"You said you'd share your thoughts with me. I guess I was wondering if you were being judgmental of him or me."
"Is there a question in there for me, Carolyn?" Ernest was stalling for time.
Good God! I have to spell it out in big letters? thought Carol. ^'Were you being judgmental? How do you feel?"
"About Ralph?" More stalling.
Carol nodded, silently groaning.
Ernest threw caution to the winds and told the truth. Mostly. "I admit that I am thrown off balance by what you tell me. And I guess I do feel judgmental of him. But I'm working on it—I don't want to close down; I want to stay entirely open to your experience.
"Let me tell you why I'm thrown off balance," Ernest continued. "You tell me he was enormously helpful to you, and I believe you. Why would you come here, pay me a great deal of money, and not tell the truth? So I don't doubt your words. Yet what am I supposed to do with my own experience—not to mention a large professional literature and powerful clinical consensus—which leads to different conclusions: namely, that sexual contact between patient and therapist is invariably destructive to the patient—and ultimately to the therapist as well."
Carol had prepared well for this argument. "You know. Dr. Lash . . . sorry, Ernest—I'll get it soon; I'm not used to shrinks being real people with first names. They usually hide behind their titles. They're usually not up front with their humanity like you. What was I saying . . . oh, yes, I took the liberty, while in the process of deciding to see you, of checking out your bibliography in the library—old work habit: checking out the credentials of doctors who are testifying in court as expert witnesses."
"And?"
"And I found out you were well trained in the natural sciences and published a number of reports of your psychopharmacological research."
"And?"
Lying on the Couch ^^ 117
"Well, is it possible you're neglecting your scientific standards here? Consider the data which you're using to form conclusions about Ralph. Look at your evidence—a totally uncontrolled sample. Be honest: Would it pass any kind of scientific muster? Of course your sample of patients who have been involved sexually with therapists consists of injured or dissatisfied patients—but that's because they're the ones that come for help. But the others—satisfied customers like me—they don't come in to see you, and you have no idea how large a population that might be. In other words, all you know is the numerator, just those who come for therapy. You know nothing about the denominator—the number of patients and therapists who have sexual contact or the number who were helped or the number for whom the experience was irrelevant."
Impressive, Ernest thought. Interesting to see her professional persona; I would not like to be on the wrong side of this woman in a courtroom.
"Do you see my point, Ernest? Is it possible I'm right? Be honest with me. Have you ever run into someone before me who wasn't harmed by such a relationship?"
His mind again drifted to Belle, Seymour Trotter's patient. Would Belle fit into the category of those who were helped^ Again, the faded picture of Seymour and Belle flitted across his mind. Those sad eyes. But maybe she was better off. Who knows, maybe they both ended up better off? Or temporarily better off. No, who can be sure of anything in that case, least of all how they ended up together? For years Ernest had wondered when they first decided to retreat to an island together. Had Seymour decided at the very end to rescue her? Or had they schemed together much earlier? Perhaps from the very beginning?
No, these were not thoughts to be shared. Ernest swept Seymour and Belle out of his mind and gently shook his head in response to Carolyn's question. "No, I haven't, Carolyn. I've never seen a patient who wasn't harmed by it. But nonetheless your point about objectivity is well taken. It will help me not to prejudge." Ernest took a long look at his watch. "We're already over our time, but I still need to check in with a couple of questions."
"Sure." Carol brightened. Another hopeful sign. First he asked me to ask him questions. No reputable shrink does that. There's even an implication he will respond to personal questions about his life — I'm going to test that next time. And now he's bending the rules by running well over the fifty minutes.
She had read the APA guideHnes to psychiatrists about how to avoid charges of sexual abuse: hold firm to all boundaries, avoid the slippery slope, don't call your patients by first names, start and end sessions promptly. Every single therapist abuse case she had been counsel for had started with the therapist extending the fifty minutes. Aha, she thought, a little slip here, a slope there, who knows where we'll be after a couple of sessions?
"First, I want to know about any discomfort you're going to be taking home from today's session. What about the powerful feelings earlier when we talked about Jed?"
"Not Jed—M."
"Sorry. Jeb. You felt faint briefly when we spoke of him."
"I'm still a little shaky, but not upset. I think you were on to something important."
"Okay. Second, I want to find out something about the space between us. You worked hard today, you took some big risks, revealed really important parts of yourself. You trusted me a great deal and I appreciate your trust. Do you think we can work together? How are you feeling about me? What's it like to have revealed so much to me?"
"I feel good about working with you. Real good, Ernest. You're personable and flexible; you make it easy to talk, and you have an impressive ability to focus on the wounded spots, spots I don't know about myself. I feel I'm in very good arms. And here is your fee." She handed him three fifty-dollar bills. "I'm in the midst of switching banks from Chicago to San Francisco, and it's more convenient to pay everything in cash."
In good arms, mused Ernest as he escorted her to the door. Isn't the expression ''in good hands"f
At the door Carol turned. With moist eyes she said, "Thank you. You're a godsend!"
Then she leaned over, gave the surprised Ernest a light hug for two or three seconds, and walked out.
As Carol descended the stairs, a wave of sadness crashed over her. Unwanted images from long ago passed through her: she and Jeb having a pillow fight; jumping and yelling in her parents' bed; her father carrying her books as he walked her to school; her mother's casket sinking into the ground; Rusty's boyish face grinning at her as he fetched her books from her high school locker; her father's calamitous reentry into her life; the sad, worn Persian rug in Dr.
Cooke's office. She squeezed her eyes to brush them all away. Then she thought about Justin, perhaps at this very moment walking hand in hand with his new woman somewhere else in the city. Perhaps near here. She reached the front entrance of the Victorian and looked up and down Sacramento Street. No sign of Justin. But a young, attractive man with long blond hair, dressed in sweat pants, a pink shirt, and an ivory sweater jogged by and charged up the stairs two at a time. Probably Lash's next sucker, she thought. She began to walk away, then turned to glance up at Ernest's office window. Goddamnit, she thought, that son of a bitch is trying to help me!
Upstairs, Ernest sat at his desk recording his notes from their session. The pungent citrus aroma of Carolyn's perfume lingered for the longest time.
SEVEN
fter Ernest's supervisory hour, Marshal Streider sat back in his chair and thought about victory cigars. Twenty years ago he had heard Dr. Roy Grinker, an eminent Chicago analyst, describe his year on Freud's couch. That was in the twenties, in the days when analytic respectability required a pilgrimage to the master's couch—sometimes for a couple of weeks, sometimes, if one dreamed of becoming an analytic mover and shaker, as long as a year. According to Grinker, Freud never concealed his glee when he made an incisive interpretation. And if Freud thought he had made a monumental interpretation, he opened up his box of cheap cigars, offered one to his patient, and suggested they have a "victory" smoke. Marshal smiled at Freud's lovable, naive handling of the transference. If he still smoked, he would have lit a celebratory cigar after Ernest's departure.
His young supervisee had been coming along nicely the past few months, but today had been a landmark session. Putting Ernest on
Lying on the Couch ^ i 2. i
the medical ethics board was nothing short of inspired. Marshal often thought that Ernest's ego was riddled with lacunae: he was grandiose and impulsive. Unruly bits of his sexual id jutted out at odd angles. But worst of all was his juvenile iconoclastic stubble: Ernest had far too little respect for discipline, for legitimate authority, for knowledge worked out over decades by diligent analysts with minds more penetrating than his.
And what better method. Marshal thought, of helping to resolve iconoclasm than appointing Ernest to judgeship? Brilliant! It was on occasions like this that Marshal yearned for observers, an audience to appreciate the work of art he had fashioned. Everyone recognized the traditional reasons for the analyst to be fully analyzed. But Marshal intended, sooner or later (his to-do list of papers had grown and grown), to write a paper about an unappreciated aspect of maturity: the ability to be creative year after year, decade after decade, in the absence of any external audience. After all, what other artists—who can still take seriously Freud's claim that psychoanalysis is a science?—can devote a lifetime to an art that is never viewed by others? Imagine Cellini casting a silver chalice of luminous beauty and sealing it into a vault. Or Musler spinning glass into a masterpiece of grace and then, in the privacy of his studio, shattering it. Horrible! Isn't "audience," Marshal thought, one of the unheralded but important nutrients that supervision provides for the not-yet-mature therapist? One needs decades of seasoning to be able to create sans spectators.
And true for life as well, Marshal reflected. Nothing worse than living the unobserved life. Again and again, in his analytic work, he had noted his patients' extraordinary thirst for his attention— indeed, the need for an audience is a major unsung factor in prolonged interminal therapy. In work with his bereaved patients (and in this he agreed with Ernest's observations in his book), he had often seen them fall into despair because they had lost their audience: their lives were no longer observed (unless they were lucky believers in a deity who had the leisure time to scrutinize their every action).
Wait! Marshal thought. 7s it really true that analytic artists work in solitude? Aren't patients an audience? No, in this matter they do not count. Patients are never sufficiently disinterested. Even the most elegantly creative analytic utterances are lost on them! And they are greedy! Watch how they suck out the marrow of an inter-
I 2.2 ^ Lying on the Couch
pretation without an admiring glance at the magnificence of its container. What about students or supervisees^ Are they not audience? Only rarely is a student perspicacious enough to grasp the artistry of an analyst. Usually the interpretation is beyond them; later in their clinical practice, maybe months, even years afterward, something will jar their memory and suddenly, in a flash, they will apprehend and gasp at the subtlety and greatness of their teacher's art.
Certainly that would be true for Ernest. The time would come when he would arrive at understanding and gratitude. By forcing him now to identify with the aggressor, I've saved him at least a year on his training analysis.
Not that he was in a rush for Ernest to finish. Marshal wanted him around for a long time.
Later that evening, after he had seen his five afternoon analytic patients, Marshal rushed home only to find the house empty and a note from his wife, Shirley, saying dinner was in the fridge and she would be back from the flower-arranging exposition around seven. As always, she had left an ikebana arrangement for him: a long, tubular ceramic bowl containing a nest of gray, angular, bare, downward-facing euonymus branches. At one end of the nest emerged two long-stemmed Easter lilies facing away from each other.
Goddammit, he thought, as he shoved the arrangement down to, and almost over the end of, the table. / had eight patient hours and one supervisory hour today — fourteen hundred dollars — and she can't put dinner out for me because she's too busy with these fucking flower arrangements! Marshal's anger dissipated as soon as he opened the plastic containers in the fridge: gazpacho with a knockout aroma, a gaily colored salad nicoise made with fresh pepper-seared tuna, and a mango, green grapes, and papaya fruit salad in a passion fruit sauce. Shirley had taped a note to the gazpacho bowl: "Eureka! At last—a negative calorie recipe: the more you eat, the skinnier you get. Only two bowlfuls—don't disappear on me." Marshal smiled. But only for a moment. He vaguely recalled some other "disappearing" joke Shirley had made only a few days ago.
As he ate. Marshal opened the afternoon Examiner to the financial section. The Dow had risen twenty. Of course the Examiner only had the one p.m. quotes, and lately the market had gyrated wildly at the end of the day. But no matter: he enjoyed checking the quotes twice daily and would see the closing quotes in the Chronicle tomorrow morning. He held his breath as he hastily punched in
the rise of each of his stocks on his calculator and computed the day's profits. Eleven hundred dollars—and it could be more by the time the market closed. A warm flush of satisfaction swept over him, and he took his first spoon of thick, crimson gazpacho studded with small gleaming green-white cubes of onion, cucumber, and zucchini. Fourteen hundred dollars from clinical billings and eleven hundred from stock profits. It had been a good day.
After the sports page and a quick glance at the world news. Marshal hastily changed his shirt and charged out into the night. His passion for exercise almost equaled his love of profits. He played basketball at the YMCA on Mondays, Wednesdays, and Fridays during his lunch break. On weekends he bicycled and played tennis or racquetball. On Tuesdays and Thursdays he had to fit in aerobic time any way he could—there was a meeting of the Golden Gate Psychoanalytic Institute at eight, and Marshal left early enough for the brisk thirty-minute walk to the institute.
With each powerful stride. Marshal's anticipation grew as he thought about the meeting that evening. It was going to be an extraordinary session. No doubt about it: there was going to be high drama. There was going to be blood spilled. Oh, the blood—yes, that was the exciting part. Never before had he so clearly apprehended the lure of horror. The carnival atmosphere at public executions in olden days, the peddlers hawking toy gallows, the buzz of excitement as the drums rolled and the doomed shuffled up the stairs of the scaffold. The hanging, the beheadings, the burnings, the drawing and quarterings—imagine a man's four limbs being tied to a team of horses who were whipped and spurred and cheered by onlookers until he was ripped into quarters, all major arteries gushing at once. Horror, yes. But someone else's horror—someone who provided a view of the precise juncture of being and nonbeing at the moment, the very instant, that spirit and flesh are wrenched asunder.
The grander the life to be annihilated, the greater the lure. The excitement during the Reign of Terror must have been extraordinary, as noble heads rolled and blood gushed crimson from royal torsos. And the excitement, too, about those sacred last words. As that juncture between being and nonbeing approaches, even freethinkers speak in hushed voices, listening, straining to hear the dying person's final syllables—as if in that very moment, when life is wrested away and flesh begins its transformation into meat, there will be a revelation, a clue to the great mysteries. It reminded Mar-
12-4 ^ Lying on the Couch
shal of the avalanche of interest in near-death experiences. Everyone knew it was sheer charlatanism, but the craze lasted twenty years and sold millions of books. God! Marshal thought, the money made on that rot!
Not that there was regicide on that night's institute agenda. But the next best thing: excommunication and banishment. Seth Pande, one of the institute's founding members and a senior training analyst, was on trial and certain to be expelled because of diverse anti-analytic activities. Not since Seymour Trotter's excommunication many years ago for screwing a patient had there been an occasion like this.
Marshal knew his personal political position was delicate and that he had to pro
ceed this evening with great caution. It was public knowledge that Seth Pande had been his training analyst fifteen years before and had been enormously helpful to Marshal both personally and professionally.
Yet Seth's star was waning; he was over seventy and, three years before, had had extensive lung cancer surgery. Always grandiose, Seth had considered it his privilege to disregard all rules of technique and morality. And now his illness and confrontation with death had freed him from any remaining strains of conformity. His analytic colleagues had grown increasingly embarrassed and irritated by his extreme anti-analytic positions on psychotherapy and his outrageous personal behavior. But he was still a presence: his charisma was so great that he was immediately sought out by the press and TV for statements on almost any breaking news story—the impact of TV violence on children, municipal indifference to the homeless, attitudes toward public panhandling, gun control, politicians' sexual imbroglios. About each of these Seth had some newsworthy, often scandalously irreverent comment. Over the last months it had gone too far and the institute's current president, John Weldon, and the old anti-Pande analytic contingent had finally worked up the guts to challenge him.
Marshal pondered his strategy: of late, Seth had so overstepped himself, been so flagrant in his sexual and financial exploitation of patients, that it would be political suicide to support him now. Marshal knew that his voice had to be heard. John Weldon was counting on his support. It would not be easy. Though Seth was a dying man, he still had his allies. Many of his present and past analysands would be present. For forty years he had played a leading intellec-