In Treatment -- Mia, week 3

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.

Mia laughs, says she just made an ass of herself and that she thinks Paul is angry. She knows he can't express his anger and so she says she will leave. He tells her that she is goading him so that she can leave and avoid looking at her own pain. Mia gets up and walks to the window. She starts talking about a show she watched about custom made sex dolls that men can have in place of being involved with real women. She compares them to a receptionist in her office who is leaving to get married. She thinks when men look at her they see blonde lawyer -- maybe good for sex but nothing else. She asks what he got from Laura. Paul asks if she thinks he chose Laura over her. Mia says she had feelings for him and she is certain he knew. And he didn't pick her. Mia imagines they had sex on the couch. Paul encourages her to keep talking about it. She thinks Paul was smitten from the first, that Laura acted seductive and girlish and she would stare at him and admire him and make him feel like he was the best. She goes on with her fantasy. She starts to cry. She thinks it was amazing for him but she felt nothing. She imagines that for Laura it was about winning, about winning him because for those minutes he was hers. She thinks maybe he held her until she fell asleep. Paul softly says that would feel good to her, that maybe that is what she wants -- to feel comforted, contained. Mia says that could never happen because she is difficult. She is certain that when she walks out that door he is relieved. Paul tells her he told her he did think about the last session and about what happened 20 years ago.

Paul gets up and goes across the room and turns on the tape she had given him. She smiles. It is a tape of Mia playing and he tells her it is beautiful. She says it is from a recital - her piano teacher told her she was the best but not to tell the others. He notes they had a secret. She says soon after that tape she was sent to live with a relative and when she came back the piano was gone.  Paul suggests maybe she gave him the tape because she thought maybe she hoped he would understand from it how she felt when they sent her away. Paul suggests she was testing him to see if he could be pushed away as her parents did.  Maybe she is angry and she also wants him to be close to her, but she is also afraid that he will leave her. 

His next patient arrives. He says they are early and sits down but she says she has to leave. At the end she reminds him he owes her the 12 minutes and then she asks if he had sex with Laura. He says it is the second week she creates a doorknob moment. She believes he is saying he had sex with Laura. Finally he says no. He picks up the deposition after she leaves.


Given that Paul goes to Maryland on the weekends, it seems problematic that he schedules any patient at 7 on Monday morning. But he has and this means he is late. And his lateness simply fuels Mia's anger and her fantasies about why. This may be a bit of acting out on Paul's part, knowing he may be operating very close to the line given train delays and other problems that can develop. In the play of transference/countertransference these kinds of things can happen, though one hopes he will reflect on it and try to see what it is about for him.

Mia's open anger and hostility is hard to be with. Given how hard she goaded him, Paul actually did very well handling his own responses. This is the second patient who has tried to get under his skin about Laura -- Alex did so last season with a far more explosive outcome. In both instances, it is likely that the unconscious motivation was to test Paul, to see how far he could be pushed before he would retaliate. And for Mia, to see if he would leave her, or make her leave as her parents had.

I have very mixed feelings about whether or not Paul should be willing to work with Mia. That she was willing to read the deposition, despite knowing it was a serious ethical breach, is cause for considerable concern. I understand being willing to take her back in order to deal with issues left from their previous work. I have often had patients return even after many years. But her anger is leading to dangerous acting out. Trust is a two way street in therapy -- the patient needs to be able to trust the therapist and likewise the therapist needs to feel some measure of trust that the patient will not willfully attempt to injure him or her. Mia re-entered Paul's life via an ethical breach and she has now repeated it. Paul has not moved to set a limit on this, to let her know that he cannot allow her to continue to act out in this way. In fact, he probably should have told his insurance company to refer him to another law firm as son as he knew Mia was there -- the conflict is simply too great. Though I think Paul handled Mia's hostility as well as could be expected, I think he is inviting further acting out from her and that it could well harm him. His passivity in the face of this is troubling.

I have said before that I believe that therapists can have an office in the home. Having said that, it is important when we do to be mindful about boundaries and creating some separation between personal space and work space. Paul is not the first nor certainly the only therapist in New York to have his office in his apartment. But, I noticed he left the sliding door between the kitchen and where he sees patients open enough for patients to see into the kitchen. Not the worst thing in the world, but it does seem to be inviting patients to want to see what they can, to fantasize what is there, and to make the container for the therapy, the physical container, less secure. Mia said his space is home more than office, putting her finger on this very problem. And with a patient like Mia, whose acting out already shows a willingness to pry deeply into Paul's life, this seems especially unwise.

© Cheryl Fuller, 2016. All  rights reserved.