I’ve become a huge fan of HBO’s phenomenal series “In Treatment”. There are a few reasons for this. First, it is so well written and craftfully acted---take John Mahoney’s recent performance as the tormented CEO “Walter”. In the midst of treatment, Walter comes face to face with his “real self”, and begins sobbing uncontrollably. He has come into contact with the grief that he feels over the choices that he felt emotionally compelled to make since childhood. Paul walks over and places one hand on his shoulder, and Walter grabs onto Paul’s leg and continues to sob---he reaches out for connection and comfort. This was a phenomenal and vulnerable moment, and one that moved me to tears. This was an Emmy winning performance by Mahoney.

Another reason for my rapt interest in this series is the character “Paul”, exquisitely played by Gabriel Byrne. As a practicing psychotherapist, I see myself in Paul, and have struggled at times with therapeutic neutrality and boundaries. Paul has broken these sacred vows on more than one occasion. His love/countertransference for Laura, allowing Alex to bring his espresso machine into his office, taking April to chemotherapy, and his dual relationship with Gina are all vivid examples of Paul’s own vulnerabilities and very human needs and feelings. I like Paul, a lot. I like the fact that he is so invested in his patient’s wellness, that he sometimes loses sight of what he can and cannot have an effect upon.

I’ve had several cases where I’ve been confronted with these kinds of feelings. Years ago, I had a male client who I was quite sexually attracted to. I recall looking forward to his visits, and I felt that he was somehow so fragile and sensitive. Not only did I have the urge to screw him, but I wanted to mother him too.  I’m not sure whether I ever discussed these feelings in supervision, but I knew that a need within me was being touched at the time, and that it had nothing to do with this patient or any kind of “love” for him. I had to step back and take a look at it, rein these feelings in, and finally work them through.

There was also the case of the brother of a Hall of Fame baseball star that I was treating. It took everything in my power to not “pry” for information about said baseball star, to not ask for more than what the patient offered.

And I have a current case—a woman who I find so charismatic, funny, and talented, that I have to stop myself from chatting with her about things that have nothing to do with the reasons for her seeking treatment.

Paul has questioned himself and his effectiveness as a therapist, and it’s true, there is a certain level of frustration and feelings of helplessness that can occur as a therapist witnesses a patient making bad choice after bad choice. All the interpretation in the world is sometimes not enough to help a person who is so entrenched in such patterns of behavior and thinking---a development of defenses and coping skills crafted over a lifetime. There is a temptation to step in, to want to give advice or offer pat interpretations to steer your patient in a direction of true change. Unfortunately, this advice would only fall on deaf ears—as Paul discovered once or twice.

My recent sessions with a 14 year-old girl with anxiety disorder speak very loudly to this conundrum. I suffered from anxiety disorder when I was a teenager, and it is traumatizing to have these overwhelming feelings; feelings that become secrets out of fear that people will think you’re abnormal or “weird”. As I sat back and listened to her tell me about her problems, I choked up---I shed a few tears as I told her how well I understood what she was feeling, and how I had been through the very same thing. I wanted to find a way to take all of her pain and worry away from her, rather than simply sending her packing to a psychiatrist for therapeutic medications. I felt her pain vis a vis my own personal suffering, but I could not save her from what she is going through. I can only walk beside her and offer her support, acceptance, and solid treatment options. 

Becoming a skilled therapist is a life’s work—not something that can be given you in graduate school. A therapist continues to evolve as they encounter each new case, and as they face their own personal issues. Paul’s crisis of faith and personal isolation in Season 2 will no doubt create a stronger, even more empathetic therapist. We’ll see I hope.

So Season 2 of In Treatment is now complete. April is recovering from cancer and leaving treatment for now, Mia is slowly coming to terms with her fear of intimacy, Oliver has a true friend in Paul, Walter is showing great courage to continue this in-depth therapy at 68 years-old, and Gina and Paul will part ways again—for now anyway. Let’s hope that we all get more of Dianne Weist as Gina.

In my tvland fantasy, all of Paul’s patients are still in treatment with him, continuing the path to self-discovery and true change, and Paul is going out on a few dates!