[An excerpt from The Patient Who Cured His Therapist: And Other Stories of Unconventional Therapy by Psychology Tomorrow’s Editor-in-Chief Stanley Siegel]
New York, January 1986
Andy Himmel and Phyllis Abrams had lived together for six years, and although they were considering marriage more seriously than ever before, they were concerned simultaneously about the future of their relationship. Initially they told their therapist, Pat, that they feared they were becoming bored with each other. They agreed that each was feeling neither thrilled nor inspired by the other. They had become completely familiar with each other’s stories. Habits of Andy’s that Phyllis had once considered en dearing were now getting on her nerves. The details of managing everyday life together had become blandly rou tine, and neither partner was introducing any originality into the relationship. Or so they said. They worried there fore-and understandably – that formalizing their relation ship might only accelerate its deterioration.
In the first half of their first session, they talked about the various ways in which a couple might become bored with each other. Their narrative, frankly, was boring. Andy was a set designer who worked at home. Phyllis was an administrative vice president of a computer software company; she worked in an office.
According to my notes, I was not present for the first two or three sessions with them because their troubles appeared to be fairly standard for couples of their age and station. I had assigned a therapist completing her post-graduate training at the Family Institute to their case. The therapist was to work alone and consult with me after the session, or each session, depending on how long she saw fit to work with the couple. I would not intervene unless the case required it, and this one did not appear to.
However, matters that at first had seemed simple and ordinary soon revealed themselves to be quite complex and extraordinary.
At some point in that first conversation, Andy revealed to Pat that before he and Phyllis shared their lives together, he had been a drug user – a drug abuser, for that matter, as he admitted after Pat probed the subject a little. He finally admitted that he had been a burned-out drug addict who had been remanded to a well-known, full-time, live-in, rehabilitation facility.
Slightly surprised at the revelation, partly because of how severe he had allowed the situation to become, Pat asked Phyllis if she had known this about Andy’s past. Phyllis knew. She knew even more. As if in a card game, Phyllis saw Pat’s surprise as a bid and upped the ante. Not only had Andy been in a treatment facility, Phyllis added almost casually, he had been asked to leave.
“Why?” Pat inquired, knowing that residential drug rehabilitation centers were hard to get into and very hard to get out of. People tried to escape from rehab centers; they didn’t ordinarily get expelled. “Why did they ask you to leave?” she repeated.
The couple immediately began evading the question, almost conspiratorially. They hesitated, exchanged knowing glances, and then skirted the subject entirely. Andy said, “Well, I have something of a temper…” and trailed off. Phyllis nodded, shrugged, and then looked down at the floor. Andy talked about his more distant past as a juvenile delinquent – a rebel, a free spirit, a creative person in an unappreciative world – then he returned for a while to the subject of marriage and his relationship with Phyllis. Respecting their reluctance to reveal what made officials expel Andy, Pat returned with him to the subject of the marriage and the relationship and asked if either of them could pinpoint a time, place, or incident where the decline might have begun.
Andy started to offer one possible answer when Phyllis interrupted to say that for a short time she had thought he was unfaithful to her. “I became suspicious for a while,” she said, “but as it turned out, he wasn’t. He wasn’t being unfaithful. So it sort of blew over. More or less.”
“What made you suspicious in the first place?” Pat asked.
Phyllis gave Andy a quick glance first, then said: “The clothes. The clothes in his closet.”
“The clothes?” Pat asked, baffled. “Yes. Women’s clothes.”
“She thought they were somebody else’s,” Andy explained. “That’s obviously what made her think I was being unfaithful. I’m home all day. There are women’s clothes in the closet; therefore, there must be another woman. But there wasn’t.”
“What were the clothes doing there?” Pat asked.
“They were mine,” Andy answered. “They still are mine. I, uh, wear them sometimes. I dress up.”
“That was also why the drug rehab people asked him to leave,” Phyllis added.
“I didn’t have my own…”
“He was stealing the girls’ clothes and dressing up in them.”
Pat’s notes indicate that at that point, as the session ended, she sensed strongly that she might need assistance from other members of the team. The narrative had taken more turns than she felt her compass could completely handle and she was feeling very vulnerable, close to overwhelmed by the couple’s evidently bizarre revelation. My notes indicate that I asked her to conduct one more session by herself, not so much because we didn’t agree with her but because it was a very busy time. We had many cases to discuss, and we all were struggling with heavy schedules.
In the second session, having thought about it for a week, Pat asked Andy to tell more about himself. Despite their original complaint, boredom was not the problem. Pat was on her way to establishing Andy’s cross-dressing as the problem in the relationship. He reinforced her initial judg ment by revealing that he had been in psychoanalysis for the past seven years. She asked him about the focus of his psychoanalysis, and he admitted to her that it was his cross dressing. He and his analyst had explored ways of making himself stop, but unsuccessfully thus far. Worse, the impulse to cross-dress seemed to be increasing of late, and he was worried about it, too. Whereas he normally would cross-dress during the week only, when Phyllis was not at home, he was starting to dress up on weekends, too.
“Before, you were doing this somewhat secretively, and now you’re doing it right in front of her?” Pat asked. Andy nodded affirmatively.
“It’s a little unsettling,” Phyllis said, “a little frightening.”
”Does it have any effect on your view of him sexually?” Pat asked.
Phyllis thought about the question and surprised Pat with her answer. “Not really,” she said. “We have an unusually exciting sex life, at least in my opinion. We both have backgrounds in amateur theater, Andy more so than I, and he is an absolute master of acting out fantasies. He creates situations and plays them out, and if I share his imagination just a little bit and go along with the game, it’s like becoming the character in a movie. Sometimes he creates characters in costume and sort of seduces me. It can be very exciting, but without risk. It’s like having a hundred different lovers but the same love.”
The session ended. Having clearly identified Andy as the patient, Pat found herself in the same position as Andy’s psychoanalyst. During our meeting later that day, Pat asked her supervisory team to observe the next session from be hind the glass, because she no longer knew what to do. In reviewing the videotapes, it seemed to me that Phyllis’s last remark implied tremendous complicity on her part. If fantasy and drama were so welcome a part of her life with Andy, you wouldn’t think his cross-dressing would be quite as frightening as she said. I began to suspect, in fact, that his accelerated cross-dressing might have some hidden pur pose in their relationship. Pat agreed, and we said we would watch the next session.
I don’t think I heard the first ten minutes of that session, my attention was so riveted on the two faces of Andy Himmel and Phyllis Abrams, whom I had never before seen. Their resemblance to each other was so distracting, to my mind, that it drowned out the sound of their conversation. He actually was the prettier of the two, his features slightly more delicate and his frame a bit smaller than hers. He was even the more feminine-looking (though he was not effeminate) in the sharpness of his nose and cheekbones. Both wore their straight, thin, sandy blond hair cut short with bangs. Both wore glasses – his wire-rimmed; hers plastic but similarly unobtrusive. Pixie-like, they had hazel eyes and the rosebud lips of children. They were roughly the same height, though she looked taller when seated.
The similarity was eerie enough to draw me into the room. I was aware of the information I had heard about these people, but I was also aware that the combination of that knowledge and their physical similarity had caused some tiny explosion in my mind, some hint of discovery, although I had as yet no fix on it. I knew only that I wanted to know more about this woman who lived with this man who cross-dressed and who already looked just like her. Pat had made him the identified patient, but my overwhelming interest was her. I asked her to tell us about her family background.
“Well, I have a sister,” she said, as if responding directly to the stimulus for my curiosity. As a bonus she added: “My sister and I are twins.”
Pat and I looked at each other. The direction of the therapy made an abrupt about-face.
Phyllis went on to describe her relationship with her sister and, mainly, their father, who insisted that they dress alike, though Phyllis always felt herself to be the chunkier, less well-behaved, and more unattractive twin. Sharon, her sister, always could control the father better than Phyllis could, primarily through coquettishness. She would become flirtatiously persuasive and cajoling to get whatever concessions she wanted from him.
Phyllis fluctuated between awe and envy when this happened, but she recalled spending more time admiring her sister’s talents and abilities than feeling jealous of them. Phyllis even had made some sacrifices to allow her sister to leave home and fulfill both their wishes to attend a private college. Their father had made clear to them that they both could go away to school, provided that one chose a school within the state university system. He could not afford room, board, and tuition for two in private colleges. Knowing how desperately Sharon wanted to attend Skidmore College in Saratoga, New York, and how impossible it was for both of them to go there, Phyllis fibbed and said that she was uncomfortable about leaving home so soon after high school. Instead she devised a compromise plan that her father could afford. While Sharon enrolled at Skidmore, Phyllis would attend a community college for two years as a commuting student, and then finish her undergraduate work at a more distant state university college.
“Where is Sharon now?” I asked. “How is she?” “She’s fine,” Phyllis said. “In fact, she’s getting married soon. Too soon, as far as I’m concerned.”
“You don’t think she’s ready for marriage?”
“Oh, no! Christ, she’s ready. She’s thirty-four! No. She’s ready. It’s me! I don’t think I’m ready for her to get mar ried. I’ve been on edge about it. I’m also a little anxious about going to a traditional, catered wedding – as a bridesmaid, no less, at my age. It feels so prom-like, so high school. She’s doing the whole nine yards, with the wedding gown and the bridal shower and the schlepping and the cocktail hour, throwing the stupid bouquet, all of that. Yuk! “And also she’s my sister. I mean, you understand that. She’s getting married and moving to some suburb in New Jersey. My sister, who I grew up with and slept with and who was my closest friend, who knew what I was thinking most of the time… all of that. She’s getting married to this very nice guy, who is nonetheless taking her to Jersey someplace. So it’s just an uncomfortable stage for me at the moment. I’m a little uneasy about it. I think that’s normal, don’t you?”
Without hesitating, I made an intervention. I said that not only did I think it was normal, I thought it lent great logic to her relationship with Andy. I told her I often found it remarkable that couples with unique needs found each other and so exquisitely satisfied those needs. “Andy looks so much like you,” I ventured, “I would imagine that when he’s dressed, he looks exactly like your sister. For that moment he allows you to continue to have that wonderful relationship with your sister, even though she is no longer with you.”
As obvious as that now seemed to Pat and me, Andy and Phyllis seemed stunned by the observation. One of the rewards of my therapeutic approach is getting to tell people that they are all right when they have been convinced that they are not. It’s even more rewarding when the information comes as a shock, with recognition and acceptance yet to follow.
“I’m also not surprised,” I continued, “that Andy is cross-dressing more at this moment than ever before, and is doing it so boldly in front of you. Somehow you must have communicated recently your heightened anxiety about truly separating from your sister now that her wedding is imminent. At your more or less secret request, Andy is replacing her for you, making a very suitable accommodation. While cross-dressing could be perceived as an act of selfish indulgence in many circumstances, here it appears to be one of devotion, loyalty, and protection.” We ended the session with both of them dazed by the possibility that they may have been each other’s best life discovery.
The next time we gathered, Andy talked about his psychoanalysis and about his various attempts to give up his cross-dressing. I asked how he went about it, what his ritual was. He told how he would awaken early in the morning and know by the way he felt that he was going to dress up that day. It would be inevitable. If he wasn’t dressing in Phyllis’s presence, he would wait eagerly for her to leave for work. As soon as the apartment was quiet, he would bathe, instead of taking a shower, using scented soaps and applying body lotion afterward. Sometimes he dressed layer upon layer, as sensuously as a stripper in reverse, in front of a full-length mirror, watching the transformation as if he were an actor. Other times he would dry his hair and apply makeup while still wearing his robe, put on undergarments first, and then dress more briskly and deliberately in front of the mirror, as if he actually were a woman and not transforming at all. Following that, he would take a walk, window shop, and enjoy his disguise; or, on the occasions that he hated that he was dressing again and felt guilty about it, he would take in a pornographic movie or even visit a peep show, always aware of the surprised glances of the citizenry as his pretty female character slipped into the forbidden shadows. Some patrons inside were fairly disgusting to him, and he hoped that the association would make him see his own behavior as similar and thus be better able to stop it.
When I heard that-and it was the second time I had heard about his efforts to stop – I challenged his previous therapy. I said I thought it a mistake to change something that evidently was so much a part of him, a function of his creativity and individuality in general, his background in the theater more specifically. What harm did he perpetrate in testing the limits of his imagination? In some ways, I said, his ability really had been in the service and to the benefit of his relationship with Phyllis. It allowed him to be an extraordinarily creative lover, as she had described him. It also gave him a marvelously imaginative tool for helping her maintain her integrity as a twin sister. He could refashion himself as her twin. ”Who else on earth could have done that for her?” I asked him. “What a gift!
“Maybe what really troubles you is the feeling that you gave little or no control over your cross-dressing,” I said. What if you were to honor this inclination of yours, this creative ability? Perhaps then you would wrest control of it. Let me make a prescription for you. Instead of leaving this activity to the whim of spontaneity, I want you to make it a scheduled ritual. Institutionalize it. Choose the day that you are going to dress and then enjoy its stages. Indulge it. Take your bath, put on your makeup and your undergarments, watch yourself become an attractive woman, and applaud your talent for it.”
“Yes!” Andy exclaimed, as if he understood absolutely. “But I won’t do it on weekends.”
“See? You’re already taking control of it,” I said, as our time ran out.
The next time we saw them, not enough time had passed for Andy to have tested the effects of the prescription though he did tell us that he had not cross-dressed on the weekend. Neither he nor Phyllis seemed as upset or frightened as they had been, but all the indications were inconclusive. We decided to let a few more weeks pass before we saw one another again. When we did, two weeks later Phyllis was visibly depressed. Her face was drawn and colorless; he seeme to have dressed haphazardly, at least for a working executive woman in New York and we asked right away if she was feeling all right. She said she was depressed but that she could not answer why. We asked Andy if he could offer any explanation for her depression and he wisely offered one that turned out to make perfect sense. He said that he was not sure, but that he had been considering the possibility that his refraining from cross-dressing in front of her might have precipitated her depression. “I’ve taken more control of it,” he said, “and it seems to have made me a little bored with it. So I haven’t been doing it at all, and the change, in the absence of any other change, seems to be what has affected her.”
“I’m not surprised,” I said. “Let’s look at it. If you were cross-dressing less, then Phyllis might be missing her sister more and feeling depressed about the separation that is looming in her life. You probably have been protecting her from the inevitable depression she would feel about the separating. So her depression now is both understandable and positive. She must feel bad about her sister; it’s natural and necessary. You protected her as much as you could have, and maybe more than you should have.”
“I should tell you, then,” Andy said, “that we’ve decided to get married after all. We’re sort of engaged. I proposed.”
“That’s wonderful,” I said. “And look how you’ve changed your relationship! She was losing a sister; you were protecting her from feeling bad about the loss, in effect by replacing her sister. But now you’ve stopped doing that and offered another form of love and protection, a more conventional form.”
During the next few sessions, Phyllis continued to be depressed, and Andy did not cross-dress. He indulged himself only once in five weeks. Phyllis protested repeatedly that she was concerned about her depression, and I responded repeatedly by saying that she should not worry. I told her, first, that she should feel depressed, that anyone in her circumstances had a right to depression; and second, that she should not worry about feeling too depressed because if she descended too far, Andy would dress up and cure her of her depression.
Sometime around the seventh or eighth session, Phyllis confessed that she had been unable to sleep. She had insomnia. She added, however, that she had suffered insomnia as a child, so she was familiar with it, more or less. Then she added that as a child, she had suffered from depression, too, mainly because her sister was so successful.
I said that the depression and the insomnia did not sur prise me, either, and in saying so, I think I surprised her again. I told her that she merely was suffering whatever she had suffered as a child. She had postponed this inevitable separation so successfully for so long that she had to go back to her childhood maladies to ache for it. “You’re finally missing your sister,” I said, “and you are having the same reactions and feeling the same feelings you felt the first time you were threatened with exactly this separation. ”All these seem to me to be part of your attachment to your sister,” I said. “They all are reproductions of past emotions, reconstructions of past behavior in past relation ships. You were the depressed twin as a child. You were an insomniac, which focused your parents’ doting, parental attention on you and freed Sharon to become independent, gave her the freedom to go off and be herself. These things were part of a system of sacrificing yourself to allow Sharon to break away. She finished becoming independent, but maybe you did not. It seems to me that what you never accomplished was separating yourself from your sister. She is forcing that upon you now by getting married, and thus fully embracing her own independence.
“It also seems to me that this is precisely the right mo inent in your life for you to accomplish that unfinished part of your past. Your sister is getting married; your fiance, Andy, is changing, and he has invited you to change your relationship together, and you seem to be ready to make the move. I would like to suggest that from now on you try to make the best use of your insomnia. When you are awake, suffering this problem from your past, use every moment of that time to think about ways of developing your independence. That should include taking control of how dose and how distant you want to be with your future husband, by asking him to be close or distant. So far you have been communicating by some secret method, and he has been picking up the messages, but I would like you to take more direct control over telling him what you want and need.”
The next two sessions were routine follow-ups. Their progress seemed slow, but it was progress. Phyllis said that she had been following the prescription. She had been ask ing Andy to cuddle her more, for instance; she also had been spending more time doing tasks alone that she enjoyed doing by herself. She mentioned more or less matter of-factly that she had been sleeping better, too.
Midway through the tenth session, which turned out to be their last, Phyllis, seeming very relaxed, slipped into a discussion about their wedding plans and mentioned casually how frustrated she was feeling about her father’s insistence that she and Andy have the same kind of wedding as Sharon – a traditional, catered affair with tuxedo-clad ushers, identically dressed bridesmaids, and all the accoutrements that Phyllis associated with barely post-adolescent unions. Both Phyllis and Andy were looking healthy and happy by this time; she was sleeping regularly, and each said he or she felt more in control of their own lives as well as their relationship. Suddenly I hit upon an idea that I thought could help punctuate the end of their therapy and begin the next chapter of their lives. I told Phyllis to approach her father and tell him precisely the kind of wedding that she wanted.
“But tell him,” I said, “just the way you would imagine Sharon telling him. Use her methods of convincing him and winning him over. Be coquettish, if that’s what she would do. Be as flirtatious as she would be. Win him over exactly the way your sister would.”
She looked at me, smiling almost sagely, but waiting for more, for a kicker or a wrap-up line.
And one came to me.
“That way,” I added, “you will become your own twin.” Her smile broadened.
Typically, we underestimate the powerful influence that siblings have over one another. Traditional psychology places a tremendous emphasis on the parent-child relation ship, but we grow up with our brothers and sisters, and they influence us almost as profoundly as do our parents. In those relationships we learn about competition, friendship, sharing, protectiveness, and trust.
The “Double Cross” case illustrates the idea that our relationship with a sibling may be even more powerful than one with a parent. Here, a woman’s conflict over separating from her twin sister becomes the pivotal issue in her relationship with a man – in fact, a mate. Metaphorically, and unwittingly, the couple tries to solve the woman’s conflict by coming together, so to speak, in a recreation of the relationship that the woman fears is about to change. They view Andy’s cross-dressing a problem because they have not examined it from the perspective that it either solves a problem or postpones Phyllis’s having to face one. While cross-dressing happens to be in Andy’s repertoire (treated in his previous psychoanalytic therapy as a sexual deviation resulting from his improperly passing through the oedipal conflict), the extreme and exaggerated role it plays at this juncture in his relationship with Phyllis clearly identifies it as a problem-solving metaphor: it both protects Phyllis and gives her time to deal with her problem.
How did I see this so quickly when the first therapist, Pat, did not? To begin with, I entered the room already armed with the information the couple had so slowly and hesitantly offered Pat. I knew that I was about to confront a couple who were anxious and upset about the man’s growing compulsion to cross-dress in the presence of the woman he purported to love. With that in mind, I was struck instantly by their physical resemblance, as I now am sure Phyllis was struck the very first time she laid eyes on Andy. The first element of her attraction to him may well have been his resemblance to her sister.
Secondly, I think that, consciously or otherwise, she detected my recognition and was sufficiently relieved by it to reveal immediately that she had a twin sister – a statement that appeared to emerge completely free of any context .but obviously did not. She saw that I saw that Andy looked just like her, and then she rushed almost eagerly to explain the resemblance. Thus, after the first few minutes of our encounter, it made perfect sense to me that she was a twin; and it made good sense that when Andy dressed as a woman, he probably looked like her sister. It did not take Phyllis very long to reveal, still without realizing it, what generous and positive function Andy’s seemingly aberrant behavior might have served: specifically, easing the pain of anticipated sibling separation. Generally speaking, people who care about each other ache to be able to smooth the partner’s way or ease his suffering. . .
While Andy and Phyllis said they were eager to eliminate the disturbing symptom from their lives, I was concerned that the separation of the sisters would take time and that altering Andy’s cross-dressing too rapidly might cause even more havoc. Because his accelerated cross-dressing stemmed from a motive outside of their consciousness, they were not in control of it – not as much as they could be. My idea, then, was to help them ritualize the phenomenon, to bring it into their consciousness and master the ritual of it so they could decide how to use it and when to give it up.
One of the main tactical ingredients in this case, as in many of the others, was to recognize that society at large would pass negative judgment on Andy for his actions. He already had been judged in previous therapy as being defective, which to me made Andy’s bold resumption of the activity all the more generous and self-sacrificial a gesture. Once we identified his resumption of cross-dressing as a noble and creative, protective activity, and not necessarily a symptom of sexual deviation, he was free to exercise control over it. Once he had control, he could choose to employ it to rescue Phyllis when he saw that she couldn’t endure her very natural anguish, or not to rescue her when she seemed able to endure it. Thus do many patients who have already invented a marvelously creative process for solving the problems solve them more efficiently once they recognize the course they have chosen and receive some encouragement for it.
By encouraging Phyllis to incorporate the opposite and complementary traits of her sister, I was encouraging the continuation of the process of sibling identification that would allow Phyllis metaphorically to take from her sister what she envied – and to complete the twinship in her sister’s absence.