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.

© Cheryl Fuller, 2018. All  rights reserved.