Tales from the Couch --- A Clinical Psychologist's True Stories of Psychopathology

I've been interested in the field of psychotherapy for a long time, having had about ten shrinks over the last sixty years of my life. I've also read a bundle of books about the field, and, at one particular balmy moment in my life, I even thought I should become a real life therapist. (I studied the field and the professionals in it for a good long while before I came to my senses).
Of all the many psychological tracts I've gone though over these years, I would put Tales from the Couch right up there, as a valuable primer on contemporary theories floating around in the field. Even better, it gives the reader a chance to get to know someone in the trenches who does his job with conviction, and caring . . . and often with pizzazz. He even admits the occasional failure.
For one of his most recalcitrant suicidal patients he recommended shock therapy despite his deep aversion to it. ECT is like bringing in a bulldozer to weed your garden of petunias. And the outcome? "It made her worse," he confesses, "set our therapy back six months." This is followed by his revealing one of his most daring therapeutic tricks, a very unprofessional gesture to his suicidal patient:
When she refused to go home or to the hospital, I allowed her to sleep in her van in front of my house. It wasn't totally safe, but nearly, and it was a violation of my privacy and the separation and my professional and personal lives. But it did keep Barbara alive.
As Wendorf points out, "Sometimes you have to go beyond the bounds of traditional therapeutic procedures, practices, even ethics, in order to do your job right."
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The writer thinks that all of us have MPD (Multiple Personality Disorder). That is, you and I at this very moment have several people sloshing around inside of us. Wendorf says that he, for instance, is "a son, a brother, a husband, a father, a psychologist, a teacher, a writer."
I'm also a bicylist, a Bonsai artist, a gardener, a lover, a sinner, and (rarely) a saint.
The difference, he says, is that he has built working boundries between those various folk wandering around inside of him. The lover stays at home, doesn't come to the office (and, presumably, he doesn't have to rely on psychological tricks when dealing with his own family). Like most of us who manage to function relatively sanely, he is able to slide between one and the other with none of them suddenly commandeering the whole box-car, taking full control.
By contrast, he writes about Jennifer, a woman with eleven different personas. From time to time, some of these will pop up, without advance notice --- sometimes even during one of her sessions with him. She will present herself first as a petite housewife and, then, suddenly, turn into a sex vampire, "playing seduction games," then, equally as easy and quickly, become a cowboy named "Cactus Jack," who says ("in a surprisingly masculine voice")
Hey, Doc, how they hanging, Old Hoss?
This is just one of the mysterious, sometimes tragic, always fascinating characters that wander through Wendorf's professional life, helping him to explicate his fascinating form of psychotherapy. As we go along with him, he offers us insight into some of his personal tics. For instance, he is not interested in working with "Junkies and Juicers." Addicts "tend to be self-absorbed, self-destructive, and self-defeating."
They are typically manipulative, dependent, and deceitful. They even lie to themselves; it's called "denial."
Alcoholics? Every psychotherapist I've known will avoid alcoholics if possible. "My depressed women patients are married to alcoholics who take advantage of them and abuse their ADHD kids. In despair the wives turn to Xanax or smoke their teenagers' dope." As Wendorf asserts, why waste time and money on a boozer when there is an incontrovertible for-free coöperative of semi-professionals that can do it better, more patiently, and for far longer than the rest of us. It's called Alcoholics Anonymous.
Tales from the Couch is a hotbed of MPDs, depressives, would-be suicides, general weirdos, border-line personalities, and paranoids who would certainly drive the rest of us bonkers. And as we follow them and author in his practice, we find ourselves thinking that they are fortunate to end up with one who appears to be creative, professional, honestly dedicated to trying to relieve others' pain.
For instance, he is, as many in his profession, haunted by would-be suicides, seeing them as the ultimate failure of the trade. He also sees them as being the ultimate blackmail threat: if you don't do what I want, I am going to off me . . . and you're the one who made me do it. He rightly sees the threat of suicide "part of an extortion racket," suggests that people who make that vow are often "too selfish and too chicken to sacrifice themselves over another person." "I've seen too many family members and friends who've been devastated by a suicide. It's an injury that is not soon healed."
We tend to think of suicide as an act of depression and desperation, and most times it is. But it is also an act of hostility and aggression. It is in fact an act of murder, even if the life you take happens to be your own. Moreover, it's often done to hurt others, the ultimate in passive-aggressiveness.
There's a terrific dose of no-nonsense here, along with a feel of a wondrous sense of one-upsmanship that allows him to use play --- play in the best sense --- to the benefit of his clients. One of his Latino clients was afraid of being seen going to Bob's office in the mental health clinic, afraid that his friends would think of him as being "loco." So they went once a sweek to good cheap restaurants and cafés: "we conducted his therapy over lunch." Not very ethical, probably even prohibited in the psych-biz now, but
Gilberto felt respected and cared for and would likely have dropped out of therapy if forced to come to my office. Besides, I frequented the same honky-tonks and dance halls he did.
"Being Chicano, Gilberto knew all the best Tex-Mex restaurants, the ones that hadn't gotten discovered, appropriated, and ruined by Gringos. So the arrangement worked well for both of us."
What is best about Wendorf is his ability to tell you about a case study, tell you what he believes is happening, then boil down the psychological discipline (without the ridiculous language of DMS-5 --- the official Diagnostic and Statistical Manual of Mental Disorders) to make it meaningful for the rest of us. He has the further advantage of being a fun and funny writer.
For instance, family systems therapy had its heyday thirty years ago under the aegis of Salvador Minuchin, Murray Bowen, Carl Whitaker, and Virginia Satir. They saw the family as a union of individuals that could, at times, go terribly bad and wrong. It is, Wendorf says, a matter of patterns. "The real pathology is in the way family members relate to each other."
Who actually becomes symptomatic and shows up as the "patient" is somewhat arbitrary and she may even be the healthiest one in the family.
Wendorf tells of a family whose deep conflicts prevented them from dealing with their son's problem of depression. "Viewed from a different perspective, the teenager's problem served the purpose of keeping his conflicted parents together." Once these problems are resolved, a family will, at times, have to create another person to be labeled "the problem." Thus a kid whose activities --- heavy dope smoking, boozing, stealing cars --- are somehow resolved, the family will have cough up someone else whose anti-social behaviour pattern forces a new trauma, exchanging (for example) a young dopester for another family member --- often part of an extended family --- to be the anorexic. Or alcoholic. Or depressive.
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It's a matter of music, Wendorf claims. The job of the therapist "is not only to help you name the tune [identify the dysfunctional interaction patterns] but to help you rewrite the song." This can involve coming up with other names. Relabelling "adolescent depression," for instance, as "rebellion" may put it "squarely in the father's realm of expertise, enabling him to resolve an otherwise mysterious malady."
Wendorg tells of having a young woman who was in college but plagued by a family who treated her as a junior high-school kid. He told her to dress up in a business suit to "confront her parents about their continuing tendency to treat her like a baby." It worked. It's tricks like this that endear us to the author, makes us wish the hell we lived in Birmingham (!) so we could make an appointment to see him when our own particular psychological life-support system goes haywire, with our need of a bit of tune-up . . . if not a purge.
Back a few decades ago when I was for some unknown reason chronically depressed, my therapist at the time took note of my depressing everyday outfit (ragged pants, torn dress shirt, scruffy brogans, bent college-professor eye-glasses) so she had me doll up in a new suit and tie and shoes and specs for a few sessions with her. I found it did perk me up some, made me stop feeling so drab.
The trickster side of psychotherapy is filled with names of the wonder-workers: Carl Jung, Fritz Perls, Carl Whittaker, Carl Rogers, Milton Erickson. The latter would put his patients into a light trances so that, as he said, his unconscious could communicate more comfortably with theirs. When he did this to me, I can't for the life of me remember what he whispered in my ear, but the post-hypnotic suggestion he stuffed in my brain popped out improbably a couple of months later, a zinging message that resonates with me to this very day.
Wendorf is enough of a student of his craft to throw in quotes or references that are impressive to curious students of the psychological process. He reminds us, and rightly so, that Freud's most astounding discovery was the most simple, learned early on in his practice.
That was, that people could begin to be weaned from their anxiety, depression, suicidal leanings and other anti-social behavior patterns by one of the most elemental acts imaginable. That is, to lie down, open their mouths, and blab.
For an hour, anything that blundered through the monkey mind was fair game, was given permission to be uttered without fear or restraint. These words would be noted by the professional sitting just out of sight, taking notes, listening . . . always listening sympathetically, non-judgmentally.
In this extremely straightforward fashion, by just verbalizing all and everything that popped up, the two of them --- one named "patient", the other named "doctor" --- could slowly begin move into the soul, begin to find clues that could lead to a genuine revelation, one that could assist the two of them to a journey of discovery; one that could effect change in one (or perhaps both) of them.
The fact is rarely cited that Freud was assisted in his own personal journey of discovery by his many patients, especially an unnamed "hysteric" that came to him for help early on in his career. As she spoke, letting her mind roam free, he would often interrupt her to ask questions, or for clarification. She put up with this distraction for some time --- after all, he was the expert --- but one day it just got to be too much.
She interrupted him in his windy questioning, told him that if he would just shut up, they could move along more quickly to discover the roots of her problem, the one that was driving her bonkers.
Wisely, he did exactly as she suggested. From that day forward, he just shut his trap, and thus, at no cost to himself, and with great relief for her, they were able proceed smartly with her treatment and, ultimately, to the relief of her previously formidable symptoms.
And thus psychotherapy was born.