In Treatment - Gina, week 2

Paul opens the door and sees Kate who has an envelope of financial aid material for Rosie. They start to have a spat. Paul asks her please not to come to his therapist's again. Tammy comes out again and they greet. She apologizes for interrupting last week.

Paul starts mentioning Tammy and Gina says they can't talk about that. Paul says he cannot be in therapy with her now. Gina says she is sorry but she respects his decision. She gets up to go and says he can stay there till the kids arrive. Paul looks unhappy. Gina asks if he wanted her to argue with him. He wants an hour of conversation, that he will pay her. She says she doesn't charge for conversation. Paul wants her to stay and talk. Paul starts to complain about his week. He looks miserable. Gina says okay, just for a few minutes.

He mentions he thought about Tammy Kent when they were 17 and wonders why he did that. Gina says he could work on that in therapy. He tells her that the lawyers are deposing Laura this week. Gina asks if he is worried that she will try to get back at him. Paul says he doesn't want to talk about his past because it his present that is causing him problems. Gina says it occurs to her that he thinks about Tammy because there is something incomplete from that period in his life when his father left his mother and when she died. 

Gina asks Paul if he thinks that Alex decided that instead of fighting his guilt any further he would just let go. Paul nods. Gina says she doesn't think Paul has no fight left in him, that if he would he could do the work and put it to rest. He says he knows he wouldn't do the work, he would just start drinking too much. Paul wonders why he does this, why he comes there to fight with her to not be in therapy. Gina says she thought about whether she could treat them both. She says if she treats both of them there must be rules, and asks what rules he would expect. He says they would have to know they cannot expect to be told anything about the other. That they both saw her would have to be an open secret -- known but not talked about. Gina asks him if he was able to do that with Laura and Alex. He says that is different because their affair was about him. Paul realizes Alex slept with Laura to show him how self-destructive he could be and Paul didn't see that at the time. Gina says he can see why she needs to be neutral. Paul says nothing will happen with Tammy until or unless they are no longer patients. Gina says she will not mention what he just told her in the deposition. She asks if he wants to proceed. He says yes.

She starts asking him for more about Tammy. That she moved in down the hall. That his father moved out shortly after. Paul says that Tammy made him excited rather than sad about what was happening in his house. Tammy would reassure him that everything would be okay, that it was okay to let his mother cry. Gina says then Tammy helped him take care of his parents. He says he saw her as his girlfriend and that made him feel better. They didn't have sex then, that it wasn't until 3 years later. That it didn't happen until his father left for one of his patients and his mother went into a deep depression. Tammy's mother was strong, unlike his. He fell in love with Tammy when her family invited him for Christmas and he went and left his mother. He went home and found his mother unconscious and somehow got her to the hospital. The memory is not there, no memory of his mother's first suicide attempt and he thinks if he had stayed with her she wouldn't have done it. Gina tells him she punished him for not staying with her, taking care of her. Gina asks what he could have done. He says he doesn't know, that all he knows is that he left her for one night and that is when she did it. Gina urges him to stay with it, because maybe he will discover some detail that he is missing. She knows for a fact that he couldn't save her, as he couldn't Alex. So he has to do whatever he can to remember that night. They end the session. Paul thanks her.

Paul calls information to get Tammy's phone number. And calls her and asks that she call him so he can ask her about his mother.


A session nicely done though I have grave reservations about the wisdom of Gina taking Paul on in therapy. She handles his resistance far more deftly than she did last season when they never really arrived at a clean contract. This time instead of arguing with him and feeding his resistance, she does a very nice maneuver by being willing to let him end it but also not gratifying his desire to be in control. This reminds me a lot of the kinds of things Sheldon Kopp, a brilliant therapist who wrote a number of books* about his experience as a therapist. He often used this kind of maneuver to deal with patient resistance and it worked brilliantly here. Had she agreed to sit and just talk with him for more than a few minutes, had she not been matter of fact about letting him know that if he wasn't there for the session they had agreed to, then she had other things she would like to do, they would have fallen into the pattern we saw last year. Once the contract is established and ground rules laid out -- ground rules I have no doubt Paul will try to break, because that is the nature of these things in therapy -- they get down to work and we see Paul willing to open a bit about himself. We can see that Paul is depressed, sad, lonely and confused and I believe Gina is correct that the origins lie in the issues he has still about his parents.

The parallels between the acting out between Laura and Alex and the potential for the same between Paul and Tammy will likely play a significant role in Paul's therapy. It is possible to work with two people who are friends with each other, but it also carries risks. Patients can and should expect confidentiality from the therapist but, and this is little mentioned, for the container of the therapy to be solid, they also need to maintain confidentiality and not discuss the therapist with each other -- this one is much harder to get across to patients and far less often honored. 


© Cheryl Fuller, 2016. All  rights reserved.