Tales from the Couch: A Clinical Psychologist’s True Stories of Psychopathology

Tales from the Couch is an interesting book and will likely appeal to non-professional readers. In 16 chapters organized by diagnosis, stories of psychotherapeutic treatment given by the author are told in a well-written style that is easy to read. It is clearly a culmination work of the author’s psychotherapeutic career, which includes as he states, his most “interesting and entertaining” patients. The author goes to great lengths to describe pathologies and events by camouflaging patients by changing their names. The tales themselves are “altered” somewhat, although in any given case, it is not clear what and how much is altered.

The book contains many catchy and meaningful phrases such as:

—in an unsuccessful therapy with a father and son: “They needed a whole different tune and maybe a different bandleader.”

—in psychotherapy: “We see the private decay under the glittering public façade.”

Dr. Wendorf seems like a talented therapist who has been able to make connection with a number of difficult and resistive patients, particularly children and adolescents, underscoring the principle that “the human relationship is the real therapy.” At times, song lyrics or other people’s quotes are used to help a patient see a particular problem from a different point of view. Symptoms of mental health diagnoses are smoothly integrated into the stories making such education easy to digest.

The folksiness of the jargon is also a potential downside to this text. It is well known that in order to make a connection with young patients, it is necessary to “talk the talk” that they use. While this is necessary in treatment, such “talk” is not appropriate in a book. Calling people druggies, autistics, paranoids, and borderlines implies that their diagnosis is the sum and substance of their identity.

Perhaps of more concern is the use of the word “entertain” which the author uses both in being entertained himself as well as entertaining his reading audience. The function of patients is not to entertain anyone. Dr. Wendorf suggests that some patients are boring, tedious, and not “very dramatic” Sometimes he sees psychotherapy as “pretty dull.” Patients have no obligation to be entertaining. Psychotherapeutic work is work, but in my experience, is consistently engaging and never boring.

A depreciating tone creeps into his descriptions such that some patients are “merely weird” or one patient is “a pig.” The author may have thought he was being funny, but in fact if a therapist believes these things about patients, he needs an attitude adjustment or the patient needs a new therapist. On one occasion “just for fun,” he and his colleagues told a drug abusing patient that the ultimate psychic high occurred with Elmer’s glue to get him to try it, which he did. There is never a reason to pull a prank on a patient “just for fun.”

Lastly, although the book makes “great efforts” to hide the identity of patients, it would be much better if the therapy settings were also generalized. For example, a patient could be Teacher of the Year in “a Midwestern state” rather than a specific one as the author identifies. Patients could be seen at “a local mental health center” rather than at clinics and centers identified by name.

It may seem that I am being critical of the author and this book. These critiques are more likely ones that would be discerned by a mental health professional and perhaps minimally noticed by a lay reader who must be aware that most mental health patients are not as “entertaining” as these stories. Each person has their own story and is not “boring” to treat. They are us.