SHRINK DREAMS: The Secret Longings, Fantasies and Prejudices of Therapists and How They Affect Their Clients. By Wayne A. Myers, M.D. Simon & Schuster. 252 pages. $11.
THESE are the true stories of 10 therapists -- including the author -- who, at least for a time, blind themselves with tangled feelings and emotional judgments based on their own needs, sorrows, bitterness and, not least, love.
When the needs and desires of the therapist gain the upper hand, patients are cast in private dreams they know nothing about, dreams that aren't their own. "How, then, can we therapists avoid letting our own needs run roughshod over those of our patients?" asks the author, Dr. Wayne Myers, professor of psychiatry at Cornell University Medical Center.
In the current climate, replete with charges by patients of physical and psychological abuse by doctors, teachers and parents, it is a good question.
And it is at the heart of "Shrink Dreams." The therapists Dr. Myers describes are respected and respectable; they have credentials (though in most states, psychotherapy may legally be practiced without any training or degrees). Yet their "dreams" read like a catalog of human frailties: envy, revenge, overcoming emptiness in one's life -- the endless search for love never received.
Larry, a "compatible fellow you would want to know better," encourages his client Darrell to have a sex-change operation, helps him arrange it, has sex with Darrell/Darlene and, in horror at his own behavior, dumps the woman he has helped to create. Larry's feelings for a patient who depends on him blind him to the immorality of his own actions. The temptation to play God is overwhelming.
Most of the cases are more subtle, their truth more difficult to ascertain. Terry, a competent psychiatrist, single and in her 50s, treats the grown daughter of her former lover. "I come down on her real hard sometimes, as if I'm going to throttle her . . . as if the words were coming out of someone else's mouth," Terry says. Months into the therapy, Terry is finally able to acknowledge this serious breach of professional ethics to her supervisor and to herself. "I thought I could be helpful," she says ruefully. "After all, I knew what the family was like."
"These cases are the exception rather than the rule in most psychotherapies," Dr. Myers contends; most therapists don't translate their fantasies into realities. But the stories call attention to a human predicament: The mix of need and power creates a blurred landscape difficult for the therapist to negotiate without outside help. For the patient, it is all but impossible.
In the "strange dialogue between two people that is psychotherapy" (as Dr. Myers describes it), where the patients tell everything and the therapists nothing, the patients' judgment may always be questioned, their reservations called resistance, their values called pathologies. And by its slightest nuance, the "great stone face" of the therapist that ideally (in the transference) reflects back to the patient his own history and expectations, speaks volumes to a client desperate for answers.
But beyond the issue of their own personal histories and pain, their reliance on theory and training drives the therapists in Dr. Myers' case histories into a relentless search beneath feelings, ideas and even moral values or religious beliefs for signs of the self-interest that, in the end, is deemed to motivate us all.
In one of the case histories, Edie, a licensed psychologist, commiserates about her client Vera's "terrible burden" -- two pained and difficult children whom she carried through war-torn Hungary to escape an oppressive regime. "I've just started to tap into her anger," Edie says proudly but later complains, "What a selfish bitch she is."
These therapists fail to acknowledge the depth of their own feelings. They identify people whom they have never met as villains in their clients' lives. Often, they neglect to see families as intricately interwoven entities. Their stories raise grave moral questions: Changing lives requires effective intervention, but how directive should therapy be? Who will be the patient's advocate, when the therapist's needs are pressing, the therapist's vision skewed? Who will know?
What if the theoretical structure on which therapy depends is not adequate to the complexities of the human lives it seeks to understand and explain? Much of contemporary American therapy is about needs and boundaries; rarely does it speak of commitment, humility or sacrifice. Yet these are just the qualities a therapist needs to allow a client to create an authentic life.
Indeed, "expansion, fulfillment, the spreading of wings" -- all goals of psychotherapy -- require the therapist to balance, selflessly and from moment to moment, between detachment and caring, separateness and involvement. These are the struggles and disciplines of intimate relationships. What meaning will they have without the deep human bond we call love?
In our fragmented society, the dream of wholeness and meaning, community and kinship has poignant and profound appeal. "Shrink Dreams" eloquently describes the tragic consequences when, hopeful of receiving these gifts, we consent to see our lives through the eyes and heart of another. The book raises honest and difficult questions. Within the confines of the shrunken world of psychotherapy, perhaps there are no answers.
Fay Lande writes from Baltimore.