In Treatment 2 -- Week 2
In Treatment -- Issues, week 2
On the HBO forums there has been considerable discussion of the note-taking issue. And we saw this week that after seeing April, Paul sat down to write some notes. Which we know from what he said to Mia when they met to discuss the lawsuit taking session notes is not his usual practice. So why now?
The answer is simple -- anxiety.
The whole issue of session notes is related more to risk management and insurance company requirements than it is to good care and the best interests of the patient. In fact. until fairly recently, it was up to the therapist what kind of notes if any notes would be taken. And, depending on licensing requirements and whether or not one accepts third party payment, it is still up to the therapist on this issue. Some therapists document via a short notation the occurrence of a session combined with billing records. Others take notes during the session. There is nothing in these approaches or any other that correlates to skill or outcome.
In a paper presented to the APA, Martin Williams explains how what starts as a way to manage risk morphs into standard of care -- and sometimes into mandated requirement:
"Why wouldn’t you want to take notes about your session? ...
Some psychologists—many more, I think, back a few decades ago and fewer today—do not think of what we do as medical, or as a treatment, or as something for which written documentation is appropriate. We see our work as forming relationships with patients, relationships that are unlike that of doctor-patient, but more like teacher-student, consultant, clergy-parishioner, or simply peers. Some of us believe that medicalizing that relationship by writing notes about how “the patient is progressing” or even about what happened during the session creates a barrier between the two people who are engaged in a personal journey together. Along those same lines, some of us eschew diagnosis and treatment plans.
It doesn’t really matter whether you agree with this Humanistic approach to psychotherapy. It serves as a good example of how risk management evolves to become the standard of care. Somewhere along the line, psychologists thought it would be a good idea to document what you did in therapy as a way of protecting yourself from certain claims, especially claims that you failed to do something. If someone claims you failed to ask your patient if he or she was still feeling suicidal, and your notes show that you did ask that question, bingo, you’re protected. If the patient later suicided, but after the session you wrote a note documenting the reasons that you believed the patient was not suicidal, and those reasons make sense to a later adjudicator, you have a degree of protection that you wouldn’t have had you just reconstructed that session from memory—subject to the skeptic’s view that your memory had been conveniently altered and rearranged to diminish your liability.
So it makes sense that those of us who want more protection would minimize their risk by taking notes, taking notes to document that we did all those things that someone later might claim we failed to do—a fine risk management idea. Fast forward to 2002 and we find that record keeping is no longer about risk management. It has become the standard of care...
One no longer keeps records to protect oneself. Now, one keeps records because not doing so is considered unethical in and of itself. Risk management evolves to become the standard of care."
Ultimately each therapist has to decide where he or she stands on this issue. If one does not accept third party payment, it is a little easier because there are not then concerns about insurers demanding to inspect files, which they have the right to do for covered patients. The therapist must weigh duty to protect the patient's interests and confidentiality vs. risk management. Consider also that patient files can be subpoenaed in other legal actions such as divorce cases and the confidentiality issue can be quite significant.
So Paul, now anxious about the lawsuit filed by Alex's father, is taking notes after seeing April, not because it makes him a better therapist but because of his fears. It isn't clear whether he is also taking notes on other patients.
This is a difficult issue. Before therapy was routinely covered or expected to be covered by insurance, risk management and these kinds of records requirements were rare for therapists. And given the low incidence of lawsuits against therapists, the fear generated by risk management folks is disproportionate. Years ago in response to someone asking how he felt about insurance coverage for analysis, a well-known Jungian analyst said that we must remember that he who pays the piper picks the tune. We do well to bear this in mind as third parties become more a part of what we do.
"Psychoanalysis cannot be considered a method of education if by education we mean the topiary art of clipping a tree into a beautiful artificial shape. But those who have a higher conception of education will prize most the method of cultivating a tree so that it fulfils to perfection its own natural conditions of growth." Jung C W, vol. 4, para. 442
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.
In Treatment - Walter, week 2
Paul closes the sleep sofa while his daughter, Rosie, is talking to her mother on the phone. There is a knock -- a messenger has an envelope from the law firm for Paul. His daughter guesses that he is being sued. Rosie asks who he can talk about it with. Paul says it is under control. She says he is condemning himself to a life of loneliness and she wonders why. She refuses his hug, because she says she won't hug him until he comes home. Paul tells her that isn't going to happen and they hug. She sees the turtle on the shelf. -- the turtle Oliver was afraid he would fail to care for.
Walter begins by saying he is sure that this week Paul has read up about him. Paul says he read about the industry but not about him. Walter believes a reporter at the Times is after him. Paul asks if it is coming from within the company. And apparently that is a possibility. He is worried that the articles are putting his daughter in jeopardy. Paul suggests maybe his anxiety is getting the better of him. Paul observes that he sounds quite confident given the circumstances.
Walter becomes quiet and Paul asks what he is thinking. He remembers the son of the founder, that they were in the Army together. The son died in a car accident and Walter thinks he might not have had he taken as good care of him as when they wee in the Army. Paul returns to the anxiety attack last week and that Walter said they always go away. Walter denies that they are panic attacks and he says he hasn't told his doctor. Paul asks if he has had another this week, after he denies they are panic attacks. Walter says yes, he did, in the elevator. Paul asks for details. Walter describes what happened and then impatiently says he can't see anything that would have caused a panic attack. Paul notes that Walter says there was a new security guard, and that the one he saw every day for 30 years died of a heart attack. Paul asks if perhaps he misses him. Walter denies any connection.
Walter asks where Paul went to school. Paul asks if he is concerned he isn't qualified to help him. Then we learn Walter has had these attacks since he was 6. Then he reveals his brother drowned when his brother was 16 and getting ready to go to college. Tommy was the golden boy. Paul asks how it was for him when he died. He says he was fine, he didn't even really know what was going on. His father told him that the brother's room was his now. Walter tells the story rather flatly. Paul asks about this. Walter says he feels sorry for his father and that his mother changed over night, her hair turned white and she changed. Paul suggests that this was a significant event, the death of his brother and his parents' grief. Paul reminds him that the panic attacks began when he started sleeping in his brother's room. Walter says they happened in his sleep so how could they be panic attacks. Walter did not come close to filling Tommy's shoes. Paul reminds him he said that when Tommy died he used the word "disappeared" and that he had expressed fear that Natalie would disappear and the security guard disappeared. Walter denies any connection.
Paul confronts Walter's resistance to any effort he makes to connect things, to go deeper, that he feels if he says something Walter doesn't like, he will leave. He says he thinks Walter doesn't trust that anyone who leaves him will be the same, be back. Walter asks if he is saying that all this started when his daughter left for Rwanda. He asks about medication. Paul says there is medication but he thinks it is important they continue as they are. Walter asks that Paul speak to his doctor and then goes to pay him. Paul tells him he can pay at the end of the month. But Walter insists and says his father always says to pay as you go.
We see in Walter something we also saw in Tony Soprano -- a powerful man who experiences panic attacks and who is not very able to put his feelings into words or even acknowledge that he has them. Paul can feel the horror of what happened in Walter's family when his brother died -- the loss for Walter, the terrible grief of his parents, and his certainty that he can never live up to the example of the now dead perfect brother. But Walter cannot feel any of it. And when Paul presses him even a little, Walter becomes very defensive and resistant. Yet these feelings have provided the fuel for his panic attacks since the death of his brother so many years ago. And we know that Walter would far rather take the pill his doctor can offer him than feel those feelings, despite what Paul tells him.
Walter is used to getting his own way in his life. He does not much like not being able to control Paul or get him to stop pushing him. So there is, as Paul accurately identified, the constant unspoken threat that Walter will leave if he doesn't like what Paul says. It means that Paul must walk a fine line between making necessary interpretations and confrontations without going to fast and giving Walter a reason to leave. Titrating interpretations is one of those things that can only be learned through experience. Notice how Walter lets Paul know at the end that he will not commit a full month by insisting he will pay as he goes. To pay by the month would mean he is willing to commit and do the work and he is not ready for that.
In Treatment- Oliver, week 2
Oliver and his parents are in the waiting room, each listening to their iPod. Alone together. And this is a good image of how they are relating to each other.
Oliver asks Paul if they are going to play another game. Paul says he has been learning about the rules of blackjack. Oliver wonders why. Paul tells him he wants to learn about the things that Oliver does and likes. Oliver says his teachers don't think he is smart, that all of them hate him because he falls asleep in class. School is boring he says. He says none of it is about real stuff. He says they are reading Lord of the Flies which is lame -- because you don't have to crash on an island for kids to be mean. Then he shows Paul the turtle he has to take home and take care of. And if he doesn't take good care of him, he will fail. And he assumes he will forget something and the turtle will die.
Paul observes his backpack is crowded. Oliver carries all of his books in case he goes to his father's, but he doesn't go there. Paul wonders why he is so tired, even at his mother's house. He says he has trouble sleeping. Paul suggests there are very stressful things in his life and wonders if there is anyone he can talk to. He says if he tells his mom, she calls his dad and then they argue. That day his mom said he isn't getting enough sleep and his dad said he isn't healthy which means fat -- because he is fat. Paul guesses he is upset about being fat. All the kids at school talk about it. They call him Piggy after the fat character in the book. Oliver tells Paul about hiding out during a party. He doesn't tell anyone about this. He says he doesn't tell his mom because she'll tell his dad and then they will fight and he doesn't want it to be his fault that they get a divorce. He wants to know if Paul can make his parents happy. Paul says he can't make them happy but he can help them to get along better. Then he invites the parents in.
Paul invites them to talk with Oliver about what is happening. Luke tells Oliver that Bess and he have decided it is best that they not live together, for good. Oliver asks why they can't live together. Luke answers that it is because they fight and Oliver assumes it is because of him. Luke says they just can't get along, that it isn't because of him. Oliver believes it is because of him, because he gets upset when they fight. Bess starts to cry and tells him they will always love him. Paul asks Oliver to wait in the waiting room. Luke says to Bess that it is no wonder he can't sleep at night. Paul says Oliver's sleeplessness and overeating is due to the stress they are all under. Paul tells them that Oliver believes he can bring them together if he behaves in a particular way. Bess guesses that Paul is saying they shouldn't get divorced. They spar. She asks Paul if he thinks they should stay together. Paul says he cares about what is best for the three of them. Bess tells Luke as bad as it was when they were together, it hasn't been better since they separated. Luke tells her they have passed the point of no return and tells her he is seeing someone else. Bess gets up and goes to the door and tells Oliver to get his things together. Oliver hears her. Luke protests that this is supposed to be his night. Paul says they won't get anywhere if whenever they get upset with each other they leave the session. Oliver asks if it isn't his night to go to his dad's and Bess says not if he isn't ready. Oliver says he is. Bess leaves. Luke suggests she walk them to the train. Luke looks happy Oliver is coming with him. They say goodbye to Paul. Oliver sees another patient waiting as they leave.
Paul sits to make a note, then sees the turtle on the floor.
A couple of points tonight--
Note how Paul slowly helps Oliver tell him about the problems at school and his anxieties about his parents. This is very nicely done. And we see how distressed, how depressed Oliver is, so much so that he expects the turtle will die, that he will fail to give it adequate care. And this symbolically expresses his fear that his parents will continue to be so caught up in their battles that they will continue to fail to take good care of him. The turtle is left behind, unconsciously, so that Paul can care for it as Paul is now caring for Oliver while he tries to help Oliver's parents see that they need to take care of him.
Oliver sees a couple leave Paul's office just before his time and he sees someone waiting when he leaves. This is so common that many therapists don't think of it as an issue. Certainly in clinic settings where most of us get early training, it is the rule rather than the exception that sessions are scheduled close together and inevitable that patients will see each other. Robert Langs sees this as a frame violation. And I must say I agree. Look at the problems this simple thing has caused -- Alex and Laura for one and this week, the people Oliver sees shape his feelings about what therapy does.
I learned first from my own analyst and then from a supervisor who was a student of Langs the value of creating space between patients allowing each one the privacy of their visit, the possibility to believe they are the only one, the security of a container which is not violated by others. This can be done by having patients leave by a different door than the one they enter through or by scheduling enough time between patients that they will not encounter each other.
In Treatment - April, week 2
April is talking on her cell phone in the hall and sounds angry. Paul is in his kitchen reading the paper when he hears her. He steps over to the door and listens a moments then goes into his office.
Paul tells April he is glad she is there. She contacted him by email. She wants to know if he has an iPhone charger. He says no and she asks to use the phone but agrees to wait until the session is over.
April has a tremor in her hand. She tells Paul that it runs in her family, getting a tremor when she is angry. She says it would help if she could use the phone. Paul tried again to get her to wait.
She is angry at Sienna who is Kyle's new girlfriend. April told Kyle she has cancer, he broke her confidence by telling Sienna who offered to pay for her treatment. She wants to be able to call Sienna back so she can hang up on her. Paul gets the phone. She asks Paul to give her a moment so he leaves the room. He waits a moment or two and then she comes to the door and they return to his office. The tremor has stopped.
April has told Paul that Kyle is the only person she has ever loved. Paul asks how it feels to see him with someone else. She says she hasn't seen them together but goes on to describe her. Paul asks about telling Kyle about her cancer. She tells him about telling Kyle, that he came over and she thought they could be friends and he kissed her as he left. She became aroused during the kiss and she began to cry and then he began to cry. He told her he is engaged and she told him she had cancer. The phone rings and they see it is Kyle. Paul tells her he won't answer. She goes on and says Kyle got angry with her after she told him because he said she was not taking care of herself.
Paul asks if she finds it hard to let herself be taken care of, that she tried to do her work and his as well when she is there. Paul says he thinks Kyle was appropriately anxious. Paul tells her that as soon as she told him last week that she had cancer she began to push him away as she did with Kyle when she told him. She tells Paul she broke it off with Kyle because she couldn't take how much he loved her, that it was too much. She tells Paul that her deepest bond is with her brother Daniel. Paul asks if she has told him and she says no, because of the struggles he has because of his autism. Daniel didn't deserve what he got. Paul asks if any of us deserves what we get. She tells Paul of episodes when she was with Kyle when she would realize she was feeling the way Daniel did, feeling alienated. She describes dissociating from her feelings. Paul tells her this and she asks what she was afraid of. And then says she slept with Kyle's best friend. That she didn't know why she did it, tried not to but did it anyway and then she told him and she couldn't forgive him. She couldn't deal with being the perfect girl to him. She hates girls like herself, hung up on her ex boyfriend.
Kyle has called every day. He offered to take her to chemotherapy. She hasn't taken the calls. Paul tells her she will need help. He asks if she would rather die than be weak, that she cannot get better without treatment. He wonders if he is her worry doll, that she can tell him and then she doesn't have to worry any longer and thus she doesn't have cancer. He tells her that talking with him will not make it go away. Paul tells her he talked with a friend who is an oncologist who told him avoiding treatment is suicidal. He tells her he has a professional duty to protect her from self-harm. She tells him he must promise not to talk to anyone else about her again, no matter what she decides. He agrees and says she must promise something in return. If she decides to stop therapy, she must call him, that he does not want her to disappear. She agrees thanks him and leaves.
Paul goes to his desk and writes a note.
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Paul is very good with adolescents/young adults like Sophie from last season and April. And this session was no exception. He tries first to keep her within the session when she asks to use the phone, but when she persists and is able to tell him why, he yields -- because to continue to refuse might well have caused her to leave or at least be more resistant. He gently creates a temenos in which April is willing to talk about what happened with Kyle and to go further and reveal some of her feelings. He allows the session to build and near the end reflects to her that he believes she is trying to put all of her fear and worry into him so that she can go away believing she is well or getting well and not have to deal with having cancer. And he tells her that he has learned by talking with a friend who is an oncologist that it is a virtual death sentence if she does not get treatment. April resists hearing this by becoming angry that he spoke to anyone, just as she got angry with Kyle for telling Sienna. Paul tells her he has a professional responsibility to try to keep her from harming herself and she calms down a bit. This was a tough interpretation for him to make followed by a tough confrontation, but one that had to made. Because if Paul colluded with April by not confronting her refusal and by not interpreting the aim of her behavior, he would not be helping her in a meaningful way. She is angry with him because he doesn't collude with her but at the same time she is relieved. The part of her that really does want help recognizes he is right and so they arrive at their agreements -- that he will not talk to anyone else about her without her permission and she will not leave therapy without calling him.
It appears Paul is taking notes after the session now, with April. Not surprising given the risk she presents as if she does not seek treatment for her cancer she almost certainly will die. Whether Paul i consciously aware of the connecting here between Alex and April we can't be certain, but his anxiety comes out in the note because he feels the risk.
In Treatment -- Mia, week 2
Mia shows up at Paul's office very early in the morning. She starts off commenting that their positions are reversed -- he used to be in Manhattan and she in Brooklyn. Then says it is strange to be back and comments on the couch, saying the old one was black and blue and that she thought that was funny.
She apologizes for her behavior last week. And that is the reason for this visit. Paul reminds her that she waited until Friday to call for an appointment. Mia agrees with Paul that she set up their last meeting because she had wanted to needle him a bit and impress him. Paul asks if she and Bennett are involved because he noticed her manner changed when he came into the room. Bennett is married. They have been involved for over a year. He has told her he wants to leave his wife and be with her but he hasn't. Mia says she doesn't need a therapist, she needs a matchmaker. Then says he does owe her.
Mia keeps asserting she is not really a patient and she asks about Paul's marriage, if he had an affair. She has been wondering what would happen if she ran into him somewhere but she imagines he already has a girlfriend. She tells him how hard it is to find an available man. Paul asks if she is asking if he would be attracted to her. She does not respond and then talks again about Bennett.
Paul attempts a joke about something Mia says and she thinks he is trying to hurt her. She does not have children and likely will not. She tells him she saw her doctor the same day she saw Paul the previous week. Seeing Paul reminded her about her life. She got the news that she wouldn't be able to have a baby Friday and went to Bennett's house to tell him and he told her to leave and didn't want to see her any longer. Then she called Paul. She asks him what he thinks now, 20 years later, about that pregnancy. Paul asks if seeing him makes her question her decision. She says that Paul's wife was pregnant the same time she was and he wanted her to get an abortion. She sounds angry which Paul notes to her. She refers to it as a decision they made. Mia wants it to be that Paul had a part in the decision she made. She tells Paul she thinks she loved the man she was involved with when she was seeing him before. She wants to go back to that moment when she decided. She never told Stevie, the father, though she told her father. Her father was supportive and even arranged the abortion and took her there. Paul reflects that she sees her father as perfectly supportive and he, Paul as otherwise. Paul notes that she never told him about the involvement of her father. Mia never told her mother.
Mia and her father had a secret morning relationship when she would stop by his store and read the paper with him. She tells him of a morning when the store was robbed; her father confronted the robber, then gave him the cash. It became a secret from her mother.
As Paul gently asks about the incident she resists by telling Paul she doesn't want therapy, she wants a partner. Paul tells her that therapy is what he has to offer, that she needs to look at how and why she decides what she does. Mia wants a quick solution which Paul tells her is not what she needs. She does not like hearing this. She tells Paul he can send her a bill, and that she probably makes more in an hour than he does. He asks if she would like to come back next week because she said he owed her. She corrects him and says he owes her a child. After she leaves Paul picks up a file from his desk, looks a some notes on a legal pad and at a tape labeled For Paul. He listens to music on it and looks at the file, presumably hers.
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Robert Langs, a psychoanalyst who has written extensively about the therapeutic frame and derivative communication in therapy, maintains that most if not all communication made by the patient is about the therapy and the therapist. Keeping this in mind, we can see that Mia started out from the beginning making derivative remarks about Paul and about her prior therapy experience with him. She starts by reminding him about the reversal in where they live and there is an implication that he is living in a lesser area than she is. Then she remarks that his old couch was black and blue and claims to have found that funny, but she also seems to be reminding him that she was bruised by that experience and perhaps as well that he was insensitive to that fact. This anger toward Paul runs throughout the session, sometimes hidden sometimes more out in the open. We can reasonably assume that dealing with her anger is going to be an important part of the work she does with Paul.
There is an interesting way in which Mia resists a therapeutic relationship with Paul in the same way that he has with Gina. She reminds him repeatedly that she is not a patient. Each time Paul moves to make an interpretation, she resists. Paul has behaved in much the same way with Gina in the past and despite their alleged therapy agreement, I expect him to do the same again. And the issue for him, as it is with Mia, is residual anger and disappointment from their previous relationship. The unconscious cross-currents here will be interesting to watch.
We see this week that at least some of Mia's issues arise from her very close relationship with her father. Her mother is curiously absent from her narrative, as if she barely existed for Mia. Mia tells us that she had this secret morning relationship with her father, meeting him at the store in a kind of clandestine way that is kept from her mother and her father tells her not to tell her mother about the robbery. This relationship is echoed in the affair she has had with Bennett, full of secrets as affairs always are. In the way that relationships with our parents have a profound influence on our adult relationships, we can see that Mia replicates hers with her parents in her contempt for her mother and for Bennett's wife and for the secrecy that no doubt provides a frisson of being in danger of discovery.
Paul does a pretty good job holding the therapeutic stance required here. His efforts at interpretation are appropriate without being aggressive except at the end but it seemed warranted then. It is important that he be as clear as possible about what his role is with her.