first floor, no long hallway. Progress was halted by a perpendicular wall set ten feet in. A single door was marked RECEPTION.

  Inside was a large unoccupied waiting room set up with blue tweed chairs and coffee tables stacked with magazines. No reception window, just a door and three signs. FRANCO R. GULL, PH.D., MARY LOU KOPPEL, PH.D., ALBIN A. LARSEN, PH.D.

  Larsen was the human rights activist with whom Koppel had shared some of her prison reform interviews. Feeding two practices for the price of one.

  Next to each sign was a call button and a tiny, faceted bulb. A sign instructed patients to announce themselves with a button push. A clear light meant the doctor was free, red signified Occupied.

  Gull’s and Larsen’s lights were red, Koppel’s wasn’t. I announced myself.

  *

  A few moments later, the blank door opened, and Mary Lou Koppel stood there wearing a red short-sleeved cashmere top over white linen pants and red shoes. In person, her dark eyes were nearly black. Clear and bright and inquisitive, and all over me. Her hair was tinted lighter than in the photos, she’d put on a few wrinkles, her bare arms were soft, freckled, plumper than the rest of her. Yellow diamond cocktail ring on her right index finger. Big canary-colored stone, surrounded by tiny sapphires. No wedding band.

  “Yes?” she said. Smooth, soft, low-pitched voice. Radio voice.

  I gave her my name, handed her the card that says I sometimes consult to the police. She read the small print. “Delaware.” She handed it back, looked into my eyes. “That’s an unusual name . . . have we met?”

  “A few years ago, but only telephonically.”

  “I’m afraid I don’t understand.”

  “The Wetmore divorce case. I was assigned by the court to make custody recommendations. You were Teresa Wetmore’s therapist.”

  She blinked. Smiled. “If I recall correctly, I wasn’t very cooperative, was I?”

  I shrugged.

  “Unfortunate,” she said. “What I couldn’t tell you at the time, Dr. Delaware—what I probably still shouldn’t tell you—was that Terry Wetmore tied my hands. She didn’t like you one bit. Didn’t trust you, forbade me to divulge anything to you. It put me in a bit of a bind.”

  “I can imagine.”

  She placed a hand on my shoulder. “The rigors of our profession.” Her hand lingered, trailed my jacket sleeve, dropped. “So what brings you here today—what else can I not cooperate with you about?”

  “Gavin Quick.”

  “What about Gavin?”

  “He was murdered two nights ago.”

  “Mur—oh my God. Oh, no . . . come in.”

  *

  She led me through a short corridor, past a copying machine and a watercooler, to one of three doors at the rear. Her office was paneled in slabs of pale bird’s-eye maple, carpeted in double-plush deep blue wool, and furnished with a glass desk on a black granite base, a Lucite desk chair, oversized, baby blue leather sofas and recliners arranged with a designer’s eye. The ceilings were cork—soundproofing. Nothing was nailed to the highly figured wood walls. Her diplomas and a framed psychologists’ license were propped in a glass étagère off to one side, along with crystal paperweights and what looked to be pueblo pottery. Sea-green drapes concealed what I assumed were the windows. Their placement meant a view of the parking lot and the alley. The room managed to be generous yet cozy. Airy yet proportioned for intimacy . . .

  Mary Lou Koppel sat behind the glass desk. I took the nearest soft chair. Very soft. I sank low, was forced to look up at her.

  She said, “This is horrible. I just saw Gavin last week. I just can’t believe it.”

  I nodded.

  “What happened?”

  I gave her the bare details, ended with the unidentified blond girl.

  She said, “That poor boy. He’d been through so much.”

  “The accident.”

  She placed her hands on the glass desktop. Her wrists were tiny, her fingers short but thin, the nails coated by clear polish. Near her right hand was a Limoges box filled with business cards, a pair of reading glasses, and a small, silver cellular phone. “Do the police have any idea what happened?”

  “No. That’s why I’m here.”

  “I’m not clear what it is that you do for them.”

  “Sometimes the same goes for me,” I said. “This time they’ve asked me to make contact with you because we’re peers.”

  “Peers,” she said. “They think I can help solve a murder?”

  “We’re talking to everyone.”

  “Well,” she said, “I was Gavin’s therapist, but I don’t see how that can be relevant. Surely you don’t think this had anything to do with Gavin’s treatment.”

  “At this point, it’s an open book, Dr. Koppel.”

  “Mary Lou,” she said. “Well, sure, I can understand that logic . . . in the abstract.” She fluffed her hair. “Before we go any further, perhaps I should see some sort of written release. I’m aware that with Gavin deceased, there’s no legal confidentiality. And I certainly don’t want to be seen as obstructive. Again. But . . . you understand, don’t you?”

  “Absolutely.” I gave her the release form the Quicks had signed. She glanced at it. “Can’t be too careful. Okay, what would you like to know?”

  “Gavin’s parents implied there were personality changes following the accident. Some falling off in his personal hygiene, what sounds like obsessive behavior.”

  “Are you familiar with the sequelae of closed-head injuries, Dr. Delaware?”

  “I’m not a neuropsychologist,” I said, “but it sounds as if there was postconcussive syndrome and some personality changes.”

  “With closed-head, anything goes—may I call you Alex?”

  “Sure.”
<
br />   She showed me gorgeous teeth. Switched back to serious. “This was a prefrontal-lobe assault, Alex. You’re aware of the role of the prefrontals in terms of emotional reactivity. For all we know, when Gavin’s head hit the back of the seat, he received the equivalent of a minor lobotomy.”

  “It had been ten months,” I said, “and he hadn’t recovered fully.”

  “Yes . . . I found that worrisome. Then again, the human brain—especially the young human brain—can be wonderfully plastic. I was hopeful.”

  “For full recovery?”

  She shrugged.

  “Plasticity,” I said. “You do neuropsych.”

  She studied me for half a second. “I keep up with the journals. There was no need for neuropsych because the organic end was being handled by a neurologist. He and I agreed there was nothing further to be gained by subjecting Gavin to yet more tests. What the patient needed was emotional support, and my job was to provide it.”

  I pulled out my notepad. “Dr. Singh.”

  “Very good man.”

  “Did he refer Gavin?”

  She nodded.

  “When?”

  “Gavin’s been in treatment for about three months.”

  “Seven months after the accident.”

  “It took a while for things to settle.”

  I pretended to read the pad. “He was referred to your group, not to you directly.”

  “Pardon?”

  “I’ve been told that Gavin began with one of your partners but switched to you.”

  She crossed her legs. The black marble pedestal blocked most of the movement, but I could see the tip of one red shoe. “Now that you jog my memory, that’s exactly what happened. Singh referred Gavin to the group and Franco—Dr. Gull—was on call. Franco saw Gavin a couple of times, then I took over.”

  “Problems between Gavin and Dr. Gull?”

  “I wouldn’t term them problems,” she said. “Back then—immediately after the accident—Gavin was extremely irritable. Once again, par for the course. You know how it can be with therapists and patients. Sometimes you mesh, sometimes you don’t. And Franco’s patient load was already heavy.”

  The black eyes found mine. “Like with you and Teresa Wetmore. I’m sure most of your patients adore you and trust you. But others . . . are you with the police full-time or do you still see patients?”

  “I do short-term private consults.”

  “No therapy?”

  “Not usually.”

  “Private practice can be tough,” she said. “The HMOs with their nonsense, the thin referral stream when money gets tight. I suppose working for the police can be helpful providing a nice steady income.”

  “I’m not employed by the police. I do short-term consults for them, too.”

  “Ah . . .” She smiled. “Anyway, Gavin did become my patient, and I felt we were making progress.” Her legs uncrossed, and she shifted forward in her chair. “Alex, I can’t think of anything I could tell you that would help a police investigation.”

  “What about Gavin’s obsessiveness?” I said.

  “I wouldn’t call it that. Nothing on the level of a full-blown OCD. Gavin could be a bit persistent, that’s all.”

  “Getting an idea in his head and not letting go?”

  She smiled. “You’re making it sound more pathological than it was. He could be a bit . . . enthusiastic.”

  “His parents said he’d switched career goals. From business to journalism.”

  That seemed to surprise her, and I wondered how well she’d known her patient.

  “People change their minds,” she said. “Young people especially. Sometimes tragedies get people to focus on what they really want to do.”

  “Is that what happened to Gavin?”

  Noncommittal nod.

  “Did he have any plans to return to college?”

  “It was hard for him to stay motivated, Alex. One of my goals was helping restore a sense of meaning to his life. But it had to be gradual. Gavin was still wrestling with the changes.”

  “So he’d slowed down cognitively.”

  “Yes, but it was subtle. And, I believe, exacerbated by emotional stress. I’m curious, Alex. Why are you so interested in his personality?”

  “I’m interested in his obsessiveness because the police are wondering if it could’ve gotten him into trouble.”

  “How so?”

  “Angering the wrong person.”

  “The wrong person.”

  “Anyone who’d react violently.”

  She touched a finger to her lip. “I’d be surprised at that—Gavin consorting with violent people. He was a nice boy, a conventional boy. He certainly never mentioned anything like that to me.”

  “Was he pretty communicative?”

  The black eyes rose to the ceiling. “How shall I put this . . . like many young men, Gavin wasn’t much for introspection.”

  “What did he talk about?”

  “I was working on getting him to open up about his feelings. Anger at feeling different. Guilt, about surviving the accident. Two of his friends were killed, you know.”

  I nodded.

  She said, “My sense was that Gavin knew he’d lost something—an edge, a sharpness—but he had trouble expressing himself about it. I suppose that could’ve been aphasic. Or just a postadolescent male’s lack of verbal skills. Either way, I knew he was wrestling with his feelings. I couldn’t push him too hard, Alex. One time, though, he did express himself in a way that I thought was extremely eloquent. This was just a few weeks ago. He came to session looking downcast. I waited him out, and finally he punched the arm of the sofa—that sofa—and shouted, ‘This is fucked, Dr. K! To everyone else I look okay, everyone keeps telling me I’m okay, but I know I’m not okay.’ Then he stopped, his chest was heaving and he was flushed, and the next time he spoke it was so soft I could barely hear him. What he said was, ‘It’s like one of those android movies. I’m not me, anymore, I’m still the box I came in, but someone’s fucking with the wiring.’ Then he said, ‘I really miss being me.’ And, finally, he cried. I thought it was a breakthrough, but the following week, he canceled his appointment, and the one after that. I’ve only seen him once, since then, and during that session it was as if nothing had happened. All he wanted to talk about was cars and sports. It was as if we were starting from square one. But that’s how it goes with young men.”

  I said, “Did he talk about his social life?”

  “Social as in dating?”

  “Yes.”

  “There’d been a girlfriend, some girl he knew in high school. But that was over.”

  “Because of the accident?”

  “That would be my assumption. Once again, I needed to step around personal topics.”

  “Gavin was guarded about his outside life.”

  “Very.”

  “Did he mention any other girls?”

  She shook her head.

  “Would you mind looking at a picture of the girl who was killed with him? It is a morgue shot.”

  She shuddered. “I don’t see the point.”

  “No problem.”

  “No, you might as well show it to me,” she said. “I need to integrate all this misfortune.”

  I placed the death shot on the glass tabletop. She didn’t attempt to touch it, just stared at it. Her mouth lost determination. A vein pulsed at her temple. Rapid pulse.

  “You know her?” I said.

  “I’ve never seen her in my life. I’m just imagining. The way it was for the two of them.”

  CHAPTER

  7

  Mary Lou Koppel walked me out of her waiting room and watched me descend the stairs. When I paused to look back, she smiled and waved her fingers.

  Back home, I checked my messages. Three nuisance calls and Allison letting me know she’d had a cancellation, it had been a long time since we’d seen a movie, did I have time tonight? I phoned her exchange, said how about dinner first, I could be there by
seven.

  Next, I booted up the computer, logged on to my faculty MEDLINE account, and reviewed articles on closed-head prefrontal injuries. With serious brain trauma, bleeding and lesions showed up on X-rays or CAT scans. But in less dramatic instances, the damage was subtle and invisible, the result of something called axonal shearing—a microscopic shredding of nerve fibers. Those cases resisted neurological tests and could be best diagnosed by neuropsychological evaluation. Instruments like the Wisconsin Card Sort or the Rey-Osterreith Complex Figure test pulling up problems in attention and thought and information processing.

  Patients with prefrontal injuries sometimes had temper-control problems. And they could grow impulsive and obsessive.

  I printed a few articles, changed into shorts and a T-shirt and sneakers, and took a long, hard run, not wanting to think about the short sad life of Gavin Quick. I thought about it, anyway, and focused on appreciating my own life. After showering and getting back into street clothes, I tried Milo at the station. By the time I’d reached his car phone, I’d put the interview with Mary Lou Koppel in context.

  She’d cooperated but really hadn’t told me much. Maybe she didn’t know much. Gavin had been in therapy for three months, and my guess was there’d been plenty of missed appointments. Combine that with his resistance and Koppel’s avoidance of his cognitive problems, and treatment didn’t amount to much.

  Mary Lou Koppel’s approach boiled down to what’s known in the trade as “supportive therapy.” Not necessarily a bad thing; sometimes all a patient needs is a yeah-saying or a shoulder to cry on. But sometimes being “supportive” is an excuse for not doing more.

  “You’re saying she was phoning it in?” said Milo.

  “Maybe she did her best. She sat in that office with Gavin, I didn’t.”

  “Chivalrous. But you still don’t like her.”

  “I have nothing against her,” I said.

  “I must’ve heard wrong. You get into why she stonewalled you the first time?”

  “She brought it up right away. Said the patient hated and distrusted me and forbade her to tell me anything.”

  “Taking a dig at you, pal?”