Episode opens with Paul talking on the phone to his son. And we learn thus that his wife has moved in with another man and Max doesn’t like him. He and Kate spar with each other, she hangs up. Wendy, the woman he mentioned to Gina at the end last season, seems to be living with Paul.

Paul has a tremor in his right hand — remember, his father died of Parkinson’s — which we see when he puts down the phone.

First patient and first visit: Sunil’s son and daughter-in-law bring him to the appointment.  Sunil certainly looks depressed — his face and his body reflect his sadness eloquently. Son, Aaron, and daughter-in-law Julia come in to session — Paul comments on this as unusual. 

Sumil has been in New York for 5 months following the death of his wife and is having trouble adjusting. As Julia talks about what the problems they are concerned about are, we see she seems to be in charge, angry and wanting Sunil to be gone, though she doesn’t say that. The son seems rather passive and caught between his father and his controlling wife. At one point, Julia wants to talk with Paul without Sunil in the room, but Paul refuses.

Aaron is a physician, an osteopath, and has prescribed Effexor for his father, because, Julia says, therapy is a shameful thing in India and reserved for the insane. Julia expresses discomfort with Sunil and the way he looks at her. Sunil says in Hindi that it is because she is empty.

Finally Paul asks Aaron and Julia to leave the room.

Paul gets an ashtray for Sunil, who had earlier taken out his tobacco only to be admonished by Julia. 

Sunil confirms with a story about a man from his childhood that psychological treatment is not seen as a positive in India. He makes a cigarette and lights it. Paul says he generally does not allow smoking but if it will make Sunil more comfortable, he is fine with it. Sunil asks if Paul ever smoked and Paul says yes, he did and sometimes misses the smell of it even today. 

With this, Sunil seems to become more willing to talk. He tells Paul that his son changed his name to Aaron from his Indian name. He finds this offensive. He implies Julia makes the decisions and says his son is not the man he used to be. He and Julia pretty clearly  do not like each other.. He tells Paul he puts the Effexor pills in a flower pot in his room. 

Sunil  tells Paul he was married for 30 years. He misses his wife, grieves for her. And when he tells Paul about this, it is clear the depth of his sorrow about her death and his loss. He says Aaron and Julia have decided to have another baby and he will be moved to the basement, thus displacing him yet again.

Session ends and Paul says he would like to help him. Sunil says maybe he could write him a prescription that would allow him to return to India and his wife would be alive and they could be together. Paul says he wishes he could bring her back. Sunil agrees to return to next week at the same time.

He thanks Paul again for letting him smoke. 

Payment is not dealt with though Julia asked about it before they left the room.  After Sunil has left, Paul opens the window.

First sessions are often tough. It can be difficult to get a handle on the patient and a sense if this is someone we can work with, someone willing to engage in the therapy process. In the first half of this session, it did not look promising. Julia was overbearing and angry and Sunil did not speak to Paul or in English. Had the session continued as it began, I don’t see that therapy would be possible. In fact I am surprised that Paul did not ask Julia and Aaron to leave sooner. As long as they remained in the room, Sunil was treated like a child. And as Paul said, it is not usual for family of an adult to be in the session.

The issue of allowing a patient to smoke in a session is an interesting one. Because I really dislike smoking, I have never allowed it. It has been years since a patient even asked if it would be all right to smoke. Some therapists allow it in the belief that some patients need that to allay their anxiety. I’m not persuaded by that argument. And it doesn’t really allow for exploration of what being able to smoke or not smoke means to the patient. No matter how long the window is open, traces of the smell of the smoke will remain in the office, in a way an intrusion of the previous patient into the time of the next one. Clearly I can find a lot of good reasons not to allow smoking in my office. And truthfully even without good clinical reasons, I still wouldn’t because I so dislike the smell. I’m interested to know what any of you have experienced on this issue.

The last thing that caught my attention is the issue of payment. Julia is in charge of the money and doles out an allowance to Sunil, further infantilizing him. My preference would be for that issue to be between Sunil and Paul, without Julia in between. If she is in charge of payment, she becomes a kind of third party to the treatment and in control of how long it can last. 

In the snippet of conversation between Paul and Kate, we know there is still a great deal of tension between them, which I suspect we will learn more about as the season progresses. As we will about Paul’s tremor.

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