In Treatment 2-- Mia Week 7

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.

Paul asks what happened after her father left. Mia makes a joke to avoid answering. She says she stayed home all week in bed. She says she knows that sounds bad but she made it through and is there now. Paul asked if she got out of bed at all -- she says no. Paul asked if she called anyone, if she thought about calling him. He reflects to her that she did what her mother did, that she lost the dream of her pregnancy and her father, both serious blows. Mia ays this is why she is done with therapy, because talking about what happened makes her feel bad. 

Mia says she is thinking about getting a parrot as a pet which she would name Paul and she would teach it to say things to her. Paul says she wants to get away from him and keep him around. Mia says she likes him and would love it if they were friends. She makes a crack that she isn't Laura, who got him outside of therapy. Paul says they never dealt with why she came back in the first place. He says she chose him the same way she chooses men -- finding someone who will let her down and when he does, as he inevitably will, she can rage about it. She demands why he didn't tell her that 20 years ago. Paul asks if she would have heard it. Paul tells her she is again blaming Paul that she hasn't had what she needs. He tells her that if she wants to change the pattern that she stay in therapy, if not with him, with someone else.

Mia asks if they can talk about his patterns -- that he likes to have a woman on the couch adoring him, that he likes to look at. She says she knows he has had fantasies about her and she continues to goad him. 

She wants him to break all the rules for her. He asks what then, would she finally feel special enough, or would she blame him for crossing the lines. He suggests that then he would need her, the lawyer, and she would be in control. He asks her how many of her clients are powerful men who failed to protect their patients. He suggests to her that the fact that she did not go in all of last week is no accident, that then she did not feel like defending powerful men, having just learned about her father. He says maybe what she has been doing all these years is defend herself, the child who needed protection. 

She says now she has nothing because of him, as she gets the connection between her life and her work. Paul tells her she has a choice now, she can make a better life. She continues to want to make Paul responsible for her disillusionment, for the breaking of the illusions she has had about her father and her life.

Paul asks when she was last happy and she says when she thought she was pregnant. And she says because she wanted the connection she could have with a child. Paul says maybe a baby is not what she needs, that it is the connection she wants and needs and that she has done some of in therapy. Paul suggests she can do that, that what she has done in therapy has been the only way she knows how to show what she needs. He says they have that connection right then in the moment. Which leaves her nonplussed. She smiles. She thanks him. Says it was a good session. They say goodbye at the door. She says she will see him next week.


This session is terrific at showing Mia's defensive style -- blaming, attacking and avoiding because Paul got too close last week and she came up face to face with a truth she found unbearable. Rather than call Paul, when she was too depressed to get out of bed, she brute forces her way through, powered no doubt in part by her angry determination to end therapy and thereby punish Paul for making her feel bad. She refused to call Paul because to do so would allow her to get the kind of care she needs which her father not only didn't give her but for which he rejected her.

It is a calculated risk to respond in the way Paul does, to a patient coming in declaring she is ending therapy. And no doubt some who watched found it problematic that Paul works fairly aggressively with her in an effort to get her to continue her work. This is a line most of us walk when a patient wants to terminate prematurely. The trick is to say enough to engage that part of the patient who does want to stay, who does want to change, without pushing too much and hardening the resolve to leave. Staying means being willing to go through the suffering that opened for Mia last week. It isn't an easy decision to make, to willingly enter knowing it will be painful. But if you look carefully for Mia's responses when Paul makes his interpretations to her, at the changes in her facial expression, you can see that she is taking in what he says. She responds caustically and defensively -- asking why he didn't tell her this years ago, suggesting he is happy that he destroyed her -- but she hears it. And this lets Paul know that she wants to stay. So he persists. Now, it is not common to make so many deep interpretations in one session, but he roots them all in the material they have been dealing with since she came. In an ordinary session, this would be too much and it was a lot even for this kind of extraordinary session. 

It has been Mia's pattern to test and test Paul to see if he will respond as her father and other men have in her life, to be taken in by the seduction and by the competence she displays. And she does so this session as well. Going after his competence, his vulnerability in the lawsuit, at erotic transference. That he withstands it without acting out with her makes him ever safer for her. 

At the end, when Paul tells her that they have the kind of connection she wants and needs, her face says it all, because if she hadn't before then, in that moment she decided to stay. There is much work ahead for her but a crucial milestone was reached in this session. She will continue to test Paul, to attack, to defend. But the chances are good that they will make progress and she will have diminishing need to defend herself in those ways.

All in all, this was satisfying ending to the Mia chapters.

Feeling worse in order to feel better -- Mia says she thinks there is something wrong to leave a doctor feeling worse than when she came. And this is a common feeling about therapy -- why do something that makes you feel worse? But when we have deep wounds, like Mia has, doing things to feel better often is more like re-arranging the deck chairs on the Titanic than it is therapy -- the ship is sinking and that is what needs to be seen and known. So, yes, being in therapy often means being willing to feel worse before feeling better. Because the only way out of the wound is through it and that means experiencing the pain and associated issues that have been defended against.

"One does not become enlightened by imagining figures of light, but by making the darkness conscious." CG Jung




© Cheryl Fuller, 2016. All  rights reserved.