Monday, February 04, 2008

In Treatment: Episode Number 6......the sub-blog


What is a "sub-blog"? My husband says he invented the term. And Laura, the patient with the erotic transference who sat in the dark for 4 hours waiting for her appointment in a little black dress, will return.

Episode 6 starts with a clogged toilet, an irritable psychotherapist who can't unclog it, an annoyed wife who doesn't get why the patients can use a different bathroom. Bathrooms play a bigger role in this show then they do in life as I know it.

Laura announces she's getting married, she talks about wanting to invite Paul to the wedding, he's a bit uneasy, "a kill joy...that congratulations was a bit labored."

Paul talks about diving, coming to the surface to quickly. Laura is a certified diver, she's happy they have an interest in common. "I don't want a depressing session, I want a happy session, show a little support."

Laura talks about a visit to her fiance's ex-girlfriend's house, her baby, how she breastfeeds the baby and how the ex-girlfriend is now a domesticated animal. Laura talks about sex, she is provocative, she flirts with Paul asking him about post-marital sex, he is clearly uncomfortable.

"You didn't answer my question, Laura. Where did this "yes" come from." Paul wants to know why she's agreed to get married.

"It's because you said "no" to me."

"We're still talking about the reality that I'm in love with you, Paul." She's insulted when he talks about fantasies.

Another uncomfortable session. Roy, Roy, please email me a Xanax. I feel for Paul, for the corner he gets painted into, for the pressure of Laura's flirtation, for his difficulty in not squirming.

Paul takes Laura back to the summer she spent in San Diego when she was 15 after her mother died. She stayed with a couple, the man was a life raft, Laura wanted him to adopt her. "Perhaps I'm an alternative to everything that Andrew represents."

Laura has to pee. The toilet is clogged, Laura wants to use another bathroom in the house. "I prefer my patients to use this bathroom." She is annoyed. She stands next to a bookshelf with a video on it labeled in marker "Wedding."

"Look, I know when I turn somebody on. The first time I saw you I thought you looked like a dead man, I wanted to take your heart in my hands and pump life into it....Just my being here has brought you back to life....and you deny it. I know it happened and you know it happened."

Paul responds...oh so cliche..."I think we're out of time, why don't we talk about this next week when you come back."

"Just tell me, I think you owe it to me, do you want me."
"No."
Oh, but we know he means Yes.
------
Okay, so someone out there is going to ask if this happens in real life. Roy, you have some of Paul's unflappability, his gentle patience that's hard to ruffle: Do your patients announce their love for you? Never mind any patient, Laura is hot, she's a doctor, she's smart and sexy and she scuba dives. She's raw and longing, injured from adolescence, someone I imagine a man might want to repair.

I've never had the male equivalent of Laura come on to me like this. Kind words, a general sense of (often mutual) affection or respect or fondness, but no patient has ever come on with a strong and crass "I want to sleep with you." And if I get through my career without such an event, it will be just fine. Of course, I'm not as hot as Gabriel Byrne.

Paul's office is in his house, it's cluttered with his stuff, he's not a blank screen. He wears a wedding ring. Some psychiatrists don't wear wedding rings-- I've only known of men who don't, yet I've never met a married female psychiatrist who doesn't wear a ring. And maybe it's only been psychoanalysts who don't wear rings, who don't want to open the session to questions about their personal life. If you ask me, it's a dumb idea-- the presence of the ring removes an element of possibility from most people's realities. Laura doesn't care about Paul's marriage and, in a way, her high pressured appeal for love and sex is sociopathic and narcissistic. The whole bathroom thing is weird, but we knew it was coming from the tension between Paul and his wife and his edginess right from the start about what bathroom his patients would use. Laura is on to something when she talks about how Paul doesn't want her to see his wife or his wife to see Laura.

The reality is that male psychotherapists get into trouble with sexual boundaries much more often then women. Perhaps it's simply because more psychiatric patients are women, maybe it's because there are women like Laura who are so seductive, maybe it's because men are more susceptible to....oh my, I'm going to get myself in trouble here.

So a little less plot synopsis, a little more commentary. How'm I doing?

17 comments:

KBAB said...

I've been lurking, but just wanted to say I thought this write up was much more useful---I have yet to watch the show but it's very interesting to me since I just started seeing a shrink. The transference aspect especially, since that's what I'm going to bring up in my appt this week. Thanks!

NeoNurseChic said...

Nice commentary. I haven't watched the show yet because I was working this evening. This topic makes me really uncomfortable, and I'll admit that. I don't like to talk to my psychiatrist about love and sex because of the very fear that he will think that's what I think about him - that I am in love with him or physically attracted to him or something. And I'm not - I wouldn't even let my mind go there even if I wanted to - and I do not want that line ever to be blurry - so I don't even like it when we talk about things anywhere related to those topics because I don't want anything I ever say to be misunderstood. The combination of talking about sex and then also dealing with a therapeutic relationship makes me more uncomfortable than anything else.

But anyway - about the ring. My psychiatrist wears a wedding band - I noticed it at the first session, or at least very early on. A few months ago, we were talking about what I think about his family, and I said I wonder about what his relationship is like with his wife. He said, "I don't think you've ever asked me if I was married." I said, "You wear a ring, so I knew you were." It's crossed my mind that perhaps a male therapist might wear a ring to dissuade clients from thinking they were a possibility....say even if the therapist wasn't married - they might still wear a ring for that purpose. It never crossed my mind that they would purposefully NOT wear one for some therapeutic purpose. That's interesting, I guess.... If I was a therapist and married, I would wear my ring. That's because I think it's important to be honest. I don't think you can second guess how a patient will react by wearing or not wearing your ring, and I think it is very important to be authentic and honest. So therefore, why not wear the ring? Unless, of course, the therapist is one of those types of people who refuses to wear a ring for other reasons...but I don't think therapy should be used as an excuse. Just MHO.

I enjoyed your commentary!

Take care,
Carrie :)

mingalls said...

thanks for more commentary! I'm enjoying reading your thoughts on the show and the discussions in the comments much more then the show itself. Except for Gabriel Byrne, of course (though he's a little old for me...)

Rach said...

Great writeup Dinah. Just wait until Wednesday's episode - you'll have a field day with that one!

I wonder how many of these boundary issues would have been minimized if his office wasn't in his house? I only know of one shrink who has an in-home office (of course, her husband was also a shrink). There was a side door - a side suite actually, but nonetheless, when the front curtains were open, you could see into the front of the house, and you knew what kind of car the shrink drove (and it wasn't a ford).
I can certainly appreciate how overhead costs are minimized by having a home office, but maybe there are some professions where it's just not appropriate to practise from home - psychiatry/counselling being one of them?

mindful said...

Much prefer the "more commentary, less plot synopsis” sub-blog. Made for very good reading and allows for a deeper discussion of the issues at play. My shrink’s office is in her home. You enter via the front door (no separate entrance) and while her office is the front room, you still get a glimpse of the rest of the house. In nearly three years of seeing her, I have only ever had to use the bathroom a couple of times. It’s the only bathroom in the house. I try to avoid using it as I am not particularly interested in knowing what hand cream, tooth paste etc she uses.

The MSILF said...

I think that might be a carryover from here - most private practice people practice from their house.

It sounds like they did juice it up for the North American audience, but what I loved is that both she and his wife are doctors, and both are totally nuts...I like that they showed that side of doctors.

Sarebear said...

I like! Actually, anything you have to say on this, I enjoy reading your point of view. Even when I disagree occasionally!

I do NOT like the actress they chose for Gina; she's so squinty-eyed, and just so . . . that stuck-up kind. But that was Friday.

Anyway, sounds like Paul was put in quite the position (that could sound wrong . . . lol).

I read a stat somewhere that 20% of therapists have gone over that boundary with 1 or more clients. The sexual/love/lust one. Not that there aren't other types of love, but anyway.

That's one out of 5, so perhaps it's not as cliche as it seems.

Paul said he'd had a mid-life crisis at 30, 40, and now, it seems, 50. At least I agree w/Gina on this one, he needs some kind of professional check-in on this issue regarding this patient.

It seems to me, I could hardly ever hear his sexy brogue earlier in the week, and it came out more as the week went on. May have been nervous shooting the first episode, or also minimizing it as part of his character with THAT particular patient.

I think there is too much personal stuff of his in there. I'm guessing Laura "borrows" the marriage videotape but that he won't notice right off . . .

I am really sensitive to Sophie, because she is at the age where I KNEW I needed professional help; but with such a distanced emotional(less, at least so I told myself) relationship with my parents at the time, and all my fears, oh, and let's throw in a big 'ole kinda sudden move across most of the country, with culture shock too (I may be Mormon, but there's your "Utah" Mormons, other western mormons, eastern, southern, I suppose. I guess it depends a great deal on the culture of the area, too; anyway, east coast to Utah was a big huge change; what's funny is I found out awhile back, in therapy, that he was the school psychologist of the school I moved to here, and he was startled as was I when I realized and verbalized this, after he related a helpful story that involved his time there as school psychologist. Oh, now THAT brought up a tangle of feelings, given how much at that time I so wished for some help or I don't know what! So much going on, that was the first time I ever seriously considered suicide. If ever there wasn't a wierd time-warp kinda transference, there you go . . .. ! Wierd coincidence, huh?)

Erm, THAT strayed quite a bit, lol! Well, maybe not, since transference is a subject!!

Anyway, now I've completely forgotten where I was at. Gonna go skip my nightly meds or halve the dose and go to bed (it's almost 4 am) so's I can get up for therapy in the am. Kinda self-defeating, there.

Anyway, gnite, see you!

Anonymous said...

I just ended eight years with my therapist. I started leaving about two years ago. Five years ago, I told her I was sexually attracted to her. No discussion about it except an "Oh that's natural, it will pass once we work through your transeferance issues." It was never discussed again. I got a very brief description of transferance with the explaination of me being bright and I would understand it. I thought I did except I wanted to fuck my therapist not my mother. I never shared anything significant with her again and did my therapy by writing but I was still silent as I shared it with noone. I thought this episode was so painful to watch but totally unrealistic, or maybe she is just narsisccistic. I would never say to my therapist, "I want you to fuck me" because I would worry how umcomfortable that would have made her and myself. I am betting this is true of most people who find themselves in that situation. Of course therapy is supposed to be the place where it is safe to say anything but I really think that after a time with your therapist, you do start monitoring what is said and their comfort level other than your own (the client)

Gerbil said...

Oh, I am so excited! Mrs. Gerbil and I just discovered last night that we can get "In Treatment" for free with Comcast On Demand! (Otherwise, we have the world's most basic cable package--nothing but the broadcast networks and a few local access channels.)

So, I vote for more commentary, less synopsis... if only because I'm much more behind on the show than on my blog reading ;)

ladyk73 said...

I am watchingn the episodes on hbo.com. I hope they keep posting them there!

So, hm...I think it is more realistic than many make think. She is over the top, sure. But...
She seems to have some very strong borderline traits. Do you see the maladaptive interpersonal bits? She shows alot of black and white thinking.

Boundaries for a patient with interpersonal relationship issues are very important. The home office is already a fuzzy boundary.

I thought he stumbled...but he did a good job at etsablishing bounderies. The bathroom thing may have clicked. Although his "no" seemed harsh, it was very neccessary.

I Have had this experience with clients declaring there attractiveness to me. It happens all the time as I am interning at the VA and all. I find it a very difficult topic to deal with. I find it hard to address and sometimes I overtly ignore the comments as a way to deal with them. Or change the subject. I very rarely deal with it.

However, I don't have formal individual sessions. All of my formal sessions are group sessions. But as a day treatment center, I have a lot of interaction.

I hope I can learn to deal with it better.

I love the subblog comments at the end....it opens the discussion

Sarebear said...

And she's a bit (ya think?) reckless too . . . impulsive. That, I can very much relate to, as well as all or nothing thinking. And I tend to attach emotionally, very easily, to father-figure authority-types. At least, when I'm not terrified of them.

It's funny, I actually cried today in therapy when I was talking about that period when I moved here. I guess typing it out here last night brought up some stuff!

Rather reckless of her to go accept to marry the guy with how she insists she feels for Paul, but then the desire to punish, as well as to distance ones' self, I suppose I understand far too well. I HATE those "instincts?" but I was never anywhere near that level. Plus, I've done a pretty good job at keeping a lid on who I am, for a large part of my life, at great damage and personal cost, but I didn't want to let anyone see the ugliness I am/have inside.

Well, that's how I FELT. Therapy is helping, now that I have access to it (yay for ins. co. increasing visits allowed from 20/year to 45/year!) Gah, I was talking about the SHOW.

Carrie, by NOT talking about anything like that, one could wonder if maybe that meant you DID have something inside, NOT that I think you do, and NOT that I think he thinks you do. Just tell him (again, grain of salt, friendly advice, ignore please if you want and I hope I'm not offending) that you are afraid to talk about any of those things you mention for fear of mis-interpretation of attachment to him, or other, besides the awkwardness of talking about sex, anyway.

Um. Guess I'll go watch the episode now, lol!! Ha ha ha. (iatrist is lowering off the gabapenting because he's not the one who orig prescribed and wants to see if it's doing anything for me and so I'm uneven, I apologize both for now, and in advance.)

ladyAK47 said...

"I hate you, don't leave me." A book about borderline PD. Not a wonderful book, but one I think of when seeing this 'client'

Sarebear said...

I just watched all week's episodes on hbo.com. I'm surprised they had all of them up, but they did.

Let's just say, oh my.

And doesn't anyone ever worry about getting sued?

Anyway, Paul IS cute. Although I don't think he @#$@# and @#$@$# have acted like he was the @#$@%%@ !@#%%. At least, not completely @%#$#$%#%.

I'm hooked. Officially.

Sarebear said...

That's all of this second week's episodes, to make that clear.

NeoNurseChic said...

Sara,

No worries - no offense taken. I always like to listen to what you have to say and what people say in comments on this blog, as there is often a lot of insight and another perspective given.

To address your comment to me - I have told him my fear of being misunderstood, and I have discussed with him my dislike of talking about these things, especially when it comes into the context of the therapeutic relationship....or when he draws parallels from something I'm saying about intimacy into the confines of my relationship with him. So, even though I don't really like to talk about it, I do discuss it with him from time to time, when it comes up. As I've said, it makes me more uncomfortable than almost anything else, so it's not something that I bring up often. However, in recent months I have made an effort to talk about things that are difficult for me, so it does come up from time to time when I'm feeling that I should share such thoughts.

Interesting that you should say, "fear of mis-interpretation of attachment to him". Interesting because I am attached to him - but not in a romantic way. In a way that I don't totally understand. I hate being dependent on another person, yet I often feel dependent on him. I have always become attached to people who I think genuinely care about me and my well being, and this particularly includes those who have shown concern about my mental health. I think this is because there are very few people who I think do care about such things, so when I meet someone who really is genuine, I do become attached to them in some way. But, as I said - not in a romantic way.

But see this is why I fear misinterpretation. How do you explain attachment to someone that doesn't fall into the confines of romantic or physical love? I am attached to him in a way that I am attached to members of my family - maybe that's the best way I can describe it. I don't know. But it's definitely something we discuss from time to time!

Thanks for your insight and thoughts!

Hugz,
Carrie :)

Sarebear said...

Carrie, I put it that way because I feared you mis-interpreting me as thinking I thought you had even an inkling of a romantic attachment.

Er, if anyone can follow that, lol!

But it's a real attachment, and my therapist has acknowledged that when I've discussed, wait, is this all in my head and you just foster this notion of the therapeutic relationship because it gets you what you want (me to trust you and open up) and it's not really real, it's just all in my mind, or fuzzy warm feelings? Non-romantic. So we've discussed it, he's been very willing and open to discussing and working on the therapeutic relationship.

He even apologized once when it became clear to him that he had made a mistake. I think that goes to that rupture repair thingie someone mentioned. But it helps for in the future, ok, well, recently, when I was all out of sorts about something in the therapeutic relationship (not romantic, and no I'm not protesting too much, it's just since that's been discussed in context with that show alot on the blog lately that I need to say that), that when I finally was able to put it in a way that he "got it", that he understood why I was having a problem and what the problem was about, the past experience helped me open up about this because I had prior evidence that he would work with me and try and understand until he DID understand, what it was that was going on, when there was a problem that it seemed like he wasn't "getting". And, now I have evidence of that again, so that's good!

Er, I don't know how I ended up here. But anyway Carrie, I hope you don't think I thought you had too much attachment, or that attachment is wrong. I just have a maze of fears I have to navigate in my mind, in order to try to function, and sometimes that comes out in the maze of words and maze of verbal construction that I term/put things in, in order to be able to say it at all.

Thanks for your kindness, it helped me to relieve alot of that fear pressure and stuff, Carrie, about what I had said!

DrivingMissMolly said...
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