"I'm afraid, Mr. Merriman, you have already seen what I can do. I've exhausted my store of observations. I'm convinced I can be most useful doing just what we've been doing these last four hours."
"Doc, you've helped me through all that childhood father stuff. I've got new insight. Good insight! But I'm impaired: I can't join my friends for a friendly game of poker. A real effective therapy should be able to fix that. Right? A good therapy should free me up enough so that I can choose how I spend my free time."
"I don't get it. I'm a therapist, I can't help you play poker."
"Doc, you know what a 'tell' is?"
"A tell?"
"Let me show you." Shelly took out his wallet and extracted a wad of bills. "I'm going to take this ten-dollar bill, wad it up, put my hands behind me, and put it into one of my hands." Shelly did as he described and then held out his hands, fists clenched in front of him. "Now your job is to guess which hand. Guess right, you keep the ten bucks; guess wrong, and you give me ten bucks. I'm going to repeat this six times."
"I'll go along with this, Mr. Merriman, but no gambling on it."
"No! Trust me, it won't work without risk. There's got to be something riding on it or it won't work. Do you want to help me or not?"
Marshal acquiesced. He was so grateful that Shelly appeared to have dropped the idea of a lawsuit that he would have agreed to playing jacks on the floor if that was what Shelly wanted.
Six times Shelly held his hands out, and six times Marshal guessed. Three times he guessed right and three times wrong.
"Okay, Doc, you won thirty bucks and you lost thirty. We're even. That's natural order. Way it should be. Here, you take the ten. Put it in your hand. Now it's my turn to guess."
Six times Marshal hid the ten in one hand or the other. Shelly missed the first one and then guessed the next five correctly.
"You win ten bucks. Doc, and I win fifty. You owe me forty. Do you need change?"
Marshal reached into his pocket, fetched out a roll of bills bound by a heavy silver money clip—his father's clip. Twenty years ago his father had succumbed to a massive stroke. While waiting for the rescue squad to respond to the 911 call, his mother had removed his
Lying on the Couch .^^ 2.45
father's money from his pocket, put the bills in her purse, and given the clip to her son. "Here, Marshal, this is for you," she had said. "You use it and think of your father when you do." Marshal took a deep silent breath, peeled off two twenties—the most he had ever lost on a bet in his life—and handed them to Shelly.
"How did you do that, Mr. Merriman?"
"Your knuckles were a little white on the empty hand—you squeezed too tight. And your nose turned, very, very, slightly, to the ten-buck hand. That is a tell. Doc. Want a rematch?"
"A good demonstration, Mr. Merriman. No rematch necessary: I get the point. I'm still not sure where this is leading, however, I'm afraid our time is just up. See you on Wednesday." Marshal rose.
"I've got an idea, a fantastic idea, about where it's leading. Want to hear it?"
"Indeed, I do, Mr. Merriman." Marshal checked his watch again and rose. "On Wednesday at four p.m. sharp."
SEVENTEEN
en minutes before their session, Carol tried to prepare herself mentally. No tape recorder today. The recorder, hidden in her purse the last session, had picked up nothing intelligible. To get a decent recording, she realized, she would have to invest in a professional-grade listening device—perhaps something she could buy in the spy store that had recently opened near Union Square.
Not that there had been anything worth recording. Ernest was being more cagey than she had expected. And more cunning. And more patient. He was devoting a surprising amount of time to winning her confidence and making her dependent on him. He seemed in no rush—probably contentedly humping one of his other patients. She, too, had to be patient: sooner or later, she knew the real Ernest would emerge, the leering, lascivious, predatory Ernest she had seen at the bookstore.
Carol resolved to be stronger. She could not keep breaking down
like she did last week when Ernest made the comment about passing on her mother's rage to her children. That observation had been ringing in her ears for the last several days and, in unexpected ways, had sharply affected her relationship with her children. Her son had even commented that he was happy that she wasn't going to be sad anymore, and her daughter had left a drawing of a big smiling face on her pillow.
And then last night, something extraordinary occurred. For the first time in weeks, Carol experienced a rush of well-being. It had happened while holding her children and reading their nightly installment of The Wonderful Adventures of Nils —the same dogeared book from which, decades ago, her mother had read to her every night. Memories returned of her and Jeb clinging to her mother and crowding their little heads together to see the pictures. Strange that from time to time in the last week she had thought about the unforgiven, banished Jeb. Not wanting to see him, of course—she had meant what she said about a life sentence—but just wondering about him: where he was, what he was doing.
But then, Carol wondered, is it really necessary to stonewall my feelings from Ernestf Maybe my tears aren't such a bad thing — they serve a purpose: they increase the semblance of genuineness here. Although that's hardly necessary — Ernest, poor sap, hasn't a clue. Yet, still, this is a risky game; why give him any influence over mef On the other hand, why shouldn't I take something positive from himf I'm paying enough. Even he has to say something useful, sometimes. Even a blind pig finds an acorn once in a while!
Carol rubbed her legs. Even though Jess, true to his word, had been a patient and gentle jogging guide, her calves and thighs ached. Jess had phoned last night and they had met early in the morning in front of the De Young Museum to jog through the rising mist around the lake and riding fields of Golden Gate Park. She had followed his advice and moved no more quickly than a fast walk, sliding, shuffling, rather than running, barely lifting her shoes from the dewy grass. After fifteen minutes, she was out of breath and looked pleadingly at Jess, gliding gracefully at her side.
"Just a few minutes more," he promised. "Keep it to a fast walk; find the pace where you can breathe easily. We'll stop at the Japanese Tea House."
And then twenty minutes into the jog, something wonderful had happened. Her fatigue vanished and Carol was suffused with a feel-
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ing of limitless energy. She looked over to Jess, who nodded and smiled beatifically as though he had been awaiting her second-wind enlightenment. Carol glided faster. She flew, weightless, over the grass. She lifted her feet higher, then higher. She could have gone on forever. And then, when they slowed and stopped in front of the tea house, Carol crumbled in a heap and was grateful for the support of Jess's powerful arm.
Meanwhile, Ernest, on the other side of the wall, was entering into his computer an incident from a therapy group meeting he had just led—a valuable addition to his article on therapist-patient in-betweenness. One of his group members had brought in a compelling dream:
AH of us group members were sitting around a long table with the therapist at one end holding a piece of paper. We were all stretching, craning our necks, leaning over, trying to see the note, but he kept it hidden. Somehow we all knew that, on the slip of paper, was written the answer to the question: Which of us do you love bestf
This question—which of us do you love best—Ernest wrote, is indeed the group therapist's nightmare. Every therapist fears that someday the group will demand to know which of its members he or she most cares for. And it is precisely for this reason that many group therapists (and individual therapists, too) are disinclined to express their feelings to patients.
What was special about this session was that Ernest had been true to his resolution to be transparent and, in so doing, felt he had handled the situation brilliantly. First he had steered the group into a productive discussion of each member's fantasy of
who was the favorite child of the therapist. That, of course, was the conventional ploy—many therapists would do that. But then he did something few therapists would: he openly discussed his feelings toward each person in the group. Not whether he liked or loved each person, of course—such global responses were never useful—but which characteristics of each drew him closer and which pushed him away. And the tactic had succeeded wonderfully: each person in the group decided to do the same thing with the others, and everyone had received valuable feedback. What a pleasure, Ernest
reflected, to lead his troops from the front rather than from the rear.
He turned off his computer and quickly leafed through his notes on Carolyn's previous session. Before rising to fetch her, he also reviewed the principles of therapist self-disclosure he had so far formulated.
1. Reveal yourself only to the extent that it will be helpful to the patient.
2. Reveal yourself judiciously. Remember you are revealing for the patient, not for yourself.
3. Have a care, if you want to stay in practice, about how your self-disclosure will sound to other therapists.
4. Therapist self-disclosure must be stage-sensitive. Consider timing: some revelations helpful late in therapy may, at an early stage, be counterproductive.
5. Therapists should not share things about which they are heavily conflicted; they should work them out in supervision or personal therapy first.
Carol entered Ernest's office determined to get results that day. She took a few steps past the doorway but did not take her seat. Instead she simply remained standing by her chair. Ernest began his descent into his chair, glanced at Carolyn looming over him, stopped in mid-air, rose again, and looked at her quizzically.
"Ernest, on Wednesday I rushed out of here so moved by what you said that I forgot something: my hug. And I can't tell you how much difference that made. How much I've missed it the last two days. It's like I'd lost you, like you no longer existed. I thought of phoning you, but your disembodied voice doesn't do it for me. I need the physical contact. Can you humor me on this one?"
Ernest, not wanting to show his pleasure at receiving a make-up hug, hesitated for a moment and said, "As long as we have an agreement to talk about it," and gave her a brief, upper-body hug.
Ernest sat down, his pulse throbbing. He liked Carolyn and loved her touch: the fleecy feel of her cashmere sweater, her warm shoulder, the thin, demure strap of her brassiere across her back, the feel of her firm breasts against his chest. Clean though the hug was, Ernest returned to his chair feeling soiled.
"Did you notice that I left without a hug?" Carol asked.
^ 5 o ^ Lying on the Couch
"Yes, I noticed it."
"Did you miss it?"
"Well, I was aware that my comment to you about your daughter struck some deep chords in you. Unsettling chords."
"You promised you'd be straight with me, Ernest. Please, no evasive shrink tactics. Won't you tell me, did you miss the hug? Is a hug from me unpleasant for you? Or pleasant?"
Ernest was aware of the urgency in Carolyn's voice. Obviously the hug had tremendous meaning to her—as an affirmation both of her attractiveness and of his commitment to be close to her. He felt cornered, searched for the right response, and then, attempting a charming smile, replied: "When the day comes that I find a hug from an attractive woman like you—attractive in every sense of the word—to be unpleasant, then that's the day to call the mortician."
Carol was extremely encouraged. "A very attractive woman — attractive in every sense of the word!" Shades of Dr. Cooke and Dr. Zweizung. Now the hunter is starting to make his move. Time for the prey to bait the trap.
Ernest continued: "Tell me more about touching and its importance to you."
"Not sure how much more I can add," she said. "I know that I think about touching you for hours on end. Sometimes it is very sexual— sometimes I am dying to have you inside me, explode like a geysei; and fill me up with your heat and your wetness. And there are other times when it's not sexual, just warm, loving, holding. Most nights this week I've gone to bed early just to imagine being with you."
No, that's not good enough., Carol thought. Vve got to be explicit, got to heat this up. But it's hard to really imagine being sexual with this creep. Fat and oily — that same stained tie day after day, those scuffed Rockport imitation dress shoes.
She continued: "My favorite scene is to imagine the two of us in these chairs and then I move over to you and sit on the floor next to you and you start to stroke my hair and then slip down to join me and stroke me all over."
Ernest had encountered other patients with an erotic transference, but none who expressed it so explicitly and none who stirred him so much. He sat silently, perspiring, weighing his options, and mightily focusing his will on not getting an erection.
"You asked me to speak honestly," Carol continued, "to say what I was thinking."
Lying on the Couch ^ 2.5 i
"And so I did, Carolyn. And you're doing exactly what you should be doing. Honesty is the chief virtue in the realm of therapy. We can, we must, speak about, express, everything ... as long as we each stay in our own physical space."
"Ernest, that doesn't work for me. Speaking and words aren't enough. You know my history with men. The distrust runs so deep. I cannot trust words. Before I saw Ralph I saw a number of therapists, each for one or two sessions. They followed procedure, followed the formula to the letter, adhered to their professional code, remained correctly remote. And every one of them failed me. Until Ralph. Until I met a real therapist—someone willing to be flexible, to work with where I was, what I needed. He saved my life."
"Aside from Ralph, none offered you anything useful?"
"Just words. When I walked out of their office, I took nothing with me. It's the same now. When I leave you without touching you, the words just disappear, you disappear, unless I have some imprint of you on my skin."
I've got to make something happen today, Carol thought. Got to get this show on the road. And over with.
"In fact, Ernest," she continued, "what I really wish today is not to talk but to sit next to you on the couch and just feel your presence next to me."
"I wouldn't feel comfortable doing that—that's not the way I can best help you. We've got too much work to do, too many things to talk about."
Ernest was growing more impressed with the depth and power of Carolyn's need for physical contact. It was not, he told himself, a need from which he had to retreat in terror. It was a part of the patient that had to be taken seriously; it was a need that had to be understood and treated like any other need.
During the previous week Ernest had spent time in the library reviewing the literature on eroticized transference. He had been struck by some of Freud's cautionary words regarding the treatment of "women of an elemental passionateness." Freud referred to these patients as "children of nature" who refused to accept the spiritual instead of the physical and were amenable only to the "logic of gruel and the argument of dumplings."
Pessimistic about treating such patients, Freud claimed that the therapist had only two, unacceptable choices: returning the patient's love or being the target of the mortified woman's fury. In either case,
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Freud said, one must acknowledge failure and withdraw from the case.
Carol was one of these "children of nature," all right. No doubt about that. But was Freud right? Were there only two possible, equally unacceptable, choices for the therapist? Freud reached those conclusions almost a hundred years ago while immersed in the Zeitgeist of Viennese authoritarianism. Perhaps things might be different now. Freud might not have been able to imagine the late twentieth century—times of greater therapist transparency, times when patient and therapist could be in truth with each other.
Carol's next words pulled Ernest out of his reverie. "Could we just move to the couch and talk there? It's too cold, too oppressive, talking to you from this di
stance. Try it for a few minutes. Just sit next to me. I promise not to ask more of you. And I guarantee that it will help me talk and get in touch with deeper currents. Oh, don't shake your head; I know all about the APA codes of behavior, and standardized tactics and conduct. But, Ernest, isn't there a place for creativity? Doesn't the true therapist find a way to help every patient?"
Carol played Ernest like a violin: she chose all the perfect words: "American Psychiatric Association," "standardized," "treatment manuals," "codes of professional conduct," "rules," "creativity," "flexibility." Like waving red words before an iconoclastic bull.
As Ernest listened, some of Seymour Trotter's words came to his mind: Formal approved technique^ Abandon all technique. When you grow up as a therapist^ you will be willing to take the leap of authenticity and make the patient's needs — not the APA professional standards — your therapy guide. Strange how much he had been thinking lately of Seymour. Perhaps it was simply comforting to know a therapist who had once trod this same path. For the moment, Ernest had forgotten, however, that Seymour never found his way back.
Was Carolyn's transference getting out of hand? Seymour had said that it cannot be too powerful. The stronger the transference, he had said, the more effective a weapon to combat the patient's self-destructiveness. And God knows that Carolyn was self-destructive! Why else would she stay in a marriage like that?
"Ernest," Carol repeated, "please sit next to me on the couch. I need it."
Ernest thought of Jung's advice to treat each patient as individu-
Lying on the Couch ^ 2.5 3
ally as possible, to create a new language of therapy for every patient. He thought of how Seymour had taken that even further and claimed that the therapist must invent a new therapy for each patient. These words gave him strength. And resolve. He stood, walked over to the couch, eased himself into the corner, and said, "Let's try it."