Season 3: Week 6

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Week 6, Thoughts

There are a couple of things from this week that I have been thinking about further.

First, about Sunil and Tarasoff warnings. It is important to remember that the Tarasoff case and subsequent case law came out of lawsuits against therapists. And the reducing liability is a major factor in whether or not confidentiality is breached to warn. Some of this comes from a wish, very strong in American culture, to believe that behavior can be predicted and therefore a therapist ought to be able to know, with some degree of certainty, when a patient says something that indicates a real threat against another person. But making that determination is very difficult and we are not very good at predicting behavior. So risk avoidance is the ruling factor many many times.

One problem is that once the therapist has breached, the therapy is done. Trust has been broken, no matter how sound the reasons and the patient is just not likely to speak openly again with that therapist and perhaps no therapist. Letting patients know at the outset of therapy that such a breach could occur if threats are spoken often means that such thoughts and fantasies may never be expressed. Does this make acting them out more likely? Who knows. But when weighing such situations, all of these factors have to be considered. 

Week 6: Paul & Adele

Paul is with a doctor who is asking questions about drug and alcohol use. The doctor suggests anti-anxiety meds which Paul refuses. The doctor writes a recommendation for a psychiatrist.

Paul is with Adele. He tells her that this doctor did not recommend her and he makes a crack about her contacts at Columbia. She asks what the doctor said. Paul said he has to wait and see -- because he is not exhibiting enough symptoms -- yet. Adele says his dilemma is like everyone’s -- not knowing what will happen. Paul asked him for a worse case scenario and he confirmed what Paul already knew, that he could become paralyzed with complete dementia in less than 4 years. Adele says less than 0.5% of people develop that form of the disease that he probably does not have. She asks what he would do if he were told with absolute certainty he had the disease and just a few years to live, what would he do? He says he might close his office and leave, move closer to the kids. She asks what he would do if he were told the opposite -- would he also lock up the office or would he stay as he is? Adele says not knowing allows him to stay in stasis, to keep things as they are. Paul says stasis is hell. He doesn’t know what actions she is talking about. 

Week 6: Jesse

Jesse is in the waiting room wearing a gold crown. A girl leaves Paul’s office and he asks her what’s wrong -- she says she has an eating disorder. He tells her Paul is his uncle and is taking him out for dinner. He says is is from Milwaukee when she asks him what school he goes to. Then he tells her he thinks she is beautiful just the way she is.

Jesse is with Paul and singing happy birthday to himself. He says now he is 17 and he is at the age of consent in New York state. Paul wishes him happy birthday. Jesse asks what happened last week, did his son set the house on fire. Paul says it was just an accident. Jesse wants to know if Max is all right and Paul says yes. Paul asks why he ran off. He says he shouldn’t have been there, that Paul should have run him off when he showed up. Then he asks Paul why he became a therapist. Paul says because he wanted to help people. Jesse asks if he is a good therapist. Paul asks if there is a way he could be better for him. Jesse says he doesn’t know what the point is, do people become happy? Paul says happy isn’t always the point. So Jesse tells him about running into the girl in the waiting room and asks what he is telling her? Paul says he is trying to help her see why she sees herself that way. And that what he thinks doesn’t really matter; it is what she thinks. Jesse says that sounds like the guys who sell fake watches. Paul says objects and people are worth what we ascribe to them.

Week 6: Frances

Adele is lying in her bed and the alarm goes off. She gets up. We see her sit at her table with a cup of coffee and her iPhone. She makes a call to Paul. She says she had an appointment open the next day and wonders if he would like to take it as their session last week was truncated and she had some lingering thoughts about it

Frances is with Paul -- she says it’s okay. Paul asks what -- she says it’s okay to say she looks tired. She says she is okay but she is hungry. She asks if he has anything to eat. He doesn’t answer right away and she says he has a kitchen, doesn’t he and then says oh it’s against the rules, she’ll be okay. Paul observes she says that a lot, that she will be okay. Is there something she is trying to tell him in that? She sighs. He asks about last night -- her stomach growls and she says see that -- it’s my stomach.

Then she says he reminds her of Izzy -- she told Izzy about the test results and Izzy accused her of being a narcissist and wasn’t that what he said of her last week? Paul says he did not say she was being a narcissist -- he said he told her he thought she should see her sister. Paul asks if Izzy came to opening night. Frances says she saw Izzy at the hospital because Tricia needed to be in the hospital. She was there with Russell and Izzy while they stabilized Tricia. 

Week 6: Sunil

Paul puts a tray with two cups on the table. There is a knock and Julia is there. She says Sunil is outside smoking so she asks to come in. Paul asks about the bruise on her arm. She says Sunil pushed her in an argument that got out of hand -- she needed stitches in her arm. Julia says they are ending treatment today and gives him a check for that session and the last. Julia says if what has happened is what comes of building an alliance in therapy, she feels for the families of his patients. She says Sunil has been getting stranger every day since he began with Paul. She is afraid of him and finds the way he looks at her disturbing. She says she thought of calling the police. Paul tells her he cannot discuss the details of the work with Sunil with her. She expresses resentment at paying for this treatment while Sunil gets worse. She says she feels for Sunil -- he is an attractive middle aged man and could have a better life. She says she is having trouble sleeping and working and asks what he would do in her situation. He says he would keep Sunil in treatment and if she wants someone to talk with, he can recommend someone. He wants to talk with Sunil -- she says fine, he obviously sides with Sunil. Sunil appears at the door as Julia leaves and says he suspects Julia told him the therapy is over.

© Cheryl Fuller, 2018. All  rights reserved.