Paul is putting water into a vase with some white peonies. He opens the door and his patient is there — early.

Thus we meet Frances, whose sister, Patricia, was Paul’s patient 18 years ago. She starts by asking if she looks like sister. Followed by talk between them of the ethics of Frances becoming Paul’s patient. He says given that it was so long in the past and that she is no longer seeing him, it is all right if Patricia is okay with it.

Frances says she called because she is opening in “Night of the Iguana” and is having trouble remembering lines. She asks if Paul sees her as a former star and then makes a joke about being the cliched narcissistic actress. Paul asks about her previous history and therapy. She ticks off a variety of alternative kinds of approaches, including seeing a shaman when she was on location. Then again in an attempt at humor suggests it is  cliche that she is coming to therapy, to the therapist her sister saw when her mother was dying. Frances says she was never attracted to traditional therapy because it seems naked, sitting and talking. She is anxious. She refers again to her sister. And then returns to the issue of the forgetting lines. She tells Paul she learns the lines and then in rehearsal, she loses them. Paul asks if the part makes her uncomfortable, if she trips over lines in particular places. She denies this is the case and asks if he saw Ava Gardner in the film version. Then that she has heard that one of the producers didn’t want her because she is too old.

We learn that she was married to a history professor at Columbia who used to help her learn lines, but they are now divorced. They have one child — 15 yr old Izzie. She says the daughter is doing well but when she tried to change custody arrangement now that she is in New York, the father became unhappy saying the daughter didn’t want it. So now she and Izzy are estranged. She says her daughter sees her as having bailed on her responsibilities by taking the play but Frances feels she doesn’t appreciate how much she passed up to do things for and with her.

We see a momentary lapse as if Frances forgets her train of thought and wonders why she started talking about the issue with custody Paul says it’s hard with teens. She talks about how she handled work and making sacrifices to see her mother when she was dying. Paul says she could handle it then but she was younger. Frances gets angry he mentions aging. She tries to turn it on him and his age. When he asks if age is a sensitive issue for her, she says she bets he is with some 25 yr old and again mentions what her sister said about him. He says they seem to talk about him a lot. 

Frances tells Paul her sister married and is now a widow. Then she says her sister is sick — with breast cancer like their mother — stage 4. Paul expresses concern about the sister — is she seeing a therapist? Frances is not happy at the focus leaving her. She says “death runs in the family”, referring to her mother and her sister both having breast cancer. She doesn’t want to be tested for the gene associated with breast cancer but sister wants her to. Then she reveals the sister now also lives in New York. At the time rehearsals started, it became clear that chemo was not helping Patricia and they had stopped treatment. 

Paul wonders if in light of a difficult divorce, estrangement from her daughter, and her sister’s illness, was it a good idea to take the play? Frances says work is the solution but she is failing. Paul suggests she might need to fail, self sabotage. Paul points out that she lost her train of thought when she accused herself of being selfish and maybe that’s what happens in rehearsal — which she is doing for selfish reasons. Paul asks if she thinks there might be some special meaning in coming to see him because of his prior relationship with her sister. Only then does she say Patricia is dying, something she has not allowed herself to say before.

She ends the session and asks if he always buys fresh flowers or did he do it for her. He suggests she pay attention to what she was feeling if she goes up in her lines.

Paul goes to his desk and picks up the phone. He speaks with another doctor and after they exchanges pleasantries about their kids, he asks for a referral to a neurologist about Parkinson’s. He is asked to hold.

There is much more energy in this session. As well as Sunil shows how slow and thick the session can be with someone who is very depressed, this one with Frances gives a good sense of what it is like to be with someone who is anxious. Throughout the session, Frances’ anxieties about aging and death weave in and around her questions, her attempts at humor and her frequent references to her sister. She gives the appearance throughout of doing a bit of a performance, trying to cover the flashes of deeper feeling and her anxiety with humor or deflection. 

When issue of whether or not it is all right for her to see Paul given that her sister was a patient years ago takes us into a piece of interesting territory. Regardless of the fact that patricia saw Paul 18 years ago, in the depth therapy perspective that relationship persists even without additional contact in the intervening years. Once a patient, always a patient in a sense as that form of relationship takes priority. So if Patricia objected to her sister seeing Paul, that would have to be dealt with and Paul likely would not see her. This may seem odd given that so many years have elapsed, but we can see through the many references that Frances makes to conversations she and her sister have had about Paul that that prior therapeutic relationship in a sense is still very much alive. I wonder about competition between Frances and Patricia, who we know is the younger sister, and what it means for Frances to start seeing her sister’s therapist. And why the sister did not call Paul when she learned of her illness and now that she is dying. I suspect Paul wonders this also. 

Paul’s expression of concern, his insistence really that Patricia should be seeing a therapist to help her cope with her illness reminds us of his work last season with Mia.

The first session in therapy is always important. Entire books have been written about the first session. Each therapist has her own way of beginning. I usually start by asking  what brings the person to me today or how I can help and then let the patient tell her story in her own way. There are others who use a more formal intake procedure, following a standard history taking format. Paul does pretty much what I do and follow the patient’s lead allowing that person’s story to unfold in its own way. In this way the first session takes the form of any session with the therapist listening, asking occasional questions, making an interpretation. Both parties are getting to know each other and the pace needs to be slow enough to keep the patient comfortable but also with enough depth to suggest how therapy is done. As a general rule, heavy interpretations do not belong in early sessions as they would likely meet with strong resistance and perhaps flight from therapy. So we see Paul asking Frances if perhaps there is a connection between the major events in her life and her problems remembering lines — a bit of testing the waters with her to see how she responds as a way of helping him to begin to understand how he must calibrate his efforts in order for her to be able to metabolize the work of therapy.

Jungians believe we get the practice that we need, that our patients bring to us the issues that we must tend to in our own lives. In these first two sessions, we see Sunil and Frances bring to Paul in their issues his own — with death, with family relationships, with estrangement from children, depression, work, and his own mortality and concerns about illness.

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