Friday, August 13, 2010

Daphne Merkin - My Life in Therapy

This article has gotten a lot of attention around the internets. What do you think?

She echoes (parrots?) a LOT Of the concerns people have about the psychoanalytic approach in particular. But this is only a small portion of the therapy being done today - the majority is actually "get em in, get em out" short-term, HMO paid-for therapy, often called "brief therapy" with one or another prefix or suffix.

My Life in Therapy

Laurie Simmons for The New York Times.
Additional prop styling by Mary Howard Studio.
All those years, all that money, all that unrequited love. It began way back when I was a child, an anxiety-riddled 10-year-old who didn’t want to go to school in the morning and had difficulty falling asleep at night. Even in a family like mine, where there were many siblings (six in all) and little attention paid to dispositional differences, I stood out as a neurotic specimen. And so I was sent to what would prove to be the first of many psychiatrists in the four and a half decades to follow — indeed, I could be said to be a one-person boon to the therapeutic establishment — and was initiated into the curious and slippery business of self-disclosure. I learned, that is, to construct an ongoing narrative of the self, composed of what the psychoanalyst Robert Stoller calls “microdots” (“the consciously experienced moments selected from the whole and arranged to present a point of view”), one that might have been more or less cohesive than my actual self but that at any rate was supposed to illuminate puzzling behavior and onerous symptoms — my behavior and my symptoms.

To this day, I’m not sure that I am in possession of substantially greater self-knowledge than someone who has never been inside a therapist’s office. What I do know, aside from the fact that the unconscious plays strange tricks and that the past stalks the present in ways we can’t begin to imagine, is a certain language, a certain style of thinking that, in its capacity for reframing your life story, becomes — how should I put this? — addictive. Projection. Repression. Acting out. Defenses. Secondary compensation. Transference. Even in these quick-fix, medicated times, when people are more likely to look to Wellbutrin and life coaches than to the mystique-surrounded, intangible promise of psychoanalysis, these words speak to me with all the charged power of poetry, scattering light into opaque depths, interpreting that which lies beneath awareness. Whether they do so rightly or wrongly is almost beside the point.

IT WAS A SNOWY Tuesday afternoon in February, and I was inching along Fifth Avenue in a taxi, my mood as gray as the sky, on my way to a consultation with a therapist in the Village who was recommended to me by Dr. O., another therapist I had seen in consultation, who in turn was referred to me by a friend’s therapist. Once again — how many times have I done this? — I was on a quest for a better therapist, a more intuitive therapist, a therapist I could genuinely call my own, a therapist who could make me happy. I liked Dr. O., a man in his 80s who struck me as having a quick grasp of the essential details, the issues that dragged along with me year after year like a ball and chain. He seemed to get to the heart of the matter — had I ever felt loved? Had I ever loved? — with disarming ease. But then, after several visits, during which I envisioned myself finally and conclusively grappling with things, toppling over the impediments that stood in my way and coming out a winner, Dr. O. suddenly announced that he couldn’t take on any new patients. He said he had given the prospect of working with me a great deal of thought but in the end didn’t think he was prepared to commit himself.

I resisted the impulse to plead on my behalf, which was my impulse around all elusive men, be they shrinks or lovers, and accepted his verdict. (I later found out that he had been very ill and was in the process of bringing his practice to a close.) I wasn’t, after all, therapistless; I had been seeing Dr. L. for the past year and a half, an older woman with a practical manner and a radically limited wardrobe (she wore only black and brown pantsuits) that I had begun to view as a symptom of her tunnel vision, so different from my own scattered and unfiltered way of being. Of late, I had been feeling increasingly dissatisfied with the tenor of our sessions; they seemed more like the sort of conversations you would have with a good friend in a coffee shop than the intense, closely-examined, hesitation-filled discourse I had come to expect from the therapeutic encounter. The subject of “transference” (the patient’s projection of feelings and situations from the past onto the therapist), which is usually at the heart of psychoanalysis, didn’t even come up for discussion, much less any examination of possible signs of “countertransference” (the analyst’s emotional reactions to the patient stemming from his or her unconscious needs and conflicts). There was the day she used the word “cute” to describe a complicated, even twisted man I was telling her about, and I found myself wondering about her own personal evolution, how much she really understood about relations between men and women. Who was to say whether she had the kind of varied real-world experience that I might benefit from, one that could yield the sort of rich understanding of social texture that the anthropologist Clifford Geertz referred to as “thick description”?

My dissatisfaction led me to wonder whether it was time for a change — or whether, at long last, it might be time to strike out on my own and weather my internal and external vicissitudes alone, perilous as that prospect might appear to a person who hadn’t been without a therapist’s support in 40-odd years. On the other hand, I couldn’t actually picture myself going without a listening ear, someone who attended to my story along with me several days a week, who was ready and waiting to receive news of my life, undramatic and unimportant in the larger scheme of things as it might be. It was one thing to mock therapy and its practitioners, as I regularly did, or to fume at the expense; it was another thing entirely to walk away from the cushioning it offered. Much as I might disparage it, I was convinced it had helped keep me alive, bounded to the earth; there were also my antidepressants, of course, steadily elevating my dopamine levels and moderating my moods, but without the benefit of talk therapy, I felt unduly fragile, like a tightrope walker absent a net. Which is why, when Dr. O. conveyed his unavailability, I did what any addict does and asked where else I could get my fix. He said he would think about who might be suitable, and about 10 days later I received a short note from him with the name of Dr. D.

This is how I came to seek out the psychiatrist in the Village, who turned out to be a man in what I guessed to be his early 60s, with saucer eyes that were given to an exaggerated registering of emotion like the eyes of a comic-book character. I arrived at his office magisterially late after the endless cab ride, wet from the snow. I felt immediately on edge, furious at myself for not having taken the subway, silently calculating how much money had evaporated along with the first 20 minutes of the session. I always resented the implacability of the therapeutic “hour” (which translated into a mingy 50, or increasingly these days, 45 minutes at most), the way it commenced at some tediously calibrated moment, like 11:10 or 5:25, instead of satisfyingly on the hour or half-hour. Not to mention the way the end of a session was visible from the start, getting ready to wave goodbye to you and your problems just as you were settling in to reflect more fully upon them. Now, having abbreviated the session even before it began, I felt full of righteous if illogical outrage: who mandated all these carefully preserved professional rituals in the first place — the couch with its flimsy little napkin covering the place where you were to lay your head, the de rigueur box of tissues, the chair (for those who preferred to sit up, like me) placed at a careful distance from the therapist’s own? What was the point of these rules? Did they serve the patient in any way or were they just a means of securing the analyst enough patients to bring in the money to pay for a weekend house?

Needless to say, I didn’t air any of these thoughts and instead went into my skittish, slightly apologetic, pre-emptively self-deprecating patient mode — intent on sounding like someone who was aware of the pathological currents that ran beneath a life that might be viewed as functional, even successful, if looked at from afar. Dr. D. spoke very little, in the manner of a true-blue analyst — the more silent the therapist, it’s safe to say, the more likely he is to favor a strict analytic approach — in a voice that was low and grave, with an almost total absence of inflection. I had to suppress the urge to ask him to speak up for fear of offending him. Still, I was struck by the way he managed to convey a spirit of deep thoughtfulness whenever he did utter a few words. “You have trouble negotiating distance, don’t you?” he asked, after I wandered into my hyperkinetic version of free association, saying what came to my mind without exercising too much editorial control, babbling on about the chilly caretaker from my childhood who never answered me when I tried to engage her, moving on to my father’s obliviousness to my youthful presence even when I was sitting next to him in a car and then to my fear of being overattached to the people in my life that I felt closest to. “It’s a problem for you either way,” he added. “Isn’t it? Too close. Too far. Neither feel entirely comfortable.” I wasn’t completely sure what he meant, but I answered that I saw his point.

I went to Dr. D. to discuss the metaphysics of therapy rather than the logistics — whether, that is, I should be in therapy at all, and if so, what for and what kind. I talked about past therapists and their different styles of treatment, most of them Freudian-derived to a greater or lesser extent, all of which had turned me off in one way or another. In therapy that was more psychoanalytically oriented, I told him, I tended to get trapped in long-ago traumas, identifying with myself as a terrified little girl at the mercy of cruel adult forces. This imaginative position would eventually destabilize me, kicking off feelings of rage and despair that would in turn spiral down into a debilitating depression, in which I couldn’t seem to retrieve the pieces of my contemporary life. I don’t know whether this was because of the therapist’s lack of skill, some essential flaw in the psychoanalytic method or some irreparable injury done to me long ago, but the last time I engaged in this style of therapy for an extended period of time with an analyst who kept coaxing me to dredge up more and more painful, ever earlier memories, I ended up in a hospital. When I got out two summers ago, I reacted to the trauma of hospitalization by seeking out the aforementioned Dr. L., who took a more contained, present-oriented approach, with far less time and energy spent trying to excavate distant hurts and grievances. While she may have had the convictions of a Freudian, she also had the manner of a strategic adviser, cheering me on in my daily life. And yet, after seeing her for 18 months, I felt that I was doing myself an injustice by merely skimming the surface, leaving myself vulnerable to the kind of massive subterranean conflict I feared would sooner or later come out of nowhere and hit me hard once again. Would I ever, I wondered, manage to find the right mix, the style of therapy that fit my particular mold? Did it even exist?

As I mulled it over for Dr. D., I noticed that I was speaking with greater detachment and less gusto than I usually brought to the occasion. Perhaps this was a response to Dr. D.’s own removed demeanor, which made me in turn wonder if patients eventually began to sound like their therapists, much in the way husbands and wives of long standing are said to resemble each other. And then there was my feeling that I better not get in too deep. I was wary by this point of the alacrity with which I attached to shrinks, each and every one of them, as if I suspended my usual vigilant powers of critical judgment in their presence merely because they wore the badge of their profession. The truth of the matter was that in more than 40 years of therapy (the only person I knew who may have been at it longer than me was Woody Allen, who once offered me his own analyst), I never developed a set of criteria by which to assess the skill of a given therapist, the way you would assess a dentist or a plumber. Other than a presentable degree of intelligence and an office that didn’t set off aesthetic alarms — I tended to prefer genteelly shabby interiors to overly well-appointed ones, although I was wary of therapists who exhibited a Collyer Brothers-like inability to throw anything away — I wasn’t sure what made for a good one. I never felt entitled to look at them as members of a service profession, which is what, underneath all the crisscrossing of need and wishfulness, they essentially were. The sense of urgency that generally took me into a new shrink’s office was more conducive to seeing myself as the one being evaluated rather than the evaluator. Was I a good-enough patient? Would this latest psychiatrist (I saw mostly M.D.’s) like me and want to take me on? Or would he/she write me off as impossibly disturbed under my cloak of normalcy?

I knew I wasn’t the most promising candidate — I was, in fact, a prime example of what is referred to within the profession as a “difficult” patient, what with my clamorous ways, disregard for boundaries and serial treatments — but perhaps this time, after so many disappointments, I would get lucky. Somewhere out there, sitting in a smaller or larger office on Central Park West or the Upper East Side, tucked behind a waiting area furnished with a suitably arty poster or two, a couple of chairs and old copies of The New Yorker and National Geographic Traveler, was a practitioner who would not only understand my lifelong sorrow and anger in an empathic (but not unduly soppy) fashion but also be able to relieve me of them. Just as some people believe in the idea of soul mates, I held fast to the conviction that my perfect therapeutic match was out there. If only I looked hard enough I would find this person, and then the demons that haunted me — my love/hate relationship with my difficult mother (who has been dead now for four years), my self-torturing and intransigently avoidant attitude toward my work, my abiding sense of aloneness and seeming inability to sustain a romantic relationship and, above all, my lapses into severe depression — would become, with my therapist’s help, easier to manage.

Therapy, as Freud himself made clear, is never about finding a cure for what ails you. Its aim, despite the lyrical moniker it is known by (“the talking cure” was not actually Freud’s phrase but rather that of Dr. Josef Breuer’s patient Bertha Pappenheim, whom Freud wrote about as Anna O.), was always more modest. Freud described it as an effort to convert “hysterical misery” into “common unhappiness,” which suggests a rather minimalist framework against which to judge progress. There is no absolute goal, no lifetime guarantee, no telling how much therapy is enough therapy, no foolproof way of knowing when you’ve gotten everything out of it that you can and would be better off spending your valuable time and hard-earned money on other pursuits.

All of which raises the question: What exactly is the point? How can you be expected to know when being in therapy is the right choice, to know which treatments are actually helpful and which serve merely to give the false sense of reassurance that comes with being proactive, with doing all that we can? Does anyone, for example, really know what “character change” looks like? That, after all, is what contemporary therapy that is more than chitchat for the so-called worried well aims to promote. More pressing, who can be trusted to answer these questions? Looked at a certain way, the entire enterprise seems geared toward the needs of the therapist rather than the patient to a degree that can feel, after a certain amount of time, undemocratic, if not outright exploitative. With no endpoint in sight, it’s possible to stay in therapy forever without much real progress; at the same time, the weight of responsibility is borne almost entirely by the patient, whose “resistance” or lack of effort-making is often blamed for any stagnancy in treatment before the possibility of a therapist’s shortcomings is even acknowledged. As the psychiatrist Robert Michels observed in his aptly titled essay “Psychoanalysis and Its Discontents,” for patients, “it often seems as if psychoanalysis isn’t even designed to help them. Patients want answers, whereas psychoanalysts ask questions. Patients want advice, but psychoanalysts are trained not to give advice. Patients want support and love. Psychoanalysts offer interpretations and insight. Patients want to feel better; analysts talk about character change.”

My abiding faith in the possibility of self-transformation propelled me from one therapist to the next, ever on the lookout for something that seemed tormentingly out of reach, some scenario that would allow me to live more comfortably in my own skin. For all my doubts about specific tenets and individual psychoanalysts, I believed in the surpassing value of insight and the curative potential of treatment — and that may have been the problem to begin with. I failed to grasp that there was no magic to be had, that a therapist’s insights weren’t worth anything unless you made them your own and that nothing that had happened to me already could be undone, no matter how many times I went over it.

And yet it seems to me that the process itself, in its very commitment to interiority — its attempt to ferret out prime causes and pivotal events from the psychic rubble of the past and the unwieldy conflicts of the present — can be intriguing enough to stand in as its own reward. In the course of growing up, we all learn to repress our unruly fantasies and to keep our more anarchic thoughts mostly to ourselves. As for our dreams and what they might signify — their “latent content,” that is, as opposed to their “manifest content” — who can be expected to be interested in them except a close friend or tolerant spouse, both of whom are assuredly only half listening? Therapy offers us a particular kind of chaste intimacy, one that in its ideal (if not always actual) form is free of the burden of desirous expectations. Or as Adam Phillips, the writer and psychoanalyst, puts it with characteristic brio: “Psychoanalysis is about what two people can say to each other if they agree not to have sex.” It is a place to say out loud all that we have grown accustomed to keeping silent, in the hope that we might better understand ourselves and our missteps, come to terms with disowned desires and perhaps even find a more direct route to an effectively examined life. It provides an opportunity unlike any other to sort through the contents of your own mind — an often painfully circuitous operation — in the presence of someone who is trained to make order out of mental chaos. Although it is possible to view the whole exercise as an expensive self-indulgence — or, as its many detractors insist in one way or another, as the disease for which it purports to be the cure — psychoanalysis is the only game in town in which you are free to look and sound your worst the better to live up to your full potential.

FREUDIAN PSYCHOANALYSIS reached its high-water mark in the 1950s, having become something of a secular religion; it offered, as Dan Wakefield observes in his book “New York in the Fifties,” a “dream of wholeness” — and, no less important, “the cure for what ailed you sexually.” All of the so-called New York Intellectuals, like Delmore Schwartz and Mary McCarthy, dipped into analytic treatment at one time or another; and James Baldwin, in a 1959 essay, noted of “the citizens of this time and place” that “when they talk, they talk to the psychiatrist; on the theory, presumably, that the truth about them is ultimately unspeakable.” In the mid-60s, psychoanalysis was still very much in vogue, having not yet become the reviled and increasingly discredited discipline it came to be in the 1980s and 1990s, when anti-Freudians like Frederick Crews and Peter Swales did their dismantling work and the psychopharmaceutical industry flourished. (My favorite line from Donald Barthelme’s 1972 short story “The Sandman” is, to my mind, more predictive than descriptive: “The prestige of analysis,” the protagonist writes to his girlfriend’s shrink, in defense of her decision to give up analysis and use the money saved to buy a grand piano, “is now at a nadir.”) Popular magazines like Redbook and McCall’s familiarized Middle America with basic Freudian concepts, the better to understand phenomena like marital discord and sibling rivalry, and references to therapy abounded in theater and film. In their book “Psychiatry and the Cinema,” Glen O. Gabbard and Krin Gabbard refer to the period from the late 1950s to the early 1960s as the “Golden Age” of psychiatry in the movies: “For a half-dozen years . . . films reflected — however imperfectly — a growing conviction in American culture that psychiatrists were authoritative voices of reason, adjustment and well-being.” In 1969, Alexander Portnoy unburdened the content of his carnal character on the silent Dr. Spielvogel and made his creator, Philip Roth, a household name.

Still, while seeing a shrink was often considered something to be proud of back in the 1960s, lending you an aura of intellectual gravitas, it was at that time largely an adults-only activity. I began seeing my first therapist, Dr. Welsh, at the age of 10, but I didn’t know of any other kids my age who availed themselves of a psychiatrist, and the entire venture filled me with shame. I’m not sure how much I told her — children at that age tend to be loyal to their backgrounds, however dysfunctional — but I do recall busily beating up dolls in her office. Welsh was kindly and gray-haired, a renowned child psychiatrist, but to me she was little more than a stranger whose courteous style confused me. For one thing, she wasn’t Jewish, which, given my Orthodox upbringing, immediately opened up a chasm of nonfamiliarity between us. For another, I kept wondering why she was so nice to me; I wasn’t used to such treatment, which was surely one reason I needed to see a psychiatrist in the first place. I couldn’t figure out a connection between the world inside her office and the world outside it; they seemed like separate universes with different rules of conduct. In one, I was listened to, when I did choose to speak, with a great deal of attentiveness; in the other I was more often than not pushed aside, my anxieties discounted or ridiculed.

At some point I stopped seeing Dr. Welsh, and in junior high I started seeing a female psychiatric social worker with a mop of gray curls whose eyes crinkled up when she smiled and whose lack of an advanced degree wasn’t lost on me. It was my first inkling that shrinks were just other people in disguise, that they didn’t belong to some special class of being. I liked this therapist, who was a warmhearted Jewish woman of a type that I associated with the Eastern European mothers of many of my classmates, but she was no match for my mother’s Germanic coldness or her unbreakable grip on me. In any event, I’m not sure how versed she was in the nether reaches of pathological enmeshment, which she would have had to be for us to get anywhere. Short of that, what I wanted was for her to be my mother, just as early on I longed for my male therapists to be my father. Substitute parenting, or “reparenting,” as it is referred to, may have been what was on offer in the therapeutic realm, but what I wanted in my overly concrete way was the real thing. I wanted, that is, to be adopted — actually adopted — just as I would later wish for one or the other of my therapists to leave his wife for me. (My model was Elaine May, who married her shrink.)

In my late teens I started seeing Dr. S., a white-haired but vigorous psychiatrist. Like most of the shrinks I would see, he was a deracinated Jew who kept regular hours on Yom Kippur, as if to prove a point. He was an old-school analyst in the American mode, meaning that he hewed to the Freudian party line but in a casual, “we’re all only human” sort of fashion, and his office was all the way over on Riverside Drive in the 80s. I remember the address well because in winter, when the wind howled along the side streets in the evenings and I had to make my way to the bus stop at the end of a session, I felt like a character out of “Dr. Zhivago.” Although he regularly doodled with his fountain pen on a prescription pad, Dr. S. never took notes, claiming that it was a matter of principle. He sometimes closed his eyes during the session, either to allow himself to relate more profoundly to what I was talking about or to take a quick nap, I was never sure which.

Dr. S.’s office, which was reachable by a spiral staircase from his apartment, was one of the most beautiful — most dignified — I would ever find myself in. It had an air of serene comprehension, of truths having been sought after, suffered through and finally arrived at right within its confines. Spacious and thickly carpeted, with whitewashed walls on which hung a series of sepia-toned prints, it was also filled with the anthropological artifacts — somber clay heads and stone figures lined his bookshelves — that many psychoanalysts feel obliged to possess in homage to Freud’s own cherished collection of tchotchkes. There was a mechanical clock that made a faint whirring sound as it flipped over from one minute to the next, making me acutely aware of stray silences and unspoken thoughts. What made Dr. S.’s setting unique, however, was the constant presence of his dog, a golden-colored beagle with soft, flappy ears. The dog would pad over to my chair when I came in and look at me with her moist sympathetic eyes, waiting to be scratched behind the ears. There were times I refused to oblige her, ignoring her mute appeal until she tucked her tail between her legs and slunk over to Dr. S.’s chair to be petted. I felt, or maybe I was only imagining, the doctor looking at me intently at those moments, taking in my unresponsiveness and making a mental note: patient inhibited and cold; resists giving affection to loving animals.

It was with Dr. S. that I began developing a style custom-made to the therapeutic encounter, especially as it played out with male shrinks. Suspicious as I was of men to begin with, based on my experience of a remote father and a passel of brothers who remained alien, sports-obsessed creatures to me, it was hard for me to believe in their interest, much less their kindly intentions. As a result, I would use up a lot of the hour making apposite, witty remarks in an effort to entertain Dr. S. (a shrink I saw a few years back found me so knee-slappingly funny that he asked whether I had ever considered becoming a stand-up comedian) and spent the rest of the time pelting him with accusatory questions as to the quality of his attention and his reasons for seeing me: Was he really listening to me? Or was he preoccupied with his dog, especially after she had been injured in a car accident on Riverside Drive? Did he ever think about me when I wasn’t sitting in front of him? Would he see me if I couldn’t afford to pay his fee? If he was only doing this for the money, I blithely continued, why hadn’t he gone into a more remunerative profession, like law or business? Why the veneer of caring?

Despite my repeated threats to leave, I continued to see Dr. S. through my college years. When I look back on it, it seems to me that he was a gem of a man, really, to put up with my hot-and-cold attitude toward the work he was trying to do with me, but it did me little good at the time. Part of the problem was that Dr. S. tended to speak in broad generalities, which I found anything but reassuring. When I would say, for instance, as I often did, that nobody cared about me (by which I mainly meant my parents), he would answer, “First you must care about yourself.” This struck me as a sleight-of-hand solution, one that only fueled my anxiety that this feeling of universal indifference was not a neurotic misperception but the truth, the horrible truth lying in wait for me to come upon it. Could it be that the essence of my treatment consisted of Dr. S.’s gently leading me up to the dismal reality that was my life — that I would be “cured” only when I faced up to my darkest fears and accepted them as legitimate rather than exaggerated?

The goal of successful psychoanalysis, I knew, especially when it came to more severe problems, was not just to modify neurotic suffering so it took on the aspect of “ordinary unhappiness,” but to effect a real difference in the patient’s way of functioning. My character, sadly enough, seemed the same as it had always been, given to angry outbursts that alienated the very people I wanted around me, followed by regretful nostalgia for that which might have been. I had succeeded in driving away my first serious boyfriend, a bearded medical student, with precisely such maneuverings. And all Dr. S. managed to come up with in response to my acute grief over Mark was the suggestion that I think of him as dead. When I came in with what I saw as a telltale dream, in which I walked up and down the hallway outside Mark’s apartment until he opened the door and saw me, thereby vindicating me in my wistful belief that he hadn’t forgotten me, that the force between us was so strong that it could lead him to intuit that I was outside his apartment door, Dr. S. insisted on pointing out the flaws in my reasoning: “You realize, don’t you, that in your dream Mark only opened the door because he heard a disturbance outside. You were walking back and forth and making noise, so naturally he wanted to find out what was going on. It had nothing to do with the feelings he once had for you. You were intruding. You could have been anyone.” I scornfully replied that the hallway was carpeted, that I wasn’t making any noise and that Mark just felt me out there. The doctor puffed sagely on his pipe and disagreed with me once again, taking the sort of gentle tone you would use with a hopelessly crazy person.

Dr. S. was fond of telling me that the past didn’t interest him “except in terms of the present,” which was all fine and well except for the fact that it left me marooned, by myself, in ghostly rooms. I felt more rather than less alone in therapy, stuck with myself and my self-destructive patterns, which I saw as direct products of the very past that Dr. S. didn’t care to explore. Weren’t analysts supposed to be expert guides through the minefields of the past? Wasn’t going back into the interior where early humiliations festered their proclaimed specialty? If not, then whence was this ever-elusive “character change” supposed to emerge? Even to this day, I’m not sure I know anyone whose character has been genuinely transformed because of therapy. If anything, most people seem to emerge as more backed-up versions of themselves.

THESE ARE SOME of the things that never happened in therapy: No one ever stopped me from doing something I was intent on doing, even if it was clear that the issue was a symbolically loaded one and worthy of further exploration before I took any action. No one ever offered to adopt me or to take me home for so much as a single night, like the British child psychiatrist D. W. Winnicott (my ideal shrink) did with one of his patients. No one ever suggested that I move away from home or stand up to my parents. No one ever offered to see me free of charge. No one ever took me on his or her lap, as the Hungarian analyst Sandor Ferenczi was known to have done, in keeping with his belief that the clinical interaction should be a reciprocally empathic, mutual encounter. (Ferenczi and Freud would eventually break over their different therapeutic stances but not before Ferenczi noted in his clinical diary that Freud shared with him the harsh sentiment “that neurotics are a rabble, good only to support us financially and to allow us to learn from their cases: psychoanalysis as a therapy may be worthless.”) And for all the emphasis on therapy’s being a place of intimate disclosure — for all the times, in between shows of hostility, that I haltingly stated my feelings of great affection or even love for my therapists — none of them ever opened up about their feelings for me other than to convey a vague liking or appreciation for some facet of my personality.

Here are some of the things that did happen in therapy: My mother once came to a session with a hipster shrink and his trippy wife-partner whom I saw briefly in my late 20s, and their opening move was to ask about the state of her sex life. She inquired stonily what this had to do with helping me, while I squirmed in my seat, wondering what I was doing with this harebrained pair. Some years later, when I was in my mid-30s, my mother came to another session, this time with Dr. E., a young and pretty psychiatrist whose last name indicated a hefty WASP lineage. During this session the three of us decided that I would marry the man I had been dating on and off for the past six years, despite the fact that I had broken off my engagement to him months earlier. We discussed the matter of my newly pending marriage as if it were simply the practical solution to a neurotic issue, having little to do with the man in question and much to do with my abiding inability to make a decision. I remember distinctly that Dr. E. and my mother agreed that I was a very loyal person and that the chances of my getting divorced, no matter how tentative I might have felt about going ahead, were minuscule. (As it turned out, I divorced less than five years later.) They also agreed that I should proceed rapidly so that I would have less time to mull things over: my nuptials were accordingly scheduled for three weeks from the day of our meeting. Needless to say, everything was hastily arranged, from the invitations to the flowers, and the whole affair had the quality of a shotgun wedding, albeit one whose urgency came not from an incipient baby but from the fear of my thorough­going ambivalence that was shared by my mother and my shrink. Dr. E. came to the ceremony, looking lovely and blond in a black velvet dress, but she left before the dinner, as if to draw a line between being a witness to the event and being a friend. She has gone on to achieve spectacular success in her career, and to this day I wonder whether she thinks of her intervention as courageous or a mistake of her youth.

Two of my therapists died on me, one quite suddenly only months after I started seeing her and the other after suffering a recurrence of leukemia during my treatment with him. A third committed suicide, jumping off the roof of the very building where I had gone to see him. He had struck me as slightly forlorn, verging on seedy, when I was his patient, like a character out of a W. Somerset Maugham novel. He moved his jaw a lot when he spoke, and I thought I heard his teeth click, suggesting ill-fitting dentures. After I arrived uncharacteristically early one day and overheard him asking out a woman on a date on his living-room phone, I decided I could not live with his desolation — my own was hard enough — and brought my visits to an end. He killed himself about a year later, and although I was not egotistical enough to imagine that his dire act had anything to do with me, I felt guilty all the same for having rejected him.

The analyst who died shortly after I began going to her was an energetic European of about 70. She went into the hospital for what was supposed to have been a routine matter and never came out. Even though this happened nearly three decades ago, to this day I think of Dr. Edrita Fried as the one who got away — the one who might have worked miracles, because she reminded me of a more benign version of my mother and thus would be uniquely capable of understanding the kind of damage that had been done. She was also, up to that point, the only therapist I chose on my own, without benefit of one of the two consultants my parents turned to for referrals. I discovered Dr. Fried by chance, stumbling across a book she wrote on the shelf of a local bookstore. It was called “The Courage to Change,” and I read it cover to cover almost on the spot; when I finished, I called her blind and, much to my surprise, she readily agreed to see me. (I thought of analysts as existing in a closed circle to which you could gain access only by mentioning the name of a colleague they approved of.) Although I must have seen Dr. Fried for just a month or two before she was hospitalized, I had already formed a strong attachment to her when I received the call that she died. I remember sitting on my bed in my dark little apartment on 79th Street, holding the phone in my hand even after the person on the other end hung up, feeling doomed.

Nothing, however, compared with the overwhelming loss I felt at the death of Dr. A., whom I saw in my mid-20s and whose re-emerged cancer I failed to pick up on even after he started to display the telltale signs of radiation treatment: skin that was reddened and raw and a toupee that covered up his thinning hair, which I didn’t at the time recognize as a toupee at all but thought of as a strange new Prince Valiant-like hairstyle he just happened to be trying out. I even questioned him about it. How did you suddenly sprout bangs? You’ve always parted your hair to the side before. That made me cringe later on when I realized the truth of the matter. Even if I could forgive myself for misreading the physical clues, I should have known something was up when he suddenly announced that he was taking an impromptu vacation during the following spring instead of waiting for the proverbial shrinkless August. (The majority of therapists take August off, as if it were a religious obligation, leaving their patients to stew in their own juices.) He was suspiciously specific about the details, almost as if he were trying to avoid any probing questions by giving me more information than I could ever need up front. First, he told me, he was planning to visit a sick uncle, then to join his family on one of their athletic trips — the kind that featured canoes and tents instead of hotel rooms — across some carefully selected part of the American wilderness. I should have smelled a rat right there and then, but the truth was that I had never been informed of Dr. A.’s illness in the first place and probably would have disavowed the evidence of its return even if I had, so focused was I on my life with him inside his office.

The trouble, you see, was that I loved Dr. A., even though this often took the form of my fighting with him. Because he happened to have a small red rug under his chair, for instance, I saw fit to tell him that red was my least favorite color. In the same vein, after I began to suspect that the carefully framed photos of mountains and forest scenes that hung on his walls were in fact taken by him — I could just imagine him trudging up a perilously narrow footpath with an up-to-the-minute camera slung across his chest — I made sure to tell him that I found them numbingly bland. In some way, I’m sure, I was trying to catch him out and prove him unworthy of my attachment, but for the most part these fights were just a ruse, a way of throwing him off the scent. Dr. A., whom I took to be in his 40s, was the only person in my life who paid close attention to my innermost being: I felt fully recognized by him, felt that he saw me as I was and that I could thus trust him with the bad as well as the good about myself. Who else besides a therapist, when it comes down to it, can you trust to accept all parts of you? Your parents, if you are lucky. So I loved Dr. A. and relied on him and fought with him, fought about the money I had to pay him, fought about the rug and the photos and his skin and his hairstyle until it was too late to straighten anything out.

Talk about a lack of proper “termination” of the psychoanalytic experience. That last week before he left, we scheduled an extra session. I felt worried about his departure, despite his elaborate explanations, and wondered out loud if Dr. A. was trying to punish me in some way for being so contentious a patient. “Of course not,” he said, laughing. “I like our fights, at least most of the time. No, I’m afraid you’re stuck with me.”

But, as it turned out, I hadn’t been stuck with him, nor he with me. A day before he was due back I received a phone call from a woman with a curt voice who introduced herself as a colleague of Dr. A.’s and told me that he wouldn’t be returning from his “vacation,” a vacation he had obviously invented to cover a hideous final absence. No niceties, no anything. When I asked what was wrong, the woman became evasive and suggested I come in to talk. I made an appointment for the next day, which wasn’t soon enough, so filled was I with panic. The woman proved to be a psychiatrist herself, with the diplomas and seating arrangement to prove it, and she seemed intent on keeping Dr. A.’s whereabouts a secret. It was the most hideous of possible scenarios, Kafkaesque really: I found myself sitting in a strange doctor’s office asking the same questions over and over again, as though persistence would yield up answers. No, he wasn’t dead, it seemed, but he was sick, too sick to plan on seeing me again even if he did get well. What about his other patients, I wanted to know. And what was wrong with him exactly? Nothing, it appeared, could be divulged. All I was entitled to know was that Dr. A. wouldn’t be coming back and that it was important I find myself another doctor. “I can give you names,” she told me. “There are other good people who can help you.” Names! I didn’t want names. “I want Dr. A. back,” I said and started to cry.

I went home and wrote Dr. A. a long letter as he lay dying, for that clearly was what he was doing. In it I expressed all the gratitude and love I had failed — not wanted — to tell him about while he was irritatingly alive. I wrote him: “I am so sad my tears could fill your swimming pool.” I was alluding to a longstanding joke between us, about his needing the money I so reluctantly paid him so he could regrout the bottom of his pool. I started paying attention to the death notices, and I came upon what I was dreading one morning in early May. It was a couple of lines, rather anonymous sounding if you weren’t familiar with the subject. Dr. A. was dead, his last bill to me still unpaid.

This past April, while I was trying to decide on whether to stay with Dr. L., in spite of her failings, or to embark on a new treatment or to take a break from therapy altogether, I went for yet another consultation. Dr. F. was famous for his tough way with patients and his theoretical contributions to the field. Although he was short and slight, there was a palpable aura of power around him, a sense that here was a man who was used to whipping patients into shape. He spent three sessions on an intake of my history, jotting down notes. I listened to my self-accounting with a tired and critical ear, wondering why I was still so out to sea, still so mired in conflict. I had decided to spare Dr. F. none of my myriad doubts, fears, fantasies and unfulfilled wishes, even though articulating some of them made me inwardly wince. I wondered whether I had become too used to seeing myself through a pathological prism, one that didn’t leave room for small pleasures — for the fleeting nature of satisfaction. If there were many things I wished I had done, there were also things I was proud of, but there seemed to be no room for them here, in this cloistered space devoted to unearthing the clouds behind the silver linings. Happiness, as we all know, can’t be pursued directly, but what was the gain in tracking down every nuance of unhappiness, meticulously uncovering origins that left a lot to be desired but that could never be changed, no matter how skillfully you tried to reconstruct them?

Dr. F. and I made a fourth appointment for him to give me his impressions as well as his suggestions on what I should do next. Knowing his reputation for being confrontational with his patients, I braced myself for the worst. Even so, I wasn’t prepared for his ruthlessly pragmatic line of thinking, which had less to do with any inner torment I alluded to and more to do with the face I presented to the world, as if I were applying for a position as a flight attendant or a sales rep. He wondered, for instance, whether I thought of losing weight. Dumbstruck, I momentarily lost my footing, and then I answered that I had. He nodded and then coldly observed, “But you lack the motivation.” No, I said, I didn’t lack the motivation forever, I just lacked it for right now. Dr. F. looked entirely unconvinced and went on to ask me if I didn’t long to be part of a couple, to have someone to visit art galleries with. I said I did but that it hadn’t worked out thus far. “You are alone,” he repeated, as if I were in a state of denial. “I know,” I answered. “Many women are alone.” He then noted that I hadn’t written as much as I might have, that I procrastinated and was often late on coming through with assignments. His tone was smug and self-congratulatory, as if he had adduced these aspects of my character on his own when in reality he was simply throwing back at me the bits of incriminating information that I had willingly offered up. I found myself growing ever more defensive, ready to rise up and fight for the rights of unsvelte, unattached and underachieving women everywhere. Who was he to cast me in his patriarchal, bourgeois mold? Sure, I could lose some weight, but how had this come to be the main diagnostic issue? And I wasn’t completely alone: I had a daughter, I had friends, I had had my share of passion, ex-boyfriends and an ex-husband, there were more things in heaven and earth than were dreamed of in Dr. F.’s philosophy.

Dr. F. concluded with the recommendation that I see him or someone like him, who was trained in his methodology, which involved focusing on the transference between patient and analyst. I thanked him for his time and, a bit dazed from the encounter, went off to get a cup of coffee and think things over. At one point in my life I would have been thrilled to be offered the chance to see Dr. F. in all his brutal confidence, hoping that he could rearrange the shape of my character where no one had succeeded before. Now, however, in my 50s, I only felt persuaded that the last thing I wanted was to put myself into Dr. F.’s hands. I realized that I had been carrying a “Wizard of Oz”-like fantasy with me all these years, hoping to find someone who would not turn out to be just another little man behind a velvet curtain. It was not that I found all my shrinks to be impostors, exactly, but it dawned on me that I no longer had the requi­site belief in the process — perhaps had never had it in sufficient quantity. After 40-odd years of trying to find my perfect therapist, I didn’t want to explore my transferential relationship with Dr. F. or anyone. I didn’t want to pay high fees for 45 minutes of conversation with someone sitting opposite me whom I knew little about but who knew shameful facts about me. I didn’t want another one-way attachment, which would come to an end when I stopped paying for it. My skeptical 20-year-old daughter once referred to therapy as “emotional prostitution,” and although I thought the term a bit reductive, there was a piece of unpleasant truth to it.

I WENT BACK a week later to Dr. L., the woman I had been seeing for the past year and a half, and told her I wanted to stop therapy — for a while or for good, I wasn’t sure. To her credit, she didn’t try to persuade me that I was making a terrible mistake or suggest that we needed to discuss my wish to leave for the next 20 sessions. She simply let me go, with warm assurances that I could return whenever I felt the urge to. I left her office feeling liberated and scared at the same time. I started walking down the block, placing my feet deliberately one after the other, as if to confirm the reality of my un-propped-up existence. The world, it was good to see, was still standing, even as I detached myself from the ur-figure of the therapist.

All those years, I thought, all that money, all that unrequited love. Where had the experience taken me and was it worth the long, expensive ride? I couldn’t help wondering whether it kept me too cocooned in the past to the detriment of the present, too fixated on an unhappy childhood to make use of the opportunities of adulthood. Still, I recognized that therapy served me well in some ways, providing me with a habit of mind that enabled me to look at myself with a third eye and take some distance on my own repetitive patterns and compulsions. In the offices of countless therapists — some gifted, some less so — I sharpened my perceptions about myself and came to a deeper understanding of the persistent claim of early, unmet desires in all of us.

Therapy, you might say, became a kind of release valve for my life; it gave me a place to say the things I could say nowhere else, express the feelings that would be laughed at or frowned upon in the outside world — and in so doing helped to alleviate the insistent pressure of my darker thoughts. It buffered me as well as prodded me forward; above all, it provided a space for interior examination, an education in disillusioned realism that existed nowhere else on this cacophonous, frantic planet. If after many years of an almost-addictive attachment, I decided it was time to come up for air, I also knew it is in the nature of addicts never to be cured, but always to be in recovery. Good as it felt to strike out on my own, I was sure that one day in the not too distant future I would be making my way to a new therapist’s office, ready to pick up the story where I left off.

Daphne Merkin is a contributing writer. She is working on a book based on an article she wrote for the magazine about her struggle with chronic depression.

This article has been revised to reflect the following correction:

Correction: August 8, 2010

An article on Page 28 this weekend about the writer Daphne Merkin’s lifelong experience with psychotherapy misstates the status of a medical condition of a therapist of hers who died suddenly. It was a recurrence of leukemia, not a remission.


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