I have been a fan of The Sopranos since the first season. I have seen every episode, most of them more than once. I have followed the ups and downs of this NJ mob guy and talked about him with my friends for 8 years. Now we approach the end.
One of the things I have liked about The Sopranos has been that the relationship between Melfi, the psychiatrist, and Tony Soprano, her patient, has been more realistically portrayed than is usual in television or movies. Her behavior in the office, the things she has said, interpretations made have been within the realm of believability.
Of course this is television, fiction, and the show is about Tony Soprano, not Melfi, and I have no reason to expect that the writers will not take dramatic license to underline some larger point they wish to make about Tony. That said, I was really disappointed by the way Melfi and her creepy supervisor, Kupferberg, behaved in the penultimate episode Sunday night.
For those who didn't see it, first came a scene in which Melfi was at a dinner party with a bunch of psychiatrist colleagues, including Elliott Kupferberg, her supervisor/therapist. So right there we have a problem because who among us attends dinner parties with our patients or therapists? Now Elliott has always been both fascinated by what he has heard from Melfi about Tony -- in that voyeuristic way that happens to the best of us -- and disapproving of her even attempting to work with someone they all have decided is a sociopath -- we could argue that one. So at the dinner party, there is a conversation about the futility of using psychotherapy with criminals, reference to an article which states that sociopaths use therapy to become better criminals, and in chimes Elliott with a thinly disguised reference to Melfi's work with Tony. The disguise easily falls away and Elliott has not only disclosed his relationship with Melfi but also violated the confidentiality of their supervision and her patient. Definitely NOT GOOD.
Then we see Melfi reading the article and the words of it landing on her like hammers. Next we see Tony in her waiting room reading a magazine from which he tears out a recipe. When she calls him in to the office, it is immediately apparent that her mood is dark and angry. Tony picks up on her mood and asks about it. She denies anger but does so in a rather abrupt and hostile way. As Tony goes on, her actions become more hostile as she cuts Tony off, then tells him she can no longer work with him, makes a half-assed referral to another psychiatrist and then all but pushes him out the door. Clearly she is acting out of her counter-transference , her anger at Elliott, her transference with him, and her feelings of humiliation with her colleagues, none of which excuses patient abandonment, which is what she does to Tony.
The two scenes accomplish their dramatic purpose by giving us a Tony whose only link into the legitimate world is severed, who finds finally in his therapist the same kind of hostile rejection he faced time and again with his mother, a relationship which was central in the therapy of the last 8 years. And we see the legitimate world underlining for us that Tony is a sociopath and beyond any possibility of redemption, a man so bad that he does not even deserve ordinary ethical behavior from his therapist or her supervisor. Okay, I get that.
We are all guilty of ethical lapses now and again. We are human after all. But in the best circumstances our errors become opportunities for learning on our part and on that of our patients. Errors can be admitted and then worked through, like any issue. But really grievous errors, like patient abandonment, effectively kill the process and harm both parties. On some level, we know that Melfi, who is after all a reasonably adequate therapist, is going to be going back over what she did again and again. She cannot heal the breach in the relationship with Tony -- there is no chance he would return and besides the series ends next week. But she will be living with what she did for a very long time. And her error ended in the office when she terminated with Tony but it began at the dinner party when she did not respond appropriately to Elliott's first reference to her patient. She should have said something then to stop the conversation or perhaps gotten up and left. But she didn't. She stayed and did nothing and so is complicit in Elliott's ethical violation as well.
One bright note -- those two scenes -- the dinner party and the termination session -- can very fruitfully find a place in training and in ethics workshops as glaring examples of what not to do. But Melfi, why did you do it? I am disappointed in you.