In Treatment 2-- Week 5
In Treatment 2-- Gina, week 5
Kate meets Paul at the train. She expresses her sorrow about his father. Paul says he appreciates that she came to the funeral and let the kids come that weekend. Paul tells Kate he wants them to try again, that he wants to come home, he loves her and he wants another chance. Kate says she is seeing someone and she might be in love with him, that she can't do it again.
Gina asks Paul how he is as he enters her office. He thanks her for the orchid she sent. He said he was sorry she wasn't there. She says she didn't think it was her place to be there. He learned at the funeral from people who knew him that he liked to sing, which he had never known.
Paul says he thinks women are good at loss but men aren't, because for men it means they lost. Paul asks how he can help his patients when his own life is such a mess. Paul denigrates his ability based on his situation. Gina points out he can't observe himself as he does his patients. She asks about the funeral. Paul says he is glad the kids were there and he hopes his children will be better about death and loss than he is. He says he learned more about his father after he died than he knew. He has no idea really who his father was, all he knows is the story he has grown up with and he never knew he was an interesting man. Gina says Paul knew he was interesting man and that is why he was so angry he wasn't home. That it was his father who had the choice to be home and he wasn't. Gina remind shim that not everyone has it in him to be a good parent. And maybe his father chose to give himself to his parent instead of his family, that he chose to fight the battle he thought he could win. Paul tells her about sitting with his father in the last moments and talking to him as he died. He apologized to his father and then he says he started complaining about his life, as he always does, and when he looked up, his father was dead. Gina asks if he thought his father waited until he came to let go. Paul denied it.
Paul says there is more between parents and children than a connection, that there are obligations and responsibilities. He does not want his children not to be like him. Gina says she wants him to talk about himself and asks if the watch he is wearing is his father's. Paul sees the things he talked about to his father as whining Gina lists the things -- divorce, his children, getting sued. She suggests he might have been hoping his father would say something meaningful to him. He says he wishes he had done or said something besides taking his watch. Gina asks if there are things he wishes he had said. He said he would have asked if his father was proud of him. Gina says he is a good doctor and he would have been proud. Paul wishes he had gone sooner, that he was afraid if he had gone sooner, after a life time of hating him, his father would have loved him. That love wouldn't have meant anything if he hadn't gotten when he needed it. Gina says Paul won't do what his father did, because he knows love matters. Paul asks if she means his father loved him. She says yes, he loved him and he did what he did. And she is sorry he didn't get the father he deserved. Maybe he can be a father to himself as he is to his boys.
Paul looks at his watch. He says he has to meet Alex's father. He leaves.
He enters a restaurant where he sees Aex's father. Paul apologizes for being late. The father says he is only meeting him there because he didn't want to stand when he talked to him. He says the lawyer told him the suit could take years so he is dropping the case. That he will drop the case and take the settlement offered by the insurance company provided he write a letter taking full responsibility for Alex's death. Paul wants to know for what purpose. He maintains he won't use the letter or institute a malpractice suit. He wants something that lets him know Paul knows he has blood on his hands. He tells Paul to talk with his lawyer and let him know what he decides.
When a parent with whom we have a history of conflict dies without any resolution, we are left to try to do the work of resolution after the death. And this is what Paul is struggling with. He had successfully kept his father at arm's length for most of his life, hating him for abandoning him and leaving him with his mother. Yet there has also been a lifetime of yearning which surfaces now in the regrets that he didn't really know his father. The tension of these contradictory feelings is evident throughout the session as he moves from scorn for his father to wishing he knew him to self deprecation. Perhaps the most telling thing he said about this was that he believes he didn't go to see him sooner because he didn't want to have his father tell him he loved him, that he preferred to hold on to his hatred because it would be too painful to learn of the love he had so wanted and needed as a child. Gina deals with all of this deftly by letting him talk because this is what he needs to do.
Paul did not tell Gina about his abortive effort to reconcile with Kate, a very painful blow to his hopes for reconstituting his family and thus somehow preventing his children coming to regard him as he did his father.
When he meets Alex's father, we see clearly what Paul had said earlier about how men respond to death and loss, that it is a defeat. Alex's father wants to win, one way or another. So now that he knows the lawsuit would be long and drawn out and possibly not winnable, he seizes on a letter of confession as the victory he will accept. Clinging to this need for a victory keeps Alex's dad from being able to complete his grieving, as much as any parent can do so, and keeps him from having to know his own part in the death of his son. All he knows is that someone has to be responsible and he wants Paul to be that someone.
Now Paul would be crazy, I believe, to agree to this demand. There would be no way to protect himself from the letter being used against him some time. And it is also true that the letter would be false. It may be that Paul could have acted to try to keep Alex from flying but that in no way means he would have succeeded or that Alex wouldn't have found some other way to kill himself. Paul needs not to become like Walter, claiming sole responsibility for something that is not his alone. Remember that Walter said that both he ad Paul have blood on their hands. I can't believe any attorney would recommend Paul accept this settlement.
In Treatment 2 -- Walter, week 5
Paul is at a hospital to visit Walter. He runs into Natalie who tells him Walter is not there for food poisoning as Walter's wife had said.
Walter is in bed, very still, very much as Paul's father was when he went to see him. Paul touches Walter's hand to wake him. Walter wonders why he is there. Paul said he was concerned that Walter missed his session. He suggests they talk. Walter says they are treating him well and he will be glad to get home. Paul tries to help Walter see that food poisoning is not the issue as Natalie and Connie ate the same food he ate. They found him only because Natalie's flight was cancelled and they returned home. Paul asks him what really happened. Walter says he caught a chill, went to bed and then woke up in the hospital. Natalie has been in New York for around a week, since Connie told her that Walter had been fired and summoned her home; his sons also flew home from California. Walter thinks Natalie only came because his wife made her feel guilty. She had wanted to talk about what happened when he visited her and she made him get out of bed and do things with her.
Paul continues to press Walter on what happened. What did he take for the chills, Paul asks and lets him know he knows they pumped his stomach and it wasn't aspirin. Walter tells Paul he needn't be concerned, that his family won't sue like Alex's did. Walter reveals he had run a background check on Paul which he didn't look at until the previous week when Paul had cancelled. He said he was relieved when the cancellation happened because all he did was go through the motions anyway. Walter says he read the background and that like him, Paul has blood on his hands. Walter refuses to acknowledge he made a suicide attempt. Paul presses. He suggests Walter had held on until Natalie was gone. Walter bursts out that he made himself act like he was better so his wife and daughter didn't hover and would leave him alone. He knew he would have enough time while they were at the airport. He had hoarded meds and hoped they would come home and find he had died in his sleep. He just wanted it all to be over and he couldn't even do that, he says. News of the real nature of his problem has been kept quiet. Walter says he didn't leave a note and tried to make it look like he just fell asleep. He sees himself as a disgraced basket case and can't imagine his wife can take it. He believes he deserves what has happened and that the people who care about him would be better without him. Paul tells him that Natalie is in a terrible place right now because if he had died, she would never have forgiven herself, just as Walter has blamed himself for his brother's death and everything that has happened. Paul tells him he attempted to impose the death penalty on himself.
Walter comes back at him by asking if this is what Paul does with his guilt. Paul says no, he always wonders what else he might have done but that all he can do is try to understand what happened and to learn from it. Walter dismisses that as possible for him because he is too old. Then he thinks that Paul wants to leave. Paul says Natalie is outside the door because she is on watch and so she looks in on him every 15 minutes. Walter says Paul should tell her he is fine. Paul says he needs to stay there longer. Paul says he won't tell them he is better, that he needs to be in the hospital longer. Walter gets angry and says he will call his lawyer. Paul says if he wants to sue him, get in line. Paul says he should stay there until he is better. Paul says he doesn't want anything to happen to him. Walter tells him to get out.
In the hall, Paul sits down next to Natalie. Paul tells her he plans to tell Walter's doctor that he is still at risk to himself. He says he is sorry that so much has fallen on her. She reveals to Paul that Connie is not good under stress, that she has been in rehab many times for alcohol and other substance abuse.
This session is the most interesting of the ones with Walter that we have seen so far. We knew, and Paul knew when Walter left last week that he was at risk. He has absorbed a blow that is the one too many for him. Having carried the burden of responsibility for his brother's death, his parents' grief, his boss's son, this final blow -- the death of children from contaminated food -- is more than he can bear. But notice how he refuses to consider at any point along the way that he is not the person solely responsible. There is an inflation here that makes him far more powerful and important than he could possibly be. This kind of inflation also contains its opposite which shows up in the feelings of worthlessness that Walter now feels -- that he is such a failure that he couldn't even succeed in killing himself. Walter needs to feel this powerful in order to escape his powerlessness, because it allows him to hold on to the belief that if he can do everything just right, nothing bad will happen, This is a good example of Guntrip's observation that most people would rather be bad than weak.
So we must wonder what it means that Walter has not succeeded in keeping his wife sober -- as Natalie tells Paul her mother has been in rehab multiple times. And it remains for Paul and Walter to consider why Walter needs to hide his wife's problems and what they mean for him.
Paul handles Walter's attempts to jab at him -- when he tells him about the background check and when he threatens to sue him and when he says Paul has blood on his hands too -- by not getting rattled or defensive which deflects the attempted blows and keeps the session going. He directs his efforts at seeing if Walter will own that he attempted suicide and acknowledge his severe depression, but with little effect. Walter, we can guess, wants to get out of the hospital so that he can try again as soon as he can be alone long enough.
In Treatment 2 -- Oliver, week 5
A patient we don't know is talking to Paul about having sex with a classmate in the law school library. There is a noise outside and when Paul investigates, he finds Oliver in the waiting room an hour and a half early. He claims to have gotten out of school early. Then he says he ran away from school. Paul says he can stay there but he will have to call Luke.
Oliver asks Paul if he is angry with him. Paul asks why he ran away from school. Oliver says he had a bad day. But why did he come to Paul's office? Oliver asks if Paul has ham and Paul offers to fix him a sandwich. Oliver tells him someone put dog shit in his locker. He says when he came to his locker at recess he found it, smeared all over everything in his locker. Paul tells him he's glad he came there to talk about it. Oliver tells Paul that his dad is mad at him too, that they fight all the time. Oliver thinks Luke broke up with Nina and he thinks it is his fault because Luke and Nina fought over Nina saying he needs more rules. Oliver hasn't told his mother about the fights with his dad.
Luke bursts in angry with Oliver for leaving school. Oliver yells that Eric put dog shit in his locker. Paul suggests Oliver wait in the waiting room while he talks with Luke.
Luke is upset that Paul was not available last week because Bess extended her vacation. Oliver is refusing to do his homework. Paul tells him that Oliver feels powerless and so he does those things he can do, like refuse homework. Luke is concerned about junk food Oliver has been sneaking, Paul tells him overeating is not uncommon with kids in his situation. Luke knows about the bullying but he says anyone can see why it happens -- Oliver is fat and smells bad too. Paul says Luke is trying not to feel the pain Oliver is experiencing so he gets angry and frustrated instead.He says Nina has sided with Oliver and not agreeing with him. Nina used to be fun but then started scrutinizing him. Paul says he thinks Luke likes having fun with Oliver but doesn't want to enforce rules and wants the women in his life to be the rules makers and enforcing.
Luke says the second Bess left town, Oliver's behavior changed. His perfect behavior didn't make his parents stop fighting or get back together so now acting out may be an attempt to get his father's attention about how he feels. Paul tells Luke that Oliver sometimes wishes they would give him away as they did the baby they were going to adopt. Luke asks if Oliver loves him, because he didn't love his father. His father's love was conditioned upon excellent behavior and when they did not conform, he withdrew from them. He talks about discovering his father having an affair and his father just screamed at them. The marriage ended then and so did his relationship with his father. He never met Bess or Oliver before he died. Luke says that lately he feels his father is laughing at him. Because he has done everything right and he is in the same position his father was in, losing his son.
Paul brings Oliver back in after telling Luke he has choices and needn't be like his father. Luke says he is sorry Oliver had such a tough day and suggests they get pizza and go to a movie, because Oliver had enough that day and deserves a break.
Again in this session, as in the previous two this week, we have layers of fathers. Present emotionally with Paul and Luke are both Paul and Luke's fathers -- Luke carrying his memories of his dad and fears that he is becoming like him and Paul, aware of his own father and fathering. And we have multiple sons present as well -- Luke, Oliver and Paul are all wounded sons of troubled fathers. This interplay of conscious and unconscious currents in depth treatment, the interplay of issues present for both therapist and patient is a key element in depth psychotherapies. And beautifully displayed here.
Notice that Oliver asks Paul for a sandwich -- on the symbolic level, he trusts that Paul will feed him what he needs, which is to be listened to on an emotional level so that his pain can be known and he can be helped. The ham sandwich is not so important in and of itself. What he is telling Paul is that he wants more of that good nourishment Paul gives him. Which this week Paul provides directly, by understanding Oliver's distress and by helping Luke to be a better dad to Oliver.
In Treatment 2 - April, week 5
Paul is pacing. He straightens a picture over the couch. April comes in.
April says the stairs are hard for her. She asks if he knows what she likes best about him and she says his eyes, that she has liked them from the first visit. She winces when the port hurts for a moment and says she doesn't remember them putting it in. She asks if he saw it. Then she thanks him for taking her. April tells him she has been having many discussions in her head the last 2 weeks. She says even in her head, he doesn't say much. Except he says to her, in his head, that of course it is all worth it if she is making herself and others happy.
April apologizes for being difficult. And she thanks him again for taking her to chemotherapy. She says she had a bad night last week and wanted to call him but didn't because she felt that he needed a break because he had cancelled. She tells him she talked to her best friend Leah. She had dreamed she had died. pal suggests that maybe it is only the part of her that resists help died. She woke up with a fever and when her friend arrived she called 911. Her friend had not known she had cancer. Her friend was surprised but came through for her. She and Leah have looked after each other for a number of years. Paul suggests to her that the people in her life -- Leah and Kyle -- have stood by her and that she only allows in people who are loyal and will stand by her. He wonders why she picks friends who will be there for her and then doesn't tell them what is happening to her until she has no choice. He asks if she believes there is a finite amount of help people will give her so she must carefully choose when she asks.
April asks about the cancellation last week. She says it was hard for her and she wonders what happened. He tells her he had a family emergency. But she is not satisfied with that response. He tells her if he could have been there for her he would have been. She asks how old he is. She says her hair has started falling out. And she still has not told her parents. She would like for Paul to tell him. He says she could ask them to come with her to therapy. She wants Paul to take her to her next chemo appointment. Paul asks why not Leah. She does not want her parents to take her to chemo -- she wants him to. He tells her he is her therapist and she needs a therapist. But she also needs a caregiver and he cannot be both. April believes it is because he can't take seeing it. And she sobs. She thought Paul was going to take care of her. She thinks that because he won't take her to chemo, that he is dropping her. She needed him last week and he wasn't there and he lets her know his father died. She sits up and wants to know how he let her go on like that. She asks if they were close and he says not really. She says she is sorry how hard it has been for him. She tells him she wants to just feel bad for him for a bit.
Paul turns again to the chemo session tomorrow and who will take her. She gets up to leave. Paul asks her to let hi know who will take her. She leaves. She hesitates in the waiting room then leaves the office.
Last week (2 weeks ago in In Treatment-land) Paul took April to her first chemo session. Because she fainted in his office and because she has told so few people about her illness, he took her. But in addition, she posed a serious danger to herself if she did not seek treatment so his action is actually justifiable on that count.
This week we see how much his action meant to April. Her attachment to him is now very clear, and in fact seems to reveal that she is seeing him as the super-good father or perhaps lover, the man who will be with her no matter what. Which of course would allow her to continue to avoid telling her parents, avoid having to deal with her own father, and avoid having to allow another person to care for her, thus preserving the reserves of caring held by her friends and likely by her parents as well.
I know that some people believe that Paul should not have acted on his impulse to take her to her treatment, and though I understand that point of view, I still believe that his action was justified and the consequences worked through. Though April has apparently developed an intense transference response, this is not altogether a problem. She needs to be able to try out being dependent and then to allow herself to turn to friends and family to provide the care she needs while Paul gives her the therapeutic safe harbor that she also needs.
I was asked in email why Paul didn't call her parents and tell them or ask them to come to a session with her. But April is not a minor so it would be a violation of her confidentiality for him to contact them without her permission. His suggestion that she invite them to a session is a good one and she has not yet rejected that outright though she firmly said she did not want her mother coming to chemo with her.
Both Mia and April pushed Paul to be the person who will take care of them tonight. And both want him to be more than a therapist to them.
In Treatment 2 - Mia, week 5
Paul's father has died. Mia arrives. He closes the doors to the rest of the apartment and puts on his father's watch and places his father's med school diploma on a shelf. Mia pours some of her water into a plant in the waiting area. Paul comes to the door and Mia asks if he is all right. She expresses condolences.
Mia asks again how he is. She found out because she asked his lawyer's secretary and because Paul had never cancelled an appointment.
Paul says it is ironic because they had been talking about her father last week. Mia wants to know what he thought about her card. He tells her he has not yet opened his mail. Mia presses him again about how he is. Mia acknowledges that she has been difficult and says she wonders who he has. She says she can see loneliness in his face.
Paul wonders if she is worried that he can give her his full attention today and tells her that she needn't worry about his feelings.He asks if she is upset that he had cancelled last week. She admits she was annoyed until she found out why. She says everything has changed now because she is pregnant. Paul gets distracted looking at the snow falling. Mia says their timing is strange -- 20 years ago he was having his first child when she was losing hers. And now she gets pregnant as his father has died. She tells him Bennett is not the father. Paul wonders about the connection between finding out Bennett and his girlfriend are having a baby and her own pregnancy. Mia denies this and says she thinks it is the musician. She thought Paul would be happy and they could celebrate. She wants him to tell her she will be a good mom and that he will be there to help her with decisions. Paul asks if it is he that she wants to help with these kinds of questions. She says her sisters are married and her mother isn't available, that her mother likes her sisters.
Mia keeps trying to talk with and about Paul as if they were a couple. She is certain no man her age will be interested when she has a young child.
She notices bronzed baby shoes on the shelf and she ass whose they are. He doesn't answer and then she accuses him of being bored, of wanting him to leave. She spins a fantasy of meeting him at a bar again.
Paul tells her that he thinks there are two issues -- one of her pregnancy and the other of not having a partner. He wonders if she is worried that there will be no one available to her when she has a child. She says picture perfect would be herself, a a baby and a man. He asks about the man and she again becomes angry and accuses him of thinking she can never have anyone. Then she leaps to wondering why she got pregnant because she claims not to like children. Paul suggests she doesn't want to have the baby. She asserts this is her last chance, no matter her feelings. Paul says this is how she was 20 years ago. She admits that is true, that then she didn't want to have a baby, she wanted an abortion. Paul reminds her that she is not in the same place now. So the question really is does she want to raise a child if she has to do it on her own. She asks if Paul will help her. He says as her therapist. But she says she needs his help because he is the father. Paul points out the fantasy, that she would like him there with her. He asks if she has told anyone. She says no one. She admits she does want to pull him in.
Mia says at the end of the hour that he should take the day off and asks that he be happy for her.
From the outset we have seen Mia's erotic transference toward Paul developing and this week it becomes more obvious as she tells him she wants him to be with her and raise her baby. Only erotic doesn't quite capture what it is that she wants, which is for Paul to be her father, and even her baby's father. Remember last week she said she could never find another man as good as her father. And this week she tells Paul he is the father. Father or lover are the ways she knows men.
So throughout this episode we have the whole issue of father weaving in and out of the session -- Paul's now dead father, Paul as father, the absent father of Mia's baby, and Mia's father are all present in the room.
In a situation like this, with a patient who wants the therapist to say what she should do, who wants the therapist to approve of and endorse what she does, it is especially important not to take a stand except in favor of the patient do what she wants to do. remember that Mia started out telling Paul it was his fault she did not have her baby 20 years ago and it is easy to imagine she would/will do the same thing this time. Paul was quite deft handling Mia this week.
Notice how absent mother is in the session. Mia doesn't like talking about her mother, believes her mother does not like her and doesn't even really want to talk about herself as a mother.