January 24, 2008
Bad therapy by troubled shrink is revealing TV
The drama, debuting Jan. 28, is scheduled daily over nine weeks. It reveals how what unfolds for the therapist, as well as the patient, in each therapy session can cause a therapist to seek help for himself. The series, co-executive produced by Noa Tishby, who brought it to HBO, is based upon an Israeli version with a similar premise that took that country by storm last year.
As a psychotherapist, when I heard of a new TV series featuring therapy sessions, I was intrigued and hopeful. I had fantasies that finally the world would learn the truth about what therapy really is and what therapists really do.
Therapists, like Jews, are a beleaguered group. We and our profession are not well understood -- "therapy is for crazy people, and I am not crazy" is what I often hear. One client told me recently, "I know you are going to make me talk about what I do not want."
Therapists are accused of being shrinks, of always putting all the blame on the "proverbial mother" and, of course, of being "Freudian" and seeing sexual underpinnings for all psychological problems. But, most importantly, what therapists hear most is, "How can you help someone by just talking to them?"
Well at last, I thought, a series that will reveal the power of the "talking cure."
On the other hand, for therapists, news of a new TV series about therapy is akin to Jews hearing news on CNN about Israel. The first question we Jews ask ourselves is, "Is it good for the Jews?" The first question I began to wonder about as I sat down to watch some of the episodes sent to me by HBO is, "Is this series going to be good for therapists?"
In real therapy, drama comes from a slow, laborious, repetitive process of restructuring the mind. The work consists of making meaning of not-yet-understood reactions and behaviors, and of returning over and over again to feelings and thoughts that are re-experienced in a different light.
New information comes out over time, as trust grows and the patient achieves greater clarity. Resistance is subtle, usually unconscious. This kind of process should not make great television.
Well, having watched the first few weeks of this series, I would have to say "In Treatment" does make great television, and it is good for therapists, but it's not what you might think.
The series kicks off with Laura, a beautiful young doctor who has just been given an ultimatum by her live-in boyfriend: "Either marry me, or we are through."
Loathing her boyfriend and the pressure he puts on her, she comments about him to Weston, "Don't you know that men are the new women? They want marriage, kids, a house." She certainly does not sound like she wants that.
What she does want is her therapist, and she reveals to Weston that she is in love with him. He looks stricken, fumbles, acts surprised, asks her to elaborate and the drama goes from there.
As a viewer, I was captivated by the dialogue, glued to my seat with my heart racing. But, as a therapist, I realized that what we had just been served was our first taste of what makes this series a riveting and compelling drama -- a series of therapy sessions livened up by the fireworks that come out of a whole list of ethical and professional boundary violations.
As therapists, we are bound by an ethical code that compels us to think carefully through such issues as how much dependence do we foster in our clients, when do our own personal issues interfere with what is "best for the client," how much personal information to share with a client and when do we bend rules for a client?
In every episode, Weston gets caught in his own confusion as to what is professional or ethical conduct, and he allows his patients to question his rules and to push him into making judgment calls that mess up both his personal and professional life.
In the episodes with Laura, Weston gets caught in one of the issues most tantalizing to nonprofessionals, as well as one of the most challenging and delicate issues for therapists: an erotic transference, or the client falling in love with the therapist. In the therapeutic process, transference occurs when a patient assigns to the therapist feelings and attitudes that were originally associated with important figures in the past.
Sometimes transference is positive, and the therapist feels that the patient adores him. Sometimes it is negative, and he becomes the object of scorn, loathing and blame. Sometimes it is erotic, and the patient feels that he or she has found their true love, the one who really loves them, cares for them, wants them and needs them.
The patient cannot tell the difference between erotic transference and falling in love. To the patient, the love feels just as tender, just as special, just as all-consuming. It demands gratification. But, to the therapist, the erotic transference is an indication of the patient's need to act out the past, rather than remember, examine, understand and find in it a way to find love in a healthy, fulfilling relationship outside of therapy.
Weston is not able help Laura uncover what lies behind her need to fall in love with him, because he has some ambivalent feelings toward her. Unable to face and own up to his real feelings, he unconsciously crosses the boundaries of ethical standards and professional conduct. We see it as he looks tenderly at Laura, as he lovingly drapes a shawl over her shoulders, as he holds her hand, as he steadies her when she gets up and appears to be wobbly.
Based on his behavior and reaction to her professed love, it is hard to believe that he was truly surprised to know that she has been in love with him for so long. It is much more likely that he has been picking up nonverbal messages from her for months in their weekly sessions but has not been willing to admit that he was falling in love with her as well.