In Treatment -- Alex, week 4

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.

Alex then says he will talk about it after he asks a question -- does Paul ever masturbate about things patients have told him. Alex tells him he won't masturbate to what he is going to tell him about what he and Laura did.

Alex critiques his own performance. He says he started at dinner thinking about his first date with his wife. He remembers her telling him that wine arouses men sexually and depresses men sexually. He told that to Laura and she just looks at him. , Paul asks why did he tell her that. He suggests that it might have sounded like an apology in advance for not being really interested. Alex says he got angry with her and began mentioning his wife every time he could. "We had sex but it was more like two animals", Alex says.

Paul asks if he was thinking about his wife or feeling guilty, which Alex denies. Alex just wants to know if his story and Laura's match. Paul tells Alex that because he felt insecure and that he hadn't performed well, he felt the need to belittle Laura by mentioning his wife. And he draws a parallel to how Alex behaved when he arrived at the session.

Alex gets up to make himself some coffee.

He finishes and then asks Paul if he really thinks he can help him. Paul tells him he can't answer that. He relates a parable and tells him that Alex is looking for a magic trick to work for him, but that the real question is whether or not Alex wants them, himself and Paul, to work on finding their way across the abyss. Alex gets it -- that he would need to be willing to trust Paul, to let go and trust and that is what got him into his situation in Iraq. Paul corrects him and says he has to rely on himself, on his own feelings.

What is the first step, Alex asks?  And he says he thinks he will go and have sex with Laura again. Alex says he knows that she is completely and totally hung up on someone else. He asks Paul if he thinks he and Laura have a chance together. Again Paul says he cannot answer. The hour ends.


It is just possible that Alex may engage in the therapy as he seems to have been more willing to hear Paul today, after the skirmishing at the beginning. And his question at the end, about whether or not he and Laura can make it if they try really hard, is also a question about the therapy with Paul.

A note about when patients arrive early -- Paul handles this by allowing Alex to pay for the additional time. Other therapists might gently remind the patient that they must wait for their own session time, still others not add time but stop after the customary 50 minutes. Most of us need the brief interval in between patients to clear our heads, return calls, go to the bathroom, things like that. For me it is a necessary time to make ready for the next person and be ready, as fully ready as I can be, to be with that person without carrying forward thoughts of the previous patient. So there are good reasons for making certain that there is enough time between patients -- in order for them not to run into each other and in order to have that buffer in between. 

In my own practice, I always schedule on the quarter hour so that I actually have between 15 and 25 minutes between patients, given a 5o minute hour.  And I have never scheduled more than 6 patients in a day, because for me, it is too much to try to see more than that. It is very unlikely that Paul sees 40 patients a week as Alex speculates -- for most therapists I know, that kind of load is just too much.

© Cheryl Fuller, 2018. All  rights reserved.