In Treatment, Week 2
In Treatment -- Paul, week 2
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.
He takes a cold pill. She offers him tea, he asks for water.
He tells her about Jake and Amy.
"Ultimatums from two women", Gina observes, Kate and Laura.
"Two", he asks, "how about three?", looking at Gina.
Gina asks if his relationship with Kate has been a wall that has protected him from attraction to his patients. Gina tells him she is not worried that Laura will breach the wall, but that Paul is hoping she will. Gina points out that Paul is surrounded by women who demand of him that he feel, that he face his feelings.
He tells Gina that Kate hates his work, hates the secrecy. She wants to make changes and he won't let her, because he agrees with her, it's not her space. He says he used to talk about patients in general terms with his family but not any more.
He asks about the issue with Laura and the bathroom, would she let Laura use the bathroom in the house? That she wanted to breach the wall. Gina asks what he did. He said he panicked, he jumped up because he panicked, he thought she was doing it on purpose. Then he asks himself why he panicked and he doesn't know. Gina asks if that has ever happened with another patient and Paul tells what happened with Sophie and the wet clothes -- a lot more intimate than using the bathroom, Gina observes. Why the panic with Laura and not with Sophie? Why is it all right for Sophie and Kate to meet but Laura scared you?
Paul confesses that he sort of wished that Laura would go into the house and see Kate. He tells Gina he clearly stated the boundary. Gina asks if he ever entertains the thought of having an affair with Laura. He knows how important it is to set the boundary, he knows it has to be clear that it will not happen. Gina asks further and Paul tells her what Laura said, how much she wants him. "That's a lot to stave off', Gina says. And then she suggests that Paul should transfer Laura to another therapist -- because the situation with Kate has made him angry and injured.
A female therapist? he asks? You?
Paul is angry with Gina, at her suggestion, at what he thinks she believes. He refuses to consider transferring Laura and tells Gina if it weren't for Kate's cheating, he wouldn't have come back. And his suspicion that because his father cheated on his mother by having an affair with a patient, she thinks he will also. She can't answer.
And then he brings up a patient he had referred to her, a male patient who fell in love with Gina. And that Gina fled to England in the face of it. He accuses her of abandoning her patient.
Paul admits he was disillusioned with her. And he keeps hitting er with her failure with her patient.
Gina asks him to be honest -- is he attracted to Laura?
Gina asserts that she is suggesting they *talk* about transferring Laura and look at his reaction -- he is attacking and defending.
The session ends with both of them exhausted.
In Treatment -- Jake & Amy, week 2
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.
Paul calls for Kate to ask how to get the blood out of the couch. There is tension between Kate and Paul. He frets about whether or not there will be a stain because he says his patients will wonder. Kate says maybe now he will replace the couch -- and then says that he could make the room nicer. She says that she is jealous of the room.
Paul tells her he went back to see Gina, which surprises Kate, who says she thought he despised Gina after what she wrote about him. Paul asks Kate why GIna is such a threat to her. Then they begin to fight about the kids, about Kate's sense that she carries all of the parenting load. Paul resists the idea of sending their son to a school for gifted children, something Kate passionately believes would be best for him as he hates school and has no friends. Kate cries and tells him he does not make her feel she is the most important thing to him, not her, not the kids compared to what happens in his office. She is furious that he is energetic and engaged with his patients and old and tired with his family. Paul looks defeated and acknowledges that he may be out of touch with Max. Kate sits down on the opposite end of the couch, the distance reflecting how little actual contact there is between them. Kate keeps trying to pull the discussion back to their relationship, which Paul clearly does not want to talk about. "Why don't we talk", she asks? He checks the clock and says "we have a few minutes, let's talk".
Kate says, "I'm seeing someone". Paul asks what she means and she asks what he thinks she means. He gets angry and asks about this man, who is he, where she sees him, what they do? She throws the details at him. Paul accuses her of deliberately betraying him while accusing him of being neglectful. One of those fights that takes couples over the brink into the territory of fatal wounds. And then he sits again and says, "Congratulations. You have ruined any chance of saving this marriage."
Kate tells him that it was past saving because he never noticed, because he never considered she might do something like this.
"Is it over? Are you going to keep on seeing him?"
Kate says it is up to him and he tells her to please leave.
There is a knock on the door. Paul tidies up and goes to answer, pulling himself together to meet with the next patient.
In this episode, we see one of the great, maybe the greatest occupational hazard for therapists. It is so very easy for therapists to get many if not most of their intimacy needs met in their work. The relationship is intimate, making us privy to the deepest issues of our patients' lives and though the work is demanding, we need only pay close attention in one hour increments with no requirement that we ourselves reveal our own interior. Patients are usually grateful and make us feel valuable. Compared with the mundane issues of family life -- squabbling kids, household chores -- life in the consulting room is vivid, alive, rewarding. And what goes on there cannot be brought back into the family, cannot be shared as other work usually can be. So the life of the therapist easily becomes split between the office and outside the office.
But the intimacy of the consulting room, while real, is bounded and is not sufficient for either party. Therapists need friends and close family who will not make them special, will be honest with them, and both give and receive love. Our friends and loved ones help keep our feet on the ground because they know us and love us, warts and pimples and all. There is nothing like changing a dirty diaper or washing dishes or the ordinary stuff of life to bring the therapist back from the cloud of adoration to solid ground again. But in order for those relationships to keep us grounded, they need our attention too, because when they become dysfunctional, the flight into the consulting room is an easy escape. If I am fighting with my husband or struggling with my kids or estranged from my friends, a call from a patient who needs me, who believes I can help and who adores me, rescues me from the unpleasant feelings those conflicts bring and makes me feel special and valued. So I become more open to my patients and avoidant of the people in my outside life.
I suspect this is what has happened to Paul and now all of it is crashing in on him -- his wife's affair, his son's school problems, his daughter's possible problems and his patients are not providing the escape they once did because they keep bringing his own issues to the surface. The more Laura declares her love for him, the more Paul is faced with the rejection of him by Kate. Laura moves toward him as Kate moves away from him. Alex's struggle for control over the sessions, over his life mirror Paul's own efforts to keep everything together. He can feel that someone in Sophie's world has broken the rules just as he tries to push away his own fears that Kate has broken the rules of marriage. Life in the office no longer provides escape from the messes in his own life.
One other thing to file away -- Kate mentions something about Gina having written about Paul in the past, in a way that suggests that this was a big factor in the rupture of Paul's relationship with Gina. I suspect we will hear more about this as it sounds like Paul may have felt betrayed by something Gina published and that will take us into the issues clinicians face when writing about cases.
In Treatment -- Sophie, week 2
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.
But Sophie can't handle much from him yet and she is still needing to test him, to try to provoke him -- by saying hurtful things about him, about his daughter. She can't trust him until she can feel fairly certain he won't try to hurt her.
When she is getting ready to leave, Kate asks if he had offered her tea and again sets that warm relaxed tone with her. And Sophie throws her arms around Kate in a long hug -- her need for this is palpable. This is another clear look into what is going on with this child.
I keep trying to figure out how many doors there are in Paul's office. There is one from the waiting room into the office. One directly to the outside. One to the bathroom. And is there yet another into the house?
I like the office. It seems warm and cozy and I can imagine sitting there. But it is also large and has a lot of stuff in it. Is it distracting, I wonder?
In Treatment -- Alex, week 2
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.
And here, at the end, Paul does a confrontation that seems momentarily at least to find its mark. He heatedly tells Alex that it is Alex who makes these decisions -- to visit Iraq, to leave his wife -- and that the decisions were already made before he came to either session. Alex wants to make it because of Paul he has chosen what he has and Paul is not accepting that. For a moment, just a moment, Alex pauses and his face shows us that he felt what Paul said, but then he ends the session, again throwing cash on the table and leaving, telling Paul he will keep him posted.
Alex is a tough patient. He comes but so far refuses to accept being in treatment, preferring instead to see this as consultation. He doesn't want to be surprised. He doesn't want to surrender to the process and go where it takes him. So the sessions become a series of parries and thrusts, a fencing match between him and Paul. I suspect Paul is wondering how he can get through to Alex and he seems to be reacting to the challenges rather than allowing them and letting Alex run out his control string, get tired of the game he is playing.
And, we now know as well that Alex's marital situation mirrors in some ways what Paul is experiencing in his own.
As a Jungian, I believe that we get the patients we need, which sounds like an odd idea. But Jungian therapy assumes that both therapist and patient are in the soup together and that both will be changed by the process. Paul's practice is filled with people with marital, sexual and commitment issues, which he is wrestling with in his own life. Were his own life not in turmoil, his responses to these patients would be different, though not necessarily better. It is just that in therapy it is not only the patient whose unconscious is at play. The classic diagram from Jung, showing the transference/countertransference process between analyst and patient, may help here:
If we look at the diagonal arrows, we see this process of patient influencing as well as being influenced by the analyst. Keeping this model in mind, it becomes easier to understand how Paul's own issues are being stirred up by those of his patients. It is not exceptional for this to happen, though it is sadly all to uncommon for therapists to be mindful of these forces at work. It is when the pot gets stirred in a major way, as for Paul now, that it becomes really important for a therapist to seek supervision, as Paul has begun again to do with Gina.
In Treatment -- Laura, week 2
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.
Despite her professed delight at getting married, at becoming a "we", she expresses dismay about what she sees in a couple she and Andrew know who have recently had a baby -- domesticated, she says and she looks appalled at the thought. And in the midst of her discomfort about domesticity, she decided to say yes to Andrew, certainly not a good sign. Paul asks where the yes came from. And she replies because Paul said no to her. And they return to the issue which has been hovering in the room the entire time.
Paul asks her what she had imagined might happen when she told him she was in love with him. And asks her to talk more about what happened after her mother died when she lived with a couple she liked, especially the man. And Paul connects her desire for him to her desire those years ago for David, the man of the couple. She then says she wants to pee and wants to use the bathroom but Paul tells her she cannot because the toilet is broken. She wants to use a bathroom in the house, which Paul objects to and suggests that they end early. Laura believes he is doing this to keep her from seeing or being seen by his wife.
Gina was right -- they are in the soup.
Laura says she knows when she turns someone on. And she tells him when she first saw him she thought he looked like a dead man and she wanted to take his heart and bring life into him. Paul tries to redirect back to her relationship with Andrew. Laura insists that Paul is turned on by her. Paul ends the hour. At the door she demands he tell her if he wants her. Paul says no. She leaves.
What was going on here? Once again we have the problem of the erotic transference. Laura does want Paul and does believe that she can make him happy, and he can thereby rescue her from her problems, as David could have rescued her from having to deal with her grieving and depressed father after her mother died. We can speculate, with some good reason, that Laura does not have much faith in men, in their ability to care for her rather than depend on her. She becomes almost scathing about Andrew's interest in domestic life and she believes she can revive Paul by loving him. But where does this leave her and her need to be dependent as well as depended upon?
All well and good and the stuff of therapy. BUT Paul's own issues are getting tripped here. In the way that some patients have the uncanny ability to do, Laura sees a truth about Paul which he is only barely able to see himself. Her projections about him are projections but as is always with projections, they hold an element of truth, and in this case the truth is that Paul's marriage is in trouble. Her projections, her declaration of love for him makes him uncomfortable precisely because his own marriage is in trouble and though he has no intention of acting out with her in the way she wishes, his anxiety already is making it difficult for him to hold his therapeutic stance with her. One hopes he will again call Gina very soon.
None of this makes Paul a bad therapist. He is simply human and this show is allowing us to see more of what is going on with him than we usually see about the therapist. Any of us in this field knows the experience of having a spat with our spouse or an issue with our kids or an annoying household problem just before a patient arrives. We have to push that stuff into the background, find and maintain our focus on the person sitting in front of us. It is something we are used to doing and it is not always easy. Paul's struggle is not especially unusual in that respect. But we have to maintain a level of awareness of these issues in the background in our own lives so that we can get help when they begin to intrude. And this is where Paul is right now.