Sitting across from someone in a therapy session is simultaneously intimate and clinical. As the therapist, you must balance a few things at once: develop a diagnostic understanding of the client while also integrating the individual experiences that make each person’s story unique.
Having sat on both sides of the therapeutic couch, so to speak, I always look forward to reading about other therapists’ experiences. In his latest book, Tales from the Couch: A Clinical Psychologist’s True Stories of Psychotherapy, clinical psychologist Bob Wendorf lets us inside his office, showing us glimpses of rich clinical relationships.
Wendorf draws from his more than thirty-six years as a psychotherapist and marriage and family therapist. He has experience in a variety of settings, including residential treatment centers, psychiatric hospitals, community mental health centers, and private practice. In the book, Wendorf focuses on a different psychological issue or diagnosis in each chapter, then illustrates it with portraits of individuals he has seen over the course of his career. While he offers stories about well-known issues like depression and anxiety, he also jumps into topics slightly off the beaten path, including enmeshment and multiple personalities.
In one section, he relays the story of Kami Sue and her daughter Kami Two, who came dressed in matching outfits and completed each other’s sentences. “The reason for this craziness, and Kami Two’s distress,” Wendorf writes, “soon became clear. She and Kami Sue shared everything. There were no secrets, no boundaries, no generation gaps. Their individual personalities blended and merged into one amorphous super-amoebic blob.” Through therapy, Kami Two begins to recognize this, saying, “I have no life, no self of my own.”
While organizing chapters around psychiatric diagnoses may sound detached and clinical, the stories are often personal and touching. A chapter called “Elvis and Asperger’s” opens with a longterm patient singing to Wendorf. The patient, Donald, was dressed in a full rhinestone-studded jumpsuit, Wendorf writes, and “was more remarkable than the real owner of Graceland.”
Living in a time before autism was a well-known diagnosis, Donald “had been diagnosed with major depression, obsessive-compulsive disorder, bipolar disorder, paranoid schizophrenia, attention deficit hyperactivity disorder, social phobia, panic disorder, and a raft of other illnesses, but really didn’t fit the classical picture for any of them.” As a result, he had been on a cocktail of different medications, with limited benefit. However, psychotherapy seemed to help — and Donald was not the only one affected by it.
“Psychotherapy is intended to be a time-limited process, which ends when problems are resolved,” Wendorf writes. “But what of a patient, like Donald, whose problems (if such they be) will never be fully resolved? Therapists are taught not to take their patients home with them (either literally or figuratively), but sometimes you can’t really help it. I’ve been seeing Donald every couple of months for years,” Wendorf writes. “… He was part of our office family, and I’m part of his, and I continue to be long even after my retirement from active practice. I’m okay with that. Besides, he and his family have been wonderfully supportive of me through some family medical crises.”
Indeed, Donald’s father made Wendorf’s son a cane to help him walk, and Wendorf and Donald occasionally meet for lunch. “As Elvis would say,” Wendorf writes, “we’re ‘taking care of business.’”
Here is a reminder that for all the learned clinical detachment, it is ultimately the human touch that makes psychotherapy so rewarding for both people.
Still, this book left me wanting more. Wendorf gives us a glimpse inside the therapist’s office as he shares with us pieces of his clients’ lives, but I felt somewhat unsatisfied with such a brief peek. I wanted to come in and sit a while.
Each chapter is full of anecdotes from different patients, but I wish Wendorf had spent more time going in depth with a few of these clients, to flesh out their problems, their tragedies, and their triumphs and to show how his therapeutic relationship with them evolved over time. While we get some of this throughout the book, I would have like to see it more developed. Many of the stories are just a brief few paragraphs in length.
Also, Wendorf’s tendency to at times refer to people by their illness, calling them “paranoids” and “autistics,” for example, feels like it is from another decade. These days, we try not to superimpose the illness onto the identity of the individual. And so, given our current emphasis on the recovery model of illness, Wendorf’s language seemed out of sync, and also at odds with the typically empathic stories that are the hallmark of his book.
On a whole, however, the book is an engaging work of storytelling, interweaving the personal and the clinical to create a highly readable text.
Tales from the Couch: A Clinical Psychologist’s True Stories of Psychotherapy
Carrel Books, November 2015
Hardcover, 224 pages