Monday, June 04, 2007

Boundaries! Boundaries! Boundaries!

So the psychiatrist is talking to her own psychiatrist and he tells her he saw another psychiatrist in the hallway and this third psychiatrist, in the hallway, gave him a quick review of the literature on psychotherapy of sociopaths, and wouldn't you know it, it seems that psychotherapy validates, rather than cures, sociopaths, and it increases, rather than decreases their criminal recidivism rate. The first psychiatrist, who in this particular setting is the patient, becomes upset. It seems that her own psychiatrist believes that her years of work with a criminal patient have been a waste-- she hasn't helped the patient, rather she's harmed him and also society as a whole by increasing his comfort with his unconscionable violent behavior. And I'm thinking: Well that's not a very therapeutic thing for the psychiatrist to say to his patient!

Soon after, the psychiatrist and her psychiatrist are at a dinner party, with lots of other psychiatrists. What are they doing sitting together at a dinner party? If it's a professional thing, shouldn't they at least sit at separate ends of the long table? Another psychiatrist begins to discuss the negative findings of psychotherapy with criminals, and the first psychiatrist (now a dinner party guest and not a patient in this setting) gets angry with her own psychiatrist-- he set this up, he wants to convince her that she's wrong to continue her work with the sociopathic patient! And then to add to the mayhem, her psychiatrist tells the entire table the identity of his patient's famous criminal patient.

So the poor psychiatrist/patient has transference issues with her own psychiatrist: she wants his approval. Even though after years of sympathetic therapy, he declared himself a HIPAA-violating jerk by telling their colleagues the identity of her nefarious patient.

So the sociopath comes for his regular psychotherapy session. Life has been hard: his son has been psychiatrically hospitalized after a serious suicide attempt and the Lexapro just isn't working for the kid, and come to think of it, only weeks ago his favorite nephew died after he killed him.

The sociopath is warm and gentle with his psychiatrist today, commenting on how meaningful her work is because she spends her days helping people the way she's helped him. The psychiatrist, now a complete transference-to-her-own-shrink/countertransference-to-her-gangster-patient mess, is visibly angry and fires the sociopathic patient after 7 years of psychotherapy. The angry sociopath leaves declaring the psychiatrist to be immoral, and I believe he's right.

I've watched this therapy evolve, and yes, it started with ducks. The series started when mob boss Tony Soprano presented to Dr. Melfi in the throes of panic attacks. Something to do with migrating ducks in his pool. Really. They've been through a lot together-- he's stolen her car to have it repaired, offered to off her rapist, driven her to drink, declared his love and survived the rejection. One more episode, and this is how they end?

ClinkShrink asked that I tell you that she wasn't any of the three psychiatrists mentioned above. And the weird thing is that I never knew Clink was in The Sopranos.

The Boston Globe had a nice write up about Tony's prospects for redemption that appeared before this episode aired: Tony Is A Monster