Following are posts made after each episode of the series, In Treatment, season 2. In the sidebar to the right, you will see each post listed. I recommend reading, and viewing, series sequentially, as the characters do overlap and even interact. If there are issues you would like to know more about, please leave a comment and I will respond.
This will be a post in progress as I reflect on the season -- so there will be additions to it as the week goes by.
One thing I thought of this morning is that this year we got glimpses of other patients Paul works with. I think this was quite helpful in a very subtle way as these others seem more ordinary as patients. So we can fairly conclude that the 4 patients we have followed have been those who most touch into Paul's own issues and thus present significant challenge to him. No therapist could stand the stress of a practice full of people like this -- it would simply be too much, so we rarely have more than a very few at a time.
Although there has been chatter about Paul's boundaries and acting out this season, and I have written about this, actually he has not really done much of it at all. Last season Paul was deep in his own crisis in his marriage and this gave rise to what we saw happen with Laura. Though he has had to deal with the aftermath of divorce, and of course with the lawsuit, nevertheless, on the whole this has been a year of resolution and so his personal stress has been decreasing. If we think of the two seasons together as a single year, which they seem roughly to be, then the crisis which marked the early part has been resolved by the divorce and this season shows us as he moves into a new normal. In the background is the building of new relationships with his kids, his own emergence from the devastation of divorce, development of his new practice. Through the windows of his office we have seen the season change from the snow of winter to spring as indeed is true in his life.
Gina is reading a letter. She puts it away in her desk. Apparently Paul is late.
Paul tells her he has asked his lawyer to call him while he is there if there is news about the hearing. He decided not to send the letter after talking with Rosie. Paul overslept and missed the hearing -- his lawyer had told him he didn't have to be there and he knows he didn't want to be there. He asks Gina about her life.
Gina says she wants to know what his lawyer thought about the hearing. Paul tells her he thought it had gone well. Gina reflects that he has been under enormous pressure all year. He compliments her on how she looks. Paul tells her about when he was in grad school and how all the students were so in love with her. They were fascinated with her ad wanted to know all about her.
Paul asks what is happening with her today. Paul's phone rings and it is his lawyer. He asks her to stay. The judge was livid at Alex's father for wasting everyone's time, that there were no triable actions of fact. The case is being thrown out. Gina smiles and tells him how happy she is.
Paul is talking with a lesbian couple when there is a knock on the door. Walter walks in on them.
Walter starts talking about having been released from the hospital. He, his wife and daughter drove to their summer place on Shelter Island. Paul asks how it was. Walter says Connie and Natalie were tentative with him. He says he wanted to be alone in his office there but they kept asking him why. He wanted to be alone. He wasn't able to tune out his wife. He went to his office and saw Natalie watching him, and felt like he was being babysat. Paul relates that to how h kept an eye on his parents when he was a little boy. Natalie brought him tea and asked to sit with him but he didn't want to talk with her about himself. He says he got clippers and start cutting brush and pruning. Paul relates the brush clearing t the work they have been doing. He relates to the week before, to the way the last session went. Walter denies any memory of it. He denies any memory of the two Walters. He denies the emotional connection to the talk about the lost Walter. Paul reminds him that he teared up when they talked about them.
Oliver and Bess are in the waiting room. Paul invites Oliver in but he doesn't want to go. Paul says he and Bess will be in the office talking and Oliver is welcome to join them if and when he wishes.
Bess looks very uncomfortable and says she knows Paul hates her because she is doing everything he told her not to. Paul asks how Oliver is handling it. She says he is handling it very badly, that if nothing else Oliver has learned to express his anger. She tells Paul she had been certain Paul would be on her side in the beginning. She says when she cam to pick up the turtle she saw he was alone so she thought Paul would be sympathetic. Paul tells her his job was to advocate for Oliver. Bess reminds him of the warning on planes that the parent should use the oxygen first. Paul says she needs to attend to Oliver now.
She rather bitterly says she had Oliver in the first place because she didn't know what to do when she graduated. Then spent 12 years focused only on him to discover she does not want to be in that life any longer. Bess tells Paul that Oliver told her he is happier with Paul than with Bess or Luke, that he wanted to live with Paul. She tells Paul that he was Oliver's best friend and she is taking him away and he will never forgive her for that. Luke arrives unexpectedly.
Paul in his kitchen when the phone rings. It is April asking to come in for a last session.
They start in silence. April complains that her hat itches and that it looks ridiculous. She says Daniel gave it to her. She let her mother tell him because she was afraid he wouldn't react. She tells Paul that the tests show that the mass behind her spine is shrinking. Paul says he is relieved for her and asks how she feels. She says she doesn't know.
Paul asks if she was surprised by the results. She asks if he is alone there, where are his children. He says they live with their mother. Then she tells him that Kyle and Sienna broke up and that he gave her a necklace to a wishbone. She is cynical about this, says it is too late because she is gone, that the girl he loved is gone, doesn't exist anymore even if she goes into remission because she will always have to tell people she has had cancer. She tells him she is repulsed by the idea of sex and thinks that part of her that wanted it is gone. Paul tells her that she is involved in recovering and desire will come back. She says he is right.
Mia arrives and Paul greets her. She is quiet, appears very collected and professional. Paul asks if she got his message. She says she did. She says she hit bottom at the end of the last session and then it got worse. Then she says she has decided she is stopping therapy.
She tells Paul she appreciates what he has done but she thinks there is something wrong if every time one goes to the doctor one feels worse. Paul asks if she expects him to persuade her to stay. Mia guesses he is angry with her for wanting to leave. Paul says the last thing he wants is to keep her there and make her feel worse.
She tells Paul she called her father and asked all the questions about her childhood. Her father got angry and turned it on her and attacked her and told her everything was her fault. Then he left saying he didn't want to talk with her again. She says thanks to therapy she has lost her father. Paul points out that she lost the version of her father she thought she had. Mia believes Paul wants her to lose everything and be shattered. Paul suggests to her that losing the fantasy of her father could open the possibility of moving on and having a good relationship. Mia wants none of it. So Paul suggests they take the remainder of the session to wrap things up.
"It's not about you, Paul. They're human beings. They're struggling with profound problems. If only you could find courage to sit with the fact that what we do is hard, and sometimes it makes you feel like an idiot. It's a humbling profession, and if you lack anything as a therapist, it's humility." -Gina
This week is when all the chickens have come home to roost for Paul, when he hits the wall of not being able to make anyone better or happier or be in less pain. Paul would do well to heed what Gina said to him or as Jung put it:
"The principle aim of psychotherapy is not to transport one to an impossible state of happiness, but to help (the client) acquire steadfastness and patience in the face of suffering. " (Jung, CW, V. 16, p.81)
This is not a message most people want to hear. It is tough to accept that suffering is part of life, that it is meaningful and unavoidable. It is hard for patients and often hard for therapists as well to stay with what is painful, to resist the urge to dart away into what is more comfortable, soothing, or easy. This way of understanding therapy also flies in the face of a feel-good orientation which seems to dominate American culture. We want to medicate, meditate or otherwise eliminate suffering, not face into it, sit in it and explore its meaning.
Paul is on the phone talking with someone about his father's estate. Every place he calls puts him on hold and he becomes frustrated and throws his phone which starts to ring just as Gina comes to the door.
Paul tells Gina that he is trying to get his father's estate settled but he keeps being put on hold. Paul asks if Gina will proofread a letter he wrote -- then tells her about meeting with Alex's father. She is astonished that Paul wrote the letter. Paul says his attorney says the letter will end the lawsuit and the insurance will pay everything. Otherwise it could go to court and he will lose because according to the lawyer, everyone hates therapists. Gina expresses skepticism about the lawyer. Paul tells her he thinks he is not helping anyone anyway and he wants to send the letter and find something else to do. Gina corrects him and says he does more than just listened to. Paul says they want love, a parent, things he can't give them.
Gina asks if what he wants to do is make people happy. He says absolutely yes, he does. He says he will become a life coach and give advice. Gina says to Paul that if Mia, as an example, were able to accept love, she wouldn't be coming to him. Paul attacks Gina for not being willing to accept responsibility for her patients. She says that doing what he says makes patients dependent on therapists and unable to decide for themselves.
Walter is in the waiting room. He has a hospital ID band on and his daughter is with him. He tells her she is not going in with him. Paul comes to the door to greet them.
Walter tells Paul it is good ti get out. He says his wife and Natalie have taken him out for lunch. His wife cried over lunch. He is humiliated that he has to have his daughter or wife with him to leave. Paul says it is because he is a danger to himself. Walter does not like the hospital -- the staff is not very bright, he thinks, not like Paul. He says the staff talks to him like he is a child. Paul says he feels patronized and Walter uses it as another occasion to compliment Paul. But Paul points out that in fact Walter seems annoyed by him and does not like how he works. Paul asks why he is sucking up to him.
Walter's face gets hard. Then he shows Paul a potholder he made in OT. He speaks scornfully of the whole program -- group therapy and what the other patients say. He says he cannot relate to them. He does not believe that he belongs with those people. Paul suggests he is angry that Paul couldn't save him from the depression he fell into. So walter counters by telling him that one of the psychiatrists said Paul was reckless and opened Pandora's box at the wrong time. Walter then bullshits about how highly he thinks of Paul. And finally he says he wants out of the hospital. He pleads with Paul to call them and tell him he can go home. Paul says first they need to talk, that he has to become honest with him.
Bess and Oliver are in the waiting room. Luke arrives. He and Bess trade barbs. Paul invites them in but Luke says he and Bess need to talk with him first. Oliver is not happy about this.
Luke and Bess sit far from each other. Luke reports that Bess called and told him she is moving upstate. Bess says she got a job offer. She has an opportunity to adjunct at Bard College but did not tell Luke until she made all the arrangements. Paul confronts Bess with the problem of not having talked with Luke about it. He asks her why this job is so important to her. She says it is a chance to get an inside track on getting a fellowship to complete her degree. Paul says it is a huge change for Oliver. Luke suspects she wants full custody of Oliver but Bess wants him to stay in the city and live with Luke. Bess thinks the best plan is for Oliver to live with Luke until June and then they can see where to go from there. Paul says this is a huge change from not wanting Oliver to stay one night with Luke to wanting him to live with him. Bess tries to make Oliver's best interests her reason. Luke says it is impossible for him to take him on full time because they can't get along. They are now fighting over who has to take care of Oliver. Paul points out that neither of them wants to take care of Oliver right now. They fall silent. He tells them they have to figure out a way to look after their son. Paul reiterates that they need to find a compromise. Luke suggests Oliver stay with Bess during the week and take the train to the city weekends. Bess thinks he is too young to go on the train by himself. Paul tells them it is potentially harmful to Oliver to uproot him. Paul keeps pushing them to think about it but Bess and Luke want to tell Oliver right now, They refuse to take time to think it through.
April is on the far end of the couch. She is angry. Paul says he is afraid that what happened last week changed their relationship. April says they have no relationship. She says she has dumped people for less. Paul suggests she wanted to tell him in person. She is furious with him. Paul says he had to tell her mother because she was delirious. She was taken to the ER with a very high fever. He tells her if it happened again he would do the same thing. She tells him she was leaving therapy.
Paul tells her he did not think it was right to leave her there alone on the brink of death. April says he does not understand what he was to her. Then she asks what her mother said to him when he called. He tells her that her mother was surprised because she didn't know April was seeing anyone. She would meet him but she did come to the hospital. He says he recognized her because they look alike. Paul tells her what he told her mother. April asks if she cried or was angry. Paul says not at all. That she had a hard time believing April would keep something like that from her. They spoke for just a few minutes because she wanted to see April.
Paul opens the door to find Mia in the waiting room. She says it is over, that she is no longer pregnant.
She says she isn't feeling well and she called in sick. She complains of being tired and not being up for the whole session. She does not want to move into the office, preferring to remain on the couch in the waiting room. Paul offers to fix her tea but she declines.
She tells Paul she started bleeding Friday and it didn't stop. Paul asks how she is emotionally. She says she's numb. That she had felt different for a little while, that she had a purpose. Being a mother answered all the questions about her life. Paul suggests there are other ways to have a child if she wants one but she rejects adoption or artificial insemination. She says she never found the right man or she pushed him away and now she has no man and no child.
Paul asks if she called anyone. That she could have called him. She says she spoke to her mother. Paul again suggest they move into the office. She follows him. Paul asks about the conversation with her mother who called when she did not attend her niece's piano recital. She had been paying for the piano lessons. Paul suggests she wanted to be certain music was not taken from them as it had been from her. When she didn't answer her mother's call, she came over and asked if she had the flu. She cried when her mother asked and her mother says maybe that's nature's way. Her mother attempted to make a consolation toast and said she was proud of her, because she is independent and has a career. She told her mother that was odd given that she always accused Mia that she had ruined her modeling career. Her mother told her she never actually had much of a career, that she lost her mind not her looks when Mia was born. She told Mia she stayed in her room because she was afraid she would kill herself and didn't want to do that to her. Her father moved into the living room when this happened but got no help for her. Paul suggests she had no mothering for a year. Mia said her mother told her when she came out of it she had a rush of feeling and wanted to be close to her but Mia was close with her father and didn't want her. And her father couldn't forgive his wife.
Kate meets Paul at the train. She expresses her sorrow about his father. Paul says he appreciates that she came to the funeral and let the kids come that weekend. Paul tells Kate he wants them to try again, that he wants to come home, he loves her and he wants another chance. Kate says she is seeing someone and she might be in love with him, that she can't do it again.
Gina asks Paul how he is as he enters her office. He thanks her for the orchid she sent. He said he was sorry she wasn't there. She says she didn't think it was her place to be there. He learned at the funeral from people who knew him that he liked to sing, which he had never known.
Paul says he thinks women are good at loss but men aren't, because for men it means they lost. Paul asks how he can help his patients when his own life is such a mess. Paul denigrates his ability based on his situation. Gina points out he can't observe himself as he does his patients. She asks about the funeral. Paul says he is glad the kids were there and he hopes his children will be better about death and loss than he is. He says he learned more about his father after he died than he knew. He has no idea really who his father was, all he knows is the story he has grown up with and he never knew he was an interesting man. Gina says Paul knew he was interesting man and that is why he was so angry he wasn't home. That it was his father who had the choice to be home and he wasn't. Gina remind shim that not everyone has it in him to be a good parent. And maybe his father chose to give himself to his parent instead of his family, that he chose to fight the battle he thought he could win. Paul tells her about sitting with his father in the last moments and talking to him as he died. He apologized to his father and then he says he started complaining about his life, as he always does, and when he looked up, his father was dead. Gina asks if he thought his father waited until he came to let go. Paul denied it.
Paul is at a hospital to visit Walter. He runs into Natalie who tells him Walter is not there for food poisoning as Walter's wife had said.
Walter is in bed, very still, very much as Paul's father was when he went to see him. Paul touches Walter's hand to wake him. Walter wonders why he is there. Paul said he was concerned that Walter missed his session. He suggests they talk. Walter says they are treating him well and he will be glad to get home. Paul tries to help Walter see that food poisoning is not the issue as Natalie and Connie ate the same food he ate. They found him only because Natalie's flight was cancelled and they returned home. Paul asks him what really happened. Walter says he caught a chill, went to bed and then woke up in the hospital. Natalie has been in New York for around a week, since Connie told her that Walter had been fired and summoned her home; his sons also flew home from California. Walter thinks Natalie only came because his wife made her feel guilty. She had wanted to talk about what happened when he visited her and she made him get out of bed and do things with her.
A patient we don't know is talking to Paul about having sex with a classmate in the law school library. There is a noise outside and when Paul investigates, he finds Oliver in the waiting room an hour and a half early. He claims to have gotten out of school early. Then he says he ran away from school. Paul says he can stay there but he will have to call Luke.
Oliver asks Paul if he is angry with him. Paul asks why he ran away from school. Oliver says he had a bad day. But why did he come to Paul's office? Oliver asks if Paul has ham and Paul offers to fix him a sandwich. Oliver tells him someone put dog shit in his locker. He says when he came to his locker at recess he found it, smeared all over everything in his locker. Paul tells him he's glad he came there to talk about it. Oliver tells Paul that his dad is mad at him too, that they fight all the time. Oliver thinks Luke broke up with Nina and he thinks it is his fault because Luke and Nina fought over Nina saying he needs more rules. Oliver hasn't told his mother about the fights with his dad.
Paul is pacing. He straightens a picture over the couch. April comes in.
April says the stairs are hard for her. She asks if he knows what she likes best about him and she says his eyes, that she has liked them from the first visit. She winces when the port hurts for a moment and says she doesn't remember them putting it in. She asks if he saw it. Then she thanks him for taking her. April tells him she has been having many discussions in her head the last 2 weeks. She says even in her head, he doesn't say much. Except he says to her, in his head, that of course it is all worth it if she is making herself and others happy.
April apologizes for being difficult. And she thanks him again for taking her to chemotherapy. She says she had a bad night last week and wanted to call him but didn't because she felt that he needed a break because he had cancelled. She tells him she talked to her best friend Leah. She had dreamed she had died. pal suggests that maybe it is only the part of her that resists help died. She woke up with a fever and when her friend arrived she called 911. Her friend had not known she had cancer. Her friend was surprised but came through for her. She and Leah have looked after each other for a number of years. Paul suggests to her that the people in her life -- Leah and Kyle -- have stood by her and that she only allows in people who are loyal and will stand by her. He wonders why she picks friends who will be there for her and then doesn't tell them what is happening to her until she has no choice. He asks if she believes there is a finite amount of help people will give her so she must carefully choose when she asks.
Paul's father has died. Mia arrives. He closes the doors to the rest of the apartment and puts on his father's watch and places his father's med school diploma on a shelf. Mia pours some of her water into a plant in the waiting area. Paul comes to the door and Mia asks if he is all right. She expresses condolences.
Mia asks again how he is. She found out because she asked his lawyer's secretary and because Paul had never cancelled an appointment.
Paul says it is ironic because they had been talking about her father last week. Mia wants to know what he thought about her card. He tells her he has not yet opened his mail. Mia presses him again about how he is. Mia acknowledges that she has been difficult and says she wonders who he has. She says she can see loneliness in his face.
Paul wonders if she is worried that he can give her his full attention today and tells her that she needn't worry about his feelings.He asks if she is upset that he had cancelled last week. She admits she was annoyed until she found out why. She says everything has changed now because she is pregnant. Paul gets distracted looking at the snow falling. Mia says their timing is strange -- 20 years ago he was having his first child when she was losing hers. And now she gets pregnant as his father has died. She tells him Bennett is not the father. Paul wonders about the connection between finding out Bennett and his girlfriend are having a baby and her own pregnancy. Mia denies this and says she thinks it is the musician. She thought Paul would be happy and they could celebrate. She wants him to tell her she will be a good mom and that he will be there to help her with decisions. Paul asks if it is he that she wants to help with these kinds of questions. She says her sisters are married and her mother isn't available, that her mother likes her sisters.
We see Paul giving his deposition for the lawsuit.
Paul is with Tammy in a coffee shop. He is upset by the deposition but doesn't want to tell her about it. Tammy also had a bad day because of her husband's bad mood. Paul is impatient to be waited on and with Tammy's talk. He is irritated by her wanting him to listen. Tammy observes they have moved rapidly from being infatuated to being irritated. Paul says he will change his time with Gina but Tammy says she already has.
Paul arrives late to see Gina because he says Rosie kept him because she wanted the keys to the car. Gona asks if they talk and he says no and they didn't when he was at home either, not for quite a while. He recals a time when it was just him and Rosie and how nice it was. He tells Gina he took April to the hospital. He says he knew it was wrong but the schedule had been made and all he to do was get her there. Gina asks if it reminded him of the day he spent with Rosie when she broke her arm.
Paul says he hates his life, that it is broken. He knows he is getting what he needs from patients because he isn't getting it from his family. Paul says she can't give it to him but she asks him to tell her what he needs. He wants water and doesn't see it is there in front of him. He says he is lonely. He misses dinner and the after dinner. He says he goes to a bar and Gina asks if he meets anyone there. He says he sees women there. He says they remind him of Mia. He tells Gina that she is the kind of woman who if she worked through her issues would be a woman for him, though he says not her but someone like her and he reassures Gina he won't fall in lo with a patient again.
The phone is ringing as Paul comes into his apartment. He finds out that his father has fallen and is in the hospital. As he puts the phone down, he sees in the paper that Walter has lost his job.
Walter is dressed in a sweater and looks depressed. He tells Paul he should be glad he no longer has his phone or Blackberry. He finally has the time to talk but believes that Paul can no longer help. Paul suggests maybe he can. Walter says he has lost his job, his good name and when he leaves the house, a pack of reporters mobs him. He says he followed the Johnson & Johnson model for handling the crisis, that he did everything right. And so the class action lawyers and his enemies within the company came after him. He says now he feels like an old man too long in the ring.
Paul asks if he is eating and sleeping all right. He is eating some and sleeps with medication. He is taking clonapine -- he takes maybe 3 a day and Paul asks if that is the prescribed dosage. He says he wants to wake up and find the past two months have been a nightmare. Paul gently asks about suicidal ideation. Walter denies he would do that because of what it would do to his wife, who bursts into tears every time she looks at him.
Oliver and his mother are at the door. Bess tells Paul that they were kicked out of their apartment and then they laugh and tell him she is going on vacation. Luke has not arrived, but Bess says he will be there to pick up Oliver.
Bess talks with Paul alone first. She tells Paul that after the last session, she and Luke took Oliver out to dinner and explained about the adoption. She says that since then everything is fine. Bess is going on vacation with her friend, which she can do because Oliver is doing so well. Paul says he doesn't think that Oliver has changed as much as she believes, that it would be unusual for his problems to clear up so quickly. Paul tells her that Oliver changed his behavior so that Bess and Luke won't see him as their problem. Bess interprets this to mean that she cannot go away without Oliver. Paul says he isn't saying that.
Why now?, Paul asks. And Bess attributes it to Luke having a girlfriend. She believes she has to create a new life, that she has never lived by herself. Paul asks how she and Luke got together.
April arrives early. She tells him she has to leave her cell phone on in case her brother calls.
She couldn't tell her mother about the cancer. She did visit Sloan-Kettering. She told her mother she is a little sick but not what was wrong. Her brother tried to kill himself. All of this tumbles out in the early part of the session. Her mother can't cope with Daniel when he wants to die. April says he can't handle feeling strange. And so April takes over with him then.
Paul tells her he worries that she is feeling strange and has no one, that her mother shares her anxieties with April but April doesn't tell her mother anything.. So she starts telling him how she feels -- depressed, out of control. Paul firmly tells her when she feels like that to call him, any time.
She tells him she saw her mother and they talked about Daniel. She always tries to look her best for her mother because of Daniel. Her mother talked about wanting to leave her father. Paul asks if maybe it is Daniel she wants to leave.
Mia comes in and heads to the kitchen because she wants breakfast. Paul tells her no because he doesn't have sessions in there. Paul says he doesn't understand why she can't eat in the other room as she sits down at the table and then asks for a napkin.
She continues talking about her weekend. Paul tells her she is speaking rapidly but she does not slow down. He gives in and half sits on a stool against the wall. She tells him about having spent the night with a musician. Paul asks if it is her intention to shock him, as she continues to describe the sexual acrobatics with the musician. She compares that guy twice to Bennett. She tells Paul that that evening she was his favorite and ten reveals that the next night she was with a cop. She describes him as taking charge and she liked that. She wants Paul to ask for details. Another comparison to Bennett. She disdainfully describes how she had to tell him what to do. Paul suggests they move into the other room and she seductively asks if he wants her on the couch.
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.
Paul is at the breakfast table in his apartment. Tammy comes in. The phone rings and it is Rosie. Paul asks if she has to leave because he thought they would take the train down together. Rosie is asking him about his father. She hangs up on him.
He runs into Tammy again at Gina's. She says Mark -- her husband? -- is in the car. She looks anxious and says she has to go.
Paul goes in to see Gina. She asks if he is okay. He says his father is sick, in late stage Parkinson's. Paul snaps at her. Paul says he can't talk with him. He is in a nursing home. Paul is angry he has to take care of him, and says he thinks his father deliberately mishandled his finances so he would have to take care of him. He says he is just waiting for him to die. Paul says it isn't that his absence is different because he was never there.
Paul discloses that he has talked with Tammy. Tammy revealed that Paul's father was with his mother when she tried to kill herself, that he went with her to the hospital. Tammy told him that his father called her mother all the time to check on his mother. and his sons. Patrick was out playing sports. Gina says his father was at work, his brother out playing sports leaving him with his mother. She talks about the unreliablility of memory. She tells him she knows his feelings are warranted but the facts may be different for that night. Paul is angry that his father did not get her into the hospital, instead leaving him to worry every day about what he would find. Gina says maybe he didn't want to take his mother away from him, or him away from his mother.
We hear Walter yelling on the phone outside the door.
Walter is still on the phone when he comes in. He tells his secretary not to call for 40 minutes. There is a business crisis. Paul offers to reschedule. Water says they have already rescheduled from earlier in the evening. Walter tries to hand him cash for his time. Paul asks if he is paying for the session in cash, but he says no, for the time lost to the rescheduling. Walter's phone rings.
Walter tells Paul about a power struggle in the office. Paul asks him to slow down because it seems like he is in the middle of a breaking crisis. Walter goes on again about what happened. Paul says he seems unable to focus and maybe they should refocus. Walter says no, he needs him now and it could be a month before he could talk again.
Walter tells Paul he spent the last 44 out of 72 hours on a plane. He tells him he flew to Rwanda to get Natalie because he knew she was in trouble. She didn't ask him to come but he knew there was trouble. He and Natalie had talked or emailed every day of her life but a week before she emailed her mother full of worry about him. He couldn't believe the way she was writing was her voice, that there was something wrong. When he got there he found she had cut off all of her hair. He says he didn't know who he was talking to -- no shoes, very thin, a child in her arms. He stood there looking at her and she asked why he was there. He says he is taking her home. She says no, she is busy. She suggests he lie down in one of the shacks there and he is appalled by the conditions. He took all of her stuff from the shack. She gets furious and screams at him for this. He got very angry. She started to cry and he held her. He tells her again they are going home. She told him to go fuck himself. Walter says she broke his heart with that.
Paul is doing a video chat with his son about how he is doing in school. There's a knock on the door and Paul tells his son he has to go because he has a patient. Max thinks it is a girlfriend.
Bess arrives to pick up the turtle. As Paul gets the turtle, Bess says Oliver has been with Luke all week. She tells him she had time to read and had a difficult three hour phone call with her sister. Bess gives Paul cookies for having cared for the turtle. Bess seems to be seeking care from Paul for herself.
Oliver and his parents are all on the couch. Paul asks how the week was. Oliver says great. He and his father went to a basketball game, watched The Godfather, went to museums. Bess asks how he slept and he says fine. Bess is looking for problems. She brings up the turtle that Oliver forgot. Oliver takes out some electronic device and says again that he got his homework done, that Nina came to help him. Bess is not happy that Nina was there. Bess feels that Luke asked Oliver to keep Nina a secret. But Oliver says he already knew her because she was his teacher last year. Bess is angry. Oliver doesn't want to say more because whatever he says makes it worse. Paul suggests that he and Oliver go to the waiting room so Luke and Bess can talk.
Paul is at his table reading the paper when the phone rings. It is April asking if she can come in early.
April comes in and has her big project for school with her. Paul asks to look at it. It is a model of two spiky towers which she says is meant to be a World Trade Center memorial. Paul compliments it.
April says she is really tired -- because of her anxiety and the lymphoma. She lies down on the couch. She says she couldn't sleep the night before. Her heart was racing, like there was something poison running through her veins and she wished she could open and make it run out. Paul tells her when she said that he thought of cancer. She says chemo, he says no, because she can choose not to have chemo.
She says it reminds her of a time when she had a song she could not get out of her head and she thought she was going insane. he asks he what she thinks that would feel like and she said falling. He asks what she kept thinking about. She tells him she kept thinking she wanted to go home but she couldn't because her home is so long ago and so far away. She tells him she is so tired she wants to lie down for a minute. She asks him to wake her at 8 -- it is 7:59. He agrees. He watches her and then a moment later softly calls her name. He gets up and touches her shoulder to try to waken her. She asks what time it is. Good she says -- it is over because the project was due yesterday but she had until 8 to turn it in. She gets up and smashes it. She says it was hideous and critiques it. Paul tells her it is very hard to see her destroy her own work. April says she did fall asleep and she dreamed she was on the model, that it was life-sized and she fell. She says it was like joy. Paul says it is different from falling into nothing. In her dream she is able to fall and release everything that she holds so tightly under control while she is awake. She is angry because now she will have to think about it. She compares what he said to how her brother is. Paul says he notices she is often trying to feel what her brother feels and that maybe she does this instead of feeling her own feelings.
Mia is outside and Paul is late for their appointment which is very early on Monday morning. Paul arrives and apologizes.
Mia wants to know why Paul is late. Paul asks about her being upset. Mia is angry that they are starting 12 minutes late. Mia asks if he had a girl friend. She says this is more home than an office. He deflects her questions. She persists in making hostile observations rather than talk about her anger. Paul asks if she is afraid he will leave again.
Mia says she doesn't want to be there. She doesn't like brownstones. She says she did not think about last week's session. Paul says he did, about her comment at the door, that he owed her a child. She continues to spar with him. She asks about Laura. Mia has read the deposition from Laura. Mia keeps talking about Laura. She tells Paul that Laura says he broke the rules for her and that he had an affair with her. She continues to goad him. Paul tries to get back to Mia and what she did -- that she crossed a boundary by reading the deposition and then bringing it there. She throws the deposition on the floor and says it is his.
On the HBO forums there has been considerable discussion of the note-taking issue. And we saw this week that after seeing April, Paul sat down to write some notes. Which we know from what he said to Mia when they met to discuss the lawsuit taking session notes is not his usual practice. So why now?
The answer is simple -- anxiety.
The whole issue of session notes is related more to risk management and insurance company requirements than it is to good care and the best interests of the patient. In fact. until fairly recently, it was up to the therapist what kind of notes if any notes would be taken. And, depending on licensing requirements and whether or not one accepts third party payment, it is still up to the therapist on this issue. Some therapists document via a short notation the occurrence of a session combined with billing records. Others take notes during the session. There is nothing in these approaches or any other that correlates to skill or outcome.
In a paper presented to the APA, Martin Williams explains how what starts as a way to manage risk morphs into standard of care -- and sometimes into mandated requirement:
Paul opens the door and sees Kate who has an envelope of financial aid material for Rosie. They start to have a spat. Paul asks her please not to come to his therapist's again. Tammy comes out again and they greet. She apologizes for interrupting last week.
Paul starts mentioning Tammy and Gina says they can't talk about that. Paul says he cannot be in therapy with her now. Gina says she is sorry but she respects his decision. She gets up to go and says he can stay there till the kids arrive. Paul looks unhappy. Gina asks if he wanted her to argue with him. He wants an hour of conversation, that he will pay her. She says she doesn't charge for conversation. Paul wants her to stay and talk. Paul starts to complain about his week. He looks miserable. Gina says okay, just for a few minutes.
He mentions he thought about Tammy Kent when they were 17 and wonders why he did that. Gina says he could work on that in therapy. He tells her that the lawyers are deposing Laura this week. Gina asks if he is worried that she will try to get back at him. Paul says he doesn't want to talk about his past because it his present that is causing him problems. Gina says it occurs to her that he thinks about Tammy because there is something incomplete from that period in his life when his father left his mother and when she died.
Paul closes the sleep sofa while his daughter, Rosie, is talking to her mother on the phone. There is a knock -- a messenger has an envelope from the law firm for Paul. His daughter guesses that he is being sued. Rosie asks who he can talk about it with. Paul says it is under control. She says he is condemning himself to a life of loneliness and she wonders why. She refuses his hug, because she says she won't hug him until he comes home. Paul tells her that isn't going to happen and they hug. She sees the turtle on the shelf. -- the turtle Oliver was afraid he would fail to care for.
Walter begins by saying he is sure that this week Paul has read up about him. Paul says he read about the industry but not about him. Walter believes a reporter at the Times is after him. Paul asks if it is coming from within the company. And apparently that is a possibility. He is worried that the articles are putting his daughter in jeopardy. Paul suggests maybe his anxiety is getting the better of him. Paul observes that he sounds quite confident given the circumstances.
Oliver and his parents are in the waiting room, each listening to their iPod. Alone together. And this is a good image of how they are relating to each other.
Oliver asks Paul if they are going to play another game. Paul says he has been learning about the rules of blackjack. Oliver wonders why. Paul tells him he wants to learn about the things that Oliver does and likes. Oliver says his teachers don't think he is smart, that all of them hate him because he falls asleep in class. School is boring he says. He says none of it is about real stuff. He says they are reading Lord of the Flies which is lame -- because you don't have to crash on an island for kids to be mean. Then he shows Paul the turtle he has to take home and take care of. And if he doesn't take good care of him, he will fail. And he assumes he will forget something and the turtle will die.
Paul observes his backpack is crowded. Oliver carries all of his books in case he goes to his father's, but he doesn't go there. Paul wonders why he is so tired, even at his mother's house. He says he has trouble sleeping. Paul suggests there are very stressful things in his life and wonders if there is anyone he can talk to. He says if he tells his mom, she calls his dad and then they argue. That day his mom said he isn't getting enough sleep and his dad said he isn't healthy which means fat -- because he is fat. Paul guesses he is upset about being fat. All the kids at school talk about it. They call him Piggy after the fat character in the book. Oliver tells Paul about hiding out during a party. He doesn't tell anyone about this. He says he doesn't tell his mom because she'll tell his dad and then they will fight and he doesn't want it to be his fault that they get a divorce. He wants to know if Paul can make his parents happy. Paul says he can't make them happy but he can help them to get along better. Then he invites the parents in.
April is talking on her cell phone in the hall and sounds angry. Paul is in his kitchen reading the paper when he hears her. He steps over to the door and listens a moments then goes into his office.
Paul tells April he is glad she is there. She contacted him by email. She wants to know if he has an iPhone charger. He says no and she asks to use the phone but agrees to wait until the session is over.
April has a tremor in her hand. She tells Paul that it runs in her family, getting a tremor when she is angry. She says it would help if she could use the phone. Paul tried again to get her to wait.
She is angry at Sienna who is Kyle's new girlfriend. April told Kyle she has cancer, he broke her confidence by telling Sienna who offered to pay for her treatment. She wants to be able to call Sienna back so she can hang up on her. Paul gets the phone. She asks Paul to give her a moment so he leaves the room. He waits a moment or two and then she comes to the door and they return to his office. The tremor has stopped.
Mia shows up at Paul's office very early in the morning. She starts off commenting that their positions are reversed -- he used to be in Manhattan and she in Brooklyn. Then says it is strange to be back and comments on the couch, saying the old one was black and blue and that she thought that was funny.
She apologizes for her behavior last week. And that is the reason for this visit. Paul reminds her that she waited until Friday to call for an appointment. Mia agrees with Paul that she set up their last meeting because she had wanted to needle him a bit and impress him. Paul asks if she and Bennett are involved because he noticed her manner changed when he came into the room. Bennett is married. They have been involved for over a year. He has told her he wants to leave his wife and be with her but he hasn't. Mia says she doesn't need a therapist, she needs a matchmaker. Then says he does owe her.
Mia keeps asserting she is not really a patient and she asks about Paul's marriage, if he had an affair. She has been wondering what would happen if she ran into him somewhere but she imagines he already has a girlfriend. She tells him how hard it is to find an available man. Paul asks if she is asking if he would be attracted to her. She does not respond and then talks again about Bennett.
A long time ago a clinical supervisor told me we get the patients that we need in this process in which both therapist and patient become immersed. With that thought in mind, let's look at the patients Paul has this year and how their issues and his relate. In Jungian terms, we see what happens in therapy as illustrated in the diagram below:
All four of the patients we will be following are ambivalent at best about being in therapy. And all of them resist Paul's efforts to encourage them to look more deeply in themselves -- this is a guess about Mia but she will be coming back with her own agenda of unfinished business from previous work with Paul; in fact it appears her desire is to deal with Paul more even than with herself. And Paul is reluctant to acknowledge his need for therapy. The ambivalence and defensiveness of his patients mirrors his. Five reluctant patients and a reluctant therapist.
Paul tells Gina he is sick of listening to people yet in his work with the patients we see, none of that shows. He does good work with all of them, reflecting something good therapists do all the time, which is to set aside personal issues in order to be present to patients. However it is essential that he be talking with someone about these feelings of his or they will inevitably leak into his work -- in impatience, overly harsh interpretations, empathic failures, and the like.
Paul is on the train. A large man takes the seat next to him and starts eating and talking. Paul looks uncomfortable. He lies to the man when asked what he does and says he is in sales.
Gina greets him at the door. She has redecorated. Paul has not talked with her in a while. He asks if his lawyer called about the malpractice case. She says he did and she will be deposed though she doesn't know how much help she can be.
There is a knock and a woman has come back to get her glasses. She and Paul know each other. Gina identifies Paul as a friend not a patient. Gina tells him she is seeing patients, that her book is doing well and she asks if he has read it. He says he hasn't, that he isn't ready for it.
Paul tells her this is the first time in his life he has lived alone.
Paul is gloomy about the suit and the outcome of it. He is afraid he will lose his license, his apartment. He says he doesn't care if he loses his license because he is sick of sitting day after day listening to people's problems.
Paul is on the phone leaving a message for his kids about a visit scheduled for the next week.
Walter arrives for a first appointment. A well-dressed man who comments on his "nice things" and then fusses with the pillow in the chair and lets Paul know he is a CEO. Paul asks him to tell him about himself but Walter wants to know what he already knows about him. Walter is surprised he knows nothing about him. He is surprised that Paul doesn't read the business section and tells him that his daughter's friends at college never read that section either -- and he sounds very disapproving. Walter keeps impressing on Paul how important he is.
He tells Paul it was his wife's idea that he seek therapy because he doesn't sleep well. Paul notes he has mentioned his wife twice and that she takes good care of him. He says he has tried Xanax and Ambien and says they did not work for him. He says his doctor told him he has underlying anxiety and should talk to someone. Walter is distressed that his whole life he was able to sleep whenever he wanted but now he can't.
Oliver and Paul are sitting on the couch. Oliver asks if they have to wait for his mother and father. They decide to play cards while they wait. Oliver suggests blackjack and expertly shuffles the deck. He gives Paul the rules. Oliver says Paul sucks at the game and he wonders why if he sucks at it, why play? Oliver doesn't really know why he is there. Paul tells him that his parents are getting divorced. Oliver denies the divorce -- he says his dad has moved out but it doesn't mean they are divorcing. He finds it annoying that his dad has moved out. Paul tells him they are meeting to help work out a solution to the problem that Oliver refuses to stay at his father's apartment.
Oliver doesn't like the food at his dad's or his friends or that it takes longer to get to school. Paul says maybe they can help get things to change at his dad's and make it easier for him to stay there. His mother arrives with Oliver's snack and complaints about the father and where he lives. She doesn't want to wait in the waiting room until the father arrives. We can see his mother is reluctant to have Oliver stay with his dad.
A young woman, April, is sitting in the waiting area. Paul opens the door and invites her in.
Paul's office has large bay windows and is comfortably furnished. April walks around looking and admires the office, mentioning she is an architecture student. She asks if he did it himself or used a decorator and when he says he did it, she congratulates him.
April tells him she is 23, a student in architecture and urban planning at Pratt. She is recently single, having just broken up with a long time boyfriend. Paul asks if that is why she has come and she says no, the breakup was fine. She says she found his name online because she wanted to see someone near Pratt who would take her insurance. She tells him no one had commented and she had assumed it was a new practice. He tells her he recently moved there. Paul tells her she needn't apologize for questions and that she needn't censor herself to spare his feelings. He asks if she has seen a therapist before and she says she had -- through student health. She speaks scornfully of the previous therapist. She felt that that therapist saw her as a complete waste of time. She tells Paul that the therapist had told her the same joke twice. Paul asks about it and she tells him. April stopped going and never spoke to the therapist despite receiving many telephone calls from her. She says she did not return the calls or tell her because she didn't ant to hurt her feelings. April gets angry and defensive at Paul's questions about her previous therapist.
Paul has made some major changes since we left him. He is now divorced from Kate and lives in Brooklyn. Each weekend he commutes back to Maryland to see his children and Gina.
Paul is awakened by a knock on the door and opens it to see Alex's father there. He is angry with Paul for not stopping Alex from flying. And he serves him with a summons in a lawsuit against him. Mr. Prince believes that talking with Paul is what killed his son and he wants Paul to have to pay for that.
We next see Paul as he comes to consult with an attorney for his malpractice case. He is surprised to see Mia, who was a patient some years ago. Paul is apprehensive about consulting her given their previous history. She urges him to proceed because they have little time until the hearing so he agrees. Paul looks stunned when he hears her say the word malpractice. She reviews the basic outlines of his background and then explains that he is being sued for $20 million, though his insurance covers only $3 million. Mia explains that the plaintiff is claiming that Alex committed suicide, which Paul does not believe.