In Treatment Week 8
In Treatment -- Paul, week 8
We know that Kate won't be with Paul this week. So where will things go with Gina?
Paul arrives and starts by mentioning Kate. He tells Gina Kate is tired of the back and forth and that he respects her choice to decide on her own.
Gina asks how Paul thinks the sessions with the two of them went. Paul damns with faint praise, by saying they helped and criticizing Gina. He talks about envying writers because they create characters ad get to decide what they will do and what will happen.
Gina tells him she is very sorry about Alex. Paul talks about the funeral and how hard it was, how futile it all is. How strange it is to see the relatives he had been hearing about and they are not so much like the people he knew from Alex. Paul moves to talking about Amy. But his tone is intellectual and he seems somewhat detached from what he is saying.
Gina says she hears from him both his intense connection with his patients but also a longing for their family and friends. Paul says Alex left him as a repository of the atrocity he committed. Gina asks how she would describe Alex's state of mind at his last session. Is Paul feeling responsible. Paul says he asks a psychiatrist who consults with the Navy and he said Alex went into vertigo. Paul says he thinks he killed himself. Paul cannot understand how Alex could live with the deaths he caused. So many expectations placed on him, yet Paul saw him as a good guy, charming and endearing underneath the posturing. Paul ays Alex asked him if he should fly, that he wanted him to tell him what to do. Gina says that was not his place. He tells Gina that Alex's father thinks it is therapy that killed him, that removing the repression made it impossible for Alex.
Gina asks Paul who he is really angry at and Paul says everyone -- all the therapy theorists. Because they force people to look at themselves and what good is it? Gina asks how long he has felt this way, how long he has wondered if therapy is helpful. He says he thinks about it everyday. The debate becomes a bit intellectual again.
Gina asks if Paul is okay and he says he is tired. She suggests he put his feet up. Paul says Alex said when something happens pilots should trust the instruments and not their instincts. Paul argues that therapists should rely more on instinct and less on knowledge. Gina asks if he has some particular patients in mind. Paul bristles. He says they are back to Laura again -- that his criticism of therapy is an excuse. Paul is angry and says he is having trouble believing in her religion, therapy. He calls her one of the experts, everything under control and says she has never lived outside of that room. He asks her if she can really help anyone and claims not to want to upset her.
Gina asks why he keeps trying to provoke her. He says he isn't trying to provoke her but is this it, is this how therapists end their lives He attacks her for her relationship with his friend Charlie. Gina tells him he has no idea what he is talking about and then she tells him what happened. She says she struggles with the fact that she is too emotional. That Paul has created a cold castrating version of her because he wants to believe that when he argues with her he is battling the forces of repression because if he sees her as she is, he won't be able to justify his behavior. She tells him that she did not act out with Charlie, who was her patient, because of her husband, because she knew that was not who she wanted to be.
Paul looks stricken. Gina says she is surprised he never saw how much she loved her husband and now she has to listen to his self-involved theories about her life. She says they punch and counterpunch each other and now she thinks maybe they should stop. He has been waiting for the controlling Gina to stop him. She says it is Paul who has to decide, he is the only one who can stop him. She says maybe he is right, but she cannot decide for him. Only he can decide. She tells him to go to Laura and find out but stop comparing his life to Gina's and stop using Charlie against her and never talk to her about him again. Then she tells him to go.
Until Paul goes after Gina, it is hard to get a real read on his feelings. He sounds a bit detached, world-weary and full of words. Paul cannot reconcile what Alex did with the man he came to care for. But he does not really say how sad he is that Alex is dead, or much at all about what he FEELS. We can imagine that this is the way Kate experiences him, using his intellect as a defense against feeling.
I still wish that Gina had drawn the line with Paul in the first session because the way they end this week was pre-ordained by their unresolved conflicts and muddy relationship. She may be right about Paul, and I suspect she is, but there never developed a solid therapeutic contract and the realities of the conflicts in the past made interpreting Paul's hostility and resistance all but impossible. So he could switch from patient to alienated colleague/student/friend and back again repeatedly. He did need for Gina to stand as the nay-sayer that he could fight with about whether or not he could be with Laura. Likely that would have developed with any therapist he worked with. But with Gina, there were real unresolved issues and they got in the way repeatedly.
In a therapy relationship, one with a clear contract and boundaries, Gina would not have revealed what she did about her marriage, her choice about Charlie. Of course, it wouldn't have come up had she and Paul not had their complex history. She could have confronted Paul cleanly about what he was trying to do, trying to make her the villain of the piece. But as soon as she felt pushed to disclose about Charlie, the therapy ended, a therapy that never really began.
I kept feeling every week that I wanted to grab Gina and tell her she was out of her mind if she thought she could function as a therapist to Paul. I wanted her to talk with him once or twice and then, with him, determine who he would do well to see. There simply was no way for this to work out well between them. There are good reasons that we do not treat friends and family and this relationship between Gina and Paul illustrates well why we don't.
I want to trust in Paul's basic good judgment and ability to determine the difference between wanting to the kind of adoration he thinks Laura will bring to him and what he has with Kate. And recognize that there is no basis for developing a relationship with Laura, that she is in love with her fantasy of him and he is responding to how wonderful being the object of that fantasy feels to him. We'll see.
In Treatment -- Jake & Amy, week 8
Well, you know how I feel about this couple. Let's see where they take us today.
Kate is standing by the office window when Paul enters after telling Max to take care of something. He and Max have been to Max's game. Kate asks Paul to close the door so she can talk with him. She tells him that she called and left a message for Gina that she won't be returning to therapy. That she does not want to go over that ground again, that she needs to figure this out on her own. She tells him that she is really happy he is seeing Gina and that she hopes she can help him.
Jake is there. Paul asks if Amy is coming and he says he doesn't think so. Jake says it has been a weird week, quiet and awkward. That Lenny seems relaxed and at ease, which he thinks is odd. Paul says kids do that when they sense tension, try to get the parents to feel better. Jake says it isn't fair.
Jake says Amy has been trying to make it up to him about Ben, doing housework, trying to kiss him, but he can't do it, can't get past it. Paul says it can be hard to relate to someone after an affair. Jake says he stood and watched her sleep one night, that she looked beautiful. And how easy it would have been to lie down next to her and put his arms around her but he couldn't. So he jumped into his car and drove away and ended up at his parents house, four hours away. It was too early to ring the bell when he got there so he slept in the car. Jake says his mother comes to see Lenny but his father is more limited in his interactions with Lenny. A knock on the window of his car wake him up and it was a cop who was someone he went to school with, someone who fulfilled his childhood dream by becoming a cop.
Jake characterizes his father as a know-it-all, and says the thing is he does know it all. His parents are professors, intellectuals whereas Jake doesn't read, isn't one of them. He does do crossword puzzles though. Paul asks what he did as a kid when everyone else was reading. He says he played music and smoked pot, and by himself. He says he talked to himself a lot. He says he loves talking with Lenny, about sports mostly. He says he never tires of hearing his son talk. Paul asks if he had that kind of relationship with his father and he says no, because his father always corrected him and his mother always deferred to his father. He says at least they didn't beat him. Pal asks when he began to write. He says no, his brother is the writer. Paul asks if he does not consider writing songs writing.
Paul says he thinks Jake likes to play down his knowledge. Asks if his family is interested in what he does. And he says because he didn't become a professor they lost interest. He says his mother would try to encourage him but his father disapproved. That his mother was intimidated by his father. At least , he says, he did not marry a woman like his mother.
They approve of Amy because she is very successful. Jake thinks Amy liked that he used to live in more reduced circumstances. Jake says he doesn't have that many people to talk with now. He is afraid of losing Lenny and he sees Amy as unstable, that this will be her second divorce and what will she do to find another man. The lights go out. Paul gets up and sees the power is off on the whole street. Paul asks if he wants to end or continue. Jake says he can see fine. We can hear street noise.
Jake says that for the first time it really feels like they are splitting up, that it feels real. Paul asks why he thinks it feels real now. Jake asks if Paul has ever felt that loss and Paul says there is a huge sadness there when you become aware of what is lost. Jake says he told his father who was not surprised. Paul asks why he went home and challenges Jake's assertion that it was an accident. Jake says he wanted to talk with his mom. Paul suggests a link between Amy and his father, that he gets something similar from both of them, criticism. Jake looks thoughtful and says he was going back to the source. Paul says that the more he works in therapy the more he can see these things. Jake asks why he would want more therapy. He says he wants to do well with his son, that he needs help from his parents, from Paul so he doesn't mess up. He says he feels scared. Paul says he wishes he could give him a road map but it isn't like that. But that wanting to do better is the beginning.
The session ends when Jake says if it were a movie, the lights would come back on.
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Jake became more three dimensional for me today, perhaps because he was not reacting to Amy but talking for himself. As the more resistant to therapy part of the couple, in turn Jake has now become the one more invested in it. He seems to have come to feel some trust for Paul and to see talking with him as a way to help him be who and what he wants to be. Jake is a man who chose the anything-but-my-father path, needing to choose a direction and way of life that would define him as not-his-dad because he could never measure up to him, or felt he couldn't. The one thing he saw himself as able to do better than his father was being a father and he takes pride in his relationship with his son, which is very unlike what he had when he was a boy. The hazard of making this kind of identification though is a problem with how to measure oneself and alienation from the yardstick he might normally use. Who can he talk with about being a father, about being a man given his relationship with his father? So Paul is filling some of that role for him, able to mirror him and allow him to see himself better than he can on his own. For me, Jake makes the case for why I would rather see couples separately than together, at least on a regular basis.
There is in Paul a bit of a feeling of melancholy during this session, an overflow from his conversation with his wife ad the sense he probably has that they may well not make it. And it is there for him as well as we know he has not been close to Max, his youngest child, certainly not like Jake is with Lenny. He does a good job of keeping this contained in himself, not disclosing more than is useful and not allowing his feelings to color his sense of possibility for Jake.
In the lights going out we have a nice example of synchronicity. Jung defines synchronicity as the meaningful occurrence of unrelated events. It no doubt feels that some master electrician threw the switch at the just right time to change the mood of the room to match Jake's mood. And at the end, when Jake says in a movie, the lights would come back then, and they don't, we can feel the heaviness of the mood linger, despite Jake's crack.
Will we see Amy again?
In Treatment -- Sophie, week 8
I always look forward to Sophie, to see Paul at his best as a therapist.
Sophie and her mother drive up to Paul's. Sophie argues with her mother about the fact that they are a bit early. Sophie tells her she doesn't have to wait. Her mother says she doesn't mind. She compliments Sophie on her hair and touches it, smiling. Sophie starts to say something at the same time as her mother does. She suggests to Sophie that after her session they might do something together. Sophie leaves the car.
Sophie is crying and sitting on the floor. Paul sits across from her also on the floor. She says everything is going to shit. She says she has tried all week to talk with her mother but she can't, she just can't. She says she just wants to talk to her. She says her father has been calling every day this week, like he is trying to be most attentive father of the week. She hasn't returned any of the calls. And she says yesterday her leg began to shake and she thinks she will be pulled from the meet. She says even if she makes the meet how can she ace the national trials if she is shaking. Something is wrong , she says. She recites the series of events from the accident to the rash she has now. Paul reminds her the dermatologist says there is nothing wrong, that it is anxiety.
Paul tells her she is trying to do 2 very big things at once -- talk with her mother and avoiding her father. And that could lead to some very difficult places, like telling her mother her secrets about her father and telling her father she is angry with him. Paul tells her about an episode he had himself years earlier. He says they found he had had an anxiety attack.
Sophie pulls up her shirt and shows him her rash and asks if that is just anxiety. She is angry with Paul for thinking she is normal. Sophie says she shocked him, he shakes his head. She thinks he is shocked by how small her breasts are. Paul asks if she is concerned. She says of course not, that when girls stop training everything explodes. Sophie say she knows she has the body of a child but that children don't want to kill themselves.
Paul asks if she is thinking about suicide again. She says yes because everything is falling apart. Paul says he remembers her telling him about being in the ambulance. And he thinks that when things go wrong, she blames herself, that she sees herself as always the problem. It never occurred to her that Sy was the problem. Paul asks her why she thinks she was the problem. She tells him to stop.
Paul asks if she has ever read the Bible. He tells her that in the New Testament God is always good and man is bad. She sees the point that people prefer to see themselves as wicked. Paul helps her to see that her father left his second wife for other reasons than that she wanted to live there. She asks if there isn't a law that parents have to love their kids forever. And Paul says she feels it must be her fault for her father to leave and that her mother became so depressed. Sophie had to make what happened be her fault because nothing else made sense.
She gets up off the floor. Paul says she saw her father cheating on her mother and does she really think that is a reason for her to be abandoned. Sophie says she found her diary from 4th grade. She says she took it out to see if he was right, about how hard it was to lie to her mother. She reads to Paul. Paul asks where she kept it and she says on her night table. Paul says it is a wonderful gift, because it shows her world. Sophie asks if he thinks she wanted her mother to find the diary. Paul says yes and to ask what was the secret she was keeping. The entry she was reading was from Sept. 11. He asks her to go on. She closes the book after reading that her father told her she was going to inherit an evil world. She asks what kind of parent would say that and then run off to photograph bimbos.
Sophie asks if he really thinks the rash and spasms are coming from her head. He says yes and he thinks she has to start to forgive herself. That her parents were going to separate anyway, that she didn't make it happen. Sophie asks how she can forgive herself. Paul says it will be slow but she has to start trying now. He tells her she deserves to be happy. Sophie smiles and looks relaxed. She asks Paul if she should go to the competition Friday. He says he thinks so. She says she has to go because her mother is waiting. He tells her if she starts to compete and starts to feel anxious to call him. He suggests something she can tell herself if she starts to feel her leg shake.
Sophie leaves. Paul sits back.
Outside her mother is waiting. Sh asks where to. Sophie says she wants to go home then says they could stop for coffee somewhere. And her mother is so happy she almost cries.
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It is a pleasure to watch Paul with Sophie. He has carefully built trust with her over these weeks and now she can talk with him, she wants to talk with him and get his help. We aren't always so successful with patients; it is with people like Sophie that we often feel so rewarded by this work.
What Paul does this week is help Sophie to see something Harry Guntrip wrote about -- that most of us would rather be bad than weak, rather be responsible for the bad things that happen, the failed relationships, than to accept that we cannot control the world and others. Because if I believe I am bad and make people treat me as they do, that means if I work hard enough, I can change and in changing, change them too. But to know that I am weak, that I have no control over other people and their behavior places me at the mercy of forces beyond me and means I am unable to make the world be as I wish it were. This is a tough pill for any of us to swallow and is a part of the work with most of the people I have worked with.
Sophie could not have heard this before today. But she now trusts Paul enough to be willing to consider that he is right. And she so wants to be close to her mother, to stop being at odds with her. So we see her start the work she needs to do to be a much happier person.
So far, Sophie is the only of Paul's patients we have seen him be successful with. The work with Laura is in tatters and his feelings threaten to destroy his marriage, his career and do harm to Laura as well. Alex is dead, perhaps a suicide. Jake & Amy are in deep difficulty. If these four were all of Paul's practice, I am certain he would be quite depressed himself. But we must remember that the work in therapy is mostly the patient's to do. The therapist must listen, reflect, interpret and monitor how things are going, but the hard work of facing into themselves belongs to the patients and we have seen a variety of ways in which some patients cannot engage that work while others do.
So it is very good to see Paul at his best with Sophie, the patient it is easiest to root for.
In Treatment-- Alex, week 8
It is raining as someone comes up the walk outside Paul's office. It's Alex's father. Paul explains about the doors, that it is custom to keep patients from running into each other.
Paul explains that he must respect the privacy of his work with Alex, though he will answer what he can. Alex's father says he wants to find something that will tell him what happened to his son.
He calls Paul on not revealing at the funeral what his relationship with Alex had been. Paul asks if he is surprised that Alex was in therapy. He says he is surprised at how secret it all is, though it is often secrets that bring people into therapy in the first place. Paul says it is often helpful to talk with someone who is not involved in your life. Alex's father says like a prostitute? Paul says he cared about Alex or he would have been a pretty poor therapist.
He asks Paul if Alex talked about things he told no one else. He says he knew Alex well when he was a little boy. Paul asks about that and he says that Alex was quiet, inventive. Paul asks if he got that, being inventive, from him and he says no, his grandfather. He says Alex and his grandfather had similar mannerisms and ways of talking and how odd that was for him, given how long the grandfather had been dead.
He asks if Paul is close to his father. Paul says his father is alive but his mind is gone. He sees him once a month, for himself rather than his father who doesn't recognize him. Alex's father says his connection with Alex is slipping away, he no longer hears him in his mind. Paul says he is still in a state of shock but his voice will come back to him.
The father apologizes for comparing what Paul does to prostitution. Then asks how he would describe Alex, as a person.
Paul says he thought Alex was an extremely strong man, strong sense of mission. Paul says he thinks Alex was struggling to find out what he wanted for himself. He asks the father if he was in the service himself. He replies that he was discharged soon after enlisting because of asthma.
Then he asks if Paul knows how the grandfather died. And Paul says yes.
Paul asks how he felt about Alex's service in the Navy. The father protests that Paul answers question with questions. Paul says Alex compartmentalized and kept feelings away from duty. He asks if Alex's emotional state made him unable to handle his duty. Paul says he can't answer.
The father says it was a training flight, simulating battle. The other pilot made a snap choice to make a getaway and Alex didn't have time to change his course. But how could it happen, it was a training exercise. Why didn't he jump? Paul says maybe he didn't think he needed it.
Michaela and his wife have been in church praying and trying to find answers. He says his faith died when his father died. A boy once beat Alex up, he says, and took his shoes. Alex didn't defend himself and he says that scared the hell out of him because a thin black skin would get him killed. He believed his son must be strong to survive. He wanted his son to be safe.
He pauses and says he envies the time Paul spent talking with Alex. He stands in front of the couch and asks if this is where he sat. He sits there. Alex could talk, he said. He said Alex and Roy could talk for hours. He says he once gave Alex hell for telling Roy he loved him. You have to challenge a boy to make him a man. Paul interprets this and the father says he is not in conflict about anything.
He mounts a protest about Alex talking to Paul instead of dealing with it himself, making a comparison to Darwin and survival of the fittest. Paul says Alex came into therapy because he needed to. Paul asks if he thinks therapy had something to do with his death.
The father says oh yes, he looked inside and now he is dead. He is angry and full of grief and blames Paul. He sits again. Asks if Paul had a son. He asks how he would feel if his son started getting advice from a man from another culture that Paul felt was wrong, what would he do. Paul says he would try to stop it if he could.
The father gets up, gets his coat and says he can't get over the feeling that he was torn apart in that room. Paul says it isn't about blaming or looking for scapegoats. He sits again. He was an outstanding person, the father says. Alex did a lifetime of trying to please his father. All of that was for him, and he needed it to feel safe, but Alex didn't. Paul says Alex loved him and admired him. The father says he would rather Alex hated him or that his death was his fuck-you. Did I kill my son, he asks. Paul says no, it was not his fault. The father says that we'll never really know. This time he gets up again, says goodbye and leaves.
The shock of Alex's death was yesterday. Now we see some of the aftermath. A father filled with grief and guilt and anger looking for answers. Paul does as well as anyone could given these circumstances.
I find I haven't a lot to say. The father is left to recognize that though he had good intentions, what he tried to teach his son may not have been what the son needed but what he needed and that in the process, he failed to know him as he might have. This is something many of us who are parents come to see, though not usually in such panful circumstances.
It seems strange to some people that confidentiality endures after the death of a patient. But Paul is as obligated to maintain Alex's privacy now as he was before the death. This can be bewildering and painful for family or other loved ones looking fr answers, but it is essential. No therapist can assume that what we hear is safe to disclose after death; only the patient is free to disclose his or her own material.
Were the Navy to mount an inquiry, they could subpoena Paul. In that circumstance, he would be obligated to offer his opinion. Therapists do not have privileged communication -- that goes only to priests and lawyers. So our records and testimony are subpoenable. But absent a subpoena, to disclose a patient's material is an ethical violation.
I wonder who or what will fill this hour next week.
In Treatment -- Laura, week 8
Will Laura be back this week?
Today opens with Paul standing outside a cemetery. There is a funeral. We see people in Navy uniforms. Is it Alex who died? Paul signs a guest book.
Yes, it is Alex's funeral. There are two ebony objects on the casket. Paul introduces himself to Alex's wife and others standing near the casket. We see people we can guess are Alex's gay friends. And Paul's son, Roy.
Paul sits down next to Roy outside the chapel and talks to him. He tries to assure Roy that thinking angry thoughts or crying is okay. Roy says he doesn't want to cry. Paul tells him he doesn't have to be strong. Roy says his father told him he had to be strong, be the man of the house when his father wasn't there. Paul says he understands that but that maybe he and his mother could help each other feel better. Paul tells Roy that he recognizes the chess piece he put on the coffin and Roy says it represents his father's favorite chess move.
Laura comes in. She thanks Paul for calling her. She asks if he is all right and Paul says he hasn't slept well, that he hasn't had a patient in therapy die while in treatment. She urges him to take some time off.
She asks if that was Alex's son that Paul was talking to. Paul says it is hard to see so many people in pain and not be able to help them. Laura say maybe it is easier to help than feel the pain. Paul remarks that his mother is buried in that cemetery. Laura asks is he comes there often and he says no, that they named their daughter after his mother and he can't bear to come and see her name.
Laura says she almost didn't come because she doesn't want to create a problem for Alex's wife. They are walking out and someone gives them directions to the gravesite. He asks if it is he whom he spoke to on the phone and Paul says yes. He introduces himself as Daniel, that Alex was staying with him -- this is one of the gay friends. Daniel says everything he ever thought about Alex got turned on its head eventually.
An older man approaches Paul and asks if he knows him. It is Alex's father. He talks about how terrible it is to pick out a plot for your child. He shows him where it is on the map. He mistakes Laura for Paul's wife.
Paul and Laura are sitting on a bench outside. Laura remarks how quiet it is and she reminisces about her mother, about liking having her shoelaces tied tight and her sheet tucked tightly. She says she likes the feeling of something holding her in. Paul apologizes for not having introduced her to Alex's father. He says his stepmother used to be mistaken for his wife because she was so much younger than his father. His father was proud that a young beautiful woman was with him. Laura asks how they met and Pal tells her that she was a patient of his father's. He says it was a nightmare and that as a teenager he was always in trouble. He says his father was a really selfish man, always took what he wanted without regard for anyone's feelings.
Laura says Paul should go to the graveside without her. Paul looks surprised. She leaves saying no one knows her anyway. Paul says he knows who she is.
I gather from what was said that Alex died while flying. Was it truly an accident or perhaps the result of his interior conflicts? I think we'll never know.
When Paul remarks that he has never had a patient he was working with die while i treatment, I could understand well his distress. This is not something most of us expect. Relatively few therapists experience the suicide of a patient and most of us see people in good or reasonably good physical health. That and the intimacy of the therapeutic relationship make the death of a patient feel a lot like a death in the family. And it gets complicated by the fact that we cannot reveal our actual relationship with the person who died.
We can see in this episode some of the reasons that Paul is drawn to Laura. She is indeed beautiful and she pays very close attention to him and expresses concern about him. Contrast this with the climate of his relationship with Kate, who is angry and pulling away from him. The quality of the personal interaction today makes a resumption of therapy pretty much impossible. Paul has invited Laura too far into his life and in doing so only fed her fantasies about him. But do note that she is taking care of him, as she did her father, and she is mistaken for his wife, as his beautiful stepmother once was also. So the theme of their fathers hovers over them as they talk.
Did Paul recognize himself as he told Laura about his father? Did he catch a glimpse of himself in the behavior of his father that so enraged him? That remains to be seen.
As much as I like this series for its relative fidelity to the reality of therapy and therapists, I am very much aware in these most recent episodes of events that are more about dramatic impact than they are faithful to the beginning of the series.