On the Couch

by Erica Kates (editor)
Atlantic Monthly Press, 1997
Review by Christian Perring, Ph.D. on Jan 3rd 2004

There are some excellent pieces in this mixed collection, although the subtitle of On the Couch, "Great American Stories About Therapy" is an overblown claim. Most of them were originally published in The New Yorker, The Atlantic Monthly, Harper's Magazine or in original collections of stories. The authors include Amy Bloom, John Updike, Charles Baxter, and Lorrie Moore. The book is divided into five sections, Loss; Secrets and Lies; Power and Dependence; Limitations; and Love.

In Lorrie Moore's very funny "If Only Bert Were Here," about a woman mourning the loss of her cat, the author makes a joke that not all readers will get. "She had already -- carefully, obediently -- stepped through all the stages of bereavement: Anger, Denial, Bargaining, Häagen-Dazs, Rage, Anger to Rage -- she said she wasn't making progress?" Her husband suggests that she should see someone. She shoots back to him, "Are we talking a psychiatrist or an affair?" She phones a number of possible candidates and asks them how long it will take them to get her over the death of her cat, but is told "we don't work that way" by all but one, who has a special offer. "You feel better by Christmas or your last session's free."

Many of the stories use psychotherapy as a way to help their main protagonists come to a central revelation about their lives, rather than as a way to understand psychopathology. In Rebecca Lee's "Slatland," a women goes to a psychologist with letters sent to her Romanian boyfriend simply because the psychologist is able to translate them. In Francine Prose's "Imaginary Problems," a family takes a trip suggested by their psychologist to create a mourning ritual for their recently deceased hamster. In Charles Baxter's "Surprised by Joy," a couple go on holiday in attempt to come to terms with the death of their child, again at the suggestion of their therapist. There's very little sense of the quality of the therapeutic interaction here, and indeed, the role of therapy as such is minimal in the stories. The focus is on the ways the patients deal with their problems. In one of the best stories of the book, "The Age of Analysis" by Lynne Sharon Schwartz, a fifteen-year-old boy deals with his anger at his father's affair in his therapy; the twist is that his parents are themselves both clinical psychologists, and Schwartz suggests how a belief in the psychotherapeutic stance can distort plain truths.

Some of the pieces are works of fantasy, such as the two that have patients systematically lying to their therapists by Lawrence Block and Stephen McCauley. Ironically, in these one gets a clearer picture of the creation of a relationship between therapist and client precisely because the essential basis is conspicuously missing. In Jonathan Baumbach's "The Psychopathology of Everyday Life," a therapist has an affair with his patient, and again we see what therapy should be through a depiction of its failure.

Two stories by Daniel Menaker feature Dr. Ernesto Morales, "the short, bald, muscular black-bearded Catholic Hispanic tyrant-genius of East Ninety-third Street." Morales is an unusual therapist, expressing himself very directly to his patients and making practical suggestions about how to live, and Menaker describes the dialog in the therapy showing the play of wits between client and therapist. But this of course is hardly typical therapy.

The editor Erica Kates suggests in her introduction that these written accounts of therapy provide a more sympathetic picture than their counterparts in film in TV, but it is far from clear that this is true. Very few of the stories give much sense of the week-to-week repetition and working through involved in psychodynamic therapy, but instead tend to assume knowledge of the character of the therapeutic experience, and indeed, of theories of therapy. Many films have depicted psychotherapy. Good Will Hunting and Sex, Lies, and Videotape are two memorable examples, and while both obviously give very stylized and partial portrayals, I'd suggest that they are more sympathetic and realistic than those in this collection of stories. One advantage of film is that it is able to convey the silence and physical relationship of two people talking to teach other much more directly than literary fiction. However, probably the best source for depiction of psychotherapy is memoirs or tales of psychotherapy by therapists or patients. It is surprisingly difficult to think of many good novels in which psychotherapy plays a central role. August by Judith Rossner is one example, Phillip Roth's Portnoy's Complaint is well known, and one might look to Irvin Yalom's works Lying on the Couch and When Nietzsche Wept. On the Couch does convey our ambivalent attitudes towards psychotherapy but in the end, this rather random collection is unrevealing about the experience of the powerful relationship between psychologist and client or the place of therapy in contemporary culture. It would be wonderful to have the most powerful portrayals of psychotherapy in American short fiction collected between two covers, but it would be disappointing if On the Couch is the best one could do.

Christian Perring, Ph.D., is Academic Chair of the Arts & Humanities Division and Chair of the Philosophy Department at Dowling College, Long Island. He is also editor of Metapsychology Online Review. His main research is on philosophical issues in medicine, psychiatry and psychology.

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