In Treatment -- Alex, week 5

Alex arrives a little early again. It's still raining.

Alex begins by telling Paul that he broke up with Laura. Tells him he took Viagra or one of those drugs and drank and then he and Laura had sex all night. Then he says he realized Laura was using him and it was over.

Paul asks him why he makes the connection between him, Laura and himself. Alex says "Tell me that something didn't happen between you and Laura." And he says that Laura talks about Paul, asks questions about him. Paul says again he will not discuss anything about his other patients with him. Alex is convinced that Paul has had sex with Laura. Alex makes hostile jabs at Paul.

Paul collects himself and Alex backs off of asking about Laura. They start to talk about Alex and his father. Paul asks how he feels and about his relationship with him. Paul reminds him about what he said abut his father the previous week -- that he was unfaithful to his mother and yet is a good man. Alex says his father is like iron, cast iron. Paul says that iron makes him thinking of something powerful yet cold.

Alex replies by asking Paul how he feels about Alex having dropped the bomb on the madrassa. Alex digs and pushes for judgment from Paul, certain he talks about him and what he did negatively. He challenges Paul to be honest with him about how he feels. Then he says that his father said nothing, just registered that he heard him when he told him about it.

Alex again attacks Paul with his assumptions about what he thinks.

Paul tells Alex that he thinks he has never dared to fight back at his father, that he has been too terrified to do so and that he comes to therapy with all his anger.

Alex hears Kate and asks if that is his wife. Paul gets uncomfortable. Alex continues to push Paul to talk abut his feelings. He talks again about Laura -- that she idealizes him yet knows nothing about him. "Who are you?", he asks. He again asks if Paul had something going on with Laura. And starts in with his notions of what Paul thinks and feels. Alex crtiticizes him fr loving a woman so much younger. 

Paul asks why Alex had to sleep with her and suggests that it was about getting back at Paul, because she was his patient. That he did it to provoke Paul, to get a reaction, any  emotional reaction.

Then Alex asks Paul how he feels about his wife being with someone else in Rome. And says he would be surprised how much he learned. That he had to investigate Paul to see who he was. Alex is walking around during this, looking smug and delighted to have this information. He reveals what he knows about Paul's daughter. 

Finally Paul loses it and jumps up to grab Alex. After this outburst, Alex leaves.

Paul picks up the mess, then is clearly upset at what has happened. He calls and cancels with a patient. Kate comes in while he is on the phone. She asks what has happened. She tells him she just got in. Kate tenderly tends to the cut Paul got on his hand when a glass got broken in the skirmish with Alex. She asks about the kids.

Kate tells him that she and the man she was in Rome with moved into separate rooms the first day and that it is completely over. A noise outside draws his attention. Kate sweeps up the glass. Paul gets ready to open the door. The next patient enters.


This is a tough one. Paul's reaction is understandable on one level given how unrelenting and violating Alex is. Anything other than anger would be very difficult to understand. But he needed to say something, to put a stop to it before he got to the boiling point. It is hard as a therapist to know really how to respond when a patient makes a verbal assault. There is a struggle between maintaining a therapeutic posture and wanting to lash out in return. And I suspect that all of us, when confronted with this kind of situation, have ended up not feeling very good about what we did, no matter which way we went.

Alex has violated the boundaries in a serious way. He has violated trust and done so with intent. Paul's interpretation that Alex acts out his anger toward his father on Paul is spot on but right now, in the moment of being under that violation of privacy, that falls by the wayside. So it isn't Paul's anger that is problematic but that he let it go too far.

The therapeutic mantle can only protect us so far when we are attacked by patients. When the criticism is of what we say or how we look or the more usual kind that happens every day in therapy, through practice and by doing our own work in therapy, w become better and better able not to take such attacks personally. But it can happen that a patient makes a particularly well aimed assault and despite all of the training, we get hurt and angry and scared. Which is what happened to Paul. And Alex is surgically precise in his attack, keeping his eye n his instrument, just like he said he does when he flies, and makes his run and drops his bombs right on Paul. In the moment he is doing exactly what he wants to do and doing it very effectively. But just as he must come to terms with the effects of his precision in bombing the madrassa, so he will have to deal with the damage his attack on Paul has done. And Paul will have to do some work himself, in himself, with what he did and what it means and how to proceed, if at all. 

And in the background of this fight between the two men is Laura. Perhaps their fight on some level is the one that didn't happen between her father and David? Because she is the match that set off the explosion, even if she is not present and even if, as he says, Alex broke off with her.






© Cheryl Fuller, 2018. All  rights reserved.