Amy has arrived before Jake and is smoking when he arrives. Jake comes on to her as they are in the garden before going into Paul’s office. They joke about names for the baby and superficially things seem better.

Amy opens saying that she did not keep the appointment with her doctor because Paul was right, she needs to think it over. They are all smiles and happy, talking about getting along better. Amy says she thinks she may want this baby and has imagined the baby, which she thinks is a girl.

Paul asks if they have talked about this decision. Amy asks what he thinks. And he wonders , despite their apparent happiness, whether they shouldn’t talk about it. Jake says this is their last session because they have decided; Amy says not necessarily. Paul reiterates that they still need to talk about it.

While Amy speaks, Jake looks away. Amy gets up and goes into the bathroom. Next we see them leaving.

And Paul finds a spot of blood on the couch — so we may fairly conclude that Amy is miscarrying.

Paul calls for Kate to ask how to get the blood out of the couch. There is tension between Kate and Paul. He frets about whether or not there will be a stain because he says his patients will wonder. Kate says maybe now he will replace the couch — and then says that he could make the room nicer. She says that she is jealous of the room.

Paul tells her he went back to see Gina, which surprises Kate, who says she thought he despised Gina after what she wrote about him. Paul asks Kate why GIna is such a threat to her. Then they begin to fight about the kids, about Kate’s sense that she carries all of the parenting load. Paul resists the idea of sending their son to a school for gifted children, something Kate passionately believes would be best for him as he hates school and has no friends. Kate cries and tells him he does not make her feel she is the most important thing to him, not her, not the kids compared to what happens in his office. She is furious that he is energetic and engaged with his patients and old and tired with his family. Paul looks defeated and acknowledges that he may be out of touch with Max. Kate sits down on the opposite end of the couch, the distance reflecting how little actual contact there is between them. Kate keeps trying to pull the discussion back to their relationship, which Paul clearly does not want to talk about. “Why don’t we talk”, she asks? He checks the clock and says “we have a few minutes, let’s talk”.

Kate says, “I’m seeing someone”. Paul asks what she means and she asks what he thinks she means. He gets angry and asks about this man, who is he, where she sees him, what they do? She throws the details at him. Paul accuses her of deliberately betraying him while accusing him of being neglectful. One of those fights that takes couples over the brink into the territory of fatal wounds.  And then he sits again and says, “Congratulations. You have ruined any chance of saving this marriage.”

Kate tells him that it was past saving because he never noticed, because he never considered she might do something like this.

“Is it over? Are you going to keep on seeing him?”

Kate says it is up to him and he tells her to please leave.

There is a knock on the door. Paul tidies up and goes to answer, pulling himself together to meet with the next patient.

In this episode, we see one of the great, maybe the greatest occupational hazard for therapists. It is so very easy for therapists to get many if not most of their intimacy needs met in their work. The relationship is intimate, making us privy to  the deepest issues of our patients’ lives and though the work is demanding, we need only pay close attention in one hour increments with no requirement that we ourselves reveal our own interior. Patients are usually grateful and make us feel valuable. Compared with the mundane issues of family life — squabbling kids, household chores — life in the consulting room is vivid, alive, rewarding. And what goes on there cannot be brought back into the family, cannot be shared as other work usually can be. So the life of the therapist easily becomes split between the office and outside the office. 

But the intimacy of the consulting room, while real, is bounded and is not sufficient for either party. Therapists need friends and close family who will not make them special, will be honest with them, and both give and receive love. Our friends and loved ones help keep our feet on the ground because they know us and love us, warts and pimples and all. There is nothing like changing a dirty diaper or washing dishes or  the ordinary stuff of life to bring the therapist back from the cloud of adoration to solid ground again. But in order for those relationships to keep us grounded, they need our attention too, because when they become dysfunctional, the flight into the consulting room is an easy escape. If I am fighting with my husband or struggling with my kids or estranged from my friends, a call from a patient who needs me, who believes I can help and who adores me, rescues me from the unpleasant feelings those conflicts bring and makes me feel special and valued. So I become more open to my patients and avoidant of the people in my outside life. 

I suspect this is what has happened to Paul and now all of it is crashing in on him — his wife’s affair, his son’s school problems, his daughter’s possible problems and his patients are not providing the escape they once did because they keep bringing his own issues to the surface. The more Laura declares her love for him, the more Paul is faced with the rejection of him by Kate. Laura moves toward him as Kate moves away from him. Alex’s struggle for control over the sessions, over his life mirror Paul’s own efforts to keep everything together.  He can feel that someone in Sophie’s world has broken the rules just as he tries to push away his own fears that Kate has broken the rules of marriage. Life in the office no longer provides escape from the messes in his own life.

One other thing to file away — Kate mentions something about Gina having written about Paul in the past, in a way that suggests that this was a big factor in the rupture of Paul’s relationship with Gina. I suspect we will hear more about this as it sounds like Paul may have felt betrayed by something Gina published and that will take us into the issues clinicians face when writing about cases.

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