In Treatment -- Reflections, week 3

This week we have seen that all of the patients, Paul included, are struggling with fears and feelings about being left. Mia was left by her parents when they sent her away. April was left by her parents when they failed to notice she was gone and by her mother when her attention was so singularly focused on Daniel. Oliver is left by his parents as they continue to fight over the corpse of their marriage. Walter was left by his brother who died and by his parents in their grief and now is left by his daughter and possibly by his company. And Paul was left by his father and mother and has left his son. Five patients scarred by and scared of leaving and being left. Five patients all reluctant to be in therapy, which they fear can only bring them more leaving and more abandonment.

Setting boundaries -- Paul seems to have difficulty setting boundaries on patients who have really strong personalities. This happened last season with Laura and with Alex -- in both cases he allowed them to act out without placing limits on what was acceptable in therapy. And we see again this season with Mia and Walter that he is not setting limits on behavior that can be destructive to the whole therapeutic endeavor.

While it is important to allow patients to express their feelings, this does not extend to allowing them to act out or against the therapy without any consequences. It isn't Mia's anger at Paul for having left and for, as she believes, having persuaded her to have an abortion, it is her acting out of that anger that poses serious problems here. Her willingness to breach her own professional ethics in order to jab at Paul is a cause for concern. Contrast the way she acted out her anger by bringing in the deposition and questioning Paul about it with the way she was able to express her feelings of wanting to be wanted and her fantasy about what happened between Paul and Laura. The former was about trying to hurt, to punish Paul; acting out feelings in this way makes any interpretation or insight about them impossible. But when she puts the feelings into words, as she does in talking about her fantasy of what happened with Laura, something new opens and it becomes possible for Paul to begin to help her. But it remains for Paul to become firm about limits and what he is willing to accept. He needs to make it clear to her that acting out of the kind she has displayed around the lawsuit is unacceptable. 

On an unconscious level, Mia no doubt both wants this therapy to fail, as it did before, and to succeed. If she succeeds in destroying it, then her beliefs about herself and about Paul will be confirmed and her world remains the same albeit not happy. But if it succeeds, if she does not end up in the same place, then that changes everything and she will need to see herself not as so powerful that she can make people leave her, but as someone who as a child was not cared for by her parents in the way she needed. And that kind of change, while it seems it would be good, is very difficult to take. On the whole, as Guntrip said, we would rather be bad than weak, rather believe we made the people around us treat us as they did than that we were powerless to make them that way.

We see this preference to be bad rather than weak in Oliver as well, who believes his feelings cause the fights his parents have. If I am bad, I have hope I can change, can somehow become good and then the people I need can be as I need them to be. But if I am weak, then I am powerless and that feels terrible.

Paul also needs to set a limit with Walter. He is able to use the demands of his business and its attendant crises to keep therapy and Paul at bay. Paul needs to address more forcefully the issue of Walter and the phone, if only to request that their session be time when the world outside has to wait.

© Cheryl Fuller, 2018. All  rights reserved.