Lying On The Couch Sparknotes

Lying on the Couch by Irvin Yalom is about the therapeutic relationships and sometimes unprofessional relationships that can form. The primary focus is on Dr. Ernest Lash, whom works out of an office in a more privileged area of San Francisco under the supervision of Dr. Marshal Streider, a highly ambitious therapist who aims to be the president of the American Psychiatric Association, but is secretly pre-occupied by greed which ends up getting him into some trouble. Dr. Lash seems to truly enjoy his work and take pride in it. This novel opens up with Dr. Lash meeting with his one client Justin, whom after 5 years and many sessions has finally decided to leave his unhappy marriage. Justin then decides he no longer needs the help of Ernest

anymore and ends his visits. We are later introduced to Carol, who is Justin ex-wife.

Carol is an attorney and a very intelligent woman. She sets out to try and ruin Dr. Lash, since she thinks he played a key role in ending her marriage. Carol’s plan is to go to Ernest for therapy sessions as a fake persona named “Carolyn”. She tries to seduce Ernest into a romantic relationship that would surely ruin his reputation and end his career. While Dr. Lash admits his attraction to Carol as part of his open policy, he never acts on it. Carol actually begins to see the benefits of therapy and they both take a lot away from the shared experience. Through-out the book it is seen how one individual’s actions can affect others, and it highlights how ethical implications should always be considered when making decisions as a professional. Once deviation is taken from the standard protocol that is when an individual starts to slide down a slipper slope that can lead to serious

consequences.

Dr. Lash openly admits that he thinks Carol is attractive, as part of his open policy. This policy could be seen as harmful though, because this could lead to Ernest spending more time discussing his own interests and topics that aren’t necessarily appropriate or beneficial to therapy. He even began to look forward to time with Carol, and had sexual fantasies about her. He realized this erotic countertransference was beginning to hinder his ability to help “Carolyn”. Which leads to the idea of whose needs are being met with these sessions? Is “Carolyn” actually getting the proper treatment or is it solely just a time for Ernest to daydream and flirt.

Dr.

Marshal Steiber has his own issues, he begins to take inside information about investments from his client Peter Macondo in order to gain wealth. Dr. Steiber later find that the information was false and now struggles with the fact that he has lost a lot of money and with revenge on his client who gave him this faulty information. Marshal hires Carol to be his attorney and help find Peter and get back his money. This ends up putting Carol in an awkward position because she now is becoming somewhat of a therapist to a therapist and listening to Marshal’s problems when no one else will. This is unethical because Dr. Steiber shouldn’t have gotten involved in financial bonds with his client, because it clearly affected treatment. It also puts a strain on Carol because although she is an attorney and there to help people in tough situations, she is in no way a train therapist and Dr. Steiber should know better than to put that type of role reversal on

her.

Finally this novel involves romantic relationships between client and therapist. It is first made known that Carol while in college had sexual relations with her school therapist while she was heartbroken and looking for some comfort after a hard break up. Her school therapist, Dr. Ralph Cooke, took advantage of her emotions and made her feel like the sex they were having was the appropriate solution to all the pain and sadness she was going through. This unprofessional relationship continued until Carol graduated and went to grad school and even then Carol would sometimes go back to her old school to have relations with Dr. Cooke. Carol believes that this relationship truly saved her life, but as we know therapist can’t have sex with their clients and therapy still be beneficial, Therapeutic progress stops when sexual contract begins. Once a client always a client even if a therapist doesn’t currently give them treatment.
This novel is full of examples of ethical issues and implications. From sexual client and therapist relationships to therapists taking advantage of client's knowledge or wealth. This novel also makes it apparent how countertransference can greatly hinder the client and therapist relationship, and how a therapist must recognize this and make changes accordingly. At the end of the day it is always about the client and in no way should their time with the therapist become anything but about them.