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Lying on the Couch

Lying on the CouchWhat happens when a psychologist writes a memoir?

To tell the truth I have to lie.

To write a memoir these days you had better be telling the truth. When I met with the publisher about Confessions of a Former Child: A Therapist’s Memoir, she specifically asked me if what I wrote was true. I hesitated, and a worried look crossed her face. Finally, I insisted it was all true, except for the parts I made up. She told me I needed to explain.

I told her that in essence, as a psychologist and a memoirist I serve at the discretion of both disciplines — the first devoted to understanding the human condition, the second to the condition of being human. Both employ methods of nonfiction writing to achieve their goal, but with a major difference: A psychologist must follow strict guidelines published by the American Psychological Association on how to talk about case studies of patients.

The Publication Manual of the American Psychological Association, Fifth Edition advises three strategies to disguise case material without changing the variables of the phenomena being described. These suggestions may be helpful for other non-fiction writers as well.

  1. Alter specific characteristics
  2. Limit the description of specific characteristics
  3. Obfuscate case detail by adding extraneous material

One, two, or all of these techniques may be needed to achieve the goal. Depending on your choice you should inform readers that you have made these alterations. The Author’s Note for Confessions of a Former Child: A Therapist’s Memoir, reads:

Out of respect for their privacy I have changed the names of some of the people who appear in this book. When referring to individuals I have worked with in therapy, I have followed the American Psychological Association’s guideline to protect confidentiality.

In Confessions of a Former Child: A Therapist’s Memoir, I reflect on aspects of my life and how these experiences influence work with my patients. This is the life work of a therapist, called countertransference — how memories and feelings in our psyche often merge and intertwine with our clients.

When I write about events in my life, the truth, with creative enhancement through metaphor and description to tell the story, is fact. But when I write about my patients, I have to bend reality. To tell their truth I must change features such as names, dates, gender, location and other details about them. I often use amalgams to blend and blur details enough to mask identity, but preserve uniqueness; to do otherwise would be unethical. Because my story involves the story of others, the work is to extract the distinctiveness of their condition, but not specify it to the point confidentiality is breached. There is an essence to the encounter with a patient that can be brought forward even while changing the characteristics embedded in the experience. My goal is to tell the truth, and to quote Frank Lloyd Wright, the truth is more important than the facts.

Let’s talk about Steve.

In the essay “Kettle of Fish” I detail the story of my second cousin Gary (his real name) who managed the famed bar by the same name in Greenwich Village. I was with him at the bar the night he died from a heroin overdose. All the events surrounding the story are true and factually accurate. Here is the opening paragraph to “Kettle of Fish.”

On the back of his right hand the roots of a marijuana plant are growing between his fingers. The tattoo spreads over his knuckles, following his veins, until disappearing under the cuff of his blue-and-white striped Van Heusen. The purple stem and distinctive pointy green leaves scramble up under the sleeve and emerge above his collar. The leaves and stems cross under his neck and disappear into the other side of his shirt. On the back of his left hand, the intense purple-and-green plant is so lush no natural flesh tone is visible. The dark blue suit he wears provides an unlikely background for such a mural. The tattoo is ten years old, a memento of his eighteenth birthday. The suit is new, chosen by the mortician this morning.

Many of the essays in the book move back and forth between events in my life and the lives of my patients. In a typical essay, an experience during therapy will activate a recollection from my life. In “Kettle of Fish,” as the essay progresses the scene changes to my work with “Steve.”

Lying on the Couch


Daniel Tomasulo, Ph.D.

Dan Tomasulo Ph.D., TEP, MFA, MAPP teaches Positive Psychology in the graduate program of Counseling and Clinical Psychology at Columbia University, Teachers College and works with Martin Seligman, the Father of Positive Psychology in the Masters of Applied Positive Psychology (MAPP) program at the University of Pennsylvania. He is Director of the New York Certification in Positive Psychology for the Open Center in New York City and on faculty at New Jersey City University. Sharecare has honored him as one of the top 10 online influencers on the topic of depression. For more information go to: http://www.dare2behappy.com/. He also writes for Psych Central's Ask the Therapist column and the Proof Positive blog.


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APA Reference
Tomasulo, D. (2018). Lying on the Couch. Psych Central. Retrieved on December 13, 2019, from https://psychcentral.com/blog/lying-on-the-couch/
Scientifically Reviewed
Last updated: 8 Jul 2018 (Originally: 26 Jul 2010)
Last reviewed: By a member of our scientific advisory board on 8 Jul 2018
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