by The Naked Lady Who Stood on Her Head: A Psychiatrist's Stories of His Most Bizarre Cases
Ray looked at her with compassion. “I understand, sweetheart, and I know that it was hard for you when all the kids moved out.”
“It’s not as bad as I thought it would be.” She turned to me and said, “My work is rewarding, and when Ray is around, we enjoy our time together. We see friends, go to movies, take walks…I just can’t get on that boat, and he knows it.” She looked pensive. “So I have to wonder, why did he go out and get it?”
Ray replied, “You know that my father had a yacht, and I’ve always loved the water. I never had the time or money when the kids were young, but now it’s a tremendous source of relaxation for me, and it’s great for business. When you wanted to become a psychologist and leave the kids with a nanny, I was fully supportive. I just wanted you to be happy.”
“I know,” she said. “I get it. This is my problem. I just can’t figure out why I’m so uncomfortable.”
“Is there anything else besides Ray’s yacht that might be stirring up these feelings?” I asked.
After a long silence, Ray said, “Think about this, Susan. You have three sisters, and none of them has a career.”
Susan looked at him. “What’s your point?”
“My point is that in your family, the girls were discouraged from pursuing a career. Let’s face it, college was a place to find a husband.” He turned to me. “I’m not saying this to be critical, but I wonder if being angry about my yacht isn’t really what’s bothering her. I think she may feel guilty about being the only girl in her family to have a career.”
Susan paused and then said, “That’s interesting. I never made that connection before. Let me think about it.”
I was impressed by their level of psychological sophistication. I might have expected it from Susan, who had professional training, but Ray was insightful as well. Though he was defensive about coming to the session, he seemed sensitive to her concerns, and she responded well when he reached out to her. In fact, I thought Ray might be on to something; Susan’s jealousy over his yacht could stem from deeper issues—perhaps her identity as a wife, mother, or therapist. Maybe she was brought up to believe that success meant being a good wife and mother and a career as a psychologist just didn’t fit the family mold. Perhaps marriage counseling wasn’t the answer. Maybe Susan would do better with individual psychotherapy. On the other hand, Susan’s feeling that Ray cared more about his yacht than about her could be a clue that something else was going on. Were there other reasons behind Ray’s buying a yacht at that time? It seemed strange, since the kids had left home, the two of them had more time to spend together now, and he knew Susan would never set foot on it. Middle-aged men do have affairs, which could explain the boat and Susan’s discomfort. Ray appeared to love his wife and was concerned about her welfare, yet sometimes when he spoke it seemed rehearsed and insincere—but maybe that was just his communication style.
“You know, I don’t know why I pushed us into couples therapy today, Dr. Small,” Susan said. “I mean, Ray’s a good husband and I’ve just been in a weird place lately.”
He put his arm around her. “There’s nothing to be embarrassed about, sweetheart. Your problems are my problems too.” Susan was comforted and went on to talk about their early courtship during school. Soon after they got married, she dropped out of college and had their first child, while Ray pursued his career and became successful at start-up companies, making a small fortune.
As the session ended, we talked about next steps. Despite their ambivalence about couples therapy, we decided to give it a short trial run and made an appointment for the following week.
I DIDN’T THINK MUCH ABOUT THE WAGNERS until the weekend when Gigi and I were hanging out on lounge chairs in the backyard, watching the kids play Marco Polo in the pool. Gigi was leafing through a travel magazine and stopped on a photo of St. Bart’s, showing beautiful people strolling past a line of yachts. She held it up to me and said, “Look how packed in these yachts on St. Bart’s are. They look like sardines.”
“What would you think if I went out and bought a yacht?” I asked.
“I’d think you’d either won the lottery or were secretly related to a Kennedy.”
“I recently saw a couple where the wife hates boats, but the husband went out and bought one anyway.”
“Why did he do that?” Gigi asked.
“He’s always wanted one. Now the kids are grown and he can afford it.”
Gigi dropped her magazine and raced to the pool to break up a Styrofoam-sword fight that was getting too rough. She came back and said, “Do they do anything together?”
“Well, yeah,” I answered. “But he’s gone almost every weekend on his yacht, and she’s getting insecure about it.”
“I can understand that. I hate it when you travel too much. It’s lonely—even with the kids around.” She looked at the pool. “Especially with the kids around. Would you mind?” she said as she pointed to our daughter, who was pummeling our now crying son with a pool noodle. I got up and confiscated the offending noodle, then threw in a couple of beach balls to distract them.
Lying back down on the lounge, I said, “They’ve been married thirty years. Their kids are grown, and he just wants to do something he’s always dreamed of. What’s wrong with that?”
“Nothing, I guess,” she said as she went back to her magazine.
“Don’t you think that having separate interests strengthens a relationship?” I asked. “I mean, as long as they’re there for each other when they need to be.”
“Yeah…”
“So why shouldn’t a husband be able to have a hobby?” I asked.
“There’s nothing wrong with a hobby, but it would be nice if it was something they could do together. Has this patient invited you out on his yacht?” she asked.
“Are you kidding? That would be so inappropriate,” I said as I realized that a part of me would like to go out on his yacht.
“You want to know what I think?” Gigi asked.
“Of course.”
“I think you’re biased. I think you’re siding with the husband. What’s the term for that again? Reverse transference or something?”
“The term is countertransference, and I’ll take it under advisement, Dr. Gigi.”
Later that afternoon I thought about the possibility that I was having a countertransference reaction that might be distorting my impression of what was going on between Ray and Susan. Freud used the term to refer to the therapist’s emotional responses to a patient during psychotherapy. An effective therapist has the capacity for empathy and will experience countertransference feelings but should not allow them to interfere with the therapy. In fact, for therapists who maintain perspective on these reactions and their distortions, countertransference offers an important opportunity to explore the patient’s inner emotional world. It helps the therapist understand how the patient’s behaviors affect others, and how the patient can create dysfunctional interpersonal patterns.
If Gigi was right about my countertransference, then what was it about Ray or Susan that might be distorting my perspective? Perhaps I was overidentifying with Ray because of his physical resemblance to me. Maybe I yearned for more time alone to pursue my own hobbies. Was I looking to escape the dog-walking, kid-watching weekends? I didn’t think so—I loved being with my family and wouldn’t trade it for anything.
Or maybe my countertransference had to do with Susan. Perhaps I felt uncomfortable seeing another mental health professional experience such doubts and insecurities about her personal life. Treating other therapists can be tricky—it can bring up feelings of insecurity that the patient might know more than you, or you might identify so much with the patient that you become blinded to his issues.
THE FOLLOWING WEEK, SUSAN AND RAY RETURNED for their second session. She looked tired and stressed. As we got started, I asked Susan how she was doing, and Ray answered for her. “Not well, Dr. Small. She’s getting worse.”
I turned to Susan and asked, “What’
s going on?”
“I don’t know…I can’t stop thinking about Ray, the yacht, why he really bought it…I mean, what’s he really doing on that thing? It’s even distracting me at work.”
“So you’re having trouble trusting Ray?” I asked.
“No, I don’t know why I’m so suspicious. It’s like I’m having a bizarre conversation with myself. It’s better when he gets home in the evening and we’re together. But then it happens again the next day.” She shook her head and looked away. “Jesus, I sound like I’m depressed.”
Ray spoke up. “Maybe Susan needs medication, Dr. Small.”
“It’s possible,” I said. “But we don’t want to jump into medication too quickly. Let’s find out more. Susan, what’s your appetite been like?”
“It’s down, and you don’t have to go through the list of depression symptoms. I have a lot of them. I do appreciate your holding back on the medicine, because I still think we have a marriage problem that isn’t resolved.”
Ray sighed. “Not again. And what would resolve it, Susan? My selling the yacht? Wouldn’t it be less drastic for you to take a couple of Prozacs?”
She glared at him. “I don’t appreciate your tone, and no, I don’t think taking Prozac is easier than finding a real answer to our problem.”
He shook his head. “Darling, we don’t have a problem. You do.”
“Let’s slow down a bit,” I interjected. “It sounds like we’re back to the basic disagreement about who’s got a problem and how to go about fixing it. Susan is worried about the situation and may be depressed. But why she’s feeling this way, and how to help her, is still unclear.”
“Look, I love my wife dearly,” Ray said as he turned to Susan. “And even though I need it for business, and it’s been my lifelong dream to have a yacht of my own, if your happiness depends upon it, I’ll sell it right now.”
Ray’s professed love for Susan seemed sincere, but his perfunctory offer to sell his yacht didn’t ring true. I wondered if he was holding something back.
She looked at him tenderly. “Honey, no one is saying you have to sell your yacht, but Dr. Small is right. Let’s slow things down and try to get a better idea of what’s going on. Maybe it does have to do with the way I was brought up, but we need to be able to talk about it.”
We did talk about it for the rest of the session, and I began to see a pattern of how Susan and Ray interacted. Every time she got anxious and expressed her concerns about the relationship, he initially got defensive but then came around and was able to calm her and bring them back together. At times he struck me as a regular family man who really cared about his wife. But other times he seemed a bit too polished and ready with an answer for everything. Something was stirring up Susan’s anxiety now, and I wasn’t sure what that was. If it had to do with her career, why didn’t this problem emerge earlier? Also, Ray had bought the yacht several years ago, so why was it an issue now? It was hard to believe it all went back to an empty-nest syndrome.
That evening, Gigi prepared a fabulous pasta feast for the four of us. The kids and I made pigs of ourselves, and I figured I’d better walk off the extra carbs. No one wanted to join me and the dog, so I took off up the street with Jake in tow. The sun was about to set, and as I caught a breathtaking view of the hillside and ocean, I heard my neighbor Bob say, “I didn’t know that they let psychiatrists out after dark.”
“Didn’t you get the memo about our special night passes?” I asked.
“Hey, did the Wagners ever call you?” he asked as he crossed the street toward me, obviously not wanting Jake back in his yard.
“How well do you know them?” I asked.
“Well, like I said, the wife has a busy Westside practice. I met the husband once at a fund-raiser. You know, I shouldn’t say anything, but…”
“But what?” I asked, curious to get a colleague to weigh in.
“There’s something about him. I mean he’s very personable and everyone seemed to be drawn to him at this event, but I don’t know.”
“What is it?” I asked.
“I just don’t trust the guy,” Bob said.
“Really? Why not?”
“He was flirting with other women every time his wife’s back was turned. Anyway, what’s happening with them?” he asked.
“You know, the usual midlife marital issues.” I didn’t want to give up too much, to avoid breaching my patients’ confidentiality.
Bob was about to ask me another question, but his cell phone rang and he had to take the call. I waved good-bye and headed home. Hearing Bob’s misgivings about Ray’s character began to fuel my own.
At their next session, Susan showed up alone. Ray had to handle a business emergency down the coast. She sat across from me on the couch, and we looked at each other, professional to professional.
“Have you ever wondered why Ray has so much business out of town?”
“No. Why should I?” she asked.
I cut to the chase. “Do you think Ray is having an affair?”
“No,” she said. “I think he’s just taking a vacation from our marriage, which I don’t appreciate.”
“Have you ever directly asked him?” I asked.
“Of course not. I don’t think there’s another woman; I think he’s just lost interest in me.”
I was in an awkward position. I had outside information from my neighbor that supported my own suspicions about Ray’s infidelity. My guess was that he was a pro at covering it up.
Susan went on for the rest of the session praising Ray for his many virtues. She didn’t want to talk about her depression and seemed to minimize the loneliness she felt whenever he was away.
THE NEXT WEEK I WAS PREPARING A lecture for an international Alzheimer’s meeting in Europe, so I tried not to schedule too many patients. As I was sorting through my presentation, my assistant buzzed me and said that a Francesca Wagner was waiting to see me, but she didn’t have an appointment.
“I’m really busy right now. Could you schedule her to come back another time?”
“I tried that, but she insists on seeing you now,” Laura said. “She says she drove up from San Diego and only needs a few minutes of your time.”
I checked my watch and said, “Okay, give me a minute and I’ll be right with her.” I closed my PowerPoint file and straightened up the desk before buzzing Laura to send the woman in.
Francesca looked to be in her late twenties and resembled Penélope Cruz with a few extra pounds. She walked briskly into the office, took a seat in front of my desk, crossed her arms, and glared at me. She seemed angry, and I had no idea why.
I tentatively asked, “What can I do for you?”
“I’ll tell you what you can do for me, Doctor. You can stop screwing up your billing and sending statements to people who never came to see you.” She paused and took a breath before continuing her rant. “Or maybe you’re pulling some type of insurance scam and sending out phony bills to see what comes back.”
“What are you talking about?” I asked. “I’m not following you.”
“Do you have any idea how much this can mess up people’s lives? It can cause fights, break up marriages—and for what, a few bucks from an insurance company?”
I was getting worried. This woman seemed unstable. How did she pick me out? Was she dangerous? She could be psychotic and have a knife or a gun in her purse. I tried to remain calm and figure out what was going on, but her intensity and anger were clouding my thinking.
“I’m sorry, Ms. Wagner, I still don’t know what you’re referring to.”
“I’m referring to this.” She pulled a piece of paper out of her purse and slammed it down on my desk so hard that I jumped. It was my bill to Susan and Ray Wagner. I quickly checked the address, and it matched the one in my records. So how had this woman gotten it? Was she a relative? Did the post office screw up? And why was she so angry about it?
“I’m not sure how you got this bill, Ms. Wagner, but it wasn’t inten
ded for you,” I said, relieved that all of this was probably just a clerical error.
“You’re damn right it wasn’t,” she said.
“So why do you have it?”
“I found it in my husband’s coat pocket when I picked up his dry cleaning.” She folded the bill back up and put it in her purse.
“Maybe it was from another Ray Wagner’s jacket,” I said, grasping for a plausible explanation.
She looked at me indignantly. “I live in San Diego. My dry cleaner is in San Diego. The bill is addressed to a Ray and Susan Wagner in Los Angeles for couples therapy. What kind of con are you trying to pull?”
“Listen, Mrs. Wagner, I’m not pulling any con, but let’s try to figure this out. Would you like a glass of water?” She nodded and I got up to pour each of us one. She was starting to calm down.
I sat back down. “Now, you said you’re from San Diego?”
“That’s right. My husband, Ray, and I live in La Jolla with our baby.”
“So your husband, Ray, had this bill in his coat pocket?” I asked.
“I already said that. But I’d like to know who the hell Susan Wagner is,” she said as her anger started building again.
I made an effort to sound calm. “Francesca, tell me about your husband.”
“He’s a successful businessman and a wonderful father.” She brightened when she spoke about him.
“And how long have you been married?” I asked.
“Two years now. It was very romantic—we got married on his yacht.”
I felt like a brick just hit me on my thick head. I understood why this Francesca Wagner was so pissed off, and why Susan Wagner had been sensing there was something not quite right in her marriage for the last couple of years. I couldn’t tell Francesca about Susan—I was bound by confidentiality. The only way Francesca was going to get to the bottom of this was by talking with Ray.
“Francesca, there’s no fraud or clerical error, but there’s not much else I can tell you. It sounds like this is something between you and your husband, and I think you should ask him about it.”