Following are posts made after each episode of the series, In Treatment. In the sidebar to the right, you will see each post listed. I recommend reading, and viewing, series sequentially, as the characters do overlap and even interact. If there are issues you would like to know more about, please leave a comment and I will respond.
Congratulations to Dianne Wiest for her Emmy for her portrayal of Gina. Well- deserved. I was sorry that Gabriel Byrne did not also win. Now to wait for the next season, coming in 2009.
Did you find it interesting that Paul was not "successful "with all of his patients? This is one of the things I appreciate about In Treatment. So I thought it might be worthwhile to talk a bit about what constitutes success or failure in therapy, because it is not so easily determined as one might think.
Take, for example, Jake and Amy. Several people have written in the comments that they feel the work here failed because they apparently end in divorce. But is this failure? Before looking at the outcome, we have to think about what we look for as success in treatment. Does it mean a marriage saved Or does it mean that the parties are able to arrive at a choice that they believe works best for them? And it also depends on who one thinks the patient is. If the patient is the marriage, then it can be argued that it is the task of the therapist to support and work for it, for the improvement and survival of the marriage. But if it is the two people, then a successful outcome might well be very different.
Laura is not the only person in her therapy; Paul is part of it also. Therapy is a relationship, an immersion of two people in the figurative bath of therapy.
For psychotherapy to be effective a close rapport is needed, so close that the doctor cannot shut his eyes to the heights and depths of human suffering. The rapport consists, after all, in a constant comparison and mutual comprehension, in the dialectical confrontation of two opposing psychic realities. If for some reason these mutual impressions do not impinge on each other, the psychotherapeutic process remains ineffective, and no change is produced. Unless both doctor and patient become a problem to each other, no solution is found. (Jung, Memories dreams Reflections, p. 143)
So, Paul needs to be able to be open to what Laura tells him, to feel what she is feeling and become able to metabolize it in such a way that he can help her to understand herself and be more conscious of her life.
But, and this is crucial, Jung also says, The patient's treatment begins with the doctor, so to speak. Only if the doctor knows how to cope with himself and his own problems will he be able to teach the patient to do the same. (Jung, Memories Dreams Reflections, p. 132)
There have been many comments and questions about the relationship between Paul and Laura in the comments to those episodes. So I want to write for a bit about transference/countertransference and look at this from a Jungian perspective. This will probably take a couple of days so get a cup of tea and let's see if we can unravel this knot a bit.
I think it helps to start with the understanding that in therapy, in the therapist's office, a special space is created. A space which resembles in some ways the space of friendship, or of intimate partners. It is quiet. Optimally there are no interruptions, no knocks on the door, no insistent ringing of the telephone. So that each session has the quality of time out of time to it. The ordinary rules of social interaction are not in play. The fundamental rule is to say whatever comes to mind, something we probably rarely if ever do in other relationships. The patient is free to speak whatever feelings or thoughts she has and the therapist has no expectation of reciprocity. It is time that belongs to the patient, is for and about her in a way that most of us simply do not experience elsewhere. That no subject is ruled out, no topic taboo, an unusual degree of intimacy develops. I can say anything, feel anything and all I have to do is put it into words.
Tomorrow I will start writing some afterthoughts on the series. For today, a couple of articles worth reading:
1. Lisa Schwarzbaum writes in Entertainment Weekly about the benefits of watching the show and concludes:
" We're erratic, contradictory, each of us an individual bundle of urges, compulsions, and rationalizations, dressed in shoes. I don't count on the good shrinks of HBO to make sense of me and you and everyone we know, but I rely on them to confirm that I'm okay, you're okay."
Nicely put, Lisa.
2. And in today's New York Times, a nice piece on marriage and marital therapy, which concludes --
"Like dentists, marriage counselors often complain that couples come in too late to save the relationship. “Frequently, they’re actually going to counseling to figure out how to break up,” Dr. Smith said. Or as Barbara Thomas — an artist in New York who with her ex-husband, the writer Michael M. Thomas, saw a counselor for years — put it, “Counseling doesn’t work when it’s putting glue on a big shattered thing.”
I suspect we all expect this to be where the shit hits the fan for Paul.
Paul looks at his phone and then calls Laura -- her machine answers. He hangs up and calls again and this time leaves a message, hoping she is there and not picking up. Then we see that she is there and listening. She picks up the phone.
Paul asks if she is okay. He says he would like to see her, that they should talk. Laura agrees. She tells him to come to her house.
Kate is in their bedroom. It looks like she fell asleep reading on the bed. She wakes up to discover Paul in the doorway watching her. He tells Kate he is going to see Laura. Kate says nothing.
Laura answers the door and says it is strange answering the door for him. He says she sounds sick; she says it's just a cold. Paul comments that her house is very nice. They both seem awkward. Laura asks if her place is as he imagined it. He says it smaller and he expected more color. Laura offers him a drink, he asks for water. Paul wanders about looking at things. His cell phone rings and he sees it is his daughter.
Jake and Amy both arrive for their session. Jake says he will miss the office -- he likes the feel of it and the clutter. Paul asks why he says they will miss it. Amy says they are getting divorced. Jake says it is because of Paul, of therapy, that therapy did them good. Amy says good if you mean a disaster.
Amy asks Paul if he has ever been through a divorce. Paul suggests maybe they could start with talking about the last week. Amy says they didn't see each other all week. Her tone is brittle and angry. Amy says she doesn't want to talk about her week, that therapy has just made her miserable.. Jake says that's not how it has been, that Paul has helped them see how they bring out the worst in each other.
Amy continues to be angry. Jake seems more at ease.
Amy says she heard Jake play when she was outside where he was but she didn't go in. Jake asks why she didn't come in. Amy says because of Paul because she couldn't remember how they used to make up. Jake says sex, that was what they did. Amy says she regrets ever having come to therapy. Jake says he thinks it is complicated, that coming to understand more feels good even as he is upset that it is falling apart.
Our final session with Sophie.
Paul is making a phone call. He is calling Laura and leaves a message saying he is hoping they can maybe have a coffee.
Sophie comes to Paul's office. A man calls to her and it is her father. She asks what he is doing there. He hugs her and says she is a knockout. Sophie asks him how he knew she would be there. He tells her that her mother says she was seeing her therapist. He tells her he hears she did really well at the trials and asks why she didn't call. She tells him she was tired. He says he couldn't come, couldn't just show up. And then he asks what's going on, is she angry with him? Sophie looks uncomfortable with him. He claims he gets crazy when she doesn't call him. She says she did call. That her mom always answers her cell phone. He tries to get her to skip her therapy session but she says no. He starts asking her about therapy what she talks about, does she talk about him. Then wants to know what she says about him? And is that why she is behaving strangely? Then he says he is coming in.
A commenter asked why I thought Alex may well have committed suicide. So I'll talk about that a bit today.
I think it is important to consider how difficult it is for Alex to acknowledge in himself anything that he thinks indicates weakness. He always has to be the best, have the best, do the best. In his world, he hasn't a readily available way to deal with his deeply conflicted feelings about having bombed the madrassah. Yet it is this conflict that underlies his reason for coming to see Paul in the first place.
We know he pushed himself so hard physically after he returned to the States that he had a coronary. His refusal to attend to his body, to pay attention to what he was doing to it, can also be seen as a way of acting out his grief, anger, guilt about what he did when he flew that fateful mission. And because he cannot express those feelings, where can they go but inside, into his body where they become symptoms?
Alex has grown up in a family where repression is a way of life, seen as a means of survival. When his father essentially tells Paul that therapy, in uncovering things better left buried, caused his son's death, he is telling a truth, at least from inside that system.
There are just 3 episodes this week, Wednesday-Friday. So today and tomorrow, let's start looking back.
Monday is Laura's day, Laura who apparently left therapy three weeks ago. We know Paul saw her last week at Alex's funeral but we have no indication that he has seen or talked with her since then. I have said before that Laura's infatuation with Paul is anchored in fantasy and the experience of being in therapy. Having someone pay close attention to what one says and to not ask anything in return is a heady experience and indeed, given the subject matter, feels and is intimate. But it is not the intimacy that grows of two people taking time to get to know each other. As we grow close to another, a lover, we become acquainted with how he or she smells, likes and dislikes, moods, history -- all the details that get knit together in a relationship. But Laura has only a limited view of Paul and her fantasy of what she hopes and wants him to be like. In truth she does not know him at all, as a person outside of his office.
We know that Kate won't be with Paul this week. So where will things go with Gina?
Paul arrives and starts by mentioning Kate. He tells Gina Kate is tired of the back and forth and that he respects her choice to decide on her own.
Gina asks how Paul thinks the sessions with the two of them went. Paul damns with faint praise, by saying they helped and criticizing Gina. He talks about envying writers because they create characters ad get to decide what they will do and what will happen.
Gina tells him she is very sorry about Alex. Paul talks about the funeral and how hard it was, how futile it all is. How strange it is to see the relatives he had been hearing about and they are not so much like the people he knew from Alex. Paul moves to talking about Amy. But his tone is intellectual and he seems somewhat detached from what he is saying.
Gina says she hears from him both his intense connection with his patients but also a longing for their family and friends. Paul says Alex left him as a repository of the atrocity he committed. Gina asks how she would describe Alex's state of mind at his last session. Is Paul feeling responsible. Paul says he asks a psychiatrist who consults with the Navy and he said Alex went into vertigo. Paul says he thinks he killed himself. Paul cannot understand how Alex could live with the deaths he caused. So many expectations placed on him, yet Paul saw him as a good guy, charming and endearing underneath the posturing. Paul ays Alex asked him if he should fly, that he wanted him to tell him what to do. Gina says that was not his place. He tells Gina that Alex's father thinks it is therapy that killed him, that removing the repression made it impossible for Alex.
Well, you know how I feel about this couple. Let's see where they take us today.
Kate is standing by the office window when Paul enters after telling Max to take care of something. He and Max have been to Max's game. Kate asks Paul to close the door so she can talk with him. She tells him that she called and left a message for Gina that she won't be returning to therapy. That she does not want to go over that ground again, that she needs to figure this out on her own. She tells him that she is really happy he is seeing Gina and that she hopes she can help him.
Jake is there. Paul asks if Amy is coming and he says he doesn't think so. Jake says it has been a weird week, quiet and awkward. That Lenny seems relaxed and at ease, which he thinks is odd. Paul says kids do that when they sense tension, try to get the parents to feel better. Jake says it isn't fair.
Jake says Amy has been trying to make it up to him about Ben, doing housework, trying to kiss him, but he can't do it, can't get past it. Paul says it can be hard to relate to someone after an affair. Jake says he stood and watched her sleep one night, that she looked beautiful. And how easy it would have been to lie down next to her and put his arms around her but he couldn't. So he jumped into his car and drove away and ended up at his parents house, four hours away. It was too early to ring the bell when he got there so he slept in the car. Jake says his mother comes to see Lenny but his father is more limited in his interactions with Lenny. A knock on the window of his car wake him up and it was a cop who was someone he went to school with, someone who fulfilled his childhood dream by becoming a cop.
I always look forward to Sophie, to see Paul at his best as a therapist.
Sophie and her mother drive up to Paul's. Sophie argues with her mother about the fact that they are a bit early. Sophie tells her she doesn't have to wait. Her mother says she doesn't mind. She compliments Sophie on her hair and touches it, smiling. Sophie starts to say something at the same time as her mother does. She suggests to Sophie that after her session they might do something together. Sophie leaves the car.
Sophie is crying and sitting on the floor. Paul sits across from her also on the floor. She says everything is going to shit. She says she has tried all week to talk with her mother but she can't, she just can't. She says she just wants to talk to her. She says her father has been calling every day this week, like he is trying to be most attentive father of the week. She hasn't returned any of the calls. And she says yesterday her leg began to shake and she thinks she will be pulled from the meet. She says even if she makes the meet how can she ace the national trials if she is shaking. Something is wrong , she says. She recites the series of events from the accident to the rash she has now. Paul reminds her the dermatologist says there is nothing wrong, that it is anxiety.
It is raining as someone comes up the walk outside Paul's office. It's Alex's father. Paul explains about the doors, that it is custom to keep patients from running into each other.
Paul explains that he must respect the privacy of his work with Alex, though he will answer what he can. Alex's father says he wants to find something that will tell him what happened to his son.
He calls Paul on not revealing at the funeral what his relationship with Alex had been. Paul asks if he is surprised that Alex was in therapy. He says he is surprised at how secret it all is, though it is often secrets that bring people into therapy in the first place. Paul says it is often helpful to talk with someone who is not involved in your life. Alex's father says like a prostitute? Paul says he cared about Alex or he would have been a pretty poor therapist.
He asks Paul if Alex talked about things he told no one else. He says he knew Alex well when he was a little boy. Paul asks about that and he says that Alex was quiet, inventive. Paul asks if he got that, being inventive, from him and he says no, his grandfather. He says Alex and his grandfather had similar mannerisms and ways of talking and how odd that was for him, given how long the grandfather had been dead.
Will Laura be back this week?
Today opens with Paul standing outside a cemetery. There is a funeral. We see people in Navy uniforms. Is it Alex who died? Paul signs a guest book.
Yes, it is Alex's funeral. There are two ebony objects on the casket. Paul introduces himself to Alex's wife and others standing near the casket. We see people we can guess are Alex's gay friends. And Paul's son, Roy.
Paul sits down next to Roy outside the chapel and talks to him. He tries to assure Roy that thinking angry thoughts or crying is okay. Roy says he doesn't want to cry. Paul tells him he doesn't have to be strong. Roy says his father told him he had to be strong, be the man of the house when his father wasn't there. Paul says he understands that but that maybe he and his mother could help each other feel better. Paul tells Roy that he recognizes the chess piece he put on the coffin and Roy says it represents his father's favorite chess move.
Laura comes in. She thanks Paul for calling her. She asks if he is all right and Paul says he hasn't slept well, that he hasn't had a patient in therapy die while in treatment. She urges him to take some time off.
Will Paul be able to get outside of himself enough today to listen to Gina? We'll see.
Paul is in his office. The phone rings. Paul asks what the dermatologist says and then addresses her as Sophie. Kate asks who it is and he says a patient the same age as Rosie. Kate asks f it is the same girl she helped with her shirt that day.
Kate starts by telling Gina that Rosie knows, that she asked Kate. Rosie asked if she were sleeping with someone. Gina asks why she asked this and Kate tells her about Rosie's call. Gina asks if the boys know. Paul says he spoke to Ian, though not specifics. Kate asks why they can't talk about this at home. Kate is angry that Paul told Ian and Paul tells her what Rosie had said to him just before that. Kate says Ian has always been on Paul's side.
Paul complains that Kate has not once apologized and said she was sorry. Kate says she has, and Gina agrees. Kate says Paul doesn't want to hear it because he hasn't decided to forgive her. Paul wants to talk about how Kate has been with the kids, and then criticizes her.
Thursday is not my favorite day of Paul's week. Jake & Amy time again.
Paul opens the door and Jake walks in. He says Amy is waiting in the car. Jake talks about how nice the neighborhood is and how much the house Paul lives in is worth. Paul says they have lived there 22 years. Jake says he hiked the Appalachian Trail when he was 17 -- the trail goes through near Paul's house. Jake asks if he and Paul might have become friends if they had met long ago.
Jake says they drove there together today -- part of the new plan, to be accommodating. Then he starts complaining about Amy's driving, that she won't talk on the phone while driving, despite the fact that she treats the car as a place to do business. So she pulls over every time. Paul asks why he doesn't drive. He says he fell asleep at the wheel a few years ago and ever since she has been the one to drive and that he hates being driven around by a woman.
Amy comes in, saying she is late this time to make up for being early last week, then says she was late on purpose to let Jake and Paul catch up. Paul states that Amy was there alone last week -- Amy bristles and says Jake knows that. Jake says he was meeting with a potential client and Amy archly asks if the client is buying. Jake backs off. Then says Amy's boss is working her too hard. She snaps at him to stop it, that he is annoying.
Sophie is waiting when Paul opens the door. She is texting someone, then she tells Paul it's her father, that he is in Boston and she may go see him next week.
Sophie starts by saying she had a dream that her father was in danger. So she called her father and he tells her that someone had broken into their hotel room and stolen his favorite camera. Sophie asserts that this is proof positive of their connection. Paul asks if going to Boston will interfere with her Olympic training. Sophie says it is not a big deal.
Paul asks when was the last time she saw her father. She says 6 months ago, that they went to a fancy restaurant with his girlfriend. He flirted with a waitress and his girlfriend got angry so they left. Sophie is unclear which girlfriend he is with now. She says she took a trip with her father to Paris when she was 13 and she lights up as she describes it.
Paul asks about the dream. But she says she doesn't want to say more about it. She says the important part is that she felt he was in danger, that they are linked. She says it was a terrible a dream, a nightmare. She asks Paul if he has nightmares. He tells her one he has had since he was a kid. She asks him what he thinks it means and Paul says he thinks it means he was going to disappoint his mother. She asks if he did and he says he doesn't think so.
It is entirely expectable that Alex returns this week -- and that he is in uniform, given the ways he has acted on his impulses in prior weeks.
And show up he does. When he opens the door Paul jokes that he feels he should salute. Alex comes in and says this is his last time at least for now, he wants to settle up. He offers to pay for next week as well and makes a crack about the gravy train ending.
Paul asks what happened and Alex tells him that he was asked to come and train new pilots. Alex tells him about how he can intimidate the younger pilots but also that he doesn't feel the project can succeed because there is too little time. Paul says it must feel great to awe the others and he shrugs and goes on to tell another way he betters them with his skill. Much bravado. Alex says he never panics. He keeps fishing for recognition of his superiority from Paul. Then he says he has pushed to be able to return to combat flying. Alex is not happy when Paul seems not to agree this is a good idea.
Well, Laura doesn't come to see Paul this week because it is a holiday, so he spends the time with his kids.
Paul is at his desk and his daughter, Rosie, comes in. She tells him her older brother is being an asshole. Paul says he is going back to school soon, can't they get along? Rosie complains that he washed her iPod when he did laundry. Paul makes a joke. Rosie is not amused and say she can't live without her music. Her phone rings and she busies herself texting.
Paul complains that texting seems more important than anything. He marvels that she types so fast. Rosie complains that it is private. He asks about the acronyms she is using. A friend has texted that he misses her so much. Rosie says he hasn't a name -- then says his name is Noah. Paul asks if he is from school; she says no. Rosie says she met him at the center, he was treated there. Paul asks how old he is and she says 18. She talks about how amazing the songs he writes are and that he works at Kinko's. She's trying to get him a better job. Paul observes she is good at that, helping people, but that sometimes people can help the most by setting boundaries. She thinks he is worried that she is sleeping with him, but she says he needn't worry. Paul wants to know if he has a record because of what he did. Rosie says she has to go.
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Kate and Paul arrive together. They are waiting for their daughter, Rosie, to check in with them so their cell phones are left on. They are concerned about where Rosie has actually been.
Rosie has been out for 24 hrs. Gina asks if this didn't happen before a few weeks ago. Kate talks about the shelter she runs, that Rosie volunteers there four times a week. Paul says she is a born social worker, always has been. And Gina asks how he knows that. Paul talks about ways Rosie mediated among friends. Paul somewhat hostilely interprets Gina's question to indicate that Rosie also mediates at home. Kate concludes that Rosie's volunteer work 4 times a week is too much. Gina asks when she started volunteering and they answer around 6 months ago. Kate thinks maybe Rosie should do more ordinary teenage stuff. Paul again interprets what he thinks Gina is actually asking. Gina tells him to stop that.
Kate calls Rosie and she answers. Paul says he wants to talk to her. Kate lies about where she and Paul are, telling her they are with an accountant. Paul says Rosie is not staying with that friend again. And then says he would ask why this now and turns the issue into a reaction to the problems between Paul and Kate. Gina points out that when Rosie vanishes, they work together. She asks if Rosie senses the conflict. Kate thinks they have concealed it well. Paul says he thinks it is more tense now because Kate ran into Laura.
Did you see Gabriel Byrne on Charlie Rose last night?
We begin this week as Amy is outside the office talking on her cell phone. Paul comes out and she says she is a little early. Paul asks if she can wait a few minutes and goes back inside.
Then we seeAmy is alone. She gets up to close the curtain. Then fluffs the pillow on the couch. Paul asks how she is and she says good. She says she rushed to get there. She says Jake is not coming. She tells Paul that they are together, that everything is fine and they are seemingly in love.
Amy says she was miffed that Paul asked her to wait outside and wonders if he would let another patient, someone he likes more, come in early. She says she knows she and Jake are not easy as patients. Paul asks how she would describe herself. She says maybe she would like for him to be different -- Harrison Ford. Paul asks how he would behave if she arrived early for a session. Amy says he wouldn't make her wait outside like a naughty schoolgirl. And she acts a bit flirty.
Pizza delivery arrives and Paul asks who ordered it. Paul says okay he'll take it but the delivery guy makes him say what kind of pizza.
Sophie is eating pizza. She says she realized she was hungry when she was on the way so she sent a text message and ordered it delivered to his office. She says she needs to gain weight. She asks how he is, how his mood is. She says he was grumpy the week before. She seems cheerful. Sophie asks if he was having a bad week and he says yes, and maybe some of it spilled over into this room. Sophie says she likes that side, the no bullshit side of him.
Paul asks why she said she needs to gain weight. Sophie says she has lost a little and she should be gaining because she is working with weights. Sy won't let her lift weights until she gains back what she lost.
Sophie asks if she can eat there because she knows there are a lot of rules. Paul asks what rules. She says the no suicide rule which Paul says is a pact. And she says also the one that he can't undress her. Paul says she can eat, and that he thought she was enjoying eating, with gusto. Then she stops and she says she doesn't want more. She has eaten only half a piece.
We open today with Paul carrying in the mail. Kate remarks that he never gets the mail and she asks if he is expecting a love letter. She tells him she saw Laura. Kate says she thought Laura quit therapy. Paul says she did but that she had called and asked to see him because her father was in the hospital. Kate angrily tells him he should have told her she was back. Paul says all she had to do was ask. She asks if he thinks he deserves her because of what she, Kate did to him. Then the time for the next patient arrives and she says he is saved by the bell again.
Alex arrives. Paul tells him he is glad he came back. Alex says it went against all of his instincts. Paul ask what were his instincts. First was to come back and beat up Paul and then he said he fell back on something he learned in the Navy, think like the enemy. Alex says he believes Paul is threatened by him, that he thinks of him as a murderer.
Paul asks if there is something people see in him that they react to. Alex says he believes Paul wanted to strangle him as soon as he came in the door and finally he had a chance to try last week. Paul says Alex treated Paul as he did in order to get the response he expects. Alex denies that it was important to him.
Paul's daughter opens the door to the office calling for him. The couch has not yet been made up. We hear the shower. She puts his glasses in their case.
Laura arrives and her phone rings before she opens the door. Apparently it is the hospital. She hands Paul a bag and says it is for him, maple syrup from the farmer's market. Your kids eat pancakes, she says.
She called early, before her appointment time. She thought her hour would be filled, but Paul says no. He asks about her father, who is in ICU. They both sit on the couch, at either end. She is weeping as she tells Paul how small her father looks. He puts his hand on her arm then withdraws it.
She says she took Paul's advice and told her father about David last week when she left her last session. Her father said he thought so when she tells him about David. Paul asks if she told him the full story. Paul reflects that her father didn't sound surprised, that maybe he knew all about it. And how does she feel about that? She denies that it could be that way.
A note or two here about what we are seeing with Paul and his patients and Paul in his own therapy.
We open with Gina carefully arranging the chairs in her office as she waits for Paul and Kate. They arrive and Gina and Kate embrace. They haven't seen each other for sometime. Exchange of small talk.
Gina moves to structure how they will proceed. Coming together was Kate's suggestion, Paul says. Gina suggests that they meet three times and then decide where to go from there.
Gina asks how it is that Paul agreed to go along with Kate's desire to come to see her. Paul talks about Kate and her going to Rome and what she told him when she got back. Paul says he wasn't able to talk with Kate, and Gina says then Kate doesn't know how he feels. Paul turns a bit and tells Kate he has felt rage and hurt and doesn't know if he can get past it. Kate asks why he couldn't talk about it and he responds with what he tells patients. Gina catches this and points out how controlled he is.
Paul says he feels like he is falling apart. He tells her about attacking Alex because he knew he was reacting to Kate's return because he heard her. He pulls back and says he can't talk about a patient there. Kate is surprised he won't talk about what Alex did, about spying on them. Gina asks how Alex learned what he did -- Paul says he doesn't know. Kate asks if Alex, whom she calls his creepy patient, is her fault too.
When Amy arrives in her running clothes, Jake is sitting in the garden outside Paul's office waiting. He says someone is with Paul. They are 5 minutes early. They have apparently not been together. They talk warily.
They are sitting apart on the couch. Paul asks how they are. Then he says that he will not tolerate violence of any kind in the office. Amy says it's all right because they have been separated for a week. Paul does not respond as Amy and Jake expect so they join together for a moment to criticize Paul. Paul tries to make it clear to them that what they have been doing is chaotic and unproductive because they do not respect boundaries.
Then Paul asks what happened. Amy starts to talk about what happened. She had taken their son to her mother's. Jake came by and they argued and then had sex. Paul asked what happened. Amy says that while Jake was still in her, he says if she leaves her, he will kill her which she found disgusting. Jake then counters that what she and her mother do to their son, feeding him junk food, is disgusting. Paul asks if Lenny is overweight. And Amy says he is like she was. Amy is very defensive about their son and about her childhood weight.
Sophie and her mother are outside until time for the appointment. Sophie does not want her to come in with her, even though Paul asked for her to come. Paul opens the door and asks the mother to come in. Sophie pushes past.
They sit as far apart on the couch as possible. Sophie wants Paul to say she can return to training. Sophie is hostile and attacking with her mother, says she is a crazy bitch that no one understands. Sophie says if she has to stay at home, she will slit her wrists. Sophie threatens that is she doesn't try out for he Olympics she will kill herself. Paul calls for a halt to the threats.
Paul supports Sophie's return to the gym. Sophie smiles smugly and Olivia looks worried and upset. Olympia leaves. Sophie smiles triumphantly.
Paul tells Sophie that he thinks he knows why she took the pills in his bathroom, that she was testing him and that he passed the test. But what if she tested someone else and they did not pass. They need to understand what she finds so attractive about death.
Alex arrives a little early again. It's still raining.
Alex begins by telling Paul that he broke up with Laura. Tells him he took Viagra or one of those drugs and drank and then he and Laura had sex all night. Then he says he realized Laura was using him and it was over.
Paul asks him why he makes the connection between him, Laura and himself. Alex says "Tell me that something didn't happen between you and Laura." And he says that Laura talks about Paul, asks questions about him. Paul says again he will not discuss anything about his other patients with him. Alex is convinced that Paul has had sex with Laura. Alex makes hostile jabs at Paul.
Paul collects himself and Alex backs off of asking about Laura. They start to talk about Alex and his father. Paul asks how he feels and about his relationship with him. Paul reminds him about what he said abut his father the previous week -- that he was unfaithful to his mother and yet is a good man. Alex says his father is like iron, cast iron. Paul says that iron makes him thinking of something powerful yet cold.
Paul is cleaning his teeth; the sofa bed is still open and the bed unmade. It is raining. Is Kate back? Is that the reason Paul is sleeping again in the office?
Laura is sitting on the couch and making a call. Paul tells her that they have to talk about ending therapy, not abruptly but to create a timeline. Laura says no, they are ending today and that it feels good. She says she feel better, relieved now that she has told him. And asks how Paul feels.
Paul tells her this comes as a bit of a shock and that he also feels sad. Laura doubts that he feels sadness, she thinks he is relieved.
He asks Laura how her week has been and she says terrible. Tells him about a patient, a 15 yr old, whose procedure goes wrong and she does not come out of the anesthesia and she stops breathing. The attending jumped in and managed to bring the patient back. She says she was terrified, that she only looks confident.
Paul asks if she expects that nothing will go wrong. He asks more about the girl.
Laura talks of the girl as being pretty and with beautiful hands whereas at her age her own nails were chewed down. Ad he asks her who was watching over her when she was young. Laura asks what good it does today to know how much she suffered then.
Paul arrives saying he is sorry to be late but he was at the market. And then asks her if she would put his bags in the refrigerator, that they contain fish heads because he is making chowder.
He begins by complimenting Gina on her dress and hair, says that she looks beautiful, softer. She replies she is going out with friends. Paul speculates they are a bunch of shrinks, which she agrees.
Paul talks about having been thinking about a woman he knew from training. Gina reminds him of the previous session, and Paul says it is not the first time he left angry. He says he is angry a lot these days.
Tells her about Sophie. Paul admits that the pills were his and in the medicine cabinet. Paul says he intervened and asked the admitting psychiatrist to release her, because he thinks she was testing him. He tells her how angry he got when Sophie told him about the guy who said she was like an abuse victim. Gina observes that he thinks he is more effective when he is involved, has an emotional response to his patients. Paul deflects saying he is just trying to tell her about his week.
Ah, the patients who least interest me again.
Paul is shelving a book, when he takes down a book of photographs of nudes. Then it is 5 o'clock and Amy arrives, without Jake. Amy says she doesn't know if he is coming and then he arrives.
Jake sits down at the opposite end of the couch from Amy. Amy sits there smiling enigmatically. Then Paul says he has to take the phone call - he says on the phone that as far as he is concerned, she can go home -- indicating Sophie, probably.
He apologizes again for taking the call. Amy asks if he usually takes calls during sessions. Paul again apologizes and says it was important. Jake at first defends Paul then agrees with Amy that at his rates, even a minute is expensive.
Paul notes that both of them keep coming, even when it is difficult. Amy sees it as indicative of their predictability. They argue a bit. Then Amy asks what happened with them. Jake says what happened is that they started therapy, that it has made things worse. Paul observes that maybe their arguments there have become more frequent, but that doesn't mean they are headed to divorce, that maybe they fight there because it is safe.
If this is Wednesday, it must be Sophie. And remember, at the end of the hour last week, Paul called Sophie's mother.
Sophie comes in looking quite different saying she was at a party the night before and stayed all night and then walked to her session. She tells Paul she had never drunk so much. And alludes to something with a boy there. Her casts are gone as is the neck brace.
She lies on the couch and looks almost as if she were going to go to sleep. She has taken off her red platform shoes, which she says she bought because of him, because he had called her mother who took her shopping. She talks about her mother, how she hates that she is a gymnast, which Sophie says is because she thinks it will stunt her physical development, especially her breasts. She talks about running away to the gym, but that she cannot get rid of her mother no matter where she goes. Paul suggests that she runs away in order to get and hold her mother's attention.
Paul asks about the shoes, says they remind him of Dorothy's shoes. That Dorothy found she could go home any time she wanted, with or without the shoes.
Alex arrives early, running into another patient as he does. He brings a check from Laura. He offer to pay for the additional time, and puts the cash, in bills and change on the table. Paul asks if he feels better now that he has paid, because he sees it as a way of expressing contempt. Alex pushes that aside and asks how many patients Paul has, because he wants to know how much money he makes. Paul asks if he wants to buy him out, become the only patient.
Paul confronts Alex's effort to control, to keep him in his place. Alex asks if he wants to know why he is early and tells him he went to the base today but forgot his ID. The guard tells him he is not on the approved list. Alex's effort to get the guard to tell them he is there fails and he does not get in. So Alex's sense of importance and ability to control were thwarted and he acts out his frustration with Paul.
He then says that his bad week started on the weekend when he slept with Laura. And he asks if she had already talked with him about it. Paul reminds him he cannot discuss other patients with him. Alex says he saw when he got to her apartment he could see that the meal was all about having sex. He criticizes the food, says it wasn't very good. He characterizes it all as a mating ritual implying he was not very interested or engaged. Alex tells Paul he knows Paul already know what happened, but Paul says what's important is what Alex felt, how he experienced it.
This week we first see Laura with Alex as he kisses her -- but then we see that the scene is in Paul's imagination, as Laura speaks his name twice.
Laura is describing her encounter with Alex -- she says he was tentative and did everything she did. She seems to be mocking him a bit -- Alex is weak because he isn't aggressive? Her demeanor is seductive, teasing Paul with the information.
Laura asserts that Alex doesn't like sex, that it was as if it were an assignment for him. (And I think about Alex talking about spending the weekend with his gay friend and wonder.) Laura says she brought herself to orgasm when Alex returned from the bathroom using him by riding his thigh. And then she says she felt terribly sad for him. She expected a sad orgasm but said she was surprised by its intensity and she thought Paul would be proud of her, for connecting with herself.
Paul confronts her with the fact that she began a relationship with his patient and his suspicion that she was getting back at him. She tries to deflect that but he points out that she told him she was thinking about Paul when she was with the man in the bathroom, and that was the session in which she told him she loved him. Paul suggests her sadness was because she was not with the man she wanted to be with. And we see a sadistic element in her telling him about it.
Paul arrives, looking edgy. Gina says he looks antsy and he says he is having urinary problems. Gina expresses empathy about it and the stress and he jumps to the conclusion that she thinks it is a psychosomatic problem -- perhaps because he thinks so? He goes to the bathroom and returns complaining there is no soap.
He says he is angry for having taken her advice, blaming what happened with Laura on Gina. It is all Gina's fault that Paul handled things with Laura the way he did -- Gina isn't willing to buy that. She tells him she thinks he acted hastily to deal with his own problems.
He admits to finding Laura attractive and that he has fantasized about her. He says he knows how to engage her and that he could manipulate her. Gina asks if she is the nurse there to keep Paul from crossing the line.
Gina confronts him with his defensiveness around talking about his feelings about Laura. He starts to tell her about Alex and that Laura has met him. Gina asks Paul why he is the betrayed man and not Andrew, Laura's fiance. And would his feelings change if Laura were to lose the transference to him? How does Laura see him, she asks?
I confess that I find Jake & Amy the least interesting of Paul's patients. So I didn't even watch this episode until this morning.
Amy arrives alone. She is smiling and says she feels fine. Paul reiterates his stance that in couples' therapy, they don't meet unless both are present. She asks what if she wants to see him for herself and Paul tells her in that case he would refer her to someone else.
Jake doesn't know she has come to the appointment and would not want her to. Amy tells Paul she believes she does not feel bad enough about the pregnancy loss. She is subtly both oppositional and flirtatious.
Amy's phone rings for the second time -- Paul wonders if it is Jake, ad she says it is. She has an unlit cigarette in her hand.
Paul confronts the flirtation.
Amy asks about the stain, expressing surprise when Paul says it came out easily. The stain, the loss of the pregnancy -- both too easy, one suspects, for Amy. Paul suggests this and now tears appear in Amy's eyes and she looks upset for the first time. Jake comes in.
Oh my goodness -- this time Sophie arrives wearing a soft collar for her neck. She was to have her casts off today but when her doctor saw her, he put the collar on her and did not remove the casts.
She gives Paul a boat model, because it is the last session. She heard his initial recommendation for at least 3 sessions as meaning 3 sessions. And they begin with Sophie asking to sit in Paul's chair, which he agrees to, and she acts his part, observing that he looks tired.
They switch places when Sophie decides to see what therapy would be like -- she seems to like it that Paul tells her that if she were, she would be in charge of the pace and direction.
Sophie slowly reveals the details of her relationship with Sy, her coach, after talking about her parents' divorce. She assumes responsibility for what happened, that she knew what she was doing. And that Sy had tried to hold the boundary, told her it could never happen. And when it did, afterwards things changed -- they had a big fight the next day and she also fell off the balance beam. Sy stopped them from having sex again, told her it would ruin both their careers if it got out. And then when Sy's wife returned, she told Sophie that their daughter was becoming too attached to her and she should not be around for a while. She knew that Darlene knew but wouldn't talk about it. The accident, when she broke her arms, happened that night, after Darlene gave her an apron she had gotten for her.
Alex comes in with a big box -- and when Paul asks him what it is, he says it is an espresso machine, top of the line. Paul asks if it is a hint about the coffee last week and he says it's no hint, it's a statement.
Alex goes on and on about buying it on eBay and his strategy for getting bargains, ignoring that Paul said he can't accept it. Finally Paul tells him to turn it off. And asks him if he doesn't think there is something aggressive in his behavior.
Paul tells Alex he is trying to understand what all this is about. Alex wants coffee that is top quality and he needs that there in order to open up. Then he whips out 6 kinds of coffee beans.
Alex says he met Laura. Alex thinks it is significant he met Laura who is also a patient and says he wants Paul to help him understand. Paul tells him they have now started therapy -- he brought a coffee machine because he needs it, which indicates he plans to come back, and then identifies himself as one patient who meets another. Paul agrees to allow Alex to leave the coffee machine so long as he continues in therapy, though he reserves the right to think the whole thing over.
Paul awakens to his alarm clock -- he's sleeping on the couch in his office. Not surprising given the events with Kate last week.
Laura bursts in dramatically. She finds his belt on the couch and asks if he was going to punish her for being late. She tells about seeing a dog hit by cars and that she had to pull over to help the dog. She is certain Paul would have also. He tells her he would not, that he would assume the dog was dead and go on. He points out to her that she would have been late even had it not been for the dog and that he would have appreciated a call. He suggests that being late was not coincidental.
She doesn't want to look at her behavior, that she was already late and that being late and not calling is very unusual for her. She does not want to consider this.
Paul's questions are not off base but he is using them to act out his own discomfort. Clearly Gina's questioning of his continuing to work with her has been on his mind.
Paul suggests that she was already angry before she came in the door and in fact considered not coming.
Gina is sitting at her computer when the phone rings. She answers and says "He is not here. He died a year ago. Please don't call back."
Paul returns to see Gina. He coughs and looks upset. He tells Gina that it's true, that Kate has been seeing a man and then makes it that Kate told him all the details, omitting that he pushed for them. Paul feels like everything is falling apart -- he tells her that Alex is leaving his wife, that Sophie is having an affair with her coach and alluded to something going on with his daughter. He says Kate says it's his fault, that she is invisible to him as are the children. Gina says she is confused by all the names and suggests they focus on Kate.
"What am I supposed to do? What am I supposed to do now?", Paul asks. He exaggerates what Kate told him and says he that he always thought sex was connected with intimacy for Kate. Gina asks if he asked for the details and when he admits he did, Gina says Kate wanted to make sure he got it. And confronts him that he knew.
Amy has arrived before Jake and is smoking when he arrives. Jake comes on to her as they are in the garden before going into Paul's office. They joke about names for the baby and superficially things seem better.
Amy opens saying that she did not keep the appointment with her doctor because Paul was right, she needs to think it over. They are all smiles and happy, talking about getting along better. Amy says she thinks she may want this baby and has imagined the baby, which she thinks is a girl.
Paul asks if they have talked about this decision. Amy asks what he thinks. And he wonders , despite their apparent happiness, whether they shouldn't talk about it. Jake says this is their last session because they have decided; Amy says not necessarily. Paul reiterates that they still need to talk about it.
While Amy speaks, Jake looks away. Amy gets up and goes into the bathroom. Next we see them leaving.
And Paul finds a spot of blood on the couch -- so we may fairly conclude that Amy is miscarrying.
I like Paul best with Sophie. He shows humor and warmth and care with her that he struggles a bit to show with his other patients. When Sophie arrives soaking wet to this session, he offers her dry clothes and gets them for her, his daughter's things. And she reminds him she can't dress or undress herself. And of course he doesn't cross that boundary and help her but gets his wife to help. I can hear the Langs --he of the squeaky tight therapeutic frame --followers falling over in horror at this. Kate is relaxed and good with Sophie who seems to appreciate the help.
In fact she appreciates Kate so much that she is the subject one of the few positive observations Sophie makes.
Paul tries repeatedly to learn more about what has been going on with Sophie, to follow his hunch about the coach and about her relationship with her parents but he doesn't get very far. For now, it is probably enough that he is laying the groundwork, quietly letting Sophie know that she can tell him. And he tells her that he sensed that someone had broken the rules with her and he knew she was testing him when he gave her the dry clothes.
Alex returns for a second session, to Paul's surprise. Again from the outset, Alex wants to be in charge, querying Paul about why he doesn't drink coffee and implying it is because of his heart. Alex spits out the coffee and Paul interprets it in light of his strong efforts to be in control.
Alex knows that there is a problem that he feels nothing about the people who were killed by his bomb. But he sees it as a consequence of "the system", that it has rendered him unable to feel guilt or anything for those people.
Paul is trying hard, maybe too hard, to get Alex to acknowledge feelings. It feels to me he is pushing interpretations too fast -- out of anxiety perhaps that Alex will not come back and he has to try to penetrate his defenses in what time he has with him?
We hear about Alex's father and then his wife, both with a touch of disdain and grudging admiration. Both of them controlling and he believes without guilt. After a lot about his wife, discovering he doesn't know her really and declaring he never loved her, he tells Paul he is leaving, thanks to Paul.
It's Monday so we see Laura again.
The episode begins with Paul fussing with a plunger and the toilet. At least once last week he was also fussing with the bathroom. Paul and his wife have a brief squabble about the problem. The session begins against the background of this marital disharmony.
Laura announces that she said yes to Andrew and the wedding is in June. Paul fidgets with his hands and looks a bit uncomfortable -- no doubt remembering his talk with Gina. He confronts Laura with the rapid change in her mood since last week. She protests and he compares what has happened to a diver getting the bends from a too rapid ascent from the depths -- he wonders if she has come up too quickly from where she was last week. She latches on to the diving metaphor and uses it to see them as having something in common. She firmly resists looking at anything that will take her again into the mood of last week. Paul tries several times to relate what she says to last week but she pushes him back.
So now we have seen Paul with each of the four patients and also seen him with Gina -- his therapist/supervisor/sounding board. Themes emerge.
~~ Laura with her disappointment in Andrew and her infatuation with Paul
~~ Sophie who cannot put into words what she is suffering at the hands of her coach and father
~~ Alex who has no room in his sense of himself for the pain and horror of having done great harm in service of his mission
~~ Jake & Amy whose unborn child is the container for their discontent and product of their ambivalence about each other
~~ And Paul whose patients set him swimming in a sea of painful feelings which underline his own -- in his marriage and with Gina.
Love and longing and disappointment and sex and fear and anger -- the stuff of therapy.
There has been an extended discussion in the comments to my post on the first episode, not surprising given that Laura's declaration of love for Paul touches on a lot of issues. I liked what Gina suggested last night -- that yes, erotic transferences are common, but when the therapist experiences problems handling one or has a strong response, that is an indicator of an issue within the therapist, most often in his own marriage. And this is why Gina repeated several times that Paul needs to get help, i.e. supervision, on this, because his own marital issues make the risks of mishandling or even acting out with his patient higher than usual.
I wish it were more common that therapists chose to be in therapy themselves, but surprisingly it is less common than most people think. It is not a requirement of licensure or training, except for psychoanalytic training. So I am pleased to know that Paul has his own therapist, Gina, played by Diane Wiest.
The episode opens as he returns to therapy after an absence of some time. Right off the bat Paul sits in the therapist's chair, which subtly suggests to us that it is not so easy for Paul to return. Gina has retired following the death of her husband. At Gina's gentle prodding, Paul begins to talk about what has brought him back -- he says he is struggling with his weight and is having another mid-life crisis, referring to one when he was 30 and another when he was 40. And finally he gets to the reason for calling Gina again -- that he is losing his patience with his patients, feeling burdened by them, annoyed. He refers to Jake and says he really got under his skin -- and if we listen between the lines, we can guess that there is something similar between his marriage and Jake & Amy's. And Laura and the erotic transference. He ruefully says that if patients could see what therapists really think and feel, they would head for the hills. He tells her he is feeling anxious before sessions.
Today we meet Jake and Amy. Jake is restless and agitated because he has arrived for the appointment with Paul and Amy has not. He paces, makes calls trying to find her. Jake does not want to stay and begin without Amy. Amy finally arrives.
This is their third session and Paul observes that Amy has been late each time. Jake interrogates Amy about where she was, clearly suspecting that she is keeping a secret from him. And then it emerges -- they are there trying to decide whether or not to have an abortion and he suspects she has finalized the plans. So among other things, this couple is struggling over whether or not to have another child, Amy's fears that she cannot do it, and Jake's desire to proceed. But they are each enacting the other's ambivalence.
Now, I rarely work with couples; I find it less satisfying than working with individuals. To me, with couples it feels like there are too many people in the room -- the couple and all of the shadow couples in their lives that they bring with them. And I simply do not feel as well equipped to deal with them as I do with individuals. So, I confess I had less investment in this episode and found it less engaging.
Tonight we meet Sophie, a 16 yr old who has come to see Paul for a professional evaluation for her lawsuit. We see that both of her arms are in casts and she tells us a bit about her accident, while claiming amnesia for any details.
The episode opens with Paul's son angling to stay home from school and getting caught out in the process. He storms out of the room telling Paul, "You never believe me!" -- which we should know will figure in Paul's work with Sophie.
Sophie declares she is not interested in therapy. She essentially tells Paul she wants as little interaction with him as possible in order to get the evaluation. So she begins as many adolescents do, with great reluctance and mistrust about the process. Paul, and we, can feel that there is more here to Sophie than meets the eye and he skillfully woos her into talking more than she'd planned and into coming back for 3 more sessions. He expertly gains some trust from her and subtly engages her in the process without pushing hard or making her take flight, though at one point near the beginning she does start to bolt. His work with her was a pleasure to watch.
Tonight we meet Alex, Tuesday's patient. Alex is a Navy pilot, arrogant and challenging who has sought out Paul because his friend and others told him Paul is the best and Alex will have nothing but the best. Alex is that patient who comes in and dares the therapist to be of any value, to get past his defenses and surprise him with something he doesn't know, hasn't thought of. Paul does a nice job of allowing Alex to feel that he is in charge, waiting for his opening to test out an interpretation.
It's easy with a patient like this to become defensive, to feel threatened and angry at being challenged in the way Alex does it. But Paul pretty much manages to avoid getting hooked and manages to surprise Alex just enough to make it likely he will return -- though in his time and on his terms. Alex needs to feel in control and cannot yet yield to needing Alex -- or probably anyone. At the end of the session he tosses his payment, in cash, onto the table as one might leave money for a hooker, and in that gesture expresses volumes.
I am happy to report, as has Glen Gabbard in Slate, that In Treatment does a good job of portraying psychotherapy reasonably accurately. The session, condensed as it is into 30 minutes, manages convey something close to what actual therapy is like, as close, probably, as television can come without turning to a reality show format, and that would be dreadful.
Our Monday night patient is Laura. Last night and on succeeding Mondays we will see her at her sessions. From the HBO website, we learn that Laura is an anesthesiologist and we learn in the session that she has been seeing Paul Weston, the therapist for about a year. Laura comes to this session in a bit of a crisis and reveals she has been outside waiting for her appointment time(9 am) for several hours. The crisis stems, she tells Paul, from an ultimatum her boyfriend, Andrew, issued that they should get married or break up, an ultimatum that caused a fight and her flight from their apartment to a friend, then a club and sexual acting out with a stranger. A stranger she also characterizes as giving her an ultimatum. In the telling of the events, she reveals that at the crucial moment with the stranger, she thought of Paul, the therapist, and attempted to extricate herself from the situation. After the revelation of what happened, she runs to the bathroom and we hear her apparently throwing up and then we see her looking at the items on the shelf over the sink. When she picks up what seems to be Paul's hairbrush and brushes her hair with it, I got a pretty good idea that we would be hearing about an erotic transference. Laura reveals to Paul that she has loved him from their first meeting and that she has felt she has in fact been unfaithful to Andrew all along because Paul is the center of her life. Paul is clearly a bit uncomfortable with Laura's declaration of love and moves quickly to enforce the boundaries.