HBO's In Treatment | Jung At Heart

In Treatment -- Further thoughts

Sat, 05 Apr 2008 10:38:32 -0400

Did you find it interesting that Paul was not "successful "with all of his patients? This is one of the things I appreciate about In Treatment. So I thought it might be worthwhile to talk a bit about what constitutes success or failure in therapy, because it is not so easily determined as one might think.

Take, for example, Jake and Amy. Several people have written in the comments that they feel the work here failed because they apparently end in divorce. But is this failure? Before looking at the outcome, we have to think about what we look for as success in treatment. Does it mean a marriage saved Or does it mean that the parties are able to arrive at a choice that they believe works best for them? And it also depends on who one thinks the patient is. If the patient is the marriage, then it can be argued that it is the task of the therapist to support and work for it, for the improvement and survival of the marriage. But if it is the two people, then a successful outcome might well be very different.

I come back again and again to Bion and his dictum that we approach sessions without memory or desire. I have to remember when I work with someone that it is not my life we are considering, nor are my choices or the choices I think I would make necessarily the best ones for the patient. This is a tough position to hold, to be as neutral about what the patient chooses as humanly possible in order that the choice be his or hers.

Many times a patient will say to me, "I know you think I should do X", because that is what they want for me to think and want. And often they are initially unhappy when I remind them that what they decide will not change my life, but it may change theirs so it is what they want, what they choose that matters. Like Paul wants Gina to make him choose whether or not to pursue Laura, he wants it to matter to her even more than it does to him because then, no matter the outcome, the responsibility rests on her, not him.

So, in the case of Jake and Amy, it is important that Paul allow them to come to their own choice about what they do. Culturally, despite a 50% divorce rate, we tend to see saving the marriage as always the better choice. Therefore many people, probably most people believe that the purpose of couples therapy is saving the marriage. My own view is that therapy cannot save a marriage unless both members of the couple want it to be saved; thus when I do work with couples, I see discovering where each party stands as the crucial first part of the work. I work with them to help them determine what is the marriage they would like, how it differs from what they have and what would have to change in order for them to feel that they want to stay. Then comes the tough part -- are they willing to do that work? And when they are not willing to do that work, when they are not willing to face into what would be required of them to have the relationship they want, then ending is the likely outcome. Then the task is to end with as little additional harm or injury done to the other as possible, which is what Jake and Amy seem willing to do when we see them at the end. To my way of thinking this is not a failure in therapy.

Tomorrow, I will look at the other patients and consider the issue of success.

In Treatment -- Afterthoughts on Paul & Counter-transference

Wed, 02 Apr 2008 19:32:15 -0400

Laura is not the only person in her therapy; Paul is part of it also. Therapy is a relationship, an immersion of two people in the figurative bath of therapy.

For psychotherapy to be effective a close rapport is needed, so close that the doctor cannot shut his eyes to the heights and depths of human suffering. The rapport consists, after all, in a constant comparison and mutual comprehension, in the dialectical confrontation of two opposing psychic realities. If for some reason these mutual impressions do not impinge on each other, the psychotherapeutic process remains ineffective, and no change is produced. Unless both doctor and patient become a problem to each other, no solution is found. (Jung, Memories dreams Reflections, p. 143)

So, Paul needs to be able to be open to what Laura tells him, to feel what she is feeling and become able to metabolize it in such a way that he can help her to understand herself and be more conscious of her life.

But, and this is crucial, Jung also says, The patient's treatment begins with the doctor, so to speak. Only if the doctor knows how to cope with himself and his own problems will he be able to teach the patient to do the same. (Jung, Memories Dreams Reflections, p. 132)

And here is where Paul is in deep water before Laura says anything about her feelings for him. He is not coping well, if at all really, with his life and his problems. And as we saw, this only became worse after her disclosure, as his wife went to Rome with another man.

Paul's feelings about Laura are what we call counter-transference. From the Jung Lexicon,

Even if the analyst has no neurosis, but only a rather more extensive area of unconsciousness than usual, this is sufficient to produce a sphere of mutual unconsciousness, i.e., a counter-transference. This phenomenon is one of the chief occupational hazards of psychotherapy. It causes psychic infections in both analyst and patient and brings the therapeutic process to a standstill. This state of unconscious identity is also the reason why an analyst can help his patient just so far as he himself has gone and not a step further.["Appendix," CW 16, par. 545.]

Paul, because he has not sufficiently dealt with the issues in his life -- his marriage, his father complex, his need to be wanted and to feel he can care for and nurture a woman, falls prey to this common hazard and counter-transferentially believes he is in love with Laura as she believes she is with him. It is his fantasy of her, that she would adore him and make him feel good as a man, which his wife does not, at least not now. Laura and Paul become infected with the same fantasy, the same psychic virus.

"If the analyst fails to be conscious of the same sufferings within himself/herself and places the total responsibility on the analysand, dismissing his or her participation (albeit unconscious) as "nothing but the transference..."then the effort is lost", Jung also writes, "But life cannot be mastered with theories, and just as the cure of neurosis is not, ultimately, a mere question of therapeutic skill, but is a moral achievement, so too is the solution of problems thrown up by the transference...The treatment of the transference reveals in a pitiless light what the healing agent really is: it is the degree to which the analyst himself can cope with his own psychic problems." (C.G. Jung, CW 18, p. 493)

The problem between Laura and Paul is not that Laura fell in love with Paul or that Paul developed feelings for her. The problem is that Paul failed to be conscious of the issues in himself that meshed so perfectly with Laura and her problems that he became blind and caught in a kind of possession so that what he felt became not a tool for helping Laura, but instead an occasion for acting out.

"For two personalities to meet is like mixing two different chemical substances: if there is any combination at all, both are transformed. It is futile for the doctor to shield himself from the influence of the patient and to surround himself with a smoke-screen of fatherly and professional authority. By so doing he only denies himself the use of a highly important organ of information" (C.G. Jung CW 16, p.71)

It is here, in the last episode, where I find cause for optimism about both Laura and Paul. Laura does get it at long last that having Paul is not what she needs or wants. And this is an important step toward changing how she lives her life and relates to men. I would hope she would find another therapist and continue to look at what happened with Paul and how it followed from her earlier life and how she might choose differently in the future.

Paul, at the very end, surrenders and seems willing finally to look at himself, to open to the therapy he needs. Whether or not Gina is the best person for him to work with is an open question, but it is a place to start.

In Treatment -- Afterthoughts on Laura & transference

Tue, 01 Apr 2008 12:13:08 -0400

There have been many comments and questions about the relationship between Paul and Laura in the comments to those episodes. So I want to write for a bit about transference/countertransference and look at this from a Jungian perspective. This will probably take a couple of days so get a cup of tea and let's see if we can unravel this knot a bit.

I think it helps to start with the understanding that in therapy, in the therapist's office, a special space is created. A space which resembles in some ways the space of friendship, or of intimate partners. It is quiet. Optimally there are no interruptions, no knocks on the door, no insistent ringing of the telephone. So that each session has the quality of time out of time to it. The ordinary rules of social interaction are not in play. The fundamental rule is to say whatever comes to mind, something we probably rarely if ever do in other relationships. The patient is free to speak whatever feelings or thoughts she has and the therapist has no expectation of reciprocity. It is time that belongs to the patient, is for and about her in a way that most of us simply do not experience elsewhere. That no subject is ruled out, no topic taboo, an unusual degree of intimacy develops. I can say anything, feel anything and all I have to do is put it into words.

Both the therapist and the patient are in this space, often referred to by Jungians as a temenos -- from the Greek meaning a sacred, protected space; psychologically, descriptive of both a personal container and the sense of privacy that surrounds an analytical relationship.

And into this unusual space, the patient brings all of her history, dreams, fears, desires, wishes, hopes, fantasies.

Let's look at what Jung says about transference --

Transference is a term used to describe the unconscious, emotional bond that arises in the analysand toward the analyst.

"Unconscious contents are invariably projected at first upon concrete persons and situations. Many projections can ultimately be integrated back into the individual once he has recognized their subjective origin; others resist integration, and although they may be detached from their original objects, they thereupon transfer themselves to the doctor. Among these contents the relation to the parent of opposite sex plays an important part, i.e., the relation of son to mother, daughter to father, and also that of brother to sister.["The Psychology of the Transference,"( CW 16, par. 357.)

Jung writes, "Careful analysis of the transference phenomenon yields an extremely complicated picture with such startlingly pronounced features that we are often tempted to pick out one of them as the most important and then exclaim by way of explanation, 'Of course, it's nothing but...' I'm referring chiefly to the erotic or sexual aspects of transference fantasies. The existence of this aspect is undesirable, but it is not always the only one and not only the essential one. Another is the will to power (described by Adler) which proves to be coexistent with sexuality and is often very difficult to make out which of the two predominates. These two aspects alone offer sufficient grounds for a paralyzing conflict". (C.G. Jung, CW 16, p.173)

Now think about Laura. Can you see an element, not only of erotic transference from her, but also power, her power to control men through sex? She brings this to her therapy as part of how she has come to experience relationships with men.

Consider an important piece of her history -- at a time when she needed her father's attention, comfort, care, he was depressed and withdrawn and unavailable to her and put her in a position of having to care for him. On the other hand, the family friend she stayed with noticed her, wanted her and she ended up in a sexual relationship with him. It seems likely that these two kinds of responses set the pattern for her relationships with men.

She comes into therapy with Paul. He listens to her, pays attention to her, notices her, helps her to make sense of her world. And activates her long frustrated father hunger which has become intertwined with sex. Life has taught her that men either fail to notice her at all or want her sexually. This man notices her and so she begins to feel as if she were in love with him. And she is, but the Paul that she is in love with is the Paul who exists in his office in that hour every week. That Paul would want her, pay attention to her and keep her in that place of feeling wanted and cared for always -- or so she fantasizes. And that fantasy is important because it holds valuable information for her about what she does want and how the way she has gone about her life has kept her from it.

Laura does exactly what the basic rule of therapy dictates -- she says what comes to mind and tells Paul she is in love with him, that she wants him. And this is the stuff of her therapy.

Tomorrow -- Paul and countertransference

In Treatment -- Afterthoughts

Sun, 30 Mar 2008 19:28:09 -0400

Tomorrow I will start writing some afterthoughts on the series. For today, a couple of articles worth reading:

1. Lisa Schwarzbaum writes in Entertainment Weekly about the benefits of watching the show and concludes:

" We're erratic, contradictory, each of us an individual bundle of urges, compulsions, and rationalizations, dressed in shoes. I don't count on the good shrinks of HBO to make sense of me and you and everyone we know, but I rely on them to confirm that I'm okay, you're okay."

Nicely put, Lisa.

2. And in today's New York Times, a nice piece on marriage and marital therapy, which concludes --

"Like dentists, marriage counselors often complain that couples come in too late to save the relationship. “Frequently, they’re actually going to counseling to figure out how to break up,” Dr. Smith said. Or as Barbara Thomas — an artist in New York who with her ex-husband, the writer Michael M. Thomas, saw a counselor for years — put it, “Counseling doesn’t work when it’s putting glue on a big shattered thing.”

Whether your marriage seems like a big shattered thing, a big bore or a big disappointment, some therapists suggest that restoring it is worthwhile. A healthy marriage is good for everything from your taxes to your soul.

“An intimate relationship inures people,” Dr. Smith said. “There’s a greater sense of well-being. You’re able to endure far, far greater hardships than on your own. That’s when the relationship is working. When it’s not working, it can destroy you.” "

In Treatment -- Paul, week 9

Fri, 28 Mar 2008 16:34:28 -0400

I suspect we all expect this to be where the shit hits the fan for Paul.

Paul looks at his phone and then calls Laura -- her machine answers. He hangs up and calls again and this time leaves a message, hoping she is there and not picking up. Then we see that she is there and listening. She picks up the phone.

Paul asks if she is okay. He says he would like to see her, that they should talk. Laura agrees. She tells him to come to her house.

Kate is in their bedroom. It looks like she fell asleep reading on the bed. She wakes up to discover Paul in the doorway watching her. He tells Kate he is going to see Laura. Kate says nothing.

Laura answers the door and says it is strange answering the door for him. He says she sounds sick; she says it's just a cold. Paul comments that her house is very nice. They both seem awkward. Laura asks if her place is as he imagined it. He says it smaller and he expected more color. Laura offers him a drink, he asks for water. Paul wanders about looking at things. His cell phone rings and he sees it is his daughter.

Paul asks if she has seen Andrew. She says yes, he brought by soup. Paul asks if she has been upset with him. She says not upset but frustrated because she doesn't know who they are to each other. Paul says they should decide. He says he knows what he wants and tells her he loves her. Laura doesn't believe him. He asks if it is because he hasn't left home. Paul starts to interpret her response and she tells him to stop. She asks what changed. Paul says he realized what he would lose if he didn't see her. Laura says he will get over her. Paul says he doesn't want to get over her. Paul again starts to tell her how she feels and she tells him to stop because she is not in therapy now and he can't tell her how she feels. He again starts to talk with her as a therapist. Paul asks if she is over him. She says no. She says she doesn't want just happiness in the moment any more; she wants something that will last. She doesn't want to be someone in his life just because his marriage ran out of steam. She says she does not want to talk.

Laura says , as she touches his face, that he doesn't really want this. Paul whispers that he does. Laura gets up and leaves the room. He gets up and follows to her bedroom. Laura is sitting on the bed and starts to undress.

An abrupt change and Paul is knocking on Gina's door. Gina answers and asks what is the matter. He tells her he saw Laura. He tells her had been calling her since the funeral and finally she picked up. He tells Gina that he had gone to her and that he told her that he was ready to be with her. Paul tells Gina that he couldn't do anything, that he had an anxiety attack and could not respond to Laura. He tells her he felt like he was suffocating, drowning in sweat. Then he got out as fast as he could. And that Laura told him she changed her mind, that she didn't want it any more. Paul says he couldn't touch her.

Gina says nothing is wrong with Paul. She reminds him that it had to be his decision. Paul says it came down to fearing he would be swallowed up by all of it and that he would lose control. Gina says the anxiety attack was him, was his, his best self stopping him. Gina says he steered himself away from something he knew he would regret and from hurting Laura and himself. If he hadn't want her so badly, it would have been easy. But he had the anxiety attack and he did what he needed to do.

Paul says Laura told him that she did not want to use sex anymore as she always had and that Paul was using her to bail himself out of his marriage. Gina says that what maters is that he did the right thing for himself and his patient.

Paul asks what is left for him now. Gina asks if he would like to talk about that. The episode ends.

Well, my hope about Paul turned out to be accurate but not in the way I thought. I did not expect Paul to go through with actually seeing Laura and telling her he was in love with her. It was my fantasy that he be able to recognize what that would mean and step back from the brink. But as it turns out, both of them acted in the way one would hope.

If we watch carefully, we can see in the awkwardness between Laura and Paul that they don't really know each other, that they have far less upon which to build anything than either of them wanted to believe. Her house, very modern and in neutral colors, stands in contrast to the richness and homey clutter of his own. They can't connect over art.

Paul's anxiety attack is, as Gina says, his psyche acting to protect him from his own bad impulse. It is, again as she says, his best self preventing him from doing something that would be very hurtful. And, in deciding she does not want Paul after all, Laura is actually demonstrating having gained from therapy.

But this is a terrible way to end in the right place. Paul has acted out and that is a big problem. And settling to talk more with Gina does not seem like an especially good idea. Paul still needs to see a therapist with whom he does not have such a tangled history. He needs to decide he actually wants help and be willing to surrender to the process in order to get it.

And Laura? Her father issues are still there in a big way. And though she seems to have for once made a choice not to use sex to have a relationship, what has she really learned from this failed therapy?

This weekend I'll pull together thoughts about the series as whole. Please leave any questions in the comments and we can continue to discuss the show.

In Treatment -- Jake & Amy, week 9

Thu, 27 Mar 2008 17:09:44 -0400

Jake and Amy both arrive for their session. Jake says he will miss the office -- he likes the feel of it and the clutter. Paul asks why he says they will miss it. Amy says they are getting divorced. Jake says it is because of Paul, of therapy, that therapy did them good. Amy says good if you mean a disaster.

Amy asks Paul if he has ever been through a divorce. Paul suggests maybe they could start with talking about the last week. Amy says they didn't see each other all week. Her tone is brittle and angry. Amy says she doesn't want to talk about her week, that therapy has just made her miserable.. Jake says that's not how it has been, that Paul has helped them see how they bring out the worst in each other.

Amy continues to be angry. Jake seems more at ease.

Amy says she heard Jake play when she was outside where he was but she didn't go in. Jake asks why she didn't come in. Amy says because of Paul because she couldn't remember how they used to make up. Jake says sex, that was what they did. Amy says she regrets ever having come to therapy. Jake says he thinks it is complicated, that coming to understand more feels good even as he is upset that it is falling apart.

Paul summarizes what he knows about them, how their relationship has developed. Amy says she was depressed when Lenny was born, Jake was elated. Paul says they have tried to illuminate their patterns and how they have coiled around each other. Now that the patterns have been revealed they can't enact them any longer.

Jake says he felt betrayed by Amy's depression after Lenny. He thought he was rescuing her from unhappiness and when she remained unhappy he felt he had been tricked. Amy says she is sorry he felt that way. Jake apologizes also.

Amy says she will miss their family.

Paul says he sees two people who have loved each other deeply, that they have come to he same place together. He asks that they consider not turning away. Jake asks if he is saying they shouldn't get divorced. Paul says therapy can help couples come together or feel better about separating. Amy wants Paul to tell them. Paul says he can't.

Paul asks if they are going to share custody. They each agree. Amy says she is not working. She says she was fired because she slept with the boss. She says she is relieved, that she got a severance package. Jake says he has a producer interested in a few songs. Paul says they need to talk about the details.

Amy asks if Jake has told his parents. He says he has and his parents were upset. He says they will figure it out, work out custody. Paul asks if they have talked to Lenny. They say not really but he has picked up on things. Jake and Amy are able to be joined in their concern about Lenny.

Amy looks very sad and says they are over and she cries. Jake also looks sad. He doesn't look at her as she sobs. Jake says they should get going because Lenny's piano lesson will soon be over. Jake also says he can't be there any longer. He tells Amy he can pick her up after he gets Lenny if she wants to talk with Paul more. We see a couple outside. Jake asks who it is and Paul says his next patients. They leave.

It is no surprise to me that Jake and Amy are divorcing. That is a decision that was made before they arrived. Therapy helped them learn a bit about themselves and each other so they are able to separate without inflicting further injury on each other Often this is what therapy accomplishes with couples. Jake came to feel better about therapy even though it did lead where he was afraid it would. One hopes that each of them will go on and do some individual work -- Jake because he continues to shape his life around not being like his father, and Amy to deal with her terrible guilt about her father's death. It seems difficult to imagine they can make better partner choices in the future without working through some of these individual issues.

Paul seems to keep trying to get them to decide not to decide yet. Perhaps this comes of his own hopes for his struggling marriage. If Jake and Amy can find their way through this terrible time, if they can survive her infidelity, maybe Paul and Kate can survive too. This no doubt underlies some of Paul's desire to get them to go on a bit and it may well be unconscious on his part.

In Treatment -- Sophie, week 9

Wed, 26 Mar 2008 17:03:53 -0400

Our final session with Sophie.

Paul is making a phone call. He is calling Laura and leaves a message saying he is hoping they can maybe have a coffee.

Sophie comes to Paul's office. A man calls to her and it is her father. She asks what he is doing there. He hugs her and says she is a knockout. Sophie asks him how he knew she would be there. He tells her that her mother says she was seeing her therapist. He tells her he hears she did really well at the trials and asks why she didn't call. She tells him she was tired. He says he couldn't come, couldn't just show up. And then he asks what's going on, is she angry with him? Sophie looks uncomfortable with him. He claims he gets crazy when she doesn't call him. She says she did call. That her mom always answers her cell phone. He tries to get her to skip her therapy session but she says no. He starts asking her about therapy what she talks about, does she talk about him. Then wants to know what she says about him? And is that why she is behaving strangely? Then he says he is coming in.

Paul answers the door with balloons in his hand. Zach asks if they are for him and Paul says no, they are for Sophie. Paul tells Zach that he can come in only if it is okay with Sophie. Sophie says it's okay. Paul says he thinks it would be better to schedule a joint session next week so he and Sophie can prepare. Sophie insists her father agree to next week. Sophie goes out after her father and says she will tell Paul to let him come in. Zach says he won't go back now because he is humiliated. And is Sophie really taking Paul seriously? Zach says he raised her to be smarter than this, then Sophie says you didn't raise me. Zach says he can't believe what he is hearing. Sophie goes back to the office.

Sophie tells Paul Zach is humiliated. Paul tells her he can't let him in without an appointment. Sophie asks if he would say the same thing to someone else. Paul tells her he understands how her mother feels because Sophie always defends him, even though Zach invades her private space. Sophie wants to make her father happy. Paul reminds her that she is the kid not the parent.

Zach knocks on the door. Sophie asks Paul to let him in, that she wants to talk to him. Paul complies.

Zach is hostile. Paul invites him to sit down. He turns to Sophie and says that she said he didn't raise her and wasn't there. Zach made a list -- he tells her that every morning from the time she was 6 until she was 10 he would get up with her, take her to practice and then take her to school. And he stayed up late every night to help her with her homework and got tutoring for himself in math so he could help her. He cries and said he would hold her when she couldn't sleep. Sat with her in the hospital when she got injured. Sophie moves to comfort him. Zach says it kills him when she doesn't call for 2 weeks. She says he didn't see her for almost three years and it didn't seem t bother him then. He says they spoke every day on the phone and she says that isn't the same. Sophie confronts him about abandoning her, about taking so long before he left his second wife, even though he knew all that time she wanted to live with him.

Then Sophie says for him to go, to leave, she doesn't want him in her life. That he can't just come and go in her life. Sophie says he doesn't know her. That Palu knows her but Zach doesn't. Zach turns to Paul and asks what he hears. Paul says he hears great anger and resentment but also a great desire for him to fight for her, to reclaim her. Zach tells Sophie that he never stopped loving her. Sophie asks what the difference is, he chose his second wife and that he can't undo it. Sophie tells him he can't put a family back together. Then she asks if he knew she tried to kill herself. She tells him it wasn't an accident that she had, that she rode her bike into the car because she was tired of being alive and then she tells him to leave. She insists that he go. She says, "It's MY therapy" and holds firm. Zach gets up and leaves.

Sophie sits again. She says I kicked my father out. Paul says she has discovered she can kick her parents out or let them in as she wants. Sophie thinks she won't see him again. Paul suggests that he may change from this. That Sophie has changed.

Sophie tells Paul she is going away to Denver to train. That she wants to be by herself, to take care of herself, without her mom or Paul. Paul tells her she can call him any time she wants. She takes her balloons and goes to the door, They hug and she says goodbye.

Paul's daughter opens the door. Rosie says sophie used to go to her school. Ad asks if that is her dad and says he looks cool. Rosie says Kate seems tense. She asks if they are talking about everything. Through the window we see Zach and Sophie sitting on the grass talking.

Though it is a resolution that comes faster than I would expect to see in real life, what happens this week is very satisfying, wonderful fruit of the work Pal and Sophie have done together.

Paul held the boundary for Sophie, kept her father from having his way until or unless she wanted him in and thus again proves to her that there are indeed adults she can trust. So when Zach comes back to the door, Sophie is ready to let him in and to tell him what she needs to say because she has the safety of Paul's office and Paul to support her. It is very clear throughout her interaction with her father that in his narcissism he has made everything about him. But this time Sophie isn't buying it from him, isn't willing to let him off the hook. That he was a good father for her first seven years does not excuse the last years when he has not been around nor the fact that he did not take a stand with his second wife when Sophie really needed him. In a sense Paul is the father to this new Sophie, a Sophie who can speak her truth and hold her ground even against the charms of her father. This all bodes well for her, though it is unrealistic to think that everything is okay for her now.

It is poignant when Rosie comes in, wanting to hear from Paul that their family will be all right -- as they look out on the scene of Sophie and her father finding their way into a new relationship with each other. Dare we hope that her wishes are well founded?

In Treatment -- week 9, continued

Tue, 25 Mar 2008 14:11:07 -0400

A commenter asked why I thought Alex may well have committed suicide. So I'll talk about that a bit today.

I think it is important to consider how difficult it is for Alex to acknowledge in himself anything that he thinks indicates weakness. He always has to be the best, have the best, do the best. In his world, he hasn't a readily available way to deal with his deeply conflicted feelings about having bombed the madrassah. Yet it is this conflict that underlies his reason for coming to see Paul in the first place.

We know he pushed himself so hard physically after he returned to the States that he had a coronary. His refusal to attend to his body, to pay attention to what he was doing to it, can also be seen as a way of acting out his grief, anger, guilt about what he did when he flew that fateful mission. And because he cannot express those feelings, where can they go but inside, into his body where they become symptoms?

Alex has grown up in a family where repression is a way of life, seen as a means of survival. When his father essentially tells Paul that therapy, in uncovering things better left buried, caused his son's death, he is telling a truth, at least from inside that system.

But Alex had more than the bombing eating away at him. There was his relationship with his father, conflicted at best, requiring of him, or so he believed, that he keep trying to prove himself in order to win his father's approval. And his murky relationship with his gay friends. No doubt Alex was no more certain about his sexuality than we are. And in his world, with his father, what room is there for that kind of confusion?

So Alex returns to duty where he is assigned to train new pilots, younger men who test themselves by vying with him, always eager to best him in training exercises. His sense of himself, now shaken some by therapy and the feelings and issues raised in his time with Paul, may depend even more than usual on his prowess in the air. And this time, his cockiness, his certainty that he is the best fails him. He develops vertigo and instead of trusting his instruments, he trusts himself. But he is not trustworthy and he crashes.

Is it suicide as it would be had he shot himself, a conscious and deliberate act? No. But so much was falling apart for him and the fact that we know he had already pushed himself into a heart attack, that it seems inescapable to me that Alex is a suicide, if not by commission, than by omission, by failure to act to save himself.

Paul did not cause Alex to kill himself. Nor did therapy. And his therapy did not create problems in his life; it led to the surfacing of what was already there. For whatever the reason -- the confluence of an error in judgment and an inability to face himself -- Alex died before he could really buckle down and do the work in therapy, work which could have led him to a very different place.

In Treatment -- week 9

Mon, 24 Mar 2008 13:16:01 -0400

There are just 3 episodes this week, Wednesday-Friday. So today and tomorrow, let's start looking back.

Monday is Laura's day, Laura who apparently left therapy three weeks ago. We know Paul saw her last week at Alex's funeral but we have no indication that he has seen or talked with her since then. I have said before that Laura's infatuation with Paul is anchored in fantasy and the experience of being in therapy. Having someone pay close attention to what one says and to not ask anything in return is a heady experience and indeed, given the subject matter, feels and is intimate. But it is not the intimacy that grows of two people taking time to get to know each other. As we grow close to another, a lover, we become acquainted with how he or she smells, likes and dislikes, moods, history -- all the details that get knit together in a relationship. But Laura has only a limited view of Paul and her fantasy of what she hopes and wants him to be like. In truth she does not know him at all, as a person outside of his office.

In a very real sense, the same is true of Paul about Laura. He has met with her for one hour a week for a year. Listening to her, offering interpretations and comments as appropriate. He hasn't any idea what she is like when she works or eats or sleeps or any of those ordinary life activities. And his own wife has grown less attentive, less adoring of him. So Laura's adulation and declarations of love become an issue for him. He is not defended in the way he and most therapists are in the usual run of events. It is our families, our friends, our interests and activities outside of the office that keep us anchored in our real lives and able to remain relatively clear about what is happening in the heated atmosphere of the consulting room, for indeed the atmosphere there is not that of the rest of life. It is time out of time, out of place and not the stuff that day to life is made of.

If Paul's marriage and home life were working better, or even if he had a solid therapeutic relationship with his own therapist, he likely would be better equipped to handle Laura's strong erotic transference. It is the weakening of his professional defenses and his failure to develop, either with Gina or someone else, a working therapeutic/clinical supervision relationship that renders him vulnerable so that he falls prey to his fantasies about Laura. And like Laura, these fantasies are all tied up in a pretty big father complex.

Falling prey to an erotic counter-transference has been one of the great bugaboos in psychotherapy. It is never ethical to have sexual relations with a patient and most consider it unethical to develop a romantic relationship with a patient, even after the therapy has ended. But as Gina says to Paul rules can't make the choice. Ultimately each therapist who finds himself or herself (and the research has shown that though both male and female therapists have transgressed, it is far more often a problem among male therapists) struggling with such a relationship must make the choice to remain professional, seek help if necessary, and restrain the impulse to act out.

I don't know about you, but I still believe that Paul will pull away, that the spell will break before he goes over the edge.

In Treatment -- Paul, week 8

Fri, 21 Mar 2008 19:03:22 -0400

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

Thu, 20 Mar 2008 19:41:54 -0400

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

Wed, 19 Mar 2008 19:48:35 -0400

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

Tue, 18 Mar 2008 19:05:37 -0400

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

Mon, 17 Mar 2008 19:39:14 -0400

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.

In Treatment -- Paul, week 7

Fri, 14 Mar 2008 10:37:12 -0400

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.

In Treatment -- Jake & Amy, week 7

Thu, 13 Mar 2008 17:00:09 -0400

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.

In Treatment -- Sophie, week 7

Wed, 12 Mar 2008 16:21:07 -0400

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.

In Treatment-- Alex, week 7

Tue, 11 Mar 2008 18:32:40 -0400

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.

In Treatment -- Laura, week 7

Mon, 10 Mar 2008 18:34:08 -0400

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.

In Treatment -- Paul, week 6

Fri, 07 Mar 2008 16:43:03 -0500

Kate and Paul arrive together. They are waiting for their daughter, Rosie, to check in with them so their cell phones are left on. They are concerned about where Rosie has actually been.

Rosie has been out for 24 hrs. Gina asks if this didn't happen before a few weeks ago. Kate talks about the shelter she runs, that Rosie volunteers there four times a week. Paul says she is a born social worker, always has been. And Gina asks how he knows that. Paul talks about ways Rosie mediated among friends. Paul somewhat hostilely interprets Gina's question to indicate that Rosie also mediates at home. Kate concludes that Rosie's volunteer work 4 times a week is too much. Gina asks when she started volunteering and they answer around 6 months ago. Kate thinks maybe Rosie should do more ordinary teenage stuff. Paul again interprets what he thinks Gina is actually asking. Gina tells him to stop that.

Kate calls Rosie and she answers. Paul says he wants to talk to her. Kate lies about where she and Paul are, telling her they are with an accountant. Paul says Rosie is not staying with that friend again. And then says he would ask why this now and turns the issue into a reaction to the problems between Paul and Kate. Gina points out that when Rosie vanishes, they work together. She asks if Rosie senses the conflict. Kate thinks they have concealed it well. Paul says he thinks it is more tense now because Kate ran into Laura.

Kate ays she saw Laura and says she is not some poor innocent thing. Kate describes her as like a girl Paul was once involved with, a very seductive woman. She accuses Paul of being just like every other middle aged man, falling in love with the beautiful young woman.

She describes Laura as having a spoiled aloof look about her, that she was very fake. They bicker about Laura and Kate says she is threatened because she is the kind of woman who always gets her man and that Paul has always wanted a woman like Laura. She says she is not Paul's fantasy. Gina reflects that even so he married Kate. Kate ays he wanted the trophy wife and got the homemaker.

Paul says he fell in love with her not just because of her beauty but also her strength, that she was grounded and strong and he needed that. Kate says she does not need him anymore. Paul looks stricken. He says he needs her and has always wanted and needed her. Kate says not like he wants Laura. And Paul asks why she does that, jumps to those conclusions.

Gina asks how it is that Kate no longer needs Paul. She says she would like a partner who was present and available but she lives without that and no longer needs it. Gina asks her what kind of partner she would like. She can't say in detail, then says she would like someone who would tell her about his day. She ays it isn't just about being wanted, that she wants to be a part of something. Then she says women like Laura are all about sex and she can't compete with that. Gina tries to tell Kate that Laura isn't the same threat that she imagines. The danger is that Paul may have fallen in love with Laura. That Kate fell in love with the way their relationship was a lot like a therapy relationship before and now she doesn't need that. And that confuses Paul. Laura loves Paul because he listens to her with attention. She admires him.

Gina says Kate is trying to redefine herself as independent within the marriage. Paul interrupts. Gina tells him that it is not all him, that Kate is part of the problem too. That being needy was what Kate did to attract Paul. Paul is angry at Gina and accuses her of trying to push Kate out, that Kate is reacting out of her childhood issues. Gina says maybe he doesn't want to talk about childhoods because then he would have to talk about his. Kate says she can't take this, that she knew it would turn into the history between them but that isn't helpful to her and she leaves. Paul follows.

I was leery of Gina's agreement to see both Paul and Kate for precisely the reason this session fell apart. The issues between Gina and Paul are completely unresolved. He cannot be open to what she says because he is engaged in resistance to her all the time out of his unresolved anger at her and his resentment that she has, quite accurately, persisted in linking his behavior to his father's. I can't see how any therapist, no mater how gifted, could surmount this problem. My choice would have been to refer the couple to another therapist, someone who neither has a prior history with and someone both can feel safe with.

That said, Gina's observations about Kate and Paul, how they came together and what is happening now, seem spot on to me. Paul has always been able to enact his therapist role with Kate, to be the strong one and once Kate no longer needs that to feel secure, they are both left not knowing how to be with each other. But instead of dealing with that -- because neither one has seen it -- they act it out; Kate with her affair and Paul by allowing himself to develop feelings for Laura. And underlying all of this are their childhood issues. It's almost never simple with couples.

Kate's action, leaving because she cannot deal with the conflict between Paul and Gina, is clear and direct. She is right that it is not helpful to her now to their problems as a couple.

Will Kate come back? Your guess is as good as mine.

In Treatment -- Jake & Amy, week 6

Thu, 06 Mar 2008 19:16:40 -0500

Did you see Gabriel Byrne on Charlie Rose last night?

We begin this week as Amy is outside the office talking on her cell phone. Paul comes out and she says she is a little early. Paul asks if she can wait a few minutes and goes back inside.

Then we seeAmy is alone. She gets up to close the curtain. Then fluffs the pillow on the couch. Paul asks how she is and she says good. She says she rushed to get there. She says Jake is not coming. She tells Paul that they are together, that everything is fine and they are seemingly in love.

Amy says she was miffed that Paul asked her to wait outside and wonders if he would let another patient, someone he likes more, come in early. She says she knows she and Jake are not easy as patients. Paul asks how she would describe herself. She says maybe she would like for him to be different -- Harrison Ford. Paul asks how he would behave if she arrived early for a session. Amy says he wouldn't make her wait outside like a naughty schoolgirl. And she acts a bit flirty.

Paul asks what has happened since last week. She says everything is fine. Paul asks why she said they were seemingly in love. Amy says Jake is meeting with someone who might commission some music and sent her alone because talking does her good. She says he is so sweet, but she sounds like she does not believe him. Paul asks if sweet is not good and she replies that sweet is fattening. Paul asks if this is worse than whispering that he was going to kill her. And she says much worse. She says even when they were having trouble together they had angry sex, that no matter what they had that. She blames Paul for that being replaced with sweetness. She says maybe she deserves being knocked around a bit.

Amy asks if Paul likes her necklace and tells him that it was a gift from Ben, her boss. She tells Paul that Ben is picking her up after her session and they are not going back to the office. She alludes to an affair. Paul asks why she doesn't say it, does she want him to stop it. She says it can't be stopped. That no one can stop it, that it is a ticking time bomb. He asks what set it off and she says the lousy sex, which she blames on therapy and Paul. She wonders why she can't stop it. He asks her if she likes Ben.

Paul goes back to the previous week and Amy saying se was overweight as a child. She says she was fat, not overweight, that her sister was gorgeous. She says that right after her father died she decided to stop eating and the next thing she knew she was 45 pounds lighter. She describes ow much she liked the control over her eating she had, that it made her feel high.

She described her father as a lovely man. And when asked about her mother, she replies that her mother is dead. She says her mother became like the evil stepmother and her sister like the evil stepsister. She grows silent after telling an incident about a dress. Paul asks if she had talked with her father about it or could she have talked with her mother. She says no and that her mother would say she was making it up.

She tells of getting even with her sister by meeting a boy she had gone out with some time before and having sex with him. Paul says she evened her account in bed and now she is evening the account with Jake in the same way. She says her father was kind and would come into their room at night and kiss them on the eyes. She says he would tell her how he loved her and hold his face in his hands. Paul points out that when Jake is tender she finds him disgusting. Does she think that tenderness is scary because she is afraid they will leave her, die on her. So she provokes Jake and gets him to treat her badly.

She says Ben will be there any moment. What should she do? Paul asks if she really wants him to tell her it's okay to have sex with her boss. Paul says he thinks it would be a really big mistake. Then she asks him to tell Jake she can't help it because she is fucked up. Paul asks if she thinks that sex with Ben will go unpunished? Isn't she maybe starting the punishment herself. She says Jake's tenderness is not love, it's neediness, weakness. Paul says she needs to look at it more closely. Amy says she feels it has happened already. Paul says it hasn't, that nothing happens without her. She says she has to go to the bathroom.

She gets her phone and calls Jake. She leaves a message that she just wanted to hear his voice. The hour ends with her sitting in the bathroom.

I underestimated the power of conflict to hold a couple together because I would not have guessed that Jake and Amy would be back together. But together is perhaps not the right word here as nothing has been dealt with at all. Jake has done a 180 and become sweet, which I suspect Amy may be right in seeing as arising from his neediness. And Amy can't feel attraction to a man who treats her well or with tenderness. We get some tantalizing insight into her as she talks about how she sees herself as having been Cinderella at the hands of her mother and sister. But unlike Cinderella, she does not seem to feel she got the prince, though we don't know much about her first husband or what he was like. Did he become soft and tender too, driving her into Jake's arms?

And we detect in Amy, as in Sophie, control over chaos through restricted eating. Sweet makes you fat, she tells Paul and I wonder if she is also saying that if she accepts Jake in his new attitude, she will become as she used to be, fat and undesirable?

And what about Jake, who believes that therapy will cause his divorce? He sends Amy to see Paul because he says talking helps her, but he doesn't come. Because maybe if he came, the wound would be opened again and the fragile peace broken?

I believe more strongly than ever that each of these people should be in individual therapy probably more than in marital therapy. The problems in the marriage reflect the problems in each of them. Amy's history with men, with her mother and father, with her feelings about herself and her body and her use of sex to get even with those who have hurt her. Jake's issues are also present with his dependence on Amy, his sense of himself, his difficulty succeeding.