InTreatment, Season 4, Week 4

Week 4 — what to say? Brooke is deeper into her relapse, pursuing unconsciousness with a vengeance. It is painful to watch. Everyone that we see her with tries to connect with her and every time at the critical juncture, she flees either literally or figuratively.

Eladio confronts Brooke — “What am I to you?”. He feels her double messages, tells her she runs hot and cold. He wants her to be with him as he is with Jeremy, his charge, whom he loves and loves enough to be honest with. 

Colin, who like the good narcissist that he is, is at turns charming and maddening. He invents stories to tell her and when caught in the lie, makes another story. She does not really respond to the one naked thing he says which is “I want you to like me.” Underneath we know he feels that he can only get people to care by doing his charm offensive, that if he is real, he will be rejected. He succeeds in making Brooke angry and she tells him she had promised herself no more narcissists because they don’t change, shooting her own arrow into Colin. She would need to hold her therapeutic stance, to let him feel, and to work to get deeper inside his need, his desire to have her like him. One wonders how she might respond differently were she sober and not mired in her own lies and emptiness.

We see how really wounded Laila is this week. Brooke is better with her but seems not to get until the end of the session that Laila is likely suicidal. 

And then Adam, who isn’t especially appealing but who tries to connect in some way with Brooke. At the beginning of the week he offers to have a child with her if that would help. And he accurately identifies that her son, gone from her since birth, is more of an idea than a reality, hence his suggestion that they could have a child together.

Brooke has another bender and this time it is the last straw for Rita who tells her she can’t stay, that when Brooke is ready to stop drinking, she can call her. Brooke complains to Adam about Rita and sadly, he colludes with Brooke’s claim to victimhood. He again tries to connect with her. They have sex but she seems hardly there—to be fair, she was drunk so unable to be present. Then as they finish, she passes out, becoming literally unconscious finally.

Watching Brooke this week was depressing. And made me angry. I wanted to shout at her and at the writer’s who have created this mess. Many years ago, I and some friends attending a family therapy workshop volunteered to role play a family for the workshop leader to “work” with. The family we fell into being was rather like the characters in this season — types, exaggerated, unrelenting. We became caricatures of family. 

I don’t know where things can go with the rest of the season. A suddenly seeing of the light on any of their parts would feel phony. Yet sliding down even further a bleak prospect. 

I noticed today that HBO has released all of the remaining episodes.I plan to watch them this weekend and next week post about what I see and reflections on this season and tissues it raises. For now, color me less than pleased.

In Treatment, Season 4, Week 3

Here we are at week 3 and I remain ambivalent about this season. In fact it took me until today, several days after they aired, to watch this week’s cases. So this week I want to focus on what it is that makes me uneasy about the characters this season, especially about Brooke.

I am beginning to feel that what appears to me as maybe sloppy work with her patients can be attributed to the fact that Brooke is drinking and has been, we learn this week, since her father died. All therapists are human with human problems. Our personal lives can become messy and troubled. But we have an ethical obligation to deal with intrusions from our personal issues into our work. And Brooke is not meeting this obligation. Yes, she talks with Rita who is, in addition to being her friend, is her AA sponsor. In a way this is a dual relationship not unlike the one Paul had with Gina. Dual relationships are problematic because both roles ultimately get short-changed. And Brooke needs more than a friend and sponsor to deal with her problems. AA can be great for gaining and maintaining sobriety, but Brooke’s issues, just from what we know so far, run deeper than her alcohol use and to a degree certainly drive her desire to drink. We don’t hear this week about Brooke dodging Paul and her regular supervision but there is no reason to believe she changed her behavior.

In each of the sessions with the three patients we see, Brooke jumps away from strong expression of their feelings. Eladio spoke movingly and intensely about his care for his charge, that he loves him which Brooke in time connected to his own need for care and for good mothering. Eladio responded by wanting to end the session early and instead of gently encouraging him to talk about what he was feeling, she assented and then immediately called her psychiatrist friend to refer him for evaluation and possible medication. When she calls him to tell him, she also tells him she questions his bi-polar diagnosis, which makes me wonder why she didn’t explore this with him further before or even if making the referral. I suspect it was Eladio’s strong emotions which elicited what looks to me like a countertransference response from Brooke.

Then Colin began with wanting to please her, to make her like him. They sparred throughout the session. Brooke becomes a bit coy in manner with him at times. At the very end he asks her if she likes him and rather than stay with that, with his, for him, rather naked need, she pushed him away. If he stays for just the mandated 4 sessions, they have only one session left. He has said he just wanted to get that requirement met and done, yet he did not show signs of wanting to bolt most of the session and with some encouragement from Brooke might well begin to sink into the process.

Finally Laila whose grandmother pretty much tells Brooke that she is not doing her job to prepare Laila for college and intimates that there won’t be many more sessions. The work with Laila, as with Eladio, for most of the session is pretty good. But, as with Eladio, when strong emotion led Laila to defend against it by taking out her phone to text her girlfriend, Brooke exits the room. She doesn’t stay and challenge Laila or encourage her to talk about what she is feeling. She just gets up and leaves the room, ostensibly to get something to drink. Laila gets ready to leave, says goodbye to Brooke who says she will see her next week. And then Brooke takes out a bottle of vodka and pours some into her energy drink. Once again, strong emotion leads Brooke to flee.

Finally in the time with Rita, the dimensions of Brooke’s behavior become clearer. Rita is caught between wanting to soothe her friend and doing what she knows as her sponsor she should do given that Brooke has relapsed. In the end, she yields to the friend side, which is a shame because Brooke needs someone to hold her accountable. Underlying the drinking on this day is news she received that she would not be able to reconnect with her son who was placed for adoption right after birth. So Brooke is grieving the death of her father, the loss of the hoped for reunification with her son, among other things. She needs help and so far at least is not only not seeking it, she is actively rejecting it. 

I am anxious to see how much more of a train wreck Brooke will create in the remaining weeks and which of her patients will settle down into therapy and stay. 

What do you think?

In Treatment, Season 4, Week 2

In the second week of this season’s In Treatment, I remain ambivalent. I like all of the actors and do not especially like any of the characters. I struggle to understand why Brooke, who describes herself as some variety of longer term probably psychodynamic therapist is seeing these patients. 

Eladio is a good candidate for depth therapy *if* it weren’t dependent on his employer paying. He would be a tough one to work with because of his history with probably drug use and shakiness of his life circumstances, but he seems psychologically minded, can reflect on himself and is so very eager to attach to Brooke. But his employer is looking for a resolution to Eladio’s insomnia, not for his personal growth so the resources for long term work are not likely there. I understand the appeal of working with Eladio and how Brooke is somewhat seduced by him, so she is going to have to keep an eye on her countertransference with him and be ready for him to leave well before he is actually ready.

Why Colin? Referred by the court — which is already an issue because Brooke is being hired for reporting on her assessment of him, not by him for therapy. In my experience these kinds of referrals rarely go anywhere past what is ordered, because the patient is not the initiator of the referral or the work. So she has accepted him and as a pro bono patient too — why? And why is the court not paying for the four sessions which it has ordered? So I am puzzled by the fact that Brooke accepted the referral. The verbal fencing he does with Brooke and the avoidance of anything resembling real  insight would wear thin pretty quickly. That he is there to get an approving report from Brooke feels to me like the only real skin he has in the game and the major reason he is there at all. The fact that he has crashed and burned his life could be the impetus for real work in therapy, but only if he is willing to drop the mask and be vulnerable. 

Then we have Laila.It is never clear that much if anything Laila talks about is really personal. Her character is drawn more as a type than as a person. The one place where I could feel her was when she talked about the way she and her girlfriend created imaginary worlds together. There was a playfulness and creativity in what she described that is very different from the brittle intellectualizing she more usually indulges in. We see in her talk about her relationship with her girlfriend a look into who Laila is underneath the mask she wears. She tells Brooke a dream, which Brooke deals with entirely as about the reality of being a black woman, which certainly is part of it. But she makes no attempt to bring the dream back to Laila and what is says about her life today. The Jungian in me wishes she had invited Laila to actually work on the dream with her as that very well might have opened this therapy up a lot more. As with the other two patients, there is every reason to feel the work with them will be short term. Laila is going off to college for one thing and her grandmother brings her to Brooke to prepare her for college. These patients seem misaligned with what Brooke purports her practice to be. 

We learn in Monday’s segment about Brooke, that Paul, from previous seasons, is Brooke’s supervisor. Rita says she thought Brooke talked with him every week. We have seen Brooke dodge his calls and emails so we know Rita is right when she asks if Brooke is avoiding him. That she is doing so is a big red flag given Brooke’s issues. It is clear that Brooke has some issues with Paul in fact, referring to him as the “world renowned Paul Weston” out of anger maybe or envy. In the process of her talking with Rita, we learn that she has thought about having a baby with Adam. We know from earlier that at age 15, she had a baby which her parents made her surrender for adoption. And now she wants to find her son.  So we have Eladio wanting a mother and Laila without a mother and Brooke struggling with the loss of her father and longing to find her son — a potent stew indeed. I was intrigued that Rita sat in one of the chairs and Brooke on the couch, reflecting perhaps the way she and Brooke are relating, more as therapist and patient than as friends.

As I said before, I like the actors this season but find the characters they are playing kind of lacking. The three patients seem like types rather than full fleshed people. They embody an issue or group — Black American teens or privileged white men or essential workers who aren’t treated that way — more than they stand out as unique individuals in need of help. Plus we haven’t heard at all how the changes wrought by COVID has impacted them, which seems quite unrealistic. In my practice my patients regularly talk about issues and feelings they have arising from the pandemic so how can it be that this is not a major element in this season?

What are your thoughts? What do you like? Dislike?  Let’s talk about it in the comments.

In Treatment, Season 4, Episodes 3 and 4

Episode 3, Laila, and Episode 4, Brooke and Rita, aired four days ago. Usually I like to post about each episode within a day of its airing but this time I have just had a hard time finding what stood out for me. So read this with my ambivalence in mind.

Laila —

Laila is brought to her first session by her grandmother who seems to think that 2 or 3 sessions should be enough. Laila, she says, is “choosing to be gay” and grandmother wants her prepared for what she faces in college.

I confess it has been years since I worked with a teenager — once my own kids were teens, I just didn’t want to deal with more teen issues. And I confess that Laila reminds me why. She is defensive, provocative, sarcastic, often hostile. Brooke manages all of this pretty well, even though none of her efforts gets Laila to speak of herself other than with labels. She gets Laila to move out of the usual physical set up of sitting opposite each other and move to a table where they eat Easter candy. But Laila stays guarded.

We don’t learn a whole lot about Laila in this episode. We know she says she is gay. She claims to be a sex addict. She’s the only child of what she describes as a workaholic. Her grandmother has taken the place of her mother — but what happened to her?

Brooke’s effort to reach Laila and her recognition that she has to earn her trust are spot on but it remains to be seen if Laila will really engage in therapy. It is the relationship between therapist and patient which is the vehicle for the work of therapy and Laila is pretty armored.

Brooke and Rita

Rita is Brooke’s friend who shows up after  having been away for a while. We learn that Brooke’s still mourning her recently deceased father, and her toxic ex Adam  is slowly but surely easing his way back into her life. And that Rita is apparently her AA sponsor of many years. So here is the dual relationship again — the friend who is also her sponsor.

This was difficult for me. I was critical of Paul in the first seasons for having a dual relationship with Gina, for the blurring of lines between friendship and supervision. But there was at least a nod given to the need for a professional component in that relationship, a component that is missing this season. All of us therapists have issues in our own lives. Part of our task is to stay on top of them and not use work with patients to deal with them. Supervision and personal therapy are the best checks on what we call countertransference. Given Brooke’s loss of her father and what seems to be complications in her relationship with her boyfriend, to say nothing of the stresses and strains she, like everyone, is subject to during the last year of COVID restrictions. 

Rita does ask Brooke some pointed questions, but the fact remains they are friends and that is the relationship, not a therapeutic one. Which is not to say that friends cannot be immensely helpful but to me, this is a case where it would help a lot if Brooke availed herself of supervision and/or therapy.

So we’ll see how this unfolds. 

In Treatment, Season 4, Colin 1

Brooke’s second patient, Colin, is a court referral, referred for four sessions of mandated therapy. He was a tech executive who fell afoul of the law and went to prison for financial crimes. The woman with him, a parole officer I suspect, tells Brooke he must attend the sessions and that the basis for the referral is his anger issues. Brooke sees Colin face to face in her home office.

Charming at first, there’s a definite darkness underneath. He complains about the burden of being a privileged white man, knowingly provoking Brooke. Colin tells Brooke he has been therapy before, is glad to be there and glad to be out of prison. He says he “fucked up” his life. His accounting of himself is liberally laced with swearing, which he checks to see if she minds. He denies any history of violence, says he is a pacifist raised by hippies.

Colin looks around a lot and evades Brooke’s questions. He asks about her husband getting her to say she is not married. She says he is her first pro bono patient. He says he wants to talk about her, get to know her. Brooke tells him she grew up in the neighborhood they are in, that her father designed some of the houses in the area.

There is throughout an underlying tension. Colin seems used to being able to charm his way into getting what he wants. Brooke asks questions he does not want to answer. He tells her had a bad day in prison and reached his breaking point — she reminds him that in fact he was put into seclusion. He says he ruined his life.

At every turn, Colin resists giving details about himself and his history. He tried to provoke her but she resists. She confronts his downplaying and evasion. Colin is impressed and says, “You’re good. I hadn’t anticipated that.” But he is angry at her confrontations and is defensive. He claims he gets “pummeled” every time he opens up. “You want me to be safe”, he says, “but I am not safe.” This leads to mini-debate about words and a brief outburst by Colin. Clearly his charm is not working as he expected.

Brooke asks how it has been since he got out of prison. He tells her it’s okay but that people don’t want to be around him. Then he says “I fucked a lot of therapists. How about you? Have you fucked a patient?” and shits on his former therapists. Brooke wonders if he is up to the work of therapy. He apologizes and attributes his behavior to stress. Lots and lots of words but not much meaning.

Colin leaves. Brooke gets up and gets herself a drink.

 Colin is a tough patient. I wonder why Brooke is willing to take him on under the four sessions mandate because it is very doubtful that anything meaningful can be accomplished in that time. No doubt there is a lot to mine in Colin’s history and it likely would take a fairly long time to get him to settle down and actually engage with Brooke in their shared work.

Colin masks his rage and hostility beneath a thin veneer of charm. He talks a lot but much of what he says seems aimed at getting a rise out of Brooke. She skillfully parries his attempts to goad her. My guess is that it is a bit of an exhausting hour — witness her need for a drink after he leaves. And what is that about? Why alcohol? 

What do you think about Colin? About Brooke’s response to him? Does anything surprise you?

In Treatment, Season 4, Eladio 1

And so we begin Season 4 of In Treatment. This is a show which does a reasonably good job portraying psychotherapy. Each session is condensed into 30 minutes, shorter than actual sessions but manages to convey something close to what actual therapy is like, as close, probably, as television can come without turning to a reality show format.

Let’s start with what is different from the get-go in this season. The show is set now in Los Angeles rather than Brooklyn. The colors of Brooke Taylor’s home office reflect a brighter California palette rather than the more somber browns and leather of Paul’s Brooklyn office. Like Paul, Brooke has her office in her home. For the past nearly 15 months nearly all therapists have been working with patients from their homes via video connection or telephone. In the first session, we see Brooke work as most of us have been, in the virtual space of video connection. This season we see in both therapist and patients a heightened sense of the need for diversity, which is a change from the first 3 seasons. We see from Brooke’s email box and photos that she has some kind of relationship, perhaps as a protege, with Paul Weston, the therapist from the earlier iteration of the show.

Our Sunday patients are Eladio and Colin. We learn from Episode 1 that Eladio is a home health aide employed by a wealthy family to care for their son; the empolyer is paying for Eladio to see Brooke. The season opens with Brooke receiving a phone call late at night. She declines the call but the caller immediately calls again and we see it is Eladio. He tells her he didn’t expect her to answer then tells her a dream. 

Next we see Eladio is video session with Brooke. Brooke apologizes for answering the phone the previous night. In what follows we learn that Eladio has not spoken with his mother for 4 or 5 months, that she had COVID and that she refused his help. And we learn he is an only child though his mother told him there was a stillbirth before he was born.

Brooke tells him he can call her in emergencies. Eladio reacts to this, telling her not to do that, to do what feels to him like rapping on the knuckles—this suggests his desire for unlimited access to Brooke. She tells him it is up to her to set boundaries. He rather quickly tells her he wants a referral for medication because he isn’t sleeping. She says she needs to know him better before she can feel comfortable making such a referral and she quotes Jung —“There is no coming to consciousness without pain.” She lets him know she is not casual about meds, that this work is not fast and that hers is not a results oriented practice.

Eladio then tells her he was diagnosed Bipolar I in college and is on lithium which he takes when he can afford to buy it. His employer does not know about his diagnosis. That he used to work with old people that he would become attached to then they would die. — that is when his sleep problems began, he says. That he fell in love with an addict who abruptly cut him off. Brooke tells him it sounds like he is haunted. Then Eladio asks her if she is going to take care of him, be his family. The session ends abruptly when his charge needs assistance.

So what do I notice?

First, like Gabriel Byrne, Uzo Aduba is riveting in the part. She is beautifully dressed in bright colors very like the furnishings in her home office. My sense though is that the orange chairs in the office are not especially comfortable and she shifts about in her seat as if that were the case. The chairs look great, but for a day’s worth of work? Maybe not so good.

Setting boundaries with Eladio right from the beginning is important. That after having seen her only twice he calls her late at night is an indicator for her that he needs boundaries. A friend of mine and I spoke recently about late night calls and that we have rarely if ever had any while in private practice. So Eladio’s call is at least unusual. And we see as the session progresses that he is hungry for a mother, being somewhat estranged from his own and having experienced so many losses. Brooke’s observation that Eladio is haunted — by the deaths of his never known sister and the patients he cared for and the disappearance of his addict lover — stands out and leads Eladio to express his need for family and care. 

What do we learn about Brooke from this first session? Her father recently died, so we know she is grieving. It looks like she lives alone. So we know that she, like most of us, is dealing with her own pain and issues as she works with her patients. Surely Eladio’s losses bring her own to her mind, as happens again and again in depth psychotherapy.

Now a quibble. In looking for the whole of the Jung quote, I learned that Jung never said: “There is no coming to consciousness without pain.” 

What he said in two separate and unrelated statements was:

“Seldom, or perhaps never, does a marriage develop into an individual relationship smoothly and without crises; there is no coming to consciousness without pain”. ~Carl Jung, Contributions to Analytical Psychology

and 

“People will do anything, no matter how absurd, in order to avoid facing their own souls. One does not become enlightened by imagining figures of light, but by making the darkness conscious.” ~Carl Jung, Psychology and Alchemy

With that small correction, still I am delighted that Jung is mentioned. And this sets Brooke within the field of depth psychotherapy and explains her statement to Eladio that hers is not a “results oriented practice.” It doesn’t mean that patients do not change but that particular results are not the goal.

What are your thoughts? Comments? Impressions?

Later today, our second patient, Colin.

Attention Fans of In Treatment!

Ten years ago, HBO’s In Treatment ended its third season with no prospects in sight for renewal. I had blogged every one of the episodes as they were broadcast, a big undertaking for what was then a relatively new blog. I loved the series and see it as the best fictional representation of therapy that I have seen. The liberties taken for the sake of drama and the way the pace of therapy was made to fit the show did not bother me for it was the issues it raised and the interactions between therapist and patient it showed that struck me. And it was a good opportunity to discuss ways the the therapist, as portrayed by Gabriel Byrne, deviated from and/or stayed with the boundaries of therapy. So when it ended, I was very disappointed. I had not only written a lot about the show, but had also used it to teach three courses in my local Senior College.

Imagine my delight when HBO announced a little while ago that it was bringing one of my all time favorite shows back for a new season. And now the debut of Season 4 is almost upon us – starting tomorrow, Sunday May 23.

We will see a new therapist, played by Uzo Aduba, a black woman. And it is set in Los Angeles rather than New York. For an overview of the coming season, check out this article from the NY Times. And I will be posting my comments on each episode starting Monday morning. 

In order to be good, I have to feel bad…

 Anyone who looks at me can see that I am fat, yet even calling myself fat and not being embarrassed or ashamed of that simple fact is less ordinary than we might think. Stigma is attached to being fat. Everywhere every day we encounter messages about weight and dieting and by implication the undesirability of fat. So, fat activists some years ago began to talk about and write about “coming out” —

“Unlike the gay body, the fat body is always already out. The fat body is of course hypervisible in terms of its mass in relation to the thinner bodies that surround it. As Moon suggests, the fat body displays ‘‘a stigma that could never be hidden because it simply is the stigma of visibility’’, and asks the question ‘‘What kind of secret can the body of the fat woman keep?’” — Samantha Murray

To come out as fat means to own it without apology or defense. It means owning my body as my own. It means surrendering the idea that the “real” me is thin and one day I will find the right diet or pill or potion that will release me and make me that “real” me. It means confronting inside myself the internalized fatism and stop hating my body. It means resting quietly within myself. 

Coming out as fat is not the same as coming out in the LGBT world. Because fat is visible and it is no secret to anyone who sees me that I am fat. In the case of fat, it is not a statement to the world, to my world, so much as a statement to myself, reflecting acceptance in myself of my body. 

But as a fat woman, in order to be good, I have to feel bad. In order to feel good, I have to be bad.

If I want to be perceived as good, I, and fat people in general, must present myself as the Good Fatty, the fat person who accepts the socially dominant viewpoint that my number one goal in life is losing weight. All I have to do is talk about trying to lose weight, about my desire to be thin. I can say I have lost 10 or 15 or 30 pounds and I will be praised for my efforts, even if it is a lie. The Good Fatty is apologetic for being fat and is in a perpetual state of trying to become thin. The Good Fatty doesn’t’t threaten thin people because she tells them she is engaged in the same struggle to subdue her body that they are. The Good Fatty is apologetic for her fat, as if she must ask forgiveness for committing an aesthetic crime with her too-muchness or must do penance for taking up too much space. She doesn’t complain that very few stores carry clothing in her size. She accepts as just that she pays more for her clothing, health care, and seats on airplanes. Because she knows she deserves it. She accepts without protest the “helpful” advice and criticism she receives from others because she is trying to become better, to become thin. She swallows her anger because she knows it is all her fault, that she has failed, and is getting what she deserves. She manages her fat identity by covering, by accepting that she should not be fat. She tries to cover her failure by always being in the process of trying to change, a perpetual state of atonement for the sin of being too big and too much.  She can be good so long as she feels bad.

But suppose I want to feel good, not bad. What then? Suppose I call myself fat. Not curvy. Not Rubenesque. Not zaftig or plump. Fat. I call myself fat. Just by calling myself fat, using that word unselfconsciously and without shame or apology, is to move away from being the Good Fatty. Just by calling myself fat, I break a taboo.

But what else? Embracing myself as I am. Coming out as myself, a fat woman who is simply who she is, what she is.

I made the decision over 40 years ago to stop dieting, I never talked about it with friends. I wasn’t dieting but I wasn’t willing to be public with having stepped out of being good, of forever being on the way to being thin. Being the Good Fatty is acting as if I embrace body hatred, dieting, guilt and shame so that I can at least be on the fringes of membership in the “normal” world. I can be good only by feeling bad. By feeling bad I can in a way be normal, be like other women. So stopping dieting is not coming out. It is an act of rebellion, to be sure, but the rebel is always defined by that against which she rebels. 

Coming out means being willing to be bad. It means letting go of the fantasy that there is a thin person inside waiting to get out and that she, not this fat me, is the real one. Coming out is to stop pretending to be trying to lose weight when I am not. Coming out means stopping defending how I eat or my health. Coming out is letting go of shame and embracing the body I have. Coming out is accepting myself, all of myself, fat and all. I can’t be good, be the way I am expected to be and do all of these things.

Perhaps the hardest thing, the most difficult part of coming out as fat, of leaving being good behind, is to really inhabit my fat body. Unconditionally. To love myself, my body exactly as it is, and not withhold that until I lose the 50 or 100 or however many pounds stand between me and being “normal”. No more apologies. No more mute acceptance of dieting advice. No more feeling bad because I take up space. That is the path to feeling good. It leads through a mountain of unexpressed rage and anger at having tried so hard for so long to be good, at having felt guilty and ashamed and bad for being too much. 

Therapy with a therapist who does not equate health with weight can be invaluable in the journey away from self-hatred to self-acceptance and love. 

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