In Treatment, Week 7
Paul, Week 7
Will Paul be able to get outside of himself enough today to listen to Gina? We'll see.
Paul is in his office. The phone rings. Paul asks what the dermatologist says and then addresses her as Sophie. Kate asks who it is and he says a patient the same age as Rosie. Kate asks f it is the same girl she helped with her shirt that day.
Kate starts by telling Gina that Rosie knows, that she asked Kate. Rosie asked if she were sleeping with someone. Gina asks why she asked this and Kate tells her about Rosie's call. Gina asks if the boys know. Paul says he spoke to Ian, though not specifics. Kate asks why they can't talk about this at home. Kate is angry that Paul told Ian and Paul tells her what Rosie had said to him just before that. Kate says Ian has always been on Paul's side.
Paul complains that Kate has not once apologized and said she was sorry. Kate says she has, and Gina agrees. Kate says Paul doesn't want to hear it because he hasn't decided to forgive her. Paul wants to talk about how Kate has been with the kids, and then criticizes her.
They squabble about the kids, trading accusations. Kate reveals to Paul that Rosie is on the pill, using her knowledge to drive home a point about Paul being out of touch. Kate says she took her to the doctor herself. And Paul asks why she didn't tell him. Paul is angry that he was not told.
Gina asks that they look at how Paul is reacting. Gina agrees that there are reasons to be angry. But Kate is trying to tell him about her relationship with Rosie and he feels excluded. Gina points out that one again they are talking about Rosie instead of the issues between them.
Gina suggests imago and Paul and Gina giggle a bit. Kate asks what it is and Paul explains disdainfully. Gina says it can be useful to get a dialogue going. Paul doesn't want to do it, kate wants to know more. What Gina describes sounds like a communication technique I know as accurate listening.
They agree. Kate begins.
To their surprise, it helps and they each see things they had not realized -- Kate that she has not had for herself a full rounded life and it is not Paul's fault; Paul that he is afraid Kate will leave to find herself.
Gina points out they are both going through something. Kate is struggling with things that she struggled with before they met and Paul looks for the young woman who can make him feel the way he used to with Kate and that takes him into his relationship with his father and hi smother. He wants and needs mothering but is also afraid to get it so he buries himself in his work.
Gina says maybe now they can begin to steer the ship on curse. But Kate says she doesn't know, that maybe she should leave. Paul asks if that is what she wants and Kate says she is not sure. Gina says it is not uncommon for couples their age to come to this crossroads but though often someone leaves, no one has and she doesn't think either is ready to leave.
The hour ends. Gina asks them to call her about next Friday. Paul's phone rings. He looks upset.
It was nice to see Paul finally be able to back off from his hostility toward Gina and anger toward Kate long enough to actually get something from the communication exercise she gave them. And to see Kate as other than brittle ad angry. So we got to see some other aspects of both of these people today.
I thought Gina did a good enough job with them, but I was puzzled by the ending. She had suggested originally that they meet three times and then decide together where to go from there, but she did not deal with that at the end. I had expected she would make a firmer recommendation and at least attempt to see if they were willing to go on. Her rather vague request that Paul call her seemed a bit off.
Though this session went fairly well, we didn't learn much new. Nor did we get a clearer sense of whether r not they want to stay together. It all feels a bit amorphous. Also left hanging is the fact that Kate left the session because she fund the arguments between Paul and Gina stressful and not helpful at all. I am very puzzled that Gina didn't return to that and ask Kate what she needs in their sessions and Paul if he can set aside his sniping at her enough to do some work on the marriage. This seems essential to the formation of a therapeutic contract.
I feel a bit disappointed in the way the relationship between Gina and Paul has unfolded. I really hoped that we would see the therapist in therapy and most of what we have seen is bickering and resistance because of their very conflicted history.
While I like Diane Wiest's portrayal of Gina, I find this segment the least satisfying of the week and really the least convincing as well.
Jake & Amy, Week 7
Thursday is not my favorite day of Paul's week. Jake & Amy time again.
Paul opens the door and Jake walks in. He says Amy is waiting in the car. Jake talks about how nice the neighborhood is and how much the house Paul lives in is worth. Paul says they have lived there 22 years. Jake says he hiked the Appalachian Trail when he was 17 -- the trail goes through near Paul's house. Jake asks if he and Paul might have become friends if they had met long ago.
Jake says they drove there together today -- part of the new plan, to be accommodating. Then he starts complaining about Amy's driving, that she won't talk on the phone while driving, despite the fact that she treats the car as a place to do business. So she pulls over every time. Paul asks why he doesn't drive. He says he fell asleep at the wheel a few years ago and ever since she has been the one to drive and that he hates being driven around by a woman.
Amy comes in, saying she is late this time to make up for being early last week, then says she was late on purpose to let Jake and Paul catch up. Paul states that Amy was there alone last week -- Amy bristles and says Jake knows that. Jake says he was meeting with a potential client and Amy archly asks if the client is buying. Jake backs off. Then says Amy's boss is working her too hard. She snaps at him to stop it, that he is annoying.
Jake turns to Paul and expresses bewilderment.
Jake says they have had a nice week. Jake says he has become her lap dog now, referring to the prior session when he told her how much he needs her. He is upset because he thought they had a good week, that being nice is not easy because it is never good enough. Amy says he keeps talking about himself. Jake asks her what she wants.
Amy says she shouldn't have come, that she is in a bad mood and Jake has been great. Jake says he really thought he had been giving her what she needs. Amy laughs and says she finds that funny. Then she says to Paul that the way Jake looks is the way he looks when he is about to hit something. Jake asks what she needs. She complains that he is tender and boring.
Paul asks what she wants. She says she wants to go home, that it was a mistake to come. Her stomach aches.
Paul asks if she would like tea. Paul asks her what it feels like. Amy says it feels like her stomach is cramping. Jake sneers. Paul asks if she has had it before. He says it happened the first time when her father died. She says it happened outside an ice cream store, that is where he took her and where he died. When she went in to get another cone, a car ran into him and killed him. Paul asks if she saw it happen. She nods and says after it did, a wave of pain passed through her stomach. The paramedics arrived and she and her father were each put on a stretcher. She was taken to the hospital. She says she doesn't feel her mother ever forgave her. For what, asks Paul? Jake tries to comfort her and she pushes him away saying she had done terrible things and then blurts out that she had sex with Ben, her boss, after her session last week. She says it was awful. She says after it was over she planned to come home, tell Jake and then quit her job but she couldn't tell him.
Jake starts to laugh. Amy asks how he can be laughing. Paul says maybe he is relieved and Jake says that's exactly it. He says it has always been a huge nightmare, the thing he feared the most and now it has happened and a weight has been lifted off his shoulders. He says he feels bad for her, sorry for her. That he thinks it is sad that she has done this after he told her how much he loved her and wanted her. He ays he doesn't feel jealous or angry.. He says he has imagined this many times and he has never imagined behaving as he is, without anger. He says he feels sad for her, for them.
Amy says Jake is right that there is a connection between what happened in the office when Jake said he loved her and what she did. That she had been feeling she would lose control. Jake asks how many times it has happened. She said once and won't again.
Paul asks if maybe she wanted him to get angry because she doesn't trust his tenderness and how hard he has worked to be good to her. So she does something that she feels is repulsive. That maybe she has never forgiven herself for leaving her father on the curb to get an ice cream. And maybe if she is bad, someday someone will forgive her.
What do you see in me, she asks Jake? He says he loved her. She questions the past tense. She tells Jake she deserves it, that he can hit her if he likes. He says they have to pick up Lenny. She says it's too early and asks that they sit there in the quiet with Paul. She asks Paul if Jake will forgive her. He tells her to ask him. She says nothing. The session ends.
Amy acts out because she needs to be forgiven, forgiven for what she believes is her responsibility for her father's death. This is business she brought with her into the marriage. And notice again the connection with food, eating, and something bad happening resulting in stomach issues. Amy and food and her body have a deeply conflicted history and relationship, involving both her troubled history with her mother and now, we see with the linkage between eating and her father's death.
Jake's reaction is not so strange. He has been imagining this revelation for a long time, has rehearsed it again and again, carried it with him like a sack. And now that it has happened, he no longer has to fear it but it is also true that for him, it happened long ago, the first time he imagined it. Or perhaps the first time when he was with Amy, because he was the man she cheated her first husband with.
Notice how relatively little Paul said in this session. He didn't need to say much as things were in motion when they came in. He made well-timed and good interpretations but otherwise stayed out of the way of what was unfolding, allowing them to use the space as a safe place to let out what is going on. But we have only begun to see what fallout remains between Jake and Amy.
Sopihe, Week 7
Sophie is waiting when Paul opens the door. She is texting someone, then she tells Paul it's her father, that he is in Boston and she may go see him next week.
Sophie starts by saying she had a dream that her father was in danger. So she called her father and he tells her that someone had broken into their hotel room and stolen his favorite camera. Sophie asserts that this is proof positive of their connection. Paul asks if going to Boston will interfere with her Olympic training. Sophie says it is not a big deal.
Paul asks when was the last time she saw her father. She says 6 months ago, that they went to a fancy restaurant with his girlfriend. He flirted with a waitress and his girlfriend got angry so they left. Sophie is unclear which girlfriend he is with now. She says she took a trip with her father to Paris when she was 13 and she lights up as she describes it.
Paul asks about the dream. But she says she doesn't want to say more about it. She says the important part is that she felt he was in danger, that they are linked. She says it was a terrible a dream, a nightmare. She asks Paul if he has nightmares. He tells her one he has had since he was a kid. She asks him what he thinks it means and Paul says he thinks it means he was going to disappoint his mother. She asks if he did and he says he doesn't think so.
Sophie tells the dream -- that she was in a hotel room and a man knocks on the door and is looking for her father. She realizes after he comes in that he is a serial killer and will kill her father as soon as he comes in. Paul asks about the hotel room, if she has been in it before. She describes a room with lots of wood. Sophie says the man in her dream was wearing shoes like Paul's, that they were Paul's shoes. Then she says the man was Paul, that he was waiting to kill her father. Sophie says her father doesn't appear, that she and Paul just sat there making small talk. Sophie says it makes sense doesn't it , because he thinks her father crossed the line with her. She says that his work and Sophie are the only important things in his life.
Paul asks what she thinks about his photographs. She says she likes him, that he loves the human form. She tells Paul that her father thinks a lot of shrinks are failed artists or writers. Paul asks how it was for her that his father was always surrounded by beautiful women. She says it was okay, he was an artist and she was used to nudity.
Paul asks if it was normal for her to be around nude women then? He asks if Sophie was naked around the house and she says no, of course not. Paul asks if both her father and mother were naked around the house. She says her mother was never naked, that she was clueless. Then she says that the nudity was only during the day when her mother was at work. Sophie says her mother was a fool for not seeing they were having sex, her father and the models. She says she saw them. Paul asks if her father knew and she says yes, he did. Afterwards he shut and locked the door. She says she was around 7. She repeats that he is an artist and that artists must be unconventional.
Paul asks if she ever told her mother about it and she says no. She again accuses Paul of suggesting she was sexually abused. He asks if she thinks something happened to her. Paul says he doesn't think she was sexually abused. Then asks why she never told her mother what she saw. Sophie says she never speaks to her mother, that she is pathetic, that she didn't see what was right in front of her eyes. Sophie says it is not her job to wake her up, that her father does not care about her. Paul suggests that she didn't tell her mother because she was afraid it would end their marriage, like she was afraid for Sy and his wife. Paul says her father burdened her with his secret. And that she is afraid that if she reveals his secret he will leave her. And that her parents will never get together again.
Paul says her father left her as well as her mother, that he left and moves around. He asks why she can't let herself be angry with him. Sophie says it's her mother she is angry with. Paul says because she is always around. Paul says she is angry with her mother for being there, for being persistent. Sophie falls silent and slumps down.
She says there is something she hasn't told him. She says she is not really interested in gymnastics anymore. That she doesn't know why. Paul says he thinks there weren't enough boundaries around when she was growing up and sports became the perfect outlet for her where there were rules and boundaries. It was a place she could run away to . And maybe she doesn't need to run away to that world now. She says she'll never make the Olympic team now. Paul asks if she has ever failed before. Never she says.
Sophie says their time is up but she doesn't move to leave. They look at each other and smile just a little. There is a look of sad relief on her face. Then she goes to the door and leaves.
Once again, Paul is at his very best with Sophie and gently moves her into dealing with the very difficult issue of her father and her mother. And helps her to begin to understand why she has been so angry with her mother.
It is a relief to know, in all probability, that Sophie is not the victim of incest, at least not physically, but the sexualization of the atmosphere around her father and his casual inclusion of her in his adult world has been damaging to her. That Paul has become an adult she can lean on, reveal herself allows her have a new safe place, one with rules and boundaries that she can depend on, and so her need for gymnastics declines.
Contrast how easy Paul is with Sophie to how strained he becomes with his own children. Without the role to define him, without the boundaries that being a therapist provides for him allows him to be more relaxed and to listen far better than he does to his own kids. Of course, with his own kids, he has to contend with his feelings and needs as well as theirs. He attempts to deal with the turmoil in his domestic life by donning his therapist manner with his kids and it doesn't work.
There are those who would say that Paul should not have offered Sophie an example of his own nightmare, and we do not know if in fact what he told her was a recurrent dream of his or one he invented. Nevertheless, doing so does free Sophie to tell him her dream and to get t the point of recognizing who the man in the dream is and thus opens the way to looking at her history with her father and mother.
How much to disclose, and where to draw the line, is always difficult to define. There are those who believe the therapist should be as completely blank a slate as is possible. But we always reveal more to our patients by our manner, our dress, accent, choice of words, books, and other elements n our environment than we know. So attempting to reveal nothing is a fruitless quest. On the other hand it is important to have some sense of why we chose to reveal things about ourselves and when or to try as best we can to be aware. In situations where we have doubt about disclosing, it is a better course to dodge the question a bit by saying it is important first to look at why it is important to the patient to know something. The way is left open to reveal if it then seems appropriate and also to go deeper into what underlies the curiosity. But with Sophie, that likely would not have worked. So Paul's disclosure seems well placed.
Alex, Week 7
It is entirely expectable that Alex returns this week -- and that he is in uniform, given the ways he has acted on his impulses in prior weeks.
And show up he does. When he opens the door Paul jokes that he feels he should salute. Alex comes in and says this is his last time at least for now, he wants to settle up. He offers to pay for next week as well and makes a crack about the gravy train ending.
Paul asks what happened and Alex tells him that he was asked to come and train new pilots. Alex tells him about how he can intimidate the younger pilots but also that he doesn't feel the project can succeed because there is too little time. Paul says it must feel great to awe the others and he shrugs and goes on to tell another way he betters them with his skill. Much bravado. Alex says he never panics. He keeps fishing for recognition of his superiority from Paul. Then he says he has pushed to be able to return to combat flying. Alex is not happy when Paul seems not to agree this is a good idea.
He tells Paul the Navy will be contacting him because he told them he was seeing him about his marriage. He asks Paul to tell them all good things because he needs this. Paul asks if Alex expects him to lie. Alex says he knows he can handle it. Paul asks if he can handle the emotional stress. Alex says it is the fault of the enemy that civilians get killed. Paul challenges him on his feeling that he is ready, that he can handle another civilian target getting hit.
His phone rings and he answers. It is Alex's wife. He tells her he will call her back. Alex says she is eager for him to fly again because he has upset her sense of order. She and everyone in his family want him to return home, including his father. Paul asks about his father's opinion. Alex says his father says a man gets back to work. Alex becomes uncomfortable.
He starts to talk about a birthday part for his son, Roy. Only family was there at Roy's request. He felt awkward realizing his father had been at his house a lot while he was gone. He says though that he is good with Roy. Roy didn't see his son much while he was gone and Alex thinks he finds it easier without him around. He describes Roy as happier without him. Paul asks if maybe Roy was happy he was there. If maybe Alex projects his feelings about his own father onto Roy.
Then he tells about a chess game they started but Roy abruptly withdrew from the game and went to his room. Alex followed him to his room and he sees Roy and it broke his heart and he turns and sees his father behind him. His father tells him that Roy had known that in three moves he would beat his father and didn't want to embarrass him. Then he pulls him into a room and rips into Alex and tells him how disappointed in him he is. His father suspects it is Paul who has turned him into a failure, a wimp. When his father left him, he felt he had been hit by a train. He locked himself into the bathroom and sat and pulled himself together. Roy was playing chess again with his grandfather. No one noticed Alex.
He left the house and drove and drove to where his gay friends had taken him and he watched the gay men and says he felt like bashing them in.
Paul asks him what became clear the day of the party. Alex says that he needed to be in Navy again where everything is clear and ordered.
Why that bar, asks Paul? He says he wanted to beat one of them up but he didn't. Paul asks if he was there because none of them would ask him to be anything but himself. And wouldn't it be better for him to deal with these things while he is on the ground not flying again?
Paul says he has decided and then he asks Paul what he would do. Paul says if he were Alex he would stay in therapy rather than continue to sweep his issues under the carpet because they will come up again. But he will not tell Alex not to fly. Alex begs him to tell the Navy he is okay because he needs that world.
Alex gets up to leave. Paul gives him his card with his cell phone number and tells him to call day or night if he needs to talk about anything. He tells Alex he has done brave work there and he wants for them to continue. Alex says good-bye.
Paul is again doing good work with Alex; they seem to have recovered from the acting out of two weeks ago, though we know that what happened then must still hang between them because they never talked about it really. Still, Paul continues to develop a therapeutic alliance with Alex and we get the sense that even though he is leaving for now, he will be back, because he found a safe place with Paul. In this sense, that Alex seems to be developing a feeling of safety there, the acting out that he did could be seen as having had positive effect. Alex threw the best he had at Paul and Paul did not abandon him or humiliate him.
Paul correctly sees how fragile Alex is and how risky it is for him to return to flying. One hopes he can find a way to respond to the Navy psychiatrist without lying or undermining Alex. I am not certain how he can accomplish this, however. It will be interesting to see if Alex does get back up in the air as soon as he wants to as it does not seem advisable given what is driving his desire.
Notice that Alex's wife, Michaela, and his father are close and in fact seem almost interchangeable for Alex. And we still have no idea how much of his engagement with his gay friends is about his desperate need for acceptance and how much is genuine attraction.
Laura, Week 7
Well, Laura doesn't come to see Paul this week because it is a holiday, so he spends the time with his kids.
Paul is at his desk and his daughter, Rosie, comes in. She tells him her older brother is being an asshole. Paul says he is going back to school soon, can't they get along? Rosie complains that he washed her iPod when he did laundry. Paul makes a joke. Rosie is not amused and say she can't live without her music. Her phone rings and she busies herself texting.
Paul complains that texting seems more important than anything. He marvels that she types so fast. Rosie complains that it is private. He asks about the acronyms she is using. A friend has texted that he misses her so much. Rosie says he hasn't a name -- then says his name is Noah. Paul asks if he is from school; she says no. Rosie says she met him at the center, he was treated there. Paul asks how old he is and she says 18. She talks about how amazing the songs he writes are and that he works at Kinko's. She's trying to get him a better job. Paul observes she is good at that, helping people, but that sometimes people can help the most by setting boundaries. She thinks he is worried that she is sleeping with him, but she says he needn't worry. Paul wants to know if he has a record because of what he did. Rosie says she has to go.
Rosie says all he wants to know is the basic facts. She tells what she would like him to ask -- like is he nice to you? does he make you feel better about your life? She says she wants to talk with him about stuff, but he makes it hard. Rosie asks if he knew she were going to do something stupid with another guy, he'd try to stop her, right? She says like if she were going to take off with him, like take off to Rome? He looks upset and asks how she knows. He asks how she knows about Rome and she says she called Kate's cell phone and she heard Ed call her babe. She says here Paul is trying to stop her from making a mistake but he is letting Kate be with another man. Paul says they are trying to work it out. Rosie says do it, fix it. "Another man is taking your wife to Rome", she says, "isn't that extreme?" "Tell me you will fix this", she cries.
Rosie leaves.
Ian comes in and asks where his pillow is. Paul gets it and asks if he is set to go. He asks Ian if he'll hang around until his mom and Max get back, that Max would love to have him come to see one of his games.
Why no morning patients, Ian asks. Paul says he has had a few patients leave. Ian asks how that is for him. He and Ian start to talk about Ian's old girlfriend. Paul asks if he is dating anyone now. Ian says no. Paul is curious about how many girls he has been with and Ian says four or five. He says they never last more than 3 months. Ian says he was cheating on his old girlfriend and Paul is surprised.
He asks if Ian and Rosie have talked about what is going on between him and Kate. Ian asks what kind of stuff and Paul says they have been having problems. That these are issues they really have to work on. Ian asks if Paul slept with someone else. Paul says no, then Ian asks if Kate did. Paul says it is him, that he met someone but they are not having an affair. Ian asks if she is a patient, which Pal denies. He asks his dad f he is miserable or happy. Is he in love with her? Paul says he isn't sure. He says he and Kate are trying to work it out. Ian says maybe it's for the best, that they have been married a long time. They start to squabble. Ian asks what he wants him to say, does he want him to please not go. Ian says he understands that Paul would get tired of how she looks at him, how she is always disappointed, what a martyr she is. Paul then defends Kate. Ian asks if it is impossible for Paul to imagine that he is genuinely on his side. Ian tells Paul this it isn't about him, it's about Paul and what he wants.
The conversations Paul has with his kids, especially with his son, don't ring true to me. Maybe because they do not align with my experience with divorce and teenagers, but it felt off to me. Rosie seemed closer to what I know as normal teenaged behavior. Or maybe it is Paul who is off because he seems more therapist than parent with them, inquiring of each of them as he might a patient.
What we do learn is that indeed Rosie knows what has been going on and she is angry with Paul. And Ian, though he doesn't know about Kate's affair, sees Kate as a problem and wants Paul to act, probably because he himself hasn't.
I am disappointed that this episode is part of the series, that it breaks what we have come to expect. Or maybe my disappointment is that Paul is really too much the therapist with his own children and that is why this episode, though about family, takes place in his office, where we see him work. Hmm, I'll have to think about that.