In Treatment, Week 3
In Treatment -- Paul, week 3
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?
Paul says she sees an older man, an authoritative strong man, a man whose strength she could take on, and that he will disappoint her. And that sex is what she uses to get concern. She thinks Paul is a coward and in love with her.
And then how Paul sees her. She's 30, beautiful. Smart. Good laugh. His face softens as he speaks of her -- she is childlike and vulnerable, fascinated with the power of sex.
Gina connects Laura's experience of having to take care of her father with Paul's having to care for his mother after her breakdown.
Then he tells Gina about Kate going to Rome with the other man. And he can't sleep in the marital bedroom. The kids seem to be falling apart, though he and Kate have not talked with them.
Gina confronts him with her sense that it is Paul who wants to run away, who wants to get away from his patients and using Gina as an accomplice, a way to shed his practice.
It really is a puzzle why Paul went back to Gina. Of course we can see that there is a powerful emotional connection there and we know they have a history together, but he steadfastly resists everything she suggests and each session is spent in a jousting match. I am puzzled about why she doesn't ask more directly why he has come back to her and steer them into dealing with the the lingering issue from the past. But I also know that it is for Paul to open that door.
I have often had the experience of patients returning to work with me, even when we ended on a difficult note. So it isn't strange that Paul would do this. Or even that he has conflicted feelings about Gina and their prior work together. So one can guess that fighting with Gina is part of the reason he is back, that the sparring is important to him as a way of defending against what he calls her pet theories, about his father and how he is replicating his father's pattern and still struggling against his own unresolved childhood issues.
In Treatment--Jake&Amy, week 3
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.
Jake and Amy begin to argue. They are tense, unhappy, angry. Jake turns the attack onto Paul. The sparring between Jake and Amy continues as they bait each other.
Jake believes Amy is always on the prowl for men. Paul suggests that the pregnancy was a way for Jake to rein her in, have control.
Amy angrily gets up to leave and tells Jake she did not want the baby and she is glad it is gone. Jake goes to the door.
Paul turns on music and stretches out on the couch, looking tired. Kate knocks and then comes in. They begin to fight -- about Kate's absence each evening, that she is going away the next week. When pushed she tells him they are going to Rome, one of the places she and Paul have enjoyed together. They end with bitterness and anger as she leaves.
Jake & Amy seem mostly to serve to bring Paul and Kate's problems to the fore. As he was leaving, Jake implied that continuing to see Paul will just push them to divorce and Paul told him if they both come, perhaps divorce need not happen. But neither Paul nor Kate seems the least inclined to head off what looks to be their own impending divorce. The anger and tension between both couples is palpable, and both men seem to be the injured parties, using their injuries to fuel their rage.
Paul's stance with Amy at the beginning when she seems to be angling to have him to herself as her therapist is an excellent one and one that I endorse. But there are other models as well. Many therapists would be willing to see either or both parties separately as well as together Yet another model deals with the couple by working with each one separately n only seeing them together at widely spaced intervals. And still others see couples work as a specialty for those specifically trained for it. There is no clear consensus on what is the best practice, as it varies by theoretical orientation and therapist preference. I have limited my own work with couples as I do not find it as rewarding as individual work.
In Treatment-- Sophie, week 3
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.
Sophie escapes into the bathroom. We hear glass break. Two pictures are on the floor, the glass on one broken.
Sophie pushes Paul to tell her if he thinks she tried to kill herself. And he tells her that even after the casts and neckbrace come off, the problems she has been struggling with will still be there and she could again find herself in a place where another accident might occur. He asks where she feels safe. She answers on the beam; with all its possibilities for injury, this is the one place where she feels safe..
After Sophie leaves, Paul calls her mother and asks her to call him so that they might discuss her return to the gym and to training.
Paul is at his best with Sophie -- he seems well attuned to her and able to confront in a gentle enough way to slowly draw her into the therapy she claims to not want. As her story comes out we get a picture of a child in jeopardy, a child who blames herself for the collapse of her parents' marriage, her father's subsequent marriage, and for ruining Sy's family. And when the glass breaks in the bathroom, Paul, and we, immediately fear she is doing something to harm herself --because suicide hangs in the room, enveloping Sophie in its tempting possibilities. We know that at least on an unconscious level, her accident was a suicide attempt. And Paul's call to her mother offers some possible relief for us because he is willing to act on his concern for her, even though he knows she will not like it.
I also noticed a parallel between Laura and Sophie. Both were seductive with a man who was supposed to maintain the boundary, not allow the wall to be breached. Sophie's story becomes yet another warning to Paul about he danger in the situation with Laura.
In Treatment -- Alex, week 3
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.
Alex has left his wife and he says it is because of Paul, of Paul helping him. He says telling her was as unemotional as telling her he was taking the car to the garage. His wife was not surprised and told him he did not surprise her even then. Alex can't admit to being hurt by her indifference. His kids haven't been told -- Alex thinks his son will understand that he had to leave to find his new life.
Notice that Alex's son, Roy, sounds like Paul's son, Max. A loner, not involved in sports, different. Alex says he finally understood that Roy is happy, just different from his dad. It turns out that Alex sees the women in his life -- his wife and mother -- as pure and wholesome and, Paul suggests, the men as dirty. Alex agrees about his father, whom he describes as a womanizer. He sees his father as having trusted only his mother, yet still he cheated on her. Paul draws the parallel between Alex in his marriage and his father in his, that Alex leaves where his father never did, his father cheated, whereas Alex leaves, he acts. Alex denies that there is any connection.
Alex says he wants to return to talking about Laura. And then he talks again about the coffee machine. Paul directs him back to the therapy. Alex tells him Laura thought the machine was terrific. He says he lost track of time because of the weekend time he spent with some gay friends and so he showed up on Monday instead of Tuesday and met Laura. He describes Laura as having something fierce about her, that she is used to getting her way and that she told him Paul was capable of ruining a cup of Lipton tea. They went to see if the dog was where it was hit but the dog was gone. They never did find the dog. Alex's phone rings and it is Laura. He takes the call and tells her he is with Paul. He hangs up and asks -- So what do you think? Should I go for her?
Paul has to repeat he can't answer that, can't give him advice.
Alex tells him Paul always helps in the end and then tells him when Laura is there to pull the handle fast because she likes a lot of foam.
Tonight we see parallels between Alex and Paul -- sons who are different, fathers who cheated, mothers revered, and marriages if not over, at least in dire jeopardy. And Laura. Like I said last week, we get the patients we need.
Alex is very difficult to deal with, because his drive to control and his aggression are so persistent. Paul tried to engage him more therapeutically but for the most part, Alex resists. We can guess that Laura and Alex talked more about Paul than he mentions and this connection between the two men hangs in the air throughout. The dynamics here are very complicated -- Alex's need to be better than best, to defeat his father and the accompanying Oedipal issues, are surely involved. He has so far shown very little willingness to submit to the therapy process, to allow himself to not be in control. What does it mean for him to be forming a relationship with Laura, who like him is Paul's patient? What are his fantasies about this, about what Paul feels? That Laura has intruded into this relationship and created a very difficult triangle has immeasurably complicated everything.
And all of this is further complicated by Paul's issues -- with his marriage and with Laura.
In Treatment--Laura, week 3
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.
Paul apologizes to her for hurting her with his response that no, he didn't want her but that he is not sorry for being honest with her.
Laura continues to attack -- refusing to consider his interpretations, his work. She tells him that all of a sudden she misses Andrew, for the first time she misses Andrew. She talks about the wedding and pokes fun a bit at Andrew's delight, that he has told everyone though she has not yet told her father. Paul probes a bit about why she hasn't told him and suggests to her that she hasn't told him because then it will be real.
Anger flares again when Paul tells her that their time is almost up -- she protests that she just got here, and he reminds her that she was a half hour late. Paul says that yes, they do need to talk about whether the therapy is helpful to her. He confronts her with his sense that she doesn't want to be his patient, she wants him entirely differently and that makes him useless to her, makes her feel hurt by his refusal. She tries to get him to give her more time. He goes on in a business like way. She leaves.
As she leaves she sees Alex arriving and asks if he is a patient. They talk for a short time and she asks if this is his regular time. He thinks it's Tuesday. She asks him if he knows of a vet and then she asks where he is headed. He offers her a ride and she accepts.
We have to assume that Paul has not spoken further with Gina since her suggestion that they look together at his treatment of Laura and whether or not continuing to see her in therapy is appropriate for her or for him. However, I think it is safe to assume that her confrontation caused Paul to look more closely at his work with Laura and to see problems he had ignored previously.
Basically patients act out with time or money. With time by coming too early, too late, the wrong day, missing the session, trying to run over time, calling the therapist. With money by failing to pay, paying late, writing a bad check, forgetting the check and so on. Whenever a patient deviates from the frame -- the ground rules of their work -- it is important to at least consider what is going on. A patient who is normally punctual who shows up late without calling is saying something with her behavior -- this is what we call acting out because she is acting out what she feels rather than putting it into words. And given how the previous session ended, Paul is within reason to suspect she didn't want to come and/or is angry with him.
But Laura has already shown us in previous sessions that she does not want to hear interpretations or to look too closely at her own behavior, even though that is the point of therapy. Paul then confronts her with his sense that she discarded him as a therapist refusing to be a patient long ago -- she has shown this with her refusal to consider interpretations, complaining when he makes them, and her desire to breach the boundaries with him.
Paul's assessment is on the mark, no doubt about it. But, it is ill-timed and driven by his anxiety. He knows Gina was right in connecting his problems with Laura with his problems with Kate. And had his marriage not been falling apart, he likely would have picked up on and dealt with Laura's attempts to evade being a patient long before this. It would have been far better for him to have taken time to work on this problem with Gina. But Paul is in the same kind of difficult relationship with Gina as Laura is with him and he is almost as resistant.
Laura is spot on when she confronts Paul by asking him if, as a therapist with 20 years experience, he shouldn't be able to handle a patient who falls in love with him.
Now about running into Alex -- I hope you have noticed that Paul's patients enter through one door and leave through another. The purpose of this kind of arrangement is to keep patients from running into one another -- to preserve their privacy and to allow each one the fantasy of being the only one. So under normal circumstances, Laura and Alex would not run into each other, even if they were scheduled on the same day. But they do encounter each other. And it is pretty clear from Laura's behavior from the outset that she will act out with Alex if she can -- remember the guy in the bathroom that Laura told Paul about the first week?
Paul needs to talk with Gina today and commit himself to working with her or someone she recommends to get his own issues under better control. And he probably should tell Laura that he suggests she find another therapist. But this is not an easy move to make -- she would experience it as rejection for one thing and if she leaves without a solid referral to another therapist, he is open to accusation of patient abandonment. Can this problem be worked through, that is can Laura and Paul hang in there and find their way back to a therapeutic relationship? Yes, but Paul absolutely needs to be consulting with Gina or another therapist all the way. A caveat here -- Laura's move toward Alex will be absolutely destructive of the therapy as this kind of acting out, being willing to behave destructively in this way makes it impossible to maintain a therapeutic relationship because she is so likely to escalate again. Once Paul finds out, and he will, he will have to act and it won't be easy.