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.

Mia takes a call from her father. 

She tells Paul she wants session notes but Paul says he doesn’t take notes. He asserts that many therapists do not take notes. They argue a bit about this and she rather snidely says she is pretty sure he took notes with her. She takes another call and Paul wanders around the office while she is out on the phone. She returns and tells Paul the photos he was looking at are not hers, that she never married. 

They move to a more comfortable sitting area and she asks if Paul consulted with anyone on the case. He tells her he consulted with Gina each week. But he is not certain Gina would agree to appear because things were strained between them.

Paul explains that Alex was not in treatment very long. Mia asked if he referred him elsewhere and why did he leave. Paul said he wanted to leave and told Paul not to mess up his, Alex’s, life. Mia says that the opposing lawyers can claim he let a depressed patient go without referral.

Paul picks up on some issues in Mia’s questions that are arising from Mia’s history — did the therapy end too soon. Paul is uncomfortable with Mia dealing with his case. Mia says they have been in this place before when she was seeing him years ago. Mia is angry because she feels Paul abandoned her and that they did not in fact deal with how things had to end when he moved. Paul comes back to the fact that Mia grabbed his case and he wonders why. He tells her he believes that she wanted him to see she is a success. She angrily throws the appearance of her success in his face. Paul reflects that she wanted to show him both how well she has done and how sad she is.

They both rise to end the meeting. He leaves. She sits back down on the couch.



Dual Relationships and Notes --

Paul was correct in the first place that it was not a good idea for him to consult Mia given their prior therapeutic relationship. To follow through would create a dual relationship even though the therapy was years in the past. Because in reality the therapeutic relationship, once established, remains in effect even if dormant. That is the tightest standard, though some would be more relaxed and say that after a few years it can be relaxed. But as we saw tonight, bits and pieces of old issues for Mia came up rather quickly and she was relating to Paul more as her therapist than as a client from very early on. So the kinds of reciprocal relationships that are commonplace  between other professions and occupations really don’t work for therapists, at least not for those who work from a psychodynamic or depth perspective. Once undertaken, the therapeutic relationship has primacy over any other relationship the two might have or want to have.

About Paul’s lack of notes. I’m sure every risk management-aware person nearly had a coronary when Paul said he didn’t take notes, that he didn’t feel the need to do so. But I understand where he is coming from and I suspect that he is correct that many do as he does, documenting patient visits through billing records but not through session notes. And in fact, because therapists do not have privileged communication — our records can be subpoenaed — many choose to keep minimal to no session notes to preserve the patient’s privacy. It is an ethical decision a therapist must make for him/herself.


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