Lying on the Couch Read Free Page A

real patient. Important material just erupted out of her. She began to live for the next session. Therapy became the center of her Hfe. Over and over she told me how important I was to her. And this was after only three months.
    "Was I too important? No, Dr. Lash, the therapist can't be too important early in therapy. Even Freud used the strategy of trying to replace a psychoneurosis with a transference neurosis—that's a powerful way of gaining control over destructive symptoms.
    "You look puzzled by this. Well, what happens is that the patient becomes obsessed with the therapist—ruminates powerfully about each session, has long fantasy conversations with the therapist between sessions. Eventually the symptoms are taken over by therapy. In other words, the symptoms, rather than being driven by inner neurotic factors, begin to fluctuate according to the exigencies of the therapeutic relationship.
    "No, thanks, no more coffee, Ernest. But you have some. You mind if I call you Ernest? Good. So to continue, I capitalized on this development. I did all I could to become even more important to Belle. I answered every question she asked me about my own Hfe, I supported the positive parts of her. I told her what an intelligent, good-looking woman she was. I hated what she was doing to herself and told her so very directly. None of this was hard: all I had to do was tell the truth.

    I o '^^. Lying on the Couch
    "Earlier you asked what my technique was. Maybe my best answer is simply: / told the truth. Gradually I began to play a larger role in her fantasy life. She'd slip into long reveries about the two of us—just being together, holding each other, my playing baby games with her, my feeding her. Once she brought a container of Jell-O and a spoon into the office and asked me to feed her—which I did, to her great delight.
    "Sounds innocent, doesn't it? But I knew, even at the beginning, that there was a shadow looming. I knew it then, I knew it when she talked about how aroused she got when I fed her. I knew it when she talked about going canoeing for long periods, two or three days a week, just so she could be alone, float on the water, and enjoy her reveries about me. I knew my approach was risky, but it was a calculated risk. I was going to allow the positive transference to build so that I could use it to combat her self-destructiveness.
    "And after a few months I had become so important to her that I could begin to lean on her pathology. First, I concentrated on the life or death stuff: HIV, the bar scene, the highway-angel-of-mercy blow jobs. She got an HIV test—negative, thank God. I remember waiting the two weeks for the results of the HIV test. Let me tell you, I sweated that one as much as she did.
    "You ever work with patients when they're waiting for the results of the HIV test.^ No} Well, Ernest, that waiting period is a window of opportunity. You can use it to do some real work. For a few days patients come face to face with their own death, possibly for the first time. It's a time when you can help them to examine and reshuffle their priorities, to base their lives and their behavior on the things that really count. Existential shock therapy, I sometimes call it. But not Belle. Didn't faze her. Just had too much denial. Like so many other self-destructive patients, Belle felt invulnerable at anyone's hand other than her own.
    "I taught her about HIV and about herpes, which, miraculously, she didn't have either, and about safe-sex procedures. I coached her on safer places to pick up men if she absolutely had to: tennis clubs, PTA meetings, bookstore readings. Belle was something—what an operator! She could arrange an assignation with some handsome total stranger in five or six minutes, sometimes with an unsuspecting wife only ten feet away. I have to admit I envied her. Most women don't appreciate their good fortune in this regard. Can you see men—especially a pillaged wreck like me—doing that at