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.

© Cheryl Fuller, 2018. All  rights reserved.