A long time ago a clinical supervisor told me we get the patients that we need in this process in which both therapist and patient become immersed. With that thought in mind, let's look at the patients Paul has this year and how their issues and his relate. In Jungian terms, we see what happens in therapy as illustrated in the diagram below:
All four of the patients we will be following are ambivalent at best about being in therapy. And all of them resist Paul's efforts to encourage them to look more deeply in themselves -- this is a guess about Mia but she will be coming back with her own agenda of unfinished business from previous work with Paul; in fact it appears her desire is to deal with Paul more even than with herself. And Paul is reluctant to acknowledge his need for therapy. The ambivalence and defensiveness of his patients mirrors his. Five reluctant patients and a reluctant therapist.
Paul tells Gina he is sick of listening to people yet in his work with the patients we see, none of that shows. He does good work with all of them, reflecting something good therapists do all the time, which is to set aside personal issues in order to be present to patients. However it is essential that he be talking with someone about these feelings of his or they will inevitably leak into his work -- in impatience, overly harsh interpretations, empathic failures, and the like.
Paul is on the train. A large man takes the seat next to him and starts eating and talking. Paul looks uncomfortable. He lies to the man when asked what he does and says he is in sales.
Gina greets him at the door. She has redecorated. Paul has not talked with her in a while. He asks if his lawyer called about the malpractice case. She says he did and she will be deposed though she doesn't know how much help she can be.
There is a knock and a woman has come back to get her glasses. She and Paul know each other. Gina identifies Paul as a friend not a patient. Gina tells him she is seeing patients, that her book is doing well and she asks if he has read it. He says he hasn't, that he isn't ready for it.
Paul tells her this is the first time in his life he has lived alone.
Paul is gloomy about the suit and the outcome of it. He is afraid he will lose his license, his apartment. He says he doesn't care if he loses his license because he is sick of sitting day after day listening to people's problems.
Paul is on the phone leaving a message for his kids about a visit scheduled for the next week.
Walter arrives for a first appointment. A well-dressed man who comments on his "nice things" and then fusses with the pillow in the chair and lets Paul know he is a CEO. Paul asks him to tell him about himself but Walter wants to know what he already knows about him. Walter is surprised he knows nothing about him. He is surprised that Paul doesn't read the business section and tells him that his daughter's friends at college never read that section either -- and he sounds very disapproving. Walter keeps impressing on Paul how important he is.
He tells Paul it was his wife's idea that he seek therapy because he doesn't sleep well. Paul notes he has mentioned his wife twice and that she takes good care of him. He says he has tried Xanax and Ambien and says they did not work for him. He says his doctor told him he has underlying anxiety and should talk to someone. Walter is distressed that his whole life he was able to sleep whenever he wanted but now he can't.
Oliver and Paul are sitting on the couch. Oliver asks if they have to wait for his mother and father. They decide to play cards while they wait. Oliver suggests blackjack and expertly shuffles the deck. He gives Paul the rules. Oliver says Paul sucks at the game and he wonders why if he sucks at it, why play? Oliver doesn't really know why he is there. Paul tells him that his parents are getting divorced. Oliver denies the divorce -- he says his dad has moved out but it doesn't mean they are divorcing. He finds it annoying that his dad has moved out. Paul tells him they are meeting to help work out a solution to the problem that Oliver refuses to stay at his father's apartment.
Oliver doesn't like the food at his dad's or his friends or that it takes longer to get to school. Paul says maybe they can help get things to change at his dad's and make it easier for him to stay there. His mother arrives with Oliver's snack and complaints about the father and where he lives. She doesn't want to wait in the waiting room until the father arrives. We can see his mother is reluctant to have Oliver stay with his dad.
A young woman, April, is sitting in the waiting area. Paul opens the door and invites her in.
Paul's office has large bay windows and is comfortably furnished. April walks around looking and admires the office, mentioning she is an architecture student. She asks if he did it himself or used a decorator and when he says he did it, she congratulates him.
April tells him she is 23, a student in architecture and urban planning at Pratt. She is recently single, having just broken up with a long time boyfriend. Paul asks if that is why she has come and she says no, the breakup was fine. She says she found his name online because she wanted to see someone near Pratt who would take her insurance. She tells him no one had commented and she had assumed it was a new practice. He tells her he recently moved there. Paul tells her she needn't apologize for questions and that she needn't censor herself to spare his feelings. He asks if she has seen a therapist before and she says she had -- through student health. She speaks scornfully of the previous therapist. She felt that that therapist saw her as a complete waste of time. She tells Paul that the therapist had told her the same joke twice. Paul asks about it and she tells him. April stopped going and never spoke to the therapist despite receiving many telephone calls from her. She says she did not return the calls or tell her because she didn't ant to hurt her feelings. April gets angry and defensive at Paul's questions about her previous therapist.
Paul has made some major changes since we left him. He is now divorced from Kate and lives in Brooklyn. Each weekend he commutes back to Maryland to see his children and Gina.
Paul is awakened by a knock on the door and opens it to see Alex's father there. He is angry with Paul for not stopping Alex from flying. And he serves him with a summons in a lawsuit against him. Mr. Prince believes that talking with Paul is what killed his son and he wants Paul to have to pay for that.
We next see Paul as he comes to consult with an attorney for his malpractice case. He is surprised to see Mia, who was a patient some years ago. Paul is apprehensive about consulting her given their previous history. She urges him to proceed because they have little time until the hearing so he agrees. Paul looks stunned when he hears her say the word malpractice. She reviews the basic outlines of his background and then explains that he is being sued for $20 million, though his insurance covers only $3 million. Mia explains that the plaintiff is claiming that Alex committed suicide, which Paul does not believe.