In Treatment, Week 5

In Treatment -- a couple of thoughts

A note  or two here about what we are seeing with Paul and his patients and Paul in his own therapy. 

Each of these patients does exactly what patients are supposed to do when they see 
their therapist: they bring their "illness", their self-destructive patterns, in the 
only way they know how—by repeating it with the therapist right there in the room. The therapist can either react as others have, or  can offer a way to begin recovering from past injuries.  At these critical moments, the path taken depends not on the patient but entirely on the therapist.

So, yes, the therapy with Alex can continue, but it falls to Paul to respond to what happened, to the fact the he acted out, probably in a way similar to Alex's father, by creating a new and different path. By apologizing. By being willing to look at it and see what was going on, what Alex was feeling.

As Paul did with Sophie when she returned and he received her without scolding or ignoring what she did and then being willing to make an entirely appropriate demand on her, that she agree not to threaten or try to kill herself again while they are working together. This is a different path for Sophie.

And yes, with Laura too. Paul must reassert the boundaries, not punitively, not reactively but out of knowing that doing so, that holding the boundary is what she needs and only through doing so can she begin to move out of her old patterns.

As Anne Ulanov writes:  How does the analyst heal the wound that has been evoked in himself or herself and still serve the patient? Ethics based on doing no harm 
demand: not by perverting the analytic relationship.  As the fictitious analyst 
remarks to himself, “She is no other, she is I.  In loving her I love myself, in 
rescuing her I redeem a part of myself—weak, frightened, ... 
of which otherwise I must be ashamed”. The analyst must turn to other 
resources, not the patient, to tend to this part of himself, as shameful or embar- 
rassing as that may be. 

In Treatment -- Paul, week 5

We open with Gina carefully arranging the chairs in her office as she waits for Paul and Kate. They arrive and Gina and Kate embrace. They haven't seen each other for sometime. Exchange of small talk. 

Gina moves to structure how they will proceed. Coming together was Kate's suggestion, Paul says. Gina suggests that they meet three times and then decide where to go from there. 

Gina asks how it is that Paul agreed to go along with Kate's desire to come to see her. Paul talks about Kate and her going to Rome and what she told him when she got back. Paul says he wasn't able to talk with Kate, and Gina says then Kate doesn't know how he feels. Paul turns a bit and tells Kate he has felt rage and hurt and doesn't know if he can get past it. Kate asks why he couldn't talk about it and he responds with what he tells patients. Gina catches this and points out how controlled he is.

Paul says he feels like he is falling apart. He tells her about attacking Alex because he knew he was reacting to Kate's return because he heard her. He pulls back and says he can't talk about a patient there. Kate is surprised he won't talk about what Alex did, about spying on  them. Gina asks how Alex learned what he did -- Paul says he doesn't know.  Kate asks if Alex, whom she calls his creepy patient, is her fault too.

In Treatment -- Jake & Amy, week 5

When Amy arrives in her running clothes, Jake is sitting in the garden outside Paul's office waiting. He says someone is with Paul. They are 5 minutes early. They have apparently not been together. They talk warily.

They are sitting apart on the couch. Paul asks how they are. Then he says that he will not tolerate violence of any kind in the office. Amy says it's all right because they have been separated for a week. Paul does not respond as Amy and Jake expect so they join together for a moment to criticize Paul. Paul tries to make it clear to them that what they have been doing is chaotic and unproductive because they do not respect boundaries.

Then Paul asks what happened. Amy starts to talk about what happened. She had taken their son to her mother's. Jake came by and they argued and then had sex. Paul asked what happened. Amy says that while Jake was still in her, he says if she leaves her, he will kill her which she found disgusting. Jake then counters that what she and her mother do to their son, feeding him junk food, is disgusting. Paul asks if Lenny is overweight. And Amy says he is like she was. Amy is very defensive about their son and about her childhood weight.

In Treatment - Sophie, week 5

Sophie and her mother are outside until time for the appointment. Sophie does not want her to come in with her, even though Paul asked for her to come. Paul opens the door and asks the mother to come in. Sophie pushes past. 

They sit as far apart on the couch as possible. Sophie wants Paul to say she can return to training. Sophie is hostile and attacking with her mother, says she is a crazy bitch that no one understands. Sophie says if she has to stay at home, she will slit her wrists. Sophie threatens that is she doesn't try out for he Olympics she will kill herself. Paul calls for a halt to the threats.

Paul supports Sophie's return to the gym. Sophie smiles smugly and Olivia looks worried and upset. Olympia leaves. Sophie smiles triumphantly.

Paul tells Sophie that he thinks he knows why she took the pills in his bathroom, that she was testing him and that he passed the test. But what if she tested someone else and they did not pass. They need to understand what she finds so attractive about death. 

In Treatment -- Alex, week 5

Alex arrives a little early again. It's still raining.

Alex begins by telling Paul that he broke up with Laura. Tells him he took Viagra or one of those drugs and drank and then he and Laura had sex all night. Then he says he realized Laura was using him and it was over.

Paul asks him why he makes the connection between him, Laura and himself. Alex says "Tell me that something didn't happen between you and Laura." And he says that Laura talks about Paul, asks questions about him. Paul says again he will not discuss anything about his other patients with him. Alex is convinced that Paul has had sex with Laura. Alex makes hostile jabs at Paul.

Paul collects himself and Alex backs off of asking about Laura. They start to talk about Alex and his father. Paul asks how he feels and about his relationship with him. Paul reminds him about what he said abut his father the previous week -- that he was unfaithful to his mother and yet is a good man. Alex says his father is like iron, cast iron. Paul says that iron makes him thinking of something powerful yet cold.

In Treatment -- Laura, week 5

Paul is cleaning his teeth; the sofa bed is still open and the bed unmade. It is raining. Is Kate back? Is that the reason Paul is sleeping again in the office?

Laura is sitting on the couch and making a call. Paul tells her that they have to talk about ending therapy, not abruptly but to create a timeline. Laura says no, they are ending today and that it feels good. She says she feel better, relieved now that she has told him. And asks how Paul feels.

Paul tells her this comes as a bit of a shock and that he also feels sad. Laura doubts that he feels sadness, she thinks he is relieved.

He asks Laura how her week has been and she says terrible. Tells him about a patient, a 15 yr old, whose procedure goes wrong and she does not come out of the anesthesia and she stops breathing. The attending jumped in and managed to bring the patient back. She says she was terrified, that she only looks confident. 

Paul asks if she expects that nothing will go wrong. He asks more about the girl.

Laura talks of the girl as being pretty and with beautiful hands whereas at her age her own nails were chewed down. Ad he asks her who was watching over her when she was young. Laura asks what good it does today to know how much she suffered then.

© Cheryl Fuller, 2018. All  rights reserved.