Silent Partner Page 6

  “Use away.”

  “Don't you want to hear what it's about?”

  “Why not?”

  “Okay, we need someone to supervise Course 305A—the clinical practicum for first- and second-year graduate students. The professor who runs it was called out of town and none of the usual substitutes are available.”

  Barrel-scraping time. “Sounds fine to me.”

  “Okay. You're licensed, right?”

  “Not until next year.”

  “Oh. Then I'm not sure . . . Hold on.” A moment later: “Okay. Because you're not licensed the pay is eight dollars an hour instead of fifteen and subject to withholding. And there's some paperwork you'll have to fill out first.”

  “You've twisted my arm.”

  “Pardon?”

  “I'll be there.”

  In theory, clinical practicum is a link between book learning and the real world, a way to introduce therapists-in-training to the practice of psychotherapy in a nurturant environment.

  At my alma mater, the process started early: During their first semester clinical-psych graduate students were assigned patients—undergrads referred from the campus counseling service and poor people seeking free treatment at the University health clinic. The students diagnosed and treated under the supervision of a faculty member. Once a week they presented their progress, or lack thereof, to peers and instructors. Sometimes things stayed on an intellectual level. Sometimes they got personal.

  Psych 305A was held in a windowless garret on the third floor of the Tudor mansion that housed the clinical program. The room was bare of furniture, painted a grayish blue, and carpeted in grubby gold shag. In one corner was a pair of foam-padded bats—the kind provided by marriage counselors for good clean fighting. In another were piled the remains of a disassembled polygraph.

  I arrived five minutes late, “some paperwork” having turned out to be a mountain of forms. Seven or eight students were already in place. They'd removed their shoes and positioned themselves against the sloping walls, reading, chatting, smoking, catnapping. Ignoring me. The room smelled of dirty socks, tobacco, and mildew.

  For the most part they were an older, seasoned-looking bunch—refugees from the sixties in serapes, faded jeans, sweat shirts, Indian jewelry. A few wore business clothes. Every one of them looked serious and burdened—straight-A students wondering if the grind was worth it.

  “Hi, I'm Dr. Delaware.” I let the title roll off my tongue with delight and some guilt, feeling like an impostor. The students looked me over, less than impressed. “Alex,” I added. “Dr. Kruse can't make it, so I'm taking over tonight.”

  “Where's Paul?” asked a woman in her late twenties. She was short with prematurely gray hair, granny glasses, a tight, disapproving mouth.

  “Out of town.”

  “Hollywood's not out of town,” said a big, bearded man in plaid shirt and overalls, smoking a free-form Danish pipe.

  “Are you one of his assistants?” asked the gray-haired woman. She was attractive but pinched-looking, with angry, nervous eyes; a Puritan in blue denim, she appraised me baldly, looked eager to condemn.

  “No, I've never met him. I'm—”

  “A new faculty member!” proclaimed the bearded man, as if uncovering a conspiracy.

  I shook my head. “Recent grad. Ph.D. last June.”

  “Congratulations.” The bearded man clapped his hands silently. A few of the others imitated him. I smiled, squatted, assumed a lotus position near the door. “What's your usual procedure?”

  “Case presentation,” said a black woman. “Unless someone's got a crisis to bounce around.”

  “Does anyone?”

  Silence. Yawns.

  “All right. Whose turn is it to present?”

  “Mine,” said the black woman. She was stocky, with a hennaed Afro haloing a round, chocolate face. She wore a black poncho, blue jeans, and red vinyl boots. An oversized carpetbag lay across her lap. “Aurora Bogardus, second year. Last week I presented the case of a nine-year-old boy with multiple tics. Paul made suggestions. I've got some follow-up.”

  “Go ahead.”

  “For starters, nothing's worked. The kid's getting worse.” She removed a chart from the carpetbag, flipped through it and gave a brief case history for my benefit, then described her initial treatment plan, which seemed well thought-out, though unsuccessful.

  “That brings us up to date,” she said. “Any questions, gang?”

  Twenty minutes of discussion followed. The students' suggestions emphasized social factors—the family's poverty and frequent moves, the anxiety the child was probably experiencing due to lack of friends. Someone commented that the boy's being black in a racist society was a major stressor.

  Aurora Bogardus looked disgusted. “I believe I'm well aware of that. Meanwhile, I've still got to deal with the damned tics on a behavioral level. The more he twitches, the angrier everyone gets at him.”

  “Then everyone needs to learn to deal with that anger,” said the bearded man.

  “Fine and dandy, Julian,” said Aurora. “In the meantime, the kid's being ostracized, I need action.”

  “The operant conditioning system—”

  “If you were paying attention, Julian, you would have just heard that your operant conditioning system didn't work. Neither did the role manipulation Paul suggested last week.”

  “What kind of role manipulation?” I asked.

  “Change the programming. It's part of his approach toward therapy—Communication Dynamics. Shake up the family structure, get them to change their power positions so that they'll be open to new behaviors.”

  “Get them to change in what way?”

  She gave me a weary look. “Paul had me instruct the parents and siblings to start twitching and shaking too. Exaggeratedly. He said once the symptom became part of the family norm, it would cease to have rebellion value for the boy and would drop out of his behavioral repertoire.”

  “Why's that?”

  She shook her head. “It's his theory, not mine.”

  I said nothing, maintained a look of curiosity.

  “Okay, okay,” she said. “According to Paul, symptoms are communications. Because the tic communication wouldn't be unique anymore, the kid would have to find some other way of working through his rebellion.”

  It sounded ill-conceived, potentially cruel, and made me wonder about Dr. Paul Kruse. “I see.”

  “Hey, I thought it was bullshit too,” said Aurora. “Going to tell Paul that, next week.”

  “Sure you will,” said someone.

  “Watch me.” She closed the chart and put it back in her bag. “Meanwhile, this poor little boy's shaking and twitching and his self-esteem is going right down the tubes.”

  “Have you thought of Tourette's syndrome?” I asked.

  She dismissed the question with a frown. “Of course. But he doesn't swear.”

  “Not all Tourette's patients do.”

  “Paul said the symptoms didn't conform to a typical Tourette's pattern.”

  “In what way?”

  Another weary look. Her answer took five minutes and was seriously flawed. My doubts about Kruse grew.

  “I still think you should consider Tourette's,” I said. “We don't know enough about the syndrome to exclude atypical cases. My advice is, refer the boy to a pediatric neurologist. Haldol may be indicated.”

  “Ye olde medical model,” said Julian. He tamped his pipe, relit it.

  Aurora moved her jaws as if chewing.

  “What are you feeling now?” one of the other men asked her. He was narrow-shouldered and thin, with rusty hair tied in a ponytail, and a drooping, ragged mustache. He wore a wrinkled brown corduroy suit, button-down shirt, extra-wide rep tie, and dirty sneakers, and spoke in a soft, musical voice saturated with empathy. But unctuous, like a confessor or kiddie-show host. “Share your feelings with us, Aurora.”

  “Oh, Christ.” She turned to me: “Yeah, I'll do what you say. If the me
dical model is what it takes, so be it.”

  “You sound frustrated,” said the gray-haired woman.

  Aurora turned on her. “Let's cut the shit and move on, okay?”

  Before Gray Hair could reply, the door opened. All eyes drifted upward. All eyes hardened.

  A beautiful black-haired girl stood in the doorway, holding an armful of books. Girl, not woman—she looked girlish, could have been an undergrad, and for a moment I thought she'd come to the wrong place.

  But she stepped into the room.

  My first thought was time warp: She had a dark, wounded beauty, like an actress in one of those black-and-white late-show films noirs, where good and evil blur, visual images vie for control with a sinuous jazz score, and everything ends ambiguously.

  She wore a clinging pink knit dress piped with white and bisected by a white leather belt, pink pumps with medium heels. Her hair had been rolled and set, every strand in place, gleaming. Her face was powdered, mascaraed, her lips glossed a wet-looking pink. The dress reached her knees. The leg that showed was shapely, encased in sheer nylon. Her jewelry was real gold, her nails long and polished—the hue of the polish identical to that of the dress but precisely one shade deeper.

  And perfume—the fragrance cut through the staleness of the room: soap and water, fresh grass, and spring flowers.

  All curves and swells, porcelain whiteness and dusty rose, flawlessly put together. Almost painfully out of place in that sea of denim and deliberate drabness.

  “Suzy Creamcheese,” somebody muttered.

  She heard it and winced, looked around for a place to sit. No empty spaces. No one moved. I shifted to one side, said, “Over here.”

  She stared at me.

  “He's Dr. Delaware,” said Julian. “Alex. He's endured the rites and rituals of this department and emerged seemingly unscathed.”

  She gave a fleeting smile, sat down next to me, folded her legs under. A stretch of white thigh showed. She tugged the dress down over her knees. It caused the fabric to go tight over her breasts and accentuate their fullness. Her eyes were wide and bright, midnight-blue, so dark the pupils blended with the irises.

  “Sorry I'm late,” she said. A sweet, creamy voice.

  “So what else is new,” said Gray Hair.

  “Any more follow-ups to present?” I asked.

  No one answered.

  “Then I guess we can move on to new material.”

  “What about Sharon?” said Ponytail, grinning at the new arrival. “You haven't shared a thing with us all semester, Sharon.”

  The black-haired girl shook her head. “I really don't have anything prepared, Walter.”

  “What's to prepare? Just pick a case, give us the benefit of your wisdom.”

  “Or at least Paul's wisdom,” said Julian.

  Snickers, nods of assent.

  She pulled at her earlobe, turned to me, seeking reprieve.

  The crack about Kruse helped explain the tension that had accompanied her entrance. Whatever his therapeutic skills at manipulating roles, this supervisor had allowed his group to be poisoned by favoritism. But I was hired help, not the one to deal with it.

  I asked her: “Have you presented at all this semester?”

  “No.” Alarmed.

  “Do you have any case you could discuss?”

  “I . . . I suppose so.” She gave me a look more pitying than resentful: You're hurting me but it's not your fault.

  Shaken a bit, I said, “Then go ahead, please.”

  “The one I could talk about is a woman I've been seeing for two months. She's a nineteen-year-old sophomore. Initial testing shows her to be within normal limits on every measure, with the MMPI Depression scale a little elevated. Her boyfriend is a senior. They met the first week of the semester and have been going together ever since. She self-referred to the Counseling Center because of problems in their relationship—”

  “What kinds of problems?” asked Gray Hair.

  “A communication breakdown. In the beginning they could talk to each other. Later, things started to change. Now they're pretty bad.”

  “Be more specific,” said Gray Hair.

  Sharon thought. “I'm not sure what you—”

  “Are they fucking?” asked Ponytail Walter.

  Sharon turned red and looked down at the carpet. An old-fashioned blush—I hadn't thought it still existed. A few of the students looked embarrassed for her. The rest seemed to be enjoying it.

  “Are they?” pressed Walter. “Fucking?”

  She bit her lip. “They're having relations, yes.”

  “How often?”

  “I really haven't kept a record—”

  “Why not? It could be an important parameter of—”

  “Hold on,” I said. “Give her a chance to finish.”

  “She'll never finish,” said Gray Hair. “We've been through this before—terminal defensiveness. If we don't confront it, cut it off where it grows, we'll be spinning our wheels the whole session.”

  “There's nothing to confront,” I said. “Let her get the facts out. Then we'll discuss them.”

  “Right,” said Gray Hair. “Another protective male heard from—you bring it out in them, Princess Sharon.”

  “Ease up, Maddy,” said Aurora Bogardus. “Let her talk.”

  “Sure, sure.” Gray Hair folded her arms across her chest, sat back, glared, waited.

  “Go ahead,” I told Sharon.

  She'd sat in silence, removed from the fray like a parent waiting out a spat between siblings. Now she picked up where she'd left off. Calm. Or on the edge?

  “There's been a communication breakdown. The patient says she loves her boyfriend but feels they're growing distant from one another. They can no longer talk about things they used to be able to discuss.”

  “Such as?” asked Julian, through a cloud of smoke.

  “Just about everything.”

  “Everything? What to have for breakfast? Stuffing versus potatoes?”

  “At this point, yes. There's been a complete breakdown—”

  “Breakdown,” said Maddy. “You've used that word three times without explaining what you mean. Try clarifying rather than restating. Operationalize the word breakdown.”

  “Things have deteriorated,” said Sharon, making it sound like a question.

  Maddy laughed. “Terrific. That makes it perfectly clear.”

  Sharon lowered her voice. “I don't really know what you're getting at, Maddy.”

  Maddy shook her head in disgust, said to no one in particular: “Why waste time on this shit?”

  “Second the motion,” someone said.

  I said, “Let's stick to the case. Sharon, why does this girl feel things have broken down?”

  “We've discussed that for several sessions. She claims she doesn't know. At first she thought he'd lost interest and was seeing another woman. He denies that—he spends all his free time with her, so she thinks he's telling the truth. But when they're together he won't talk and seems angry at her—or at least she feels that. It came on all of a sudden, got worse.”

  “Did anything else happen at that time?” I asked. “Some kind of stressful event?”

  Another blush.

  “Did they begin having sex at that time, Sharon?”

  Nod. “Around then.”

  “Were there sexual problems?”

  “It's hard to know.”

  “Bullshit,” said Maddy. “It would be easy to know if you'd done your job properly.”

  I turned to her and asked, “How would you go about getting that kind of information, Maddy?”

  “Be real, establish rapport.” She ticked each phrase off with her finger. “Know the specific defenses of the client—be prepared for the defensive bullshit and roll with it. But if that doesn't work, confront and stay with it until the client knows you mean business. Then simply go for it—bring up the subject, for Christ's sake. She's been seeing this woman for two months. She should have done all of t
hat by now.”

  I looked at Sharon.

  “I have,” she said, the blush still in force. “We've talked about her defenses. It takes time. There are problems.”

  “Sure are,” said Julian.

  “Seck-shoo-all problems,” enunciated Maddy. “Say the ‘S' word, honey. Next time it'll be easier.”

  Scattered laughter. Sharon seemed to be taking it calmly. But I kept my eye on her.

  “Share the problems with us,” Walter was urging, grinning and playing with his ponytail.

  “They . . . she isn't satisfied,” said Sharon.

  “Is she coming?” asked Julian.

  “I don't think so.”

  “Don't think so?”

  “No. No, she isn't.”

  “Then what are you doing to help her come?”

  She bit her lip again.

  “Speak up,” said Maddy.

  Sharon's hands began to shake. She laced her fingers together to hide it. “We've . . . we've talked about . . . reducing her anxiety, relaxing her.”

  “Oh, Christ, blame the woman,” said Maddy. “Who says it's her problem? Maybe it's him? Maybe he's a bumbler. Or a preemie.”

  “She says he's . . . okay. She's the one who's nervous.”

  “Have you done any deep muscle relaxation?” asked Aurora. “Systematic desensitization?”

  “No, nothing that structured. It's still hard for her to talk about it.”

  “Wonder why,” said Julian.

  “We're just working on trying to stay calm,” said Sharon. It sounded like self-description.

  “Hard to be calm about primal issues,” soothed Walter. “Have they done oral sex?”

  “Uh, yes.”

  “Uh, in what way?”

  She looked back down at the carpet. “The usual.”

  “I don't know what that means, Sharon.” He looked at the others. “Do any of you?”

  Orchestrated smiles and shakes of the head. A predatory bunch. I pictured them as full-fledged therapists in a few years. Scary.

  Sharon was looking at the floor, fighting a losing battle with her hands.

  I thought of intervening, wondered whether that violated the norms of the group. Decided I didn't care if it did. But being too protective would harm her more, in the long run.

  While I was deliberating, Walter said, “What kind of oral sex?”