LYING ON THE COUCH

By Irvin D. Yalom, Basic Books, 369 pages.

"The therapy hour is designed to be a temple of honesty," says one of the characters in "Lying on the Couch," flagging the capital-I irony of the title of Irvin Yalom's new novel. Among other things, this entertaining book is a real fib-fest. Patients dissemble, therapists don't own up and by imposing narrative neatness on psychological messes, Yalom (a Stanford psychiatrist in real life) plays into the deception, as well -- anyone who's been in therapy knows how opaque it all really is. There's nothing muddled about "Lying on the Couch," however. The story streams along brightly in Yalom's second novelistic foray -- he's best known for "Love's Executioner" (1989), a nonfiction book that offered moving vignettes from his own practice -- even if the prose occasionally eddies in cliches.

The plot concerns San Francisco shrink Ernest Lash, Yalom's stand-in, and Lash's supervisor, Dr. Marshal Streider, plus several of their patients. One is bent on tricking Lash into a license-losing sexual transgression, another is a compulsive gambler who plays into Streider's obsession with money and status. (It's not surprising that Streider is a strider; Yalom loves significant monikers. Ernest Lash lashes himself with self-doubt, though he is very earnest. A patient who feels rage toward men is dubbed Leftman.) Lash is the iconoclastic good guy who believes in revealing himself to the patient; Streider is the old-school bad guy who thinks flaky Ernest is "therapeutically incontinent."

The forbidden candy offered by all of this, of course, is that we patients/readers get to eavesdrop on other people's sessions, and see things from the therapist's perspective -- both impossibilities in real life. There's plenty of transference and counter-transference along the way, plus nice set pieces on dream therapy and other fun tropes. Therapists are wounded when their patients progress without their help; patients resent their therapist's airs of all-knowingness. When Dr. Lash counsels Carol Leftman in one session, for example, Yalom nicely punctures the doc's pretensions: "Carol tried to nod in rapt agreement. Oh how brilliant, she thought. Shall I genuflect?"

To his credit, Yalom also serves up plenty of shrink-sensitive topics -- petty infighting within the psychiatric governing associations, the role of money in treatment, the narcissistic wound therapists feel because no one sees their work but their patients. "Nothing is worse than living the unobserved life," as Streider reflects, in a narcissistic twist on the old truism. Yalom has solved that problem; it doesn't take a genius to figure that this book is based on his own practice. As such, there's more than an air of self-serving to the whole enterprise. As the author writes, "Ernest realized he must focus not on content but on process -- that is the relationship between patient and therapist. Process is the therapist's magic amulet." Yeah, plus it moves the plot along, and makes the therapist the dispenser of cures. Which is why, in the end, "Lying on the Couch" is truly fiction.

-- Katherine Whittamore

Katherine Whittamore lives in Cambridge, Mass. Her work has appeared in Smithsonian, the Boston Globe and Lingua Franca.

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