Wednesday, May 27, 2009

In Treatment: The end of Season Two: Walter Signs on and Paul Signs Off


Walter returns after his hospitalization. He arrives early and barges into Paul's session, surprised that Paul has other patients. I'm surprised Paul doesn't lock his door.

It's a busy session, and I won't recap it here. Instead, let me just talk about the parts that grabbed my attention.

Walter mentions "tearing up" the session before-- clearly he's embarrassed and later he will mention that when he was young, boys were taught never to cry. In fact his father shook him hard when he cried after his brother's death. Paul, however, doesn't let Walter get away with "tearing up," he reminds Walter that he "sobbed." One more episode where Paul shoves the truth in his patient's faces...a habit he has that may feel like real psychotherapy, but to me it sometimes feels too harsh, too inconsiderate of someone's need to protect themselves a little. And this is a man who just had a serious suicide attempt and was hospitalized. Personally, I would have back off when Walter mentioned "tearing up," I wouldn't have shoved in his face that he sobbed. Walter has already proved that despite his tough exterior, he's really fragile.

At the end of the session, Paul tells the 68-year-old Walter that he can still change. He implies that an introspective, insight-oriented psychotherapy is a higher way to go then simply having them both talk to Walter's psychopharmacologist (--hmm, and what would they say?) and having Walter restored to his old self with his old ways. Walter says he's an old dog, but Paul pushes with a hopefulness for future change and better ways, better relationships, and Walter bites: he'll come more often, a few times a week: Where do we start? There are echoes of Paul's lost efforts to have a better relationship with his own, now-dead father, and Paul focuses on how there is still time for Walter to improve his relationship with his two sons--even though Walter explicitly states that this is not his goal. Is Paul using Walter to address his own loss?

And finally, we're left with the question of the appropriateness and the real capacity of insight-oriented psychotherapy to help someone change. I'm a psychotherapist, I believe it helps. But, I might look at this totally differently then Paul does. Paul seems to see Walter in terms of his weaknesses, as someone who should be ripped down and built back up differently-- he cages changing his ways of reacting as a positive. I might look at Walter as someone who had been through a lot (his brother's death, his lost childhood, Vietnam, his wife's problems, immense struggles with guilt, a crushed career, an episode of depression, the indignity he saw in his recent hospitalization, and the list marches on) and view him as someone who has been quite successful. I might emphasize his successes, that maybe it's fine to return him to just being him. It's not that I think there is anything wrong with Walter working on his relationships with his family members-- that might be good-- but I would not phrase this sort of change in such deep and all-or-nothing terms, complete with judgment. Will a 68-year-old change in such extreme ways? I think I'd follow the patient's agenda a little more closely and be a little less intent on holding to an ideology, if that makes sense. Sometimes therapy is more about getting people to accept themselves than it is about getting them to change.
-----------------------
Gina and Paul have a nicer session-- it's warmer. He tells her how lovely she looks and he reminisces about seeing her back when he was a grad student and she was out with her husband at their country club (Paul was the valet parker). He talks about how Gina has helped him be more hopeful. In the middle of the session, Paul's lawyer calls and says the case against him is being dismissed. Paul talks about April's choice to leave therapy and his realization of the uncertainty of the work: "all I can do is walk with them for a while, keep them company through a rough patch...if we're lucky there's someone in the room who can listen" Gina realizes that Paul is terminating his treatment with her. "I'm just disappointed that we're here again," she tells him. Don't these people ever accept that patients sometimes feel helped? Is there some gold standard for self-awareness, when is it reasonable to end? Isn't there ever a "Call if you need to come in?" Why is therapy such an all-or-nothing thing here? Do people ever get better or do they just abandon each other? Can anyone terminate without the therapist saying "I'm just worried..." about your tools, your timing, the wisdom of this decision.

"Some days I feel like I'm sitting there with a patient and we're two mice with our legs stuck in a glue trap." He talks about hating his chair, about the loneliness of psychotherapy and how he needs to be with more people. Paul needs a break from the intensity of one-on-one psychotherapy.

We all think Paul is a good therapist, don't we? People like this show-- I've lost count of how many people have asked me if I've seen In Treatment. There's something about Paul-- his striking looks, his eyes, his intensity, his accent, the depth of his conversation, his interest, his caring. Something about his charisma is entangling and enchanting, and it takes hold.

Our time is up.