Lying On The Couch

A Novel


By Irvin D. Yalom

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From the bestselling author of Love’s Executioner and When Nietzsche Wept comes a provocative exploration of the unusual relationships three therapists form with their patients. Seymour is a therapist of the old school who blurs the boundary of sexual propriety with one of his clients. Marshal, who is haunted by his own obsessive-compulsive behaviors, is troubled by the role money plays in his dealings with his patients. Finally, there is Ernest Lash. Driven by his sincere desire to help and his faith in psychoanalysis, he invents a radically new approach to therapy — a totally open and honest relationship with a patient that threatens to have devastating results.

Exposing the many lies that are told on and off the psychoanalyst’s couch, Lying on the Couch gives readers a tantalizing, almost illicit, glimpse at what their therapists might really be thinking during their sessions. Fascinating, engrossing and relentlessly intelligent, it ultimately moves readers with a denouement of surprising humanity and redemptive faith.


Lying on the Couch is a witty, gripping and hugely entertaining novel from which the reader effortlessly learns a great deal about the theory and practice of psychotherapy.”

—David Lodge, author of Therapy and The Art of Fiction.


Many have helped me in the precarious crossing from psychiatry to fiction: John Beletsis, Martel Bryant, Casey Feutsch, Peggy Gifford, Ruthellen Josselson, Julius Kaplan, Stina Katchadourian, Elizabeth Tallent, Josiah Thompson, Alan Rinzler, David Spiegel, Saul Spiro, Randy Weingarten, the guys of my poker game, Benjamin Yalom, and Marilyn Yalom (without whom this book could have been written with far greater comfort). To all, my deepest gratitude.


Three times a week for the past five years, Justin Astrid had started his day with a visit to Dr. Ernest Lash. His visit today had begun like any of the previous seven hundred therapy sessions: at 7:50 A.M. up the outdoor stairs of the Sacramento Street Victorian, handsomely painted in mauve and mahogany, through the vestibule, up to the second floor, into Ernest’s dimly lit waiting room, permeated with the rich, moist aroma of Italian dark roast. Justin inhaled deeply, then poured coffee into a Japanese mug adorned with a hand-painted persimmon, and sat on the stiff green leather sofa and opened the San Francisco Chronicle sports section.

But Justin could not read about yesterday’s baseball game. Not on this day. Something momentous had happened—something that demanded commemoration. He folded his newspaper and stared at Ernest’s door.

At eight A.M. Ernest put Seymour Trotter’s folder into his file cabinet, glanced quickly at Justin’s chart, straightened his desk, placed his newspaper in a drawer, put his coffee cup out of sight, rose, and, just before opening his office door, looked back to scan his office. No visible signs of habitation. Good.

He opened his door and for a moment the two men looked at each other. Healer and patient. Justin with his Chronicle in hand, Ernest’s newspaper hidden deeply in his desk. Justin in his dark blue suit and Italian striped silk tie. Ernest in a navy blue blazer and Liberty flowered tie. Both were fifteen pounds overweight, Justin’s flesh spilling into chins and jowls, Ernest’s belly bulging over his belt. Justin’s mustache curled upward, stretching for his nostrils. Ernest’s manicured beard was his tidiest feature. Justin’s face was mobile, fidgety, his eyes jittery. Ernest wore large goggle spectacles and could go for long periods without blinking.

“I’ve left my wife,” Justin began, after taking a seat in the office. “Yesterday evening. Just moved out. Spent the night with Laura.” He offered these first words calmly and dispassionately, then stopped and peered at Ernest.

“Just like that?” Ernest asked quietly. No blinking.

“Just like that.” Justin smiled. “When I see what has to be done, I don’t waste time.”

A little humor had entered their interaction over the past few months. Ordinarily, Ernest welcomed it. His supervisor, Marshal Streider, had said that the appearance of humorous byplay in therapy was often a propitious sign.

But Ernest’s “just like that” comment had not been good-natured byplay. He was unsettled by Justin’s announcement. And irritated! He had been treating Justin for five years—five years of busting his ass trying to help him leave his wife! And today Justin casually informs him that he left his wife.

Ernest thought back to their very first session, to Justin’s opening words: “I need help getting out of my marriage!” For months Ernest had painstakingly investigated the situation. Finally he concurred: Justin should get out—it was one of the worst marriages Ernest had ever seen. And for the next five years Ernest had used every known psychotherapy device to enable Justin to leave. Every one had failed.

Ernest was an obstinate therapist. No one had ever accused him of not trying hard enough. Most of his colleagues considered him too active, too ambitious in his therapy. His supervisor was forever remonstrating him with, “Whoa, cowboy, slow down! Prepare the soil. You can’t force people to change.” But, finally, even Ernest was forced to give up hope. Though he never stopped liking Justin and never stopped hoping for better things for him, he gradually grew convinced that Justin would never leave his wife, that he was immovable, rooted, that he would be stuck for life in a tormented marriage.

Ernest then set more limited goals for Justin: to make the best of a bad marriage, to become more autonomous at work, to develop better social skills. Ernest could do this as well as the next therapist. But it was boring. Therapy grew more and more predictable; nothing unexpected ever happened. Ernest stifled yawns and pushed his glasses up the bridge of his nose to keep himself awake. He no longer discussed Justin with his supervisor. He imagined conversations with Justin in which he raised the question of referring him to another therapist.

And here, today, Justin saunters in and nonchalantly announces he has left his wife!

Ernest tried to conceal his feelings by cleaning his goggle spectacles with a Kleenex yanked from the box.

“Tell me about it, Justin.” Bad technique! He knew it instantly. He put his glasses back on and jotted on his notepad: “mistake—asked for information—countertransference?”

Later, in supervision, he would go over these notes with Marshal. But he knew himself that it was nuts for him to be pulling for information. Why should he have to coax Justin to continue? He should not have given in to his curiosity. Incontinent—that’s what Marshal had called him a couple of weeks earlier. “Learn to wait,” Marshal would say. “It should be more important for Justin to tell you this than for you to hear it. And if he chooses not to tell you, then you should focus on why he comes to see you, pays you, and yet withholds information from you.”

Ernest knew Marshal was right. Yet he did not care about technical correctness—this was no ordinary session. The sleeping Justin had awakened and left his wife! Ernest looked at his patient; was it his imagination or did Justin appear more powerful today? No obsequious head bowing, no slouching, no fidgeting in his chair to adjust his underwear, no hesitancy, no apologies about dropping his newspaper on the floor next to his chair.

“Well, I wish there were more to tell—it all went so easily. Like I was on automatic pilot. I just did it. I just walked out!” Justin fell silent.

Again, Ernest couldn’t wait. “Tell me more, Justin.”

“It’s got to do with Laura, my young friend.”

Justin rarely spoke of Laura, but when he did she was always, simply, “my young friend.” Ernest found that irritating. But he gave away nothing and remained silent.

“You know I’ve been seeing her a lot—maybe I’ve minimized that a bit to you. I don’t know why I’ve kept it from you. But I’ve been seeing her almost daily, for lunch, or a walk, or going up to her apartment for a romp in the hay. I’ve just been feeling more and more together, at home, with her. And then, yesterday, Laura said, very matter-of-factly, ‘It’s time, Justin, for you to move in with me.’

“And you know,” Justin continued, brushing away the mustache hairs tickling his nostrils, “I thought, she’s right, it is time.”

Laura tells him to leave his wife and he leaves his wife. For a moment Ernest thought about an essay he had once read on the mating behavior of coral reef fish. Apparently marine biologists can easily identify the dominant female and male fish: they simply watch the female swim and observe how she visibly disrupts the swim patterns of most male fish—all but the dominant males. The power of the beautiful female, fish or human! Awesome! Laura, barely out of high school, had simply told Justin it was time to leave his wife, and he had obeyed. Whereas he, Ernest Lash, a gifted, a highly gifted therapist, had wasted five years trying to pry Justin out of his marriage.

“And then,” Justin went on, “at home last night Carol made it easy for me by being her usual obnoxious self, hammering at me for not being present. ‘Even when you’re present, you’re absent,’ she said. ‘Pull your chair up to the table! Why are you always so far away? Talk! Look at us! When was the last time you made a single unsolicited comment to me or the children? Where are you? Your body’s here—you’re not!’ At the end of the meal, when she was clearing the table and banging and clattering the dishes, she added, ‘I don’t even know why you bother to bring your body home.’

“And then suddenly, Ernest, it came to me: Carol’s right. She’s right. Why do I bother? I said it again to myself, Why do I bother? And then, just like that, I said it out loud. ‘Carol, you’re right. In this, as in all other things, you are right! I don’t know why I bother coming home. You’re absolutely right.’

“And so, without another word, I went upstairs and packed up everything I could in the first suitcase I found and walked out of the house. I wanted to take more, to come back in for another suitcase. You know Carol—she’ll slash and burn everything I leave behind. I wanted to come back for my computer; she’ll take a hammer to it. But I knew it was then or never. Walk back into the house, I told myself, and you’re lost. I know me. I know Carol. I didn’t look to the right or the left. I kept on walking, and just before I closed the front door I leaned my head in and yelled, not knowing where Carol or the kids were, ‘I’ll call you.’ And then I got the hell away!”

Justin had been leaning forward in his chair. He took a deep breath, leaned back exhausted, and said, “And that’s all there is to tell.”

“And that was last night?”

Justin nodded. “I went directly to Laura’s and we held each other all night. God, it was hard to leave her arms this morning. I can hardly describe it, it was so hard.”

“Try,” Ernest urged.

“Well, as I started to unfold myself from Laura, I suddenly had an image of an amoeba dividing in two—something I hadn’t thought about since high school biology class. We were like the two halves of the amoeba separating bit by bit until there was just one thin strand connecting us. And then, pop—a painful pop—and we were separate. I got up, got dressed, looked at the clock, and thought, ‘Only fourteen more hours until I’ll be back in bed folded together again with Laura.’ And then I came here.”

“That scene with Carol last evening—you’ve dreaded it for years. Yet, you seem high-spirited.”

“Like I said, Laura and I fit together, belong together. She’s an angel—made in heaven for me. This afternoon we go apartment hunting. She has a small studio on Russian Hill. Great view of the Bay Bridge. But too small for us.”

Made in heaven! Ernest felt like gagging.

“If only,” Justin continued, “Laura had come along years ago! We’ve been talking about what rent we could afford. On my way here today I started to calculate what I’ve spent on therapy. Three times a week for five years—how much is that? Seventy, eighty thousand dollars? Don’t take this personally, Ernest, but I can’t help wondering what would have happened if Laura had come along five years ago. Maybe I would’ve left Carol then. And finished therapy, too. Maybe I’d be looking for an apartment now with eighty thousand dollars in my pocket!”

Ernest felt his face flush. Justin’s words clanged in his mind. Eighty thousand dollars! Don’t take this personally, don’t take this personally!

But Ernest gave nothing away. Nor did he blink or defend himself. Nor point out that, five years ago, Laura would have been about fourteen and Justin couldn’t have wiped his ass without asking Carol’s permission, couldn’t get to noon without calling his therapist, couldn’t order from a menu without his wife’s guidance, couldn’t dress in the morning if she didn’t lay out his clothes. And it was his wife’s money, anyway, that paid the bills, not his—Carol earned three times as much as he did. If not for five years of therapy, he’d have eighty thousand dollars in his pocket! Shit, five years ago Justin couldn’t have figured out which pocket to put it in!

But Ernest said none of these things. He took pride in his restraint, a clear sign of his maturation as a therapist. Instead he innocently asked, “Are you high-spirited all the way down?”

“What do you mean?”

“I mean, this is a momentous occasion. Surely you must have many layers of feelings about it?”

But Justin did not give Ernest what he wished. He volunteered little, seemed distant, distrustful. Finally Ernest realized that he must focus not on content but on process—that is, on the relationship between patient and therapist.

Process is the therapist’s magic amulet, always effective in times of impasse. It is the therapist’s most potent trade secret, the one procedure that makes talking to a therapist materially different and more effective than talking to a close friend. Learning to focus on process—on what was happening between patient and therapist—was the most valuable thing he had gotten from his supervision with Marshal and, in turn, was the most valuable teaching he himself offered when he supervised residents. Gradually, over the years, he had come to understand that process was not only an amulet to be used in times of trouble; it was the very heart of therapy. One of the most useful training exercises Marshal had given him was to focus on process at least three different times during each session.

“Justin,” Ernest ventured, “can we take a look at what’s happening today between the two of us?”

“What? What do you mean ‘what’s happening’?”

More resistance. Justin playing dumb. But, Ernest thought, maybe rebellion, even passive rebellion, wasn’t a bad thing. He remembered those scores of hours they had worked on Justin’s maddening obsequiousness—the sessions spent on Justin’s tendency to apologize for everything and to ask for nothing, not even to complain about the morning sun in his eyes or to ask if the blinds could be lowered. Given that background, Ernest knew he should applaud Justin, support him for taking a stand. The task today was to help him convert this back-assed resistance into overt expression.

“I mean, how do you feel about talking to me today? Something’s different. Don’t you think?”

“What do you feel?” Justin asked.

Whoops, another very un-Justin response. A declaration of independence. Be happy, Ernest thought. Remember Geppetto’s glee when Pinocchio first danced without strings?

“Fair enough, Justin. Well, I feel distant, left out, as though something important has happened to you—no, that’s not right. Let me put it this way: as though you have made something important happen and you want to keep it separate from me, as though you don’t want to be here, as though you want to exclude me.”

Justin nodded appreciatively. “That’s accurate, Ernest. Real accurate. Yeah, I do feel that. I am staying away from you. I want to hang on to feeling good. I don’t want to be brought down.”

“And I’ll bring you down? I’ll try to take it away from you?”

“You’ve already tried,” said Justin, uncharacteristically looking directly into Ernest’s eyes.

Ernest raised his eyebrows quizzically.

“Well, isn’t that what you were doing when you asked if I were high-spirited all the way down?”

Ernest caught his breath. Whoa! A real challenge from Justin. Maybe he had learned something from therapy after all! Now Ernest played dumb. “What do you mean?”

Of course I don’t feel good all the way down—I’ve got lots of feelings about leaving Carol and my family forever. Don’t you know that? How could you not know? I’ve just walked away from everything: my home, my Toshiba laptop, my kids, my clothes, my bicycle, my racquetball racquets, my neckties, my Mitsubishi TV, my videotapes, my CDs. You know Carol—she’ll give me nothing, she’ll destroy everything I own. Owww . . .” Justin grimaced, crossed his arms and crouched over as if he had just been slammed in the belly. “That pain’s there—I can reach it—you see how close it is. But today, for one day, I wanted to forget, even for a few hours. And you didn’t want me to. You don’t seem even pleased that I finally left Carol.”

Ernest was staggered. Had he given away so much? What would Marshal do in this spot? Hell, Marshal wouldn’t be in this spot!

“Are you?” Justin repeated.

“Am I what?” Like a stunned boxer, Ernest clenched his opponent while his head cleared.

“Pleased at what I’ve done?”

“You think,” Ernest weaseled, trying hard to regulate his voice, “I’m not pleased with your progress?”

“Pleased? You don’t act like it,” Justin responded.

“And what about you?” Ernest weaseled again. “Are you pleased?”

Justin let up and ignored the weaseling this time. Enough was enough. He needed Ernest and he backed off: “Pleased? Yes. And scared. And resolved. And wavering. Everything all mixed up. The main thing now is for me never to go back. I’ve broken away and the important thing now is to stay away, to stay away forever.”

For the rest of the hour, Ernest tried to make amends by supporting and exhorting his patient: “Hold your ground . . . remember how long you yearned to make such a move . . . you’ve acted in your best interests . . . this may be the most important thing you’ve ever done.”

“Should I go back to discuss this with Carol? After nine years, don’t I owe it to her?”

“Let’s play it out,” Ernest suggested. “What would happen if you went back now to talk?”

“Mayhem. You know what she’s capable of doing. To me. To herself.”

Ernest didn’t have to be reminded. He vividly remembered an incident Justin had described a year ago. Several of Carol’s law partners were coming over for a Sunday brunch and, early in the morning, Justin, Carol, and the two children had gone out shopping. Justin, who did all the cooking, wanted to serve smoked fish, bagels, and leo (lox, scrambled eggs, and onions). Too vulgar, Carol said. She wouldn’t hear of it, even though, as Justin reminded her, half the partners were Jewish. Justin decided to take a stand and began to turn the car toward the delicatessen. “No, you don’t, you son of a bitch,” Carol shouted, and jerked at the steering wheel to turn it back. The struggle in moving traffic ended when she crashed the car into a parked motorcycle.

Carol was a wildcat, a wolverine, a madwoman who tyrannized through her irrationality. Ernest remembered another car adventure that Justin had described a couple of years ago. While driving on a warm summer night, she and Justin had argued about the choice of a movie—she for The Witches of Eastwick, he for Terminator II. Her voice rose, but Justin, who had been encouraged by Ernest that week to assert himself, refused to give in. Finally she opened the car door, again in moving traffic, and said, “You miserable fucker, I’m not going to spend another minute with you.” Justin grabbed at her, but she sank her nails into his forearm and, as she jumped out into the traffic, plowed four violent red furrows into his flesh.

Once out of the car, which had been moving about fifteen miles per hour, Carol lurched forward for three or four jolting steps and then slammed into and over the hood of a parked car. Justin stopped the car and rushed to her, parting the crowd that had already gathered. She lay on the street, dazed but serene—stockings ripped and bloodied at the knees, abrasions on her hands, elbows and cheeks, and an obviously fractured wrist. The rest of the evening was a nightmare: the ambulance, the emergency room, the humiliating interrogation by the police and the medical staff.

Justin was badly shaken. He realized that even with Ernest’s help he could not outbid Carol. No stakes were too high for her. That dive out of the moving car was the event that had broken Justin for good. He could not oppose her, nor could he leave her. She was a tyrant, but he had a need for tyranny. Even a single night away from her filled him with anxiety. Whenever Ernest had asked him, as a thought experiment, to imagine walking away from the marriage, Justin became filled with dread. Breaking his bond to Carol seemed inconceivable. Until Laura—nineteen, beautiful, ingenuous, brash, unafraid of tyrants—had come along.

“What do you think?” Justin repeated. “Should I act like a man and try to talk this over with Carol?”

Ernest reflected on his options. Justin needed a dominant woman: Was he merely exchanging one for another? Would his new relationship resemble, in a few years, his old one? Still, things had been so frozen with Carol. Perhaps, once pried away from her, Justin might be open, even briefly, for therapeutic work.

“I really need some advice now.”

Ernest, like all therapists, hated to give direct advice—it was a no-win situation: if it worked, you infantilized the patient; if it failed, you looked like a jerk. But in this instance he had no choice.

“Justin, I don’t think it’s wise just yet to meet with her. Let some time pass. Let her collect herself. Or perhaps try seeing her with a therapist in the room. I’ll make myself available or, better yet, give you the name of a marital therapist. I don’t mean the ones you’ve seen already—I know they didn’t work out. Someone new.”

Ernest knew that his advice would not be taken: Carol had always sabotaged marital couples therapy. But content—the precise advice he gave—was not the issue. What was important at this point was process: the relationship behind the words, his offering Justin support, his atoning for weaseling, his making the hour wholesome again.

“And if you feel pressed and need to talk before our next session, call me,” Ernest added.

Good technique. Justin appeared soothed. Ernest regained his poise. He had salvaged the hour. He knew his supervisor would approve of his technique. But he himself did not approve. He felt soiled. Contaminated. He had not been truthful with Justin. They had not been real with each other. And that was what he valued about Seymour Trotter. Say what you will about him—and Lord knows a lot had been said—but Seymour knew how to be real. He still remembered Seymour’s response to his question about technique: “My technique is to abandon technique. My technique is to tell the truth.”

As the hour ended, something unusual transpired. Ernest had always made a point of physically touching each of his patients at every session. He and Justin customarily parted with a handshake. But not this day: Ernest opened the door and somberly bowed his head to Justin as he left.


It was midnight, and Justin Astrid was less than four hours out of her house, when Carol Astrid began cutting him out of the rest of her life. She began on the closet floor with Justin’s shoelaces and a pair of pinking shears and ended four hours later in the attic cutting the big red R out of Justin’s tennis sweater from Roosevelt High School. In between she went from room to room methodically destroying his clothes, his flannel sheets, his fur-lined slippers, his glass-covered beetle collection, his high school and college diplomas, his porno video library. Photos of his summer camp where he and his co-counselor posed with their group of eight-year-old campers, his high school tennis team, the senior prom with his horse-faced date—all were slashed to pieces. Then she turned to their wedding album. With the help of a razor-blade knife that her son used for model plane construction, she soon left no trace of Justin’s presence at St. Marks, the favorite site of fashionable Episcopal weddings in Chicago.


On Sale
Mar 25, 2014
Page Count
384 pages
Basic Books

Irvin D. Yalom

About the Author

Irvin D. Yalom, MD, is professor emeritus of psychiatry at the Stanford University School of Medicine. He was the recipient of the 1974 Edward Strecker Award and the 1979 Foundations’ Fund Prize in Psychiatry. He is the author of When Nietzsche Wept (winner of the 1993 Commonwealth Club gold medal for fiction); Love’s Executioner, a memoir; Becoming Myself, a group therapy novel; The Schopenhauer Cure; and the classic textbooks Inpatient Group Psychotherapy and Existential Psychotherapy, among many other books. He lives in Palo Alto, California.

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