Rafael Yglesias - Dr. Neruda's Cure for Evil

“You can take off your shoes,” I said, following a routine.

He pushed off each of his Keds sneakers without untying them and flopped back. Only his torso, however. His legs draped over the side, feet skimming the parquet floor — another indication that he wasn’t happy about lying down.

“Do you want to be on the couch?”

He shrugged. I saw, but pretended not to. “What did you say?”

“It’s okay,” he said, almost inaudibly.

“I’m glad we’re doing what you want,” I said and immediately regretted it. What in God’s name did I mean by this taunting comment?

“What?” he mumbled.

“Nothing,” I said, compounding my mistake. A therapist should be the last person on earth to maintain that something said casually has no meaning. Besides, he had probably heard me. His “What?” was a reaction to the oddness of my remark. My cover-up just made things worse. For a moment I considered ending the session and fetching someone else to see him. Unfortunately, Susan was the only other staff present at that hour and she was busy.

“You can put your feet up,” I said.

He winced. His reaction was unmistakable: my suggestion caused him pain. Yet he promptly raised his feet to the couch. He submitted, but did not relax: keeping his knees bent, arms rigid, palms pressed onto the cushions, as if prepared to leap up.

I left my seat to move to the wing chair placed a little behind and to the side of the patient’s head on the couch. That would keep me out of sight unless he twisted his head and gave me an angle to view his expressions. Although it may strike the reader as silly, this seating arrangement was a deliberate reform of the tradition, which is a chair placed directly behind the couch, to prevent both therapist and patient from any chance of seeing each other’s face.

Gene heard my movement. Our floor had buckled from water damage over the winter and groaned at the slightest pressure. His head snapped to the side, his feet arched, and his right arm reached out as if to ward off an attack, like a newborn’s startle reflex.

“I’m going to sit in this chair,” I explained. Gene twisted to watch me. “If I stay behind my desk you’ll have to shout.”

He nodded. I settled into the wing chair. Gene remained in his pose. It was an uncomfortable position he couldn’t maintain for long.

I decided to unveil the mystery of my suggesting the couch. That was one of Susan’s lessons — don’t build unnecessary walls between patient and doctor. “I prefer it when people are willing to lie on the couch,” I said. “That way I can listen to you without having to think about my own face — whether I should smile or frown or look blank. That takes away from the time I should be spending listening to you. And you’re free to let your thoughts wander. It frees both of us to concentrate on you and not on our manners. But if you don’t feel comfortable we can work with you sitting up. I see several people who hate the idea of the couch and we’ve done fine.”

For a moment he remained frozen in that awkward twist. Then he allowed his head to fall back and his arm returned to his side. His knees straightened a little.

“So you’re staying on the couch?” I asked.

He shrugged. Shrugging while lying down is difficult but he could move his skinny shoulders as expressively as his eyebrows. I was trying to elicit something positive or negative from him, a clear statement of personal preference. His passive behavior and suppressed anger at his own obedience is a common pattern; I hoped to learn whether that was typical of all his relationships or a defense mounted for this situation.

“So, Gene, do you want to stay on the couch?”

“I guess.” That was a barely audible murmur.

“Do you want to be here at all? Or is it entirely your mother’s idea?”

Another silence. His fear of answering was palpable. “I don’t know,” he said at last. He seemed relieved to have come up with this temporizing response.

“Guess,” I said.

“Guess?” he asked, his adolescent huskiness breaking up into a child’s trill.

“Yeah. Take a guess. Do you want to be here?”

“I had to,” he complained. “One Room told my Mom I had to.”

“So it’s not your mother’s idea?”

He shrugged.

“And you don’t want to be here?”

“I don’t know.”

I waited.

He waited. Then he complained, “How can I know until afterwards?”

“You can’t know whether you want to be here until after you’ve come and gone?”

Again, Gene tried to twist to see me. He could only accomplish that by raising himself but he didn’t feel that rebellious. He gave up, letting his head lie sideways, mouth in a pout.

“What do you mean?” he said, back to a mumble.

“You said you can’t know whether you want to be here until afterwards.” I paused. I was about to push this beyond my formal training. Susan wouldn’t mind, but, strange as it might seem after her success with me, I wasn’t comfortable with her bolder methods. “I don’t believe you,” I said mildly.

“It’s true,” he said sadly. “I don’t know if I like something until …” He trailed off, sighed, and then added, “Sometimes for a long time.”

I had my answer, in a way. He was passive about everything. Well, I thought, brushing aside my transitory dislike, this is an easy case. Well identify his feelings and with that recognition a gradual confidence in expressing them and insisting on their acknowledgment will relieve his depression and anxiety.

“I think you’re confusing two things,” I said. “Not wanting to be here is a feeling; knowing whether you’re right not to want to be here is a judgment.”

Gene shut his eyes. He drew up his legs. Turned sideways on the couch, that put him in a fetal position. His left hand drew close to his chest. I peered at it and discovered what I expected to: his thumb was hidden inside his fist. He was fighting an urge to suck it.

“I want to know what you feel, Gene. I’m not worried about whether you’re right or wrong to feel it. That’s something you can decide, or maybe the world can decide. Personally, I don’t think there is any right or wrong when it comes to feelings. Actions, yes. Not feelings. Our job is to help you know what you feel.”

Gene opened his eyes. He brought the fist with the hidden thumb up to his chin. “I didn’t want to come,” he said, his voice trembling. He paused, hardly breathing. What did he expect from me? Shouting? Violence?

“So you don’t want to be here?”

He nodded. His fist covered his mouth now, the entombed thumb centered on the lips. Was he pushing them in and out as before? That was a sucking motion. Freud would have his diagnosis by now. He’d grab a helmet and flashlight and move resolutely back into the cave of time to illuminate the story of Gene’s breast-feeding — and, I knew uneasily, he might be right to go on that quest.

“Do you want to be on the couch?”

He shook his head, moaning a little. He had regressed dramatically and it happened again: I didn’t like him. Why was he so undefended? I felt an urge to shout at him to sit up and act like a man. Fight me, I thought, staring at the ball he had made himself into.

“Then why are you lying on it?”

He shook his head and moaned again.

“Gene, I don’t know what that sound you’re making means.”

He moaned some more, head still shaking no.

I lost it again. “If you don’t talk to me, I’ll have to end the session.” There was sweat at my temples. I was literally hot from emotion. I was shamed by all these blunders, but I couldn’t seem to stop making them.

His moaning ceased at my scolding, of course. He dropped his fist to his stomach and covered it with the other hand. His face looked sweet and innocent. “Sorry,” he said in a low, contrite voice. Thanks to my mistake I had lost ground.