In Treatment, Week 1

In Treatment -- the first week

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.

In Treatment -- Paul

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. 

In Treatment-- Jake & Amy

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.

In Treatment-- Sophie

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.

In Treatment -- Alex

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. 

In Treatment -- Laura

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. 


© Cheryl Fuller, 2018. All  rights reserved.