In Treatment -- Mia, week 2

Mia shows up at Paul's office very early in the morning. She starts off commenting that  their positions are reversed -- he used to be in Manhattan and she in Brooklyn. Then says it is strange to be back and comments on the couch, saying the old one was black and blue and that she thought that was funny.

She apologizes for her behavior last week. And that is the reason for this visit. Paul reminds her that she waited until Friday to call for an appointment. Mia agrees with Paul that she set up their last meeting because she had wanted to needle him a bit and impress him. Paul asks if she and Bennett are involved because he noticed her manner changed when he came into the room. Bennett is married. They have been involved for over a year. He has told her he wants to leave his wife and be with her but he hasn't. Mia says she doesn't need a therapist, she needs a matchmaker. Then says he does owe her.

Mia keeps asserting she is not really a patient and she asks about Paul's marriage, if he had an affair. She has been wondering what would happen if she ran into him somewhere but she imagines he already has a girlfriend. She tells him how hard it is to find an available man. Paul asks if she is asking if he would be attracted to her. She does not respond and then talks again about Bennett.

Paul attempts a joke about something Mia says and she thinks he is trying to hurt her. She does not have children and likely will not. She tells him she saw her doctor the same day she saw Paul the previous week. Seeing Paul reminded her about her life. She got the news that she wouldn't be able to have a baby Friday and went to Bennett's house to tell him and he told her to leave and didn't want to see her any longer. Then she called Paul. She asks him what he thinks now, 20 years later, about that pregnancy. Paul asks if seeing him makes her question her decision.  She says that Paul's wife was pregnant the same time she was and he wanted her to get an abortion. She sounds angry which Paul notes to her. She refers to it as a decision they made. Mia wants it to be that Paul had a part in the decision she made. She tells Paul she thinks she loved the man she was involved with when she was seeing him before. She wants to go back to that moment when she decided. She never told Stevie, the father, though she told her father. Her father was supportive and even arranged the abortion and took her there. Paul reflects that she sees her father as perfectly supportive and he, Paul as otherwise. Paul notes that she never told him about the involvement of her father. Mia never told her mother.

Mia and her father had a secret morning relationship when she would stop by his store and read the paper with him. She tells him of a morning when the store was robbed; her father confronted the robber, then gave him the cash. It became a secret from her mother.

As Paul gently asks about the incident she resists by telling Paul she doesn't want therapy, she wants a partner. Paul tells her that therapy is what he has to offer, that she needs to look at how and why she decides what she does. Mia wants a quick solution which Paul tells her is not what she needs. She does not like hearing this. She tells Paul he can send her a bill, and that she probably makes more in an hour than he does. He asks if she would like to come back next week because she said he owed her. She corrects him and says he owes her a child. After she leaves Paul picks up a file from his desk, looks a some notes on a legal pad and at a tape labeled For Paul. He listens to music on it and looks at the file, presumably hers.


Robert Langs, a psychoanalyst who has written extensively about the therapeutic frame and derivative communication in therapy, maintains that most if not all communication made by the patient is about the therapy and the therapist. Keeping this in mind, we can see that Mia started out from the beginning making derivative remarks about Paul and about her prior therapy experience with him. She starts by reminding him about the reversal in where they live and there is an implication that he is living in a lesser area than she is. Then she remarks that his old couch was black and blue and claims to have found that funny, but she also seems to be reminding him that she was bruised by that experience and perhaps as well that he was insensitive to that fact. This anger toward Paul runs throughout the session, sometimes hidden sometimes more out in the open. We can reasonably assume that dealing with her anger is going to be an important part of the work she does with Paul.

There is an interesting way in which Mia resists a therapeutic relationship with Paul in the same way that he has with Gina. She reminds him repeatedly that she is not a patient. Each time Paul moves to make an interpretation, she resists. Paul has behaved in much the same way with Gina in the past and despite their alleged therapy agreement, I expect him to do the same again. And the issue for him, as it is with Mia, is residual anger and disappointment from their previous relationship. The unconscious cross-currents here will be interesting to watch.

We see this week that at least some of Mia's issues arise from her very close relationship with her father. Her mother is curiously absent from her narrative, as if she barely existed for Mia. Mia tells us that she had this secret morning relationship with her father, meeting him at the store in a kind of clandestine way that is kept from her mother and her father tells her not to tell her mother about the robbery. This relationship is echoed in the affair she has had with Bennett, full of secrets as affairs always are. In the way that relationships with our parents have a profound influence on our adult relationships, we can see that Mia replicates hers with her parents in her contempt for her mother and for Bennett's wife and for the secrecy that no doubt provides a frisson of being in danger of discovery.

Paul does a pretty good job holding the therapeutic stance required here. His efforts at interpretation are appropriate without being aggressive except at the end but it seemed warranted then. It is important that he be as clear as possible about what his role is with her. 

© Cheryl Fuller, 2018. All  rights reserved.