In Treatment 2 -- week 4 | Jung At Heart

In Treatment -- Gina, Week 4

Mon, 27 Apr 2009 22:34:51 -0400

We see Paul giving his deposition for the lawsuit.

Paul is with Tammy in a coffee shop. He is upset by the deposition but doesn't want to tell her about it. Tammy also had a bad day because of her husband's bad mood. Paul is impatient to be waited on and with Tammy's talk. He is irritated by her wanting him to listen. Tammy observes they have moved rapidly from being infatuated to being irritated. Paul says he will change his time with Gina but Tammy says she already has.

Paul arrives late to see Gina because he says Rosie kept him because she wanted the keys to the car. Gona asks if they talk and he says no and they didn't when he was at home either, not for quite a while. He recals a time when it was just him and Rosie and how nice it was. He tells Gina he took April to the hospital. He says he knew it was wrong but the schedule had been made and all he to do was get her there. Gina asks if it reminded him of the day he spent with Rosie when she broke her arm.

Paul says he hates his life, that it is broken. He knows he is getting what he needs from patients because he isn't getting it from his family. Paul says she can't give it to him but she asks him to tell her what he needs. He wants water and doesn't see it is there in front of him. He says he is lonely. He misses dinner and the after dinner. He says he goes to a bar and Gina asks if he meets anyone there. He says he sees women there. He says they remind him of Mia. He tells Gina that she is the kind of woman who if she worked through her issues would be a woman for him, though he says not her but someone like her and he reassures Gina he won't fall in lo with a patient again.

Paul says he needs a woman. For sex, Gina asks. Yes. And fun and contact with another human. Gina asks about Tammy and tells him she doesn' know what happened with Tammy. Paul says Gina knew it would happen , that he would have sex with Tammy.

Gina asks if he has been to see his father and he says he hasn't but Patrick has kept him informed. Paul tries to deny he cares about the fact that his father is dying. Gina says Paul is like a baby who has awakened and needs someone but believes that no one will come or help him even though his father is right there. Gina tells him that he is not being a grown son to his father and that keeps him locked in as a child with his father. She tells him he need sot be there.

We see Paul on Monday in his father's room. His father is in the bed, unconscious. There is a Do Not Resuscitate sign above the bed. Paul sits by the bed and says hello ad apologizes for not being there earlier. His father does not respond. He is crying. His father has been lying still all day. He picks up the paper to read him the sports page. Paul says he forgot what it would mean to him if h came, then admits he knew but was too angry. He says he is sorry, that he knows it wasn't his dad's fault that his mother did, that they couldn't save her.He weeps. And takes his father's hand.

This was a jumpy session -- from the deposition to Tammy to Gina to Paul's father and seems to have been written this way to allow us to see where things are with Paul. We don't learn much about Paul nor is there really much of a session with Gina. Making the session a departure from the basic format of the show. It seems to have been intended to create the means to show us Paul with his father and feeling the impending loss.

In Treatment -- Walter, week 4

Mon, 27 Apr 2009 22:00:46 -0400

The phone is ringing as Paul comes into his apartment. He finds out that his father has fallen and is in the hospital. As he puts the phone down, he sees in the paper that Walter has lost his job.

Walter is dressed in a sweater and looks depressed. He tells Paul he should be glad he no longer has his phone or Blackberry. He finally has the time to talk but believes that Paul can no longer help. Paul suggests maybe he can. Walter says he has lost his job, his good name and when he leaves the house, a pack of reporters mobs him. He says he followed the Johnson & Johnson model for handling the crisis, that he did everything right. And so the class action lawyers and his enemies within the company came after him. He says now he feels like an old man too long in the ring.

Paul asks if he is eating and sleeping all right. He is eating some and sleeps with medication. He is taking clonapine -- he takes maybe 3 a day and Paul asks if that is the prescribed dosage. He says he wants to wake up and find the past two months have been a nightmare. Paul gently asks about suicidal ideation. Walter denies he would do that because of what it would do to his wife, who bursts into tears every time she looks at him.

His wife had called Paul because she is worried about him. Walter does not find it comforting that people are expressing sympathy and he had to promise his wife he would come to see Paul. Paul suggests that he imagines it must feel like he is going through some kind of crucible. An old friend who has gone through something similar has reappeared in his life and tells him about having taken up photography. He gave him a book of photos of a town in PA that is burning from underground fires. He says he threw the book out a soon as his friend left, thinking he was an old fool for having made it.

Paul says it sounds like he believes his life is over now. Walter asks Paul what he thought of him when he first came to see him and then proceeds to tell him that Paul saw him as greedy, a man who let babies die. Paul says on the contrary he is angry about what has happened to Walter, at how he has been treated. He tells Paul about trying to teach students that once a company loses its name, it has lost everything. Paul asks if that is what has happened to him and what of loyalty -- why hasn't Mr. Donaldson been loyal to him? Walter wants to believe the father didn't want it but had to yield to pressure. When Walter went to see him, all he did was say too bad and wished him luck. After 35 years, that was it. Paul is astonished -- Walter made him one of the richest men in the country and that is all he got? Donaldson also asked him why his daughter was in Rwanda. Paul suggests that by going to Natalie when he did, he was trying to bring both crises -- the business and with Natalie -- to a head. Natalie thinks he was guilty and Walter believes Paul and everyone else thinks so too -- because, as Paul points out, Walter believes he is responsible despite having done everything he could. Paul points out that Walter talks about the elder Donaldson as if he were a father. And that he does not want to look at his role in it. Walter did the same thing when his brother died. Walter says it was his fault, his fault that his brother died. Tommy came to him before he went out one night to jump into he quarry and he told him he could do it. Tommy died that night and Walter felt responsible because he told him he could do it. And with that his family was destroyed.

"There are lots of them, destroyed families", Walter says. Paul asks if he is all right. He urges Walter to come in the next day. Or soon thereafter. Walter refuses and leaves.

Walter is deeply depressed and unwilling to accept any help. He actively rebuffs any effort Paul makes to express empathy for his situation or to ally with him. This has been a consistent theme with Walter who is determined to be the one responsible for whatever goes wrong. Working with someone like Walter is very difficult because of his efforts to thwart any efforts by the therapist to align with him. The relationship with the therapist is the vehicle for what happens in therapy and when the patient insists on keeping the therapist away, it is easy to become frustrated and discouraged. Therapists are not free of the normal desire to feel wanted and accepted, even though we do our best to be conscious of this and not act based on it.

The whole session has an ominous air to it. Walter's depressed mood. His efusal to allow Paul to help at all. His rejection of any more positive way to view his situation. His remark at the end -- "There are lots of them, destroyed families." And his outrage at Paul's suggestion that he was not responsible for his brother's death nor solely responsible for what happened with his company. Paul is clearly concerned about Walter's risk for suicide which is why he tried to get him to commit to an appointment the next day or to let him consult with his physician. The circumstances make it allowable and even expectable that Paul should warn Walter's wife of his concern, though given the tenuous nature of the therapeutic relationship with Walter could be a risky thing to do.

In Treatment -- Oliver, week 4

Mon, 27 Apr 2009 21:30:46 -0400

Oliver and his mother are at the door. Bess tells Paul that they were kicked out of their apartment and then they laugh and tell him she is going on vacation. Luke has not arrived, but Bess says he will be there to pick up Oliver.

Bess talks with Paul alone first. She tells Paul that after the last session, she and Luke took Oliver out to dinner and explained about the adoption. She says that since then everything is fine. Bess is going on vacation with her friend, which she can do because Oliver is doing so well. Paul says he doesn't think that Oliver has changed as much as she believes, that it would be unusual for his problems to clear up so quickly. Paul tells her that Oliver changed his behavior so that Bess and Luke won't see him as their problem. Bess interprets this to mean that she cannot go away without Oliver. Paul says he isn't saying that.

Why now?, Paul asks. And Bess attributes it to Luke having a girlfriend. She believes she has to create a new life, that she has never lived by herself. Paul asks how she and Luke got together.

Bess says she got pregnant the last semester of college and moved in with Luke. They got married. She was crazy about him and wanted to marry him. Her parents were furious until Oliver was born and then they had eyes only for him. For the first few years, they saw little of each other -- Luke was working and Bess took care of Oliver and then she went back to school. But she couldn't leave home behind and felt meaningless. So she dropped out. She has never worked and now has to do so. Paul suggests this is a opportunity to reconnect with the self she left behind. Again she accuses Paul of telling her she is not taking good care of Oliver. She looks out the window and sees her friend has arrived. She looks for assurance that Oliver will be fine while she is gone. Bess anxiously asks Oliver to say he will be all right. Oliver looks uncomfortable. She leaves.

Oliver sits on the window seat and looks a bit glum. Paul asks how he is and he says fine. Oliver tells Paul he made new house for the turtle. He keeps looking out the window. Paul asks if he is worried about her going away. Oliver denies any sleep issues. Oliver seems a bit testy and evasive.

Paul reminds him about the bully he told him about a couple of weeks ago. Oliver tells him about Maya who is his friend. Last week the bully told everyone Oliver was in love with her but she won't go out with him because he is fat. Oliver tells Paul he won't stay fat because he stopped eating. Paul asks him how he is making it through the day without any food. Paul tells him he needs some help to know how to lose weight. Oliver tells him he doesn't need help and he doesn't want to talk about it.

They move to the main part of the room. Paul tells him he knows they told him about the adoption. Oliver had expected that they would tell him he was adopted because he doesn't look like them. His parents gave the baby away because they were fighting and he thinks they might give him away if he does not behave. He wishes he was adopted. Paul tells him he used to feel like that when he was a kid, which Oliver is glad to hear. He wishes they would give him away because all they do is fight and he believes they are not going to stop. Paul asks where he would go and he says maybe he could go where they would want him. Oliver notices his father should be there. Paul offers to call but Oliver says he can do it. As he thought, it goes to voice mail. Paul tells him he can hang out here if he likes because his next appointment cancelled. He offers to play blackjack with him. Oliver says he is starving. Paul asks if he would like a sandwich and they go into the kitchen. Oliver looks around as he enters the kitchen. Oliver asks for ham and swiss cheese with mustard. Oliver asks where the doors in the kitchen lead. He asks if Paul's son drew the picture on the refrigerator and if it is the house where he lives. He enjoys the sandwich. Paul asks if he is still hungry and he nods.

This session is quiet, soft. In the beginning with Bess, we begin to get the picture of the family Oliver is a part of. Two parents thrown together by an accidental pregnancy who married young, not really knowing themselves, much less each other and then distracting themselves with the business of making a life. Bess mentions in passing that once her parents saw Oliver they forgot all about her for him -- suggesting that she feels displaced with her own parents by her child. And we can guess that at least some of Bess's persistent anxiety about Oliver comes as a result of her ambivalence about having had him in the first place. For it is Oliver who caused her to derail her life and get married and end up where she is now, uncertain about how to create an independent life for herself.

Oliver feels he is not wanted by his parents, at least unconsciously, and he is at least partially correct. It can happen with children who are unplanned and not altogether wanted that they pick up on the ambivalence of their parents and see themselves and their existence as the source of their parents dissatisfactions with their lives. And, in a way, they are correct but it is not their responsibility. So we see Oliver wishing his parents would give him away to parents who would want him -- so both he and his parents would be happy.

Luke shows his own ambivalence by being late to pick up Oliver, and on some level confirming what Oliver feels. His parent both seem to be trying to both cling to and get away from their child as an outgrowth of their ambivalence and their conflicted relationship.

So why is it okay for Paul to invite Oliver into his kitchen and feed him? Yes, it is a boundary violation, but the boundaries with kids on things like this are not as tight as they are with adults. Oliver has not eaten so he is in fact hungry, though the hunger e has is emotional as well as physical. And he has had a tough time talking with Paul this session. So offering to make him a sandwich allows Paul to show Oliver he can really hear him and meet him where he needs to be met. Oliver has a chance to see that Paul does know about being away from his kid so he just might understand how it is for Oliver. In the last scene, Oliver is exploring Paul, checking him out as he hasn't really so far. The sandwich is good and he enjoys it but, as he tells Paul when he asks, he is still hungry. And Paul understands.

It is a pleasure to watch Paul patiently stay with Oliver in this session.

In Treatment -- April, week 4

Sun, 26 Apr 2009 20:55:15 -0400

April arrives early. She tells him she has to leave her cell phone on in case her brother calls.

She couldn't tell her mother about the cancer. She did visit Sloan-Kettering. She told her mother she is a little sick but not what was wrong. Her brother tried to kill himself. All of this tumbles out in the early part of the session. Her mother can't cope with Daniel when he wants to die. April says he can't handle feeling strange. And so April takes over with him then.

Paul tells her he worries that she is feeling strange and has no one, that her mother shares her anxieties with April but April doesn't tell her mother anything.. So she starts telling him how she feels -- depressed, out of control. Paul firmly tells her when she feels like that to call him, any time.

She tells him she saw her mother and they talked about Daniel. She always tries to look her best for her mother because of Daniel. Her mother talked about wanting to leave her father. Paul asks if maybe it is Daniel she wants to leave.

Paul asks about her father. She says he was never around much. She liked talking with her father at the end of his day. Paul points out that neither parent was available to her for her to lean on. Paul talks about the burden for Daniel's care eventually falling on her. April feels horrible that she doesn't want to take care of him. Paul tells her she can make other choices.

Paul says they have to talk about chemo. The phone rings and it is Daniel but he did not talk to the person he was supposed to see. She starts to get up to go get Daniel when she faints. Paul tells her she fainted and she needs to eat. Paul tells her she is treating him the way she treats her mother, not letting him help her. She thinks he means he can't handle what is happening to her, that she scared him. Paul said he can help her even though she is sick and it is scary. She is terrified, angry and believes she will die. She is afraid he will not be able to handle what is going to happen to her, that he will leave her and that he will hate her for letting her help him.

Her mother calls. She tells her mother that Daniel is in Central Park and she asks if she would go get him because she can't leave. Her mother hangs up. Paul tells her to sit down. He tries to impress on her that they don't have time to delay treatment. He asks her what it is about being there with him that makes things seem different, so that they make sense to her. She says he does. He proposes going with her to the hospital. She asks if he will come with her now. He agrees.

They leave.

Paul has succeeded in winning April's trust, at least as much as she is willing to trust anyone. She arrives early. She responds pretty openly. And then admits it is Paul that makes the space there safe for her. Which allows him to get her to allow him to accompany her to the hospital to start chemo.

This is another tough situation. April is functionally alone. Under ordinary circumstances, Paul -- any good therapist -- would take the time to explore more of what keeps April from being able to get through to her parents, to find care for herself. But there isn't time for that kind of patient exploration. Making Paul's willingness to step in to accompany April understandable. Understandable and risky too. Because April is very hungry for a caring parent and once he has stepped into that role, it will not be easy to step out of it and help her to get what she needs from people already in her life.

A long time ago, when I was first in analysis, I asked my analyst many times what the rules were. And he told me there were no rules, which I found maddening. I wanted to know the rules so that I could follow them and be good. I did not at all understand what he was talking about. Which was that his job was to be the analyst I needed and that would almost certainly be different in a variety of ways from what another patient would need.

Paul is trying to be the therapist April needs. And right now April needs a therapist who will be with her in the way that Daniel's teacher was with him. April needs a therapist who will hear how needy she is and be willing to be with her. Paul is willing to receive her needs and be there. And he must also be willing to weather the storm that will inevitably follow when he is unable to be a new parent for her. That storm holds the potential for April confronting her fears and rage at her parents and becoming better able to allow others to help her at the same time that it poses a lot of danger for her and for the therapy. While technically what Paul does is an enactment, I think I would likely do the same thing under the circumstances. The risk managers out there are no doubt gasping in horror at the whole thing but sometimes we have to be willing to take a chance.

Added April 27 --

When the therapist feels such an intense need to help a patient, to get a patient to do something, it is a clear indicator that there is a counter-transference reaction going on. It is natural to want the people we see to become happier and to have better lives but the intensity of the desire in Paul is what tips us off. Paul was unable to make his mother want to stay alive or make her get well. April's vulnerability taps into this and creates in Paul pressure to help her. So he becomes less able to stand back a little and avoid being directive with her.

Now, her situation is indeed perilous which would tend to induce this sense of urgency in most of us. And as I said above, many of us would feel moved to do as he does. But what is important for Paul to come to understand is how his own issues are involved in the intensity of his reactions.

In treatment -- Mia, week 4

Sun, 26 Apr 2009 20:54:26 -0400

Mia comes in and heads to the kitchen because she wants breakfast. Paul tells her no because he doesn't have sessions in there. Paul says he doesn't understand why she can't eat in the other room as she sits down at the table and then asks for a napkin.

She continues talking about her weekend. Paul tells her she is speaking rapidly but she does not slow down. He gives in and half sits on a stool against the wall. She tells him about having spent the night with a musician. Paul asks if it is her intention to shock him, as she continues to describe the sexual acrobatics with the musician. She compares that guy twice to Bennett. She tells Paul that that evening she was his favorite and ten reveals that the next night she was with a cop. She describes him as taking charge and she liked that. She wants Paul to ask for details. Another comparison to Bennett. She disdainfully describes how she had to tell him what to do. Paul suggests they move into the other room and she seductively asks if he wants her on the couch.

Paul tries to explore with her what triggered the weekend and being with 2 different men. She says Bennett asked her to have lunch with him and told her that he was leaving his wife for his girlfriend, who is the receptionist that she spoke disdainfully the previous week. Mia cannot acknowledge that she is hurt by Bennett's betrayal.

Paul asks if she said goodbye before leaving the men. She uses it as a reason to get angry with Paul, assuming he is angry at and disapproving of her. She wants him to tell her not to behave that way. So Paul says please don't do that again because it is dangerous and she will get hurt. For a moment she softens and then gets annoyed again. Paul suggests the musician was a symbol for the opportunity she lost when she left the drummer 20 years earlier. Paul asks how the cop made her feel and she says safe. She found out when the cop wouldn't drive her home that he was married.

Paul tells her that when she has sex with a married man, he has secrets with her, secrets from his wife. He points out the similarity to her taking her breakfast into his kitchen so she could feel different from his other patients, special. Paul reminds her that she told him about having coffee with her father at his store, that it was secret from her mother. Then she tells him that her father came over and had brunch with her. She reveals he father seemed not himself -- that he didn't notice her. And she took care of him -- like a parent, Paul observes. And she wants her father to take care of her and love her. She says she can't find anyone as good as her father. Paul reminds her that her father is married to her mother and asks if she thinks that has anything to do with her relationships with married men.

Paul says he thinks there is something about the relationship with her father is not altogether comfortable and compares it to her going into the kitchen -- how her speech was rapid and she knocked over the milk. He asks her if maybe she is not entirely comfortable being alone with her father, is she his? She becomes very uncomfortable and says he made her feel bad. She says she does not want to feel like that, to have this be her life.

Nicely done, Paul! I was concerned at the beginning when Paul allowed Mia to stay in the kitchen and sat down to talk with her there. But he did an excellent job of letting her go on and then later interpret the behavior in a way that registered.

As I watched this session I thought about ways that Mia would behave differently with a woman therapist. Her behavior with Paul has been at least in part a replication of the pattern she learned with her father. This compulsion to repeat this pattern -- to be made to feel special by a man and to hold secrets with him -- is the only way she knows how to relate to men. Even letting him know last week that she knows about Laura is a repetition because now she and Paul have a secret from Laura, whom she assumes he had an affair with.

With a woman therapist she would more likely be believing the therapist resented her and was envious of her. Of course, we can't know this for certain, but she almost certainly would not be doing what she attempts with Paul.

From Paul's patience with her limit testing, we came to learn how sad she is really -- that she wants a different life, to have a family and the things she always dreamed of but she is afraid she cannot have them. What she knows how to have are illicit relationships with married men, relationships in which she and the husband share a secret hidden from the wife. But these relationships never give her what she wants.

When Mia was in the kitchen, Paul noted her rapid speech. And she knocked over the milk and attempted to make a joke of it. Both are strong indicators of her anxiety. She is aware of having transgressed and is waiting for Paul to make her behave, to be the firm daddy with her. Her references to Bennett are filled with contempt about his lack of sexual prowess and weakness -- which serve as a handy cover for her pain at having been discarded by him, not for his wife but for the receptionist she sees as less than she is. When Paul manages to connect this behavior with how things were with her father, he manages to penetrate her defenses enough for her to allow herself to be vulnerable, at least briefly, and admit to what she wants.

In the universe of the very tight frame, Paul would not allow her into the kitchen, but then again, he would not have his office in his home. And remember he left the door to the kitchen ajar last week thus inviting her to see into the private area of his home. Paul's unconscious is at work in this also.