In Treatment

In Treatment (HBO, 2008) is a TV series (closely based on an Israeli TV drama called Be Tipul) which centres on Paul Weston, a 53-year old Maryland-based psychotherapist. Each episode depicts a single therapy session and provides an excellent exercise in dialogue and close camera work. Gabriel Byrne plays Paul and his soft blue eyes, wrinkled smile and lilting Irish accent work well to create the impression of a kind, likeable and intense therapist who is also quite preoccupied by his own troubled marriage and mid-life crisis.

I watched the first seven episodes of Season One this weekend and I was initially quite impressed. The sessions are divided up according to weeks. Monday is Laura (a young woman with Borderline tendencies who falls in love with Paul), Tuesday is Alex (a narcissistic Navy pilot who was responsible for the death of 16 Iraqi boys in a religious school), Wednesday is Sophie (suicidal teenager), Thursday is Jake and Amy (a bickering couple) and Friday sees Paul in his own supervision / therapy. The sessions are addictive and a little over-dramatic but I was pulled in and interested, at least for the first five or so episodes.

What I liked about In Treatment was the experimental format, the extended dialogue, the clever use of the therapeutic frame and other therapy devices. The troubled therapist adds an interesting dimension and I was intrigued to see how the Israeli influence would work in an American series. There were many issues which deserve a lot of discussion, such as erotic transference, empathy, narcissism and so on. What I didn’t like was the inevitable over-dramatisation, the sexual voyeurism, the lack of understanding between therapist and patient and what I took as simply bad therapeutic technique.

Many of Paul’s interpretations made me cringe. As a therapist I know when I’m off the mark with what I say and I had this same sensation for much of the episodes. Paul will gaze off into the middle distance and say something profound rather than staying with his patients and connecting with their experience. Of course a lot of this has to do with the demands of TV and it also has to do with the plot. Paul’s shortcomings as a therapist are partly what make this series interesting. It’s a classic case of “Doctor heal thyself”. One example of a bad interpretation: Paul starts telling Laura, the young woman patient who has fallen in love with him, about scuba diving and the bends rather than focusing on what she’s just presented to him, which is her engagement to her boyfriend.

I was interested to see the reaction on the Internet and it seems largely positive. What I would be more interested in is seeing the reaction from therapists themselves. My own initial impressions after seven episodes are very mixed. There’s a big difference between playing the role of a therapist and actually doing therapy. I really don’t think this is something you can read from a script. Empathy is something you can feel and it’s either there or it’s not. My initial impression was that it simply wasn’t there. Anyone else seen it? Does it work for you?

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7 Responses to In Treatment

  1. litlove says:

    I haven’t seen it although it sounds very intriguing. I’m a big fan of Frasier, which is quite evidently far, far more facile with very little interest in properly exploring the work of a therapist, but it is funny. I guess in all drama series, creative decisions will be taken in order to enhance the plot and build character and so on, which is the last thing to happen in life. Your average therapy session would probably be tremendously dull for the small screen. There’s a French novel by Marie Cardinal, Les mots pour le dire that’s the best therapy novel I’ve read. But when it got translated into English, the decision was taken to cut a chunk out because ‘the material was repetitive and had already been covered before’. So there you go. People just don’t understand.

  2. Pete says:

    Litlove – I’ve just searched for info on Marie Cardinal and “The Words to Say It” will be duly added to the TBR list. She sounds very interesting. As for TV therapy, for me it started with Thirtysomething (more for the intense conversations than for any session that I can remember). But books have so much more time to spend on all the little details which matter.

  3. doctordi says:

    I loved Frasier too… actually, I loved Niles. Thinking about it now, I guess Frasier’s comic tenor allowed it to avoid much of what you’ve identified as problematic in this new show, Pete. Frasier absolutely didn’t have to empathise; indeed, his failure to empathise was one of the core funny bones driving the whole series. In a dramatic show, that all changes, and your example of one of his bad interpretations made me cringe. I don’t know if I could get into therapy in a drama format… and for you as a practitioner, isn’t light relief more tempting?!

  4. Pete says:

    doctorDi – I think we’re all in agreement on loving Frasier. I loved the comic rivalry between the brothers and that physio had an annoying voice at times but she was easy to like. And you’re so right about needing other light relief rather than a troubled therapist failing to empathise! Far too close to work for me since it’s not just the story I’m watching but the whole damn thing. How about a show about an aspiring novelist and all the dramas that go with that 😉

  5. Haven’t seen an episode yet but I plan to. I’d like to do what you did… watch several episodes at one sitting, or over a weekend. Several of my clients have brought it up, “love the show,” and that makes me curious, too.

    But like you have explained, I imagine I will have a critical eye and focus too much on what seems unrealistic or unethical or poor therapeutic form.

    So many movies that feature a shrink seem to end (or begin) with some kind of sexual misconduct. I remember one movie, can’t remember the title, where the psychologist terminates therapy so he can date the “ex-client.” The general public will see this as reasonable when, in fact, it’s completely unethical and likely harmful to the client.

    Ok, sorry to have blathered on. Interesting topic. I’ll get back to you when I (finally) see the show! (Imagine how much I’ll go on once I do, huh?)

  6. Oh, and yes, big fan of Frasier here, too. I just love Niles. I laugh just seeing a still shot of him. The friction between the brothers is a hoot.

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