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In TreatMent 2 -- Week 7
In Treatment 2 -- Reflections on the Season
This will be a post in progress as I reflect on the season -- so there will be additions to it as the week goes by.
One thing I thought of this morning is that this year we got glimpses of other patients Paul works with. I think this was quite helpful in a very subtle way as these others seem more ordinary as patients. So we can fairly conclude that the 4 patients we have followed have been those who most touch into Paul's own issues and thus present significant challenge to him. No therapist could stand the stress of a practice full of people like this -- it would simply be too much, so we rarely have more than a very few at a time.
Although there has been chatter about Paul's boundaries and acting out this season, and I have written about this, actually he has not really done much of it at all. Last season Paul was deep in his own crisis in his marriage and this gave rise to what we saw happen with Laura. Though he has had to deal with the aftermath of divorce, and of course with the lawsuit, nevertheless, on the whole this has been a year of resolution and so his personal stress has been decreasing. If we think of the two seasons together as a single year, which they seem roughly to be, then the crisis which marked the early part has been resolved by the divorce and this season shows us as he moves into a new normal. In the background is the building of new relationships with his kids, his own emergence from the devastation of divorce, development of his new practice. Through the windows of his office we have seen the season change from the snow of winter to spring as indeed is true in his life.
Major crises in a therapist's life are bound to create issues in his work life as well. That is true for any professional because we are all only human and not able to keep the personal completely out of the professional all of the time. That Paul made significant errors last season is not surprising. I have seen this in therapists I know. Indeed during my own divorce years ago, I struggled to maintain my focus as my own personal issues threatened to engulf my work. It would be lovely if at times like these we could take a leave of absence, but as most of us are in private practice, that is rarely feasible. So we muddle through doing the best we can to show up and do the best work we can in the moment. Yes, this means we will make mistakes, but mistakes are always a possibility regardless of our personal issues. Striving for perfection is doomed to failure as nothing in nature, not even the very best therapist, is perfect. What we have seen this season is Paul working his way through his crisis and in the end coming to a place of better understanding of hat his work is about, thus enabling him to be a better therapist going forward. We are all works in progress.
I have also been thinking more about April and why she will not be back to work with Paul. I have argued before that Paul's decision to take April to chemo and to call her mother were the right choices. And I believe they were. But they also effectively spelled the end to the therapy. It was a boundary that Paul crossed, yes, but I believe he would have been remiss to do otherwise because the circumstances were dire and what he did was what she needed. It was indeed a life or death choice -- and making the choice for April's life meant also choosing the death of the therapy, something Paul may have known unconsciously. These are very rare kinds of choices. But when the well-being of the patient stands in opposition to the life of the therapy, what choice has the therapist except to act for the patient?
In Treatment 2 -- Gina, Week 7
Gina is reading a letter. She puts it away in her desk. Apparently Paul is late.
Paul tells her he has asked his lawyer to call him while he is there if there is news about the hearing. He decided not to send the letter after talking with Rosie. Paul overslept and missed the hearing -- his lawyer had told him he didn't have to be there and he knows he didn't want to be there. He asks Gina about her life.
Gina says she wants to know what his lawyer thought about the hearing. Paul tells her he thought it had gone well. Gina reflects that he has been under enormous pressure all year. He compliments her on how she looks. Paul tells her about when he was in grad school and how all the students were so in love with her. They were fascinated with her ad wanted to know all about her.
Paul asks what is happening with her today. Paul's phone rings and it is his lawyer. He asks her to stay. The judge was livid at Alex's father for wasting everyone's time, that there were no triable actions of fact. The case is being thrown out. Gina smiles and tells him how happy she is.
She asks Paul what he is going to do. How did he do with his patients this week. He tells her that to his surprise it went well, doing what she had told him. He tells her April left, and that in part it is because he took her to chemo, but she also needs to stop thinking about herself. He says he is proud of her as well as concerned. He says he understood her reasoning and that surprised him. He talks about the similarities between Walter and April. He says that he realizes that practicing this way he may never know if he is helping or not. He sees that what he can do is walk with them for a while as they make sense of their lives. He doesn't have to be perfect. He also knows he doesn't want to work with Gina.
She is upset though she denies taking it personally. She says she is disappointed that they are here again. He says he is not stopping with her in anger. Gina tells him she wants to be sure he knows why he is doing what he is doing. She tells him she knows she crossed a line and she also knows he lost two patients in the past week. So he thinks he should let her go too, Gina says she has come to represent everything he resents in his work. She says if he needs to go, he should go. But she is concerned he is punishing her for failing to protect him. She asks if there is a connection between the ending of the suit and ending therapy. He says he can't keep coming to her for the mothering he didn't get. He says he plans to keep being a therapist. He says he hates his chair. She asks if he wants to practice standing up. Gina asks if he has thought about supervising. She says she thinks he would be good at it. Paul says he knows he needs to be with more people. GIna says part of her would love to let him go but she is concerned about the timing. She asks if he met someone this week. He tells Gina about meeting a woman and he plans to see her again. Paul asks if Gina has a date and she admits she does.
Paul tells her she is an excellent therapist, that he wouldn't have survived without her. Gina tells him that she is not going to say that her door is always open. He says he understands.
This is the ending I expected. I have said all along that Paul should not be seeing Gina for therapy because their relationship is too tangled. Ad in a way that is what he tells her when he says he wants to end it. She has indeed seen him through the crises of the last year -- Laura, Alex, the divorce, the lawsuit, the death of his father, his professional crisis. He needed her and she was there. But last week she did not play the good loving mother to him when she got angry with him and I believe that burst a bubble he had about her. He makes several references this week to Gina;s holding to boundaries and Paul resents this, because it clearly marks him as a patient and not as her friend, her student, her surrogate son. And once the need for the mother is ended, with the resolution of the suit, he wants to be rid of her.
Paul is right. He needs more of a life. It is an all too common error for therapists to have too few social contacts, too little time with friends who are not also therapists, and thus they can tend to seek to get their intimacy needs met through their patients. This is what Paul has been doing. Several patients this week remarked on Paul's solitary life, where his work and living space blur together. But Paul also still needs to be in therapy because he has by no means worked his way through the many issues that have come to the fore this year. He wants to see himself as like April -- as needing to take time now to live without all the self analysis and inspection. But he is not April. And developing a richer life and being in therapy are not mutually exclusive. Just as he expresses concern that April hasn't the resources to deal with the next crisis, so also I doubt Paul has them either.
At the end when Gina says he r door won't be open to him again, she does herself and Paul a great favor. She is unwilling to deal with him again, to accept the abuse he tends to heap on her along with his refusal to stay and deal with it. This is a boundary she needed to set last year. Better late than never.
Later this week I will post reflections on the whole season.
In Treatment 2 -- Walter, Week 7
Paul is talking with a lesbian couple when there is a knock on the door. Walter walks in on them.
Walter starts talking about having been released from the hospital. He, his wife and daughter drove to their summer place on Shelter Island. Paul asks how it was. Walter says Connie and Natalie were tentative with him. He says he wanted to be alone in his office there but they kept asking him why. He wanted to be alone. He wasn't able to tune out his wife. He went to his office and saw Natalie watching him, and felt like he was being babysat. Paul relates that to how h kept an eye on his parents when he was a little boy. Natalie brought him tea and asked to sit with him but he didn't want to talk with her about himself. He says he got clippers and start cutting brush and pruning. Paul relates the brush clearing t the work they have been doing. He relates to the week before, to the way the last session went. Walter denies any memory of it. He denies any memory of the two Walters. He denies the emotional connection to the talk about the lost Walter. Paul reminds him that he teared up when they talked about them.
Walter tells Paul about a dream he had that week. In his dream, his boss tells him it wasn't his fault and he apologized to him and offered him his old job. But in the dream he couldn't speak and he woke up in a sweat. Paul wonders if perhaps he doesn't want his old life back. That he genuinely didn't feel the strain he was under before.
Walter tells him he did make him think about his father, in the way he looked at Walter when he walked in on the previous session. His father had insomnia and worked the night shift. He would come down and want to talk with his father and he would look at him in a way that made him feel his father wanted to get rid of him, as he felt Paul wanted to. He talks about having fixed drinks for his mother and then worrying she would fall asleep while smoking in bed. Paul says yes, they were grief stricken, but Walter was lonely and needed them. The parents seem never to have had time together for Walter. He remembers his own sons used to spy on him the same way he had on his father. He thinks his sons aren't interested in him and doesn't want to think they are.
He tells of his family moving and of rising his bike back to the old house. Paul suggests he did that to try to find his own old self, the self he was before his brother died. There was nothing in the new home except duty and loneliness. Walter is moved but says he won't cry because he knows it made Paul uncomfortable and disgusted him. Paul asks if he cried when Tommy died. He says he started to cry, but his father picked him up and shook him and told him not to ever cry in front of his mother. Paul asks if that was when he started to shut down. Walter asks why the split Paul has identified is a bad thing because he has done well. Paul tells him the dutiful part of him got praise and reward, but he lost something important. He got rewarded for not paying attention to himself, to his wants and needs. So the only way to feel valued is to carry the weight. Walter takes a drink of water and says Walter the CEO is gone now. Paul tells him the crash was already inevitable when he first came to see him. Walter say he knows he missed his life, that he is 68 and hasn't lived one minute for himself and what is he to do with that? Paul tells him that this is the time to stop taking care of everyone else. Walter asks if this is what he wanted, to break him down?
Paul tells them they can put him back together but there is another route, a deeper route that will allow him to discover parts of himself he doesn't know. He will have to come more often. Walter asks if he really wants to spend more time with him. Paul says he would like to be with him.
Walter gets up and asks when they start!
Okay, I am gushing now! Another terrific session. And good work with a very tough patient. But Paul had begin to get through to Walter several weeks ago when he saw him in the hospital, when Walter was unable to intimidate him. And last session when he opened up the two Walters and helped him begin to see the split off vulnerable part of himself that had been so long lost.
This week we see only the faintest hints of the hostility and aggression that so marked the early sessions with Walter. We see a man who is ripe and ready for going further but who needs to know it will be worth it. This is exactly the kind of work Jung talks about as essential for the last third of life. It is the opportunity to change the outcome of the story one has been living. Paul is able to help Walter see that he can change the ending of his story, can find a new meaning in the rest of his life, so that life is not lost.
Natural life is the nourishing soil of the soul. Anyone who fails to go along with life remains suspended, stiff and rigid in midair. ... From the middle of life onward, only he remains vitally alive who is ready to die with life. For in the secret hour of life's midday the parabola is reversed, death is born. The second half of life does not signify ascent, unfolding, increase, exuberance, but death, since the end is its goal. The negation of life's fulfillment is synonymous with the refusal to accept its ending. Both mean not wanting to live, and not wanting to live is identical with not wanting to die. Waxing and waning make one curve. C. G. Jung
We cannot live the afternoon of life according to the programme of life's morning, for what was great in the morning will be little at evening, and what in the morning was true will at evening have become a lie. ~ C.G. Jung
In Treatment 2 -- Oliver, Week 7
Oliver and Bess are in the waiting room. Paul invites Oliver in but he doesn't want to go. Paul says he and Bess will be in the office talking and Oliver is welcome to join them if and when he wishes.
Bess looks very uncomfortable and says she knows Paul hates her because she is doing everything he told her not to. Paul asks how Oliver is handling it. She says he is handling it very badly, that if nothing else Oliver has learned to express his anger. She tells Paul she had been certain Paul would be on her side in the beginning. She says when she cam to pick up the turtle she saw he was alone so she thought Paul would be sympathetic. Paul tells her his job was to advocate for Oliver. Bess reminds him of the warning on planes that the parent should use the oxygen first. Paul says she needs to attend to Oliver now.
She rather bitterly says she had Oliver in the first place because she didn't know what to do when she graduated. Then spent 12 years focused only on him to discover she does not want to be in that life any longer. Bess tells Paul that Oliver told her he is happier with Paul than with Bess or Luke, that he wanted to live with Paul. She tells Paul that he was Oliver's best friend and she is taking him away and he will never forgive her for that. Luke arrives unexpectedly.
He says he was at the old apartment packing up things and he needed to talk with someone. They talk about Oliver being so angry. Luke tells Paul he is spending the next few days with Oliver before he leaves but he doesn't now what they will do given Oliver won't speak to him. Luke says he was remembering when they first moved into the apartment, before Oliver was born. They share stories of what it was like and they laugh together.
Paul notes the ease they have with each other. Bess says it is because it is over now, that Luke knew long before she did. They had each been trying to get the other to be different. Luke sadly says that all this time and effort all that they are is two people who shouldn't have gotten married. Paul suggests that maybe now they can begin to work together as Oliver's parents, that he is the one thing they have done together. Bess says she has to go back to the apartment. She suggests that Luke could take Oliver that night. She says she is going to see if she can get Oliver to come in and talk. He tells her that though he has been hard on her, he admires her courage.
Luke ruefully says he has the next 2 1/2 days to make up for the past 12 years. He thinks it will be a disaster -- the plan they have worked out. He is not happy being a divorced dad only seeing his child on the weekend. Paul asks if he feels he has failed. He says he does, because he didn't want to be like his father. He says he has already lost him. Oliver won't come to him when he has problems. He says he never learned how to take care of him, that he always passed him off to Bess. Paul asks if he loves his son. He says yes, of course he does. He rues having let Bess take Oliver without a fight. Paul tells him what matters is what kind of father he is going to be now. Oliver will always want his father so he cannot give up on himself or Oliver. Luke asks Paul for any tips. Paul says there is a good chance things will get worse before they get better. He will have to let Oliver be angry and take it, keep showing up. Take it step by step. Be there.
Paul and Luke go out to try to get Oliver to talk with Paul. Luke tells him he knows he is angry but it is not Paul's fault. He tells him he will be glad he talked with him later on when he is not so angry. Oliver looks up and reluctantly agrees.
Paul and Oliver go into the office. Oliver tells Paul he didn't help him at all. Paul says he is sorry he let him down. He tells him he cannot solve his problems but he can talk with him about everything that is going on, that it might make him feel less alone. Oliver tells him this was his last day of school and they had a party for him. His nemesis Eric was not thee because he got hurt. Maya got him a going away present. He says he will miss his house, that it was weird when his dad came to help pack. His parents started to cry and he hated seeing that. Paul tells him he once saw his dad cry and he got angry because he wanted them to be happy. Oliver asks what he did. He says he stayed angry for a long time then he understood and felt okay Paul tells him to ask them when he needs to understand and when he can't get answers, to call him and they can work together. He asks Paul if his son lives far away. Paul says yes. And he misses him all the time. He tells Oliver what it is like for him and his son. He gets up to make a call. He calls Oliver's cell phone. Oliver says this is dumb but he looks pleased. They role play what they can talk about and how Oliver can tell his parents things. Paul says he thinks Oliver is going to be okay. Oliver says he will call next week.
Oliver smiles and the session ends.
I melt when I see Paul work with a child. He is so good at reaching Oliver in just the right way. This whole ending was done superbly, from the time with Bess, to the piece with Luke and Bess and urging them to focus on being parents together in a way that we can hope they will be ale to do now, to his support of Luke. Luke needed that support from Paul, needed to have the capacity for good parenting he has named and reinforced, and Paul did that in a masterful way. Luke's face softened as he began to see a way that ultimately he and Oliver will be all right.
We know that Paul is going through with his son what Luke is with Oliver. That Paul's son is very angry with him and that Paul is ding his best to allow the anger and keep showing up. Because like Oliver, his son needs to know that his father will not stop loving him because of the anger. This is not an easy task for any parent, to receive the anger without striking back, to maintain an open posture and be there waiting until the day the child is willing to come to him or her. Paul himself waited too long and so was not able to do that with his own father, so he missed what he is hoping Oliver and his own son will eventually come to.
Again, we see how Paul can and likely will continue to help Oliver. By making the call to him an going through what it would be like to talk with him, he lets Oliver see that moving won't kill the relationship, that he will still be there to help him. Just telling him would not have accomplished this with the depth that actually enacting it did. This was masterful on Paul's part. Oliver will be all right and he will continue to get wat he needs from Paul and from his parents as they grow up with him.
In Treatment 2 -- April, week 7
Paul in his kitchen when the phone rings. It is April asking to come in for a last session.
They start in silence. April complains that her hat itches and that it looks ridiculous. She says Daniel gave it to her. She let her mother tell him because she was afraid he wouldn't react. She tells Paul that the tests show that the mass behind her spine is shrinking. Paul says he is relieved for her and asks how she feels. She says she doesn't know.
Paul asks if she was surprised by the results. She asks if he is alone there, where are his children. He says they live with their mother. Then she tells him that Kyle and Sienna broke up and that he gave her a necklace to a wishbone. She is cynical about this, says it is too late because she is gone, that the girl he loved is gone, doesn't exist anymore even if she goes into remission because she will always have to tell people she has had cancer. She tells him she is repulsed by the idea of sex and thinks that part of her that wanted it is gone. Paul tells her that she is involved in recovering and desire will come back. She says he is right.
Paul asks about her message that this is her last session. She says she wants to stop. And Paul says she needs help during her recovery. He would like to schedule sessions with her parents and maybe with Daniel and she yells at him to stop and calls him an asshole and gets up and runs into the other room. She apologizes and he says it's not necessary. She challenges that and Paul tells her he's her therapist and she does not have to take care of his feelings.
They sit down again. Paul suggests she reacted so strongly because only a part of her wants to leave but another part wants to stay. She says what is the point because she could get worse. Her head is itching and she refuses to take off the hat. She says she dropped out of school last week. She says she'll never get a job as an architect because her work is shit. She said she only went to grad school to make her mother happy because she could know she had a plan. Her mother used to say a mother is only as happy as her least happy child and would look at Daniel, while April would think she was looking at the wrong child.
Paul asks why she didn't take a leave of absence. She says she won't go back. Paul says she is cutting ties not only with him but with everyone. She says she is 23 and had cancer so where can she go from there. Paul asks where she would go if she could go anywhere. She says back, back to her home. She says she is thinking of going from one organic farm to another getting room and board for her labor until she forgets everything.
She says she doesn't want to be the one who survives, because it is so hard. Paul asks if it was like that before she got sick. She says no, that before there was a path, steep and difficult but it was there. Paul tells her that her life's path was changed without her consent and it is so hard to handle. He tells her she will grow older, fall in love have children if she wants to. She says he doesn't know that. He tells her sometimes we have to act to make it so, that she can't see possibility now but that doesn't mean there is none. She is crying and fingering the necklace. She says she thinks she will be alone her whole life because she can't imagine loving anyone again.
She says she went to his web page. He wryly says it is empty and she says it isn't now. That there is a comment from Sophie, who has good things to say about him. He thanks her for telling him. April says he has really helped her. He says he didn't do that much, that she did the work. She insists that he let her thank him and then let her leave. he asks if she is sure because they have accomplished a lot. She says she came in with cancer and she is leaving with cancer. He says that all of her feelings are a good thing. She smiles and accepts what he says. He says if not with him, she needs to be talking with someone. She says, not him. She says not him because he is the guy who saved his life He asks if she would like him to refer her to another therapist. Se says maybe later but she wants to focus on getting well now. She scratches her had more. Paul gets up and goes to a drawer and brings back a leather hat which he says was his father's. She asks if she can try it on and he says yes. She tells him to look away and then she laughs -- the hat is a flight helmet and she loves it.
She gets up, thanks him and kisses his cheek. And then she leaves.
Another good session, though wistful. April is struggling with allowing hope to re-enter her life. She is willing to see that she may indeed need ongoing support. And she knows that what Paul was willing to do -- take her for chemo and call her mother -- was what she needed and that he contributed to saving her life. She is grateful to him but she feels she cannot continue working with him because he saved her life. I understood what she was saying on a visceral level but am finding it harder to put into words. I think this is her way of preserving the feelings and experiences she has had with him, preserving them against the destructive urges she is still experiencing -- in leaving school, in believing she cannot have love and a normal life. Leaving now allows her to continue to hold him as her savior and given what she tells Paul Sophie wrote about him -- and a nice way that was of updating us on her -- she sees him as someone able to help, it is not at all unlikely that she will return. She accepts the hat, which was Paul's father's and it is not hard to imagine her wanting to return it one day when she no longer needs it. But in taking it, she is taking Paul with her. Eventually she will call Paul, not for a referral to another therapist but to come back to work with him. Or maybe that is my wishful thinking.
And I suspect that this is better for both Paul and April. For April to give her time to be with what she has now and go on recovering and for Paul because he still wants to do too much with and for her, which he showed in his telling her about sessions they could have with her parents and her brother. That is Paul's agenda, an agenda he has to set aside in order to be able to meet her fully where she is and to receive her agenda. We cannot create a plan for our patients' lives because those are not our lives to live. The agenda must be the patient's because it is the patient who must live it.
In Treatment 2-- Mia Week 7
Mia arrives and Paul greets her. She is quiet, appears very collected and professional. Paul asks if she got his message. She says she did. She says she hit bottom at the end of the last session and then it got worse. Then she says she has decided she is stopping therapy.
She tells Paul she appreciates what he has done but she thinks there is something wrong if every time one goes to the doctor one feels worse. Paul asks if she expects him to persuade her to stay. Mia guesses he is angry with her for wanting to leave. Paul says the last thing he wants is to keep her there and make her feel worse.
She tells Paul she called her father and asked all the questions about her childhood. Her father got angry and turned it on her and attacked her and told her everything was her fault. Then he left saying he didn't want to talk with her again. She says thanks to therapy she has lost her father. Paul points out that she lost the version of her father she thought she had. Mia believes Paul wants her to lose everything and be shattered. Paul suggests to her that losing the fantasy of her father could open the possibility of moving on and having a good relationship. Mia wants none of it. So Paul suggests they take the remainder of the session to wrap things up.
Paul asks what happened after her father left. Mia makes a joke to avoid answering. She says she stayed home all week in bed. She says she knows that sounds bad but she made it through and is there now. Paul asked if she got out of bed at all -- she says no. Paul asked if she called anyone, if she thought about calling him. He reflects to her that she did what her mother did, that she lost the dream of her pregnancy and her father, both serious blows. Mia ays this is why she is done with therapy, because talking about what happened makes her feel bad.
Mia says she is thinking about getting a parrot as a pet which she would name Paul and she would teach it to say things to her. Paul says she wants to get away from him and keep him around. Mia says she likes him and would love it if they were friends. She makes a crack that she isn't Laura, who got him outside of therapy. Paul says they never dealt with why she came back in the first place. He says she chose him the same way she chooses men -- finding someone who will let her down and when he does, as he inevitably will, she can rage about it. She demands why he didn't tell her that 20 years ago. Paul asks if she would have heard it. Paul tells her she is again blaming Paul that she hasn't had what she needs. He tells her that if she wants to change the pattern that she stay in therapy, if not with him, with someone else.
Mia asks if they can talk about his patterns -- that he likes to have a woman on the couch adoring him, that he likes to look at. She says she knows he has had fantasies about her and she continues to goad him.
She wants him to break all the rules for her. He asks what then, would she finally feel special enough, or would she blame him for crossing the lines. He suggests that then he would need her, the lawyer, and she would be in control. He asks her how many of her clients are powerful men who failed to protect their patients. He suggests to her that the fact that she did not go in all of last week is no accident, that then she did not feel like defending powerful men, having just learned about her father. He says maybe what she has been doing all these years is defend herself, the child who needed protection.
She says now she has nothing because of him, as she gets the connection between her life and her work. Paul tells her she has a choice now, she can make a better life. She continues to want to make Paul responsible for her disillusionment, for the breaking of the illusions she has had about her father and her life.
Paul asks when she was last happy and she says when she thought she was pregnant. And she says because she wanted the connection she could have with a child. Paul says maybe a baby is not what she needs, that it is the connection she wants and needs and that she has done some of in therapy. Paul suggests she can do that, that what she has done in therapy has been the only way she knows how to show what she needs. He says they have that connection right then in the moment. Which leaves her nonplussed. She smiles. She thanks him. Says it was a good session. They say goodbye at the door. She says she will see him next week.
This session is terrific at showing Mia's defensive style -- blaming, attacking and avoiding because Paul got too close last week and she came up face to face with a truth she found unbearable. Rather than call Paul, when she was too depressed to get out of bed, she brute forces her way through, powered no doubt in part by her angry determination to end therapy and thereby punish Paul for making her feel bad. She refused to call Paul because to do so would allow her to get the kind of care she needs which her father not only didn't give her but for which he rejected her.
It is a calculated risk to respond in the way Paul does, to a patient coming in declaring she is ending therapy. And no doubt some who watched found it problematic that Paul works fairly aggressively with her in an effort to get her to continue her work. This is a line most of us walk when a patient wants to terminate prematurely. The trick is to say enough to engage that part of the patient who does want to stay, who does want to change, without pushing too much and hardening the resolve to leave. Staying means being willing to go through the suffering that opened for Mia last week. It isn't an easy decision to make, to willingly enter knowing it will be painful. But if you look carefully for Mia's responses when Paul makes his interpretations to her, at the changes in her facial expression, you can see that she is taking in what he says. She responds caustically and defensively -- asking why he didn't tell her this years ago, suggesting he is happy that he destroyed her -- but she hears it. And this lets Paul know that she wants to stay. So he persists. Now, it is not common to make so many deep interpretations in one session, but he roots them all in the material they have been dealing with since she came. In an ordinary session, this would be too much and it was a lot even for this kind of extraordinary session.
It has been Mia's pattern to test and test Paul to see if he will respond as her father and other men have in her life, to be taken in by the seduction and by the competence she displays. And she does so this session as well. Going after his competence, his vulnerability in the lawsuit, at erotic transference. That he withstands it without acting out with her makes him ever safer for her.
At the end, when Paul tells her that they have the kind of connection she wants and needs, her face says it all, because if she hadn't before then, in that moment she decided to stay. There is much work ahead for her but a crucial milestone was reached in this session. She will continue to test Paul, to attack, to defend. But the chances are good that they will make progress and she will have diminishing need to defend herself in those ways.
All in all, this was satisfying ending to the Mia chapters.
Feeling worse in order to feel better -- Mia says she thinks there is something wrong to leave a doctor feeling worse than when she came. And this is a common feeling about therapy -- why do something that makes you feel worse? But when we have deep wounds, like Mia has, doing things to feel better often is more like re-arranging the deck chairs on the Titanic than it is therapy -- the ship is sinking and that is what needs to be seen and known. So, yes, being in therapy often means being willing to feel worse before feeling better. Because the only way out of the wound is through it and that means experiencing the pain and associated issues that have been defended against.
"One does not become enlightened by imagining figures of light, but by making the darkness conscious." CG Jung