I am wary of patients with highly developed social skills, smooth operators.
Perhaps it is because of envy — I, too, wish to charm the world. Or perhaps it is because social skills and psychotherapy are fundamentally incompatible. A good therapist seeks truth, while good social skills require a kind of tactful falsity, a suppression of honest feeling in service of oiling the relational machine. Of course charm is usually an asset, but it may be also be a shield or a weapon. Social skills may be so effective in getting people what they want, they lose track of themselves, what they really want. They start believing their own lies.
I don’t like smooth operators, yet K, in the opening minutes of our first interview, deployed immense charm and I did not hesitate to take him on as a patient. Why? Maybe it was because he was black and mildly disabled and his story was poignant. He pressed all my politically correct buttons. I took pride in the diversity of my urban private psychotherapy practice. I treated the rich and the poor, the sick and the well, all races and nationalities and sexual orientations, my personal social justice campaign.
K looked vaguely familiar. I must have seen him in the neighborhood, which made sense because he told me he was a resident in psychiatry in the nearby medical center. I felt flattered that he, a psychiatrist in training, would choose to see me, a psychologist, for psychotherapy — there is a hierarchy of status in my profession, with psychiatry at the top, reigning over psychologists, who, in turn, outrank social workers and counselors. I knew already from our telephone conversation that he had Googled my name, was impressed with my background and was willing to pay full fee.
It’s a good thing when patients come to you predisposed to like you. It bodes well for the development of a working alliance. K was smooth, no doubt about it, but his presentation did not feel staged. He filled out the requisite forms and made light of the confidentiality agreement, as most of my patients do. K had brought his dog B with him and asked if he could take him into the consulting room. Another plus. I like dogs. “Sure,” I said and smiled at him as he waited for me to be seated. A gentleman, I mentally noted. “So, what brings you here? “I asked.
He talked easily, with animation. His wife had suddenly left him, he told me. K hadn’t see it coming (not a great characteristic for a future psychiatrist, I mused). He reported that he had arrived home one day and was shocked to discover that she was gone, taking all her things. Now he could not sleep or concentrate. He was drinking too much and found himself spilling all his woes to B (the dog), who, he said would listen, gaze back soulfully and cry with him. K’s eyes began to tear up, and, indeed B began howling. “If only your wife was as empathic,” I responded , as I handed him a tissue.
K grew up in the South, the only child of working class parents in a black neighborhood. He had a marked gait problem as a child, eventually corrected, but enough of a disability as to make him poor at sports, a victim of neighborhood bullying, and a disappointment to his tyrannical father. His church-going mother adored and indulged him, chauffeuring him to medical appointments and a white Catholic middle school where he excelled. He eventually obtained a full scholarship to a highly selective college and later, to an Ivy medical school. K’s mother died when he was in high school, a tragic loss for him, leaving him without protection from his critical, verbally brutalizing father.
“After my wife left, I figured out where she lived. It wasn’t hard,” he said. He was silent awhile and then looked at me steadily. “I would go there at night and peer through her window.” His pain was palpable. “You want her back so much,” I reflected. As the session unfolded I started connecting the dots — abandonment by women — not exactly a deep interpretation. Aiming for empathy, I stated the obvious — that he had disappointing experiences with women. He nodded, adding that he hated his white female chief (“Hmm — there’s his anger,” I thought).
In fact he hated most of his colleagues, male or female, who, incidentally, were all white, all wimps. He turned out to be an epic hater, and he surreptitiously acted on his hostility. He enjoyed intimidating his co-workers, playing the “black” card. He came to work late and was deliberately, overtly lazy. His colleagues wouldn’t dare confront him, the lone black resident, their valuable integration factor. Sometimes he intentionally mixed up medical charts. “No one said anything,” he bragged.
K told me he had started stalking his ex-wife. “One night, when she wasn’t in her apartment, I broke in,” said. The conversation wasn’t proceeding in a way I expected. … uh oh! He became animated. “I killed her cat; I choked it until its eyes popped out.” I was stunned, inwardly praying to the gods of psychotherapy to guide me through this. Was I supposed to be neutral, empathize, offer an interpretation? Should I remain stone-faced and ask him how it felt to kill the cat? What would Freud do? Dr. Phil? K began to laugh. He was daring me to respond, enacting his rage, enacting it against me. He was enjoying my discomfort. This is a movie, I thought, not a psychotherapy session. This guy is a sociopath.
” I am unable to help you,” I said, with as much firmness as I could muster. “Please go now.”
He didn’t move. He started begging me to allow him to be my patient. “I need help. I have a compulsion” He started talking rapidly. B became alert. “I’m a frotteurist. I rub up against women on the T….. I organize my day around this. I’m good at it. I pick rush hour, the most crowded time. I never get caught” He was sweating, breathing heavily, mesmerized by his confession and its effect on me.
I realized with horror why he looked familiar. He had frotteurized me a few weeks ago. ago. Like most victims of frotteurism, I wasn’t sure it was happening as it was happening. Now I knew. Evidently he had followed me home and used my address to ascertain information about me.
I told him to get out, with no “please” this time. He smirked, but left with B. I called the police, and then I took a bath. Neddless to say, I did not collect my fee.
Note that the patient’s identity is disguised