In Treatment -- Paul, week 4

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.

He tells Gina that when Sophie collapsed he called for Kate, who had gone to Rome. He muses that one of the reasons he married Kate is that she is not a victim, unlike his mother.

He says he hasn't been alone in the house for 18 years -- both kids are away too.He says he makes a mean chowder, maybe he will get lucky. Maybe he will invite the woman he mentioned earlier. Her husband too? No, not the husband but Gina and this woman. He makes light of it, is a bit flirtatious.

Gina tells him h is showing her how it feels to be with Laura, how it feels to be a therapist with Laura, a patient who flirts with him. That Laura draws him into her life as he has been drawing Gina in. Paul tells her about the detail Laura gave about the sex with Alex and that he would have to be made of rock not to react, not to feel a little jealous. Paul thinks that's what Laura wanted. Gina wonders about that.

Gina suggests that Paul wants her to make rules so he has something to push against. Paul says this issue, attraction to patients, always gets them on rocky ground. Paul tries to make a case that if he transfers Laura to another therapist, then in 6 months or a year he could see her socially. Gina says no, that no matter how long, he will always be her therapist. Paul tries to argue. But of course, Paul knew this was Gina's stance which is why he came to her. Gina makes him look at all the things Laura has done to get an Oedipal response from him, and that he knows this. But he wants to overlook that because he wants to be desired.

Paul again turns away from Laura to attack Gina and a critical evaluation she wrote about him. Her letter led to him not becoming the head of the institute. Gina brings him back again to his issues with his father and that her one letter drove him out of the institute. Paul says that letter made him a better therapist, maybe better than Gina.

Gina asks again why he came. He acknowledges that he wanted to test himself, knew she would say what she has about Laura. Paul tries to make the case that he is better because he has more feelings for his patients. He asks if she misses having patients because he always wondered if she actually liked doing this work. Paul says he can't help but connect with the patient but he doesn't see her doing that.

Then he talks again about Laura, about a session when she cried. And he says it was a victory of a kind, that she would do that. But that it was different with her, moving somehow. And that was when he decided to come to Gina, because if Gina couldn't convince him to stay away, how could he do it himself. He admits it is tough being alone with her. He says he wants to look at this, to deal with it, to make sure that what he wants is not immoral or unethical, that it is not an abuse of his power with a patient.

Gina says she will not push him out, won't reject him. But that doesn't mean she will let him do something harmful. But that she will hang in with him no matter what.

Paul says he loves her, he loves Laura. He knows it is a cliche. And that part of him does not care what it mean or what it costs.


So now we know why Paul came to Gina. He fights her because if he defeats her, if he can meet every one of her objections, then he can do what he wants, he can have a relationship with Laura. But he came to Gina because he knows she will fight and he wants her to win. Because he knows she is right, that there is no ethical way he can ever have a romantic relationship with Laura. He needs for GIna to win or he will indeed recapitulate what his father did. And the only way out of this is through it. So he has rightly committed to working it through with Gina.

Paul thought he could avoid being like his father by taking pride in how he was different, by being better than him. But these efforts usually fail, because the shadow lurks there and brings him to having to see how he is just like his father, his father who ran off with a patient, and that he must see this and find his way to make a different choice. Making this different choice, not acting out with Laura is the only way to move through this, for him and for Laura.

Ethics for a psychotherapist demand that we recognize that no matter how long the time since the therapy ended, we remain in a therapeutic relationship with our patients. That relationship takes primacy over any other possibility. The law varies about how long an interval must pass before sexual contact with a former patient is acceptable, but the ethical stance is that no interval is long enough.

© Cheryl Fuller, 2018. All  rights reserved.