Healing?

bent branch
bent branch

“Psychoanalysis cannot be considered a method of education if by education we mean the topiary art of clipping a tree into a beautiful artificial shape. But those who have a higher conception of education will prize most the method of cultivating a tree so that it fulfils to perfection its own natural conditions of growth.”Jung CW, vol. 4, para. 442

People come to therapy expecting cure or healing from their problems. I don’t think of therapy as healing in the usual sense. To heal means to make whole or healthy, to recover or restore and comes from the root kailo meaning whole or uninjured. In order to think of what I do as healing, I would need to see the people I work with, and indeed myself, as broken, ill and I don’t, not in the sense of illness. Barbara Stevens Sullivan has a wonderful way of putting this:

“In some sense, a person is her wounds. A sapling, planted beside a supportive stake that the gardener neglects to remove, will grow around the stake. The stake’s presence will injure the growing tree; the tree will adapt by distorting its “natural” shape to accommodate the stake. But the mature tree will be the shape it has taken; it cannot be “cured” of the injury, the injury is an intrinsic aspect of its nature.” (The Mystery of Analytical Work, p. 175)

I do believe that all humans are wounded, varying in degree and type of wound, but we are all wounded. My first professor in abnormal psychology put it this way — from the moment of conception we are bombarded by influences of all kinds, both noxious and helpful and as adults we are who we are at least in part due to the effects of these influences. Some of us will be more scarred than others, but none of us will be unmarked by the experiences of our lives. So wounded per se is the normal state, not a state of ill-health. 

Now, the extent to which our wounds make our lives complicated and/or difficult is where therapy enters in. Problems in living are what bring most people that I have seen into therapy — the desire to experience life in a different way is the motivator. There is no procedure or pill or technique I can apply that will close the wound. I don’t have any tools in my toolkit that can create change in anyone. I don’t even really have a tool kit. what I do is listen and witness and sit with the people who choose to come to work with me, to tell their stories, share their suffering, explore their dreams. 

Whether or not healing is the appropriate description for becoming conscious of something that is an integral part of us, an unerasable part of our history, is something I balk at a bit. I can become more conscious of the ways I have internalized people and issues in my life. Becoming more conscious of them increases the array of possible responses I have available to me, so I can choose differently and thus find myself not in the old familiar ruts but in very different relationship to myself and those around me. That is what I believe therapy does for people.

I cannot ever be who I might have been had I not had the mother I had or the experiences in life I have had — I am indelibly marked by them. My life has been shaped by the containers in which I have grown. In the container of my own analysis, I have become freer in how I live my life and perceive my possibilities through the process of examining my thoughts, behaviors, history, dreams, reactions. That is what talk therapy as I know and do it is about.

Someone who knew me when I was 25 and knows me now would not notice too very many things different about me except that I am heavier, my hair is grey and I am wearing glasses rather than contacts — all external manifestations of age and the life I have lived. Someone who knew me very well then and now might notice that I am calmer, less prone to sarcasm, more contemplative, warmer, maybe more confident. They would recognize my delight in words and willingness to express opinions, that I have a dry sense of humor. That I am a bit shy and reserved, keep a pretty tight zone of privacy around myself. But on the whole, I would likely seem more relaxed.

The changes I have experienced in my life as the result of a long analysis are interior, and though they shape what others see, are most likely unknown to others. Those inner changes were hard won. The forces against them from my early life were fierce and did not go down without a ferocious fight. Through those hours of talk with my analyst, I began to be able to see the destructive bits and then to be able to not act on them, to let them go by, like bubbles rising in champagne. I still have moments of feeling like I used to feel, but I see it, I feel it when it happens and I now have the freedom to make choices that do not feed those moments and so they do not grow into hours or days as once they did.

I see therapy  as opening the door to new possibilities. I cannot undo my history, make myself as if my childhood or any part of my life had been ideal, but I can become more conscious of the ways that history and my interpretations of it have operated in my life. And that allows me to choose from a wider array of possible behaviors as I go forward. I think we are all wounded to greater and lesser degrees. So is therapy healing? If by that we mean it makes the wounds go away, I’d have to say no. But if we mean does it make life better, does it help us become freer, more alive, open to creativity? Definitely yes.

It’s the relationship

Many, maybe most people believe that therapists “do” something which makes patients feel better because it is hard to believe that it is the relationship between the therapist and the patient which is the healing factor.

If I go to the dentist because I have pain in my mouth and the dentist doesn’t help, I likely will seek help elsewhere, and that seems reasonable. But I look to the dentist to *do* something to make me feel better. The dentist does not usually, at least in acute situations, require of me that I do more than be cooperative and hold my mouth open. But psychotherapy is a different thing altogether. Therapists do not perform procedures upon patients in order to relieve their suffering. We might sometimes wish we could and certainly patients wish we would, but it just isn’t that way.

In any depth psychotherapy, the therapist does not tell the patient how to solve problems. The focus of treatment is exploration of the patient’s psyche and habitual thought patterns. The goal of treatment is increased understanding of the sources of inner conflicts and emotional problems. This understanding is what we call insight. Now insight without action is pretty useless. But the therapist doesn’t say to do this or that but instead might ask how this new understanding might be put into action in the patient’s life.

In order to accomplish this work of therapy, the patient and therapist must have a good working relationship, or therapeutic alliance. The patient needs to feel that the therapist is on her side, so to speak, allied with her in her desire to have a better, happier life. And in turn, the therapist needs from the patient a willingness to do the work of therapy, to put feelings into words, to talk about what she is thinking and feeling. And that includes being willing to talk about feelings of anger, disappointment or frustration about the therapy or therapist.

“For psychotherapy to be effective a close rapport is needed, so close that the doctor cannot shut his eyes to the heights and depths of human suffering. The rapport consists, after all, in a constant comparison and mutual comprehension, in the dialectical confrontation of two opposing psychic realities. If for some reason these mutual impressions do not impinge on each other, the psychotherapeutic process remains ineffective, and no change is produced. Unless both doctor and patient become a problem to each other, no solution is found.”  C.G. Jung

Most often when I hear people saying that therapy isn’t helping, I am also hearing an expectation that the therapist will tell the person what to do in order to feel better. And  to a very limited degree, we can do some of that — like take a walk or write in a journal or try painting or some other creative outlet when having difficulty between sessions. But on the big things — like whether or not to stay in a marriage or change careers or leave home or any of many many other important life decisions, we cannot tell a patient what to do. We, as human beings ourselves, have enough trouble finding our way through the complexities of our own lives and not only cannot, but really should not presume to be in a position to make decisions for others in their lives. No matter how much the patient may want it. But talking about wanting that, being angry that the therapist won’t do it — that is the stuff of therapy. Because it is the relationship with the therapist that facilitates change.

Ultimately we behave with the therapist the way we do with most important people in our lives, with the same kinds of assumptions about the therapist and about ourselves. And we do so unquestioningly. 

It is also true that it is difficult for the therapist to respond to feelings and issues that the patient does not talk about. All rumors to the contrary, we are not mind readers! This underlies the basic therapeutic dictum that the patient should say whatever comes to mind.

Now of course, this is difficult for most of us, conditioned as we are by social norms, by rules we have learned from our parents. Remember Thumper in Bambi:”If you can’t say something nice, don’t say anything at all”? Most of us operate on some version of that in our relationships and avoid saying things to another person that we think might make them uncomfortable or angry with us. But therapy is a place where Thumper’s Rule needs to be suspended. So, if you don’t tell the therapist you don’t feel cared about, there isn’t much the therapist can do to help you explore those feelings. Similarly if you are angry with the therapist, have sexual feelings toward him or her, or any of the myriad of other feelings and thoughts about the therapist you might have. It all belongs in therapy. Putting those feelings into words is a key  part of what therapy is about, after all, because that opens the doorway to understanding where they come from and how to deal with them in ways that are helpful rather than destructive in life.

You Don’t Always Get What You Want

A couple of years ago I read The Last Asylum, by Barbara Thomas. It’s one of those books that has stayed with me and leads me to think more deeply about the things she writes about — madness, analysis, healing. 

Thomas came to analysis wanting her analyst to take care of her, much as she wanted and got friends to take care of her. She wanted him to give her answers, to tell her what to do to feel better. It took a number of years for her to come to the place of accepting that he could not and would not tell her what to do or give her answers or take care of her. What he could do was help her to find her own answers but in order to do that she had to surrender.

This brings to mind a day when my daughter was 4 and had an epic tantrum. The kind of tantrum where I sat on the floor holding her, careful to keep my head out of the way of her flailing and hurling of her own head and let her be in that state, let her cry and yell and flail and just lovingly hold her so that she did not hurt herself or me. Finally she stopped yelling and the storm subsided into tears and then calm. I let go of her and she turned and said ”Mommy, why did I do that?” Just as Thomas railed at her analyst until she finally let go, my little girl had to do the same. Though of course there were many times in her childhood that she got angry with me or her father or brother, many times she felt us thwarting her desires, she found words to express those feelings and there were no more epic tantrums. In a way this is what Thomas describes. She had to go through that long struggle to get her way, to get what she wanted in order to get what she actually needed. She had to reach the point of surrender in order for her to get that.

And isn’t that what happens to many if not most people in analysis or in any other intense intimate relationship? Does there not come a time when to get what we need, we must surrender our insistence on what we want? Because we must learn the difference between want and need. Or as the Rolling Stones put it, “No, you can’t always get what you want But if you try sometime, you just might find You get what you need”. Thomas did not get what she wanted. My daughter didn’t get what she wanted. In my own analysis, I didn’t get what I wanted. But in surrendering that, low and behold, we got what we needed. The same is true in therapy. In order to get what we want, we need to surrender to the process and if we stick with it, we will get what we need.

Slow

Summer is the time for slowness. I have been reading a lot but not writing much, though I expect to remedy that in the next little while. Meanwhile, here is a lovely quote about therapy from Freud:

 “Nothing takes place between them except that they talk to each other. The analyst makes use of no instruments— not even for examining the patient—nor does he prescribe any medicines. If it is at all possible, he even leaves the patient in his environment and in his usual mode of life during the treatment…The analyst agrees upon a fixed regular hour with the patient, gets him to talk, listens to him, talks to him in his turn and gets him to listen… It is as though he were thinking: ‘Nothing more than that?… ‘So it is a kind of magic,’ he comments: ‘you talk, and blow away his ailments.’ Quite true. It would be magic if it worked rather quicker. An essential attribute of a magician is speed—one might say suddenness—of success. But analytic treatments take months and even years: magic that is so slow loses its miraculous character.”

In Treatment, Season 4, Weeks 5 & 6

 

 

I watched the last 4 episodes of this season last week. I had really looked forward to this show. I wanted to like it and be as interested as I was in the first 3 seasons. It hasn’t turned out that way. I have not even felt moved to write about the episodes in the way I did originally. So today I will offer my impressions of the season as a whole and talk about what bothered me about it.

I have said before that I very much like the actors. They do heroic work with what they have been given. But the whole thing lacks the verisimilitude that marked the first 3 seasons. It’s not the acting but the scripts, I think. In Treatment in its original form was notable for being the best representation of psychotherapy in a drama that we have seen. Compare it with Couples Therapy on Showtime and of course, the differences are glaring. Couples Therapy is a documentary series with a real therapist so does not operate in the confines of drama. In a way, comparing the two series is unfair. In Treatment took risks and experimented with format in ways that made it more compelling than it would have been as a normal drama. And it might even be that it paved the way for CouplesTherapy by demonstrating there is an audience for such a series. All of that is to the good. So what didn’t I like this season?

As I have said before the “patients” this season all feel to me like types and not so much like real people. The dialogue too often felt academic and a bit stilted. The stories just don’t ring true for the characters. I WANTED to care for the patients and the therapist, but I couldn’t muster the empathy. The dialogue just lacks believability. I found myself rolling my eyes at the screen and expressing my annoyance out loud, which I guess shows I was engaged at least at the negative level.

No therapist is perfect. Jungians speak of the “wounded healer” — that we are drawn in part to our work because of our own wounds. We deal with those wounds in our personal therapy and analysis so as not to act them out with patients but to have our experiences serve as a source of deep understanding. Brooke like most if not all of us is wounded. That doesn’t bother me. But she, through the course of the season, is an actively drinking alcoholic and is not in treatment herself, not actively, which means she is impaired. The problems this creates actually to my mind dominate just about everything she does. While we learn that Paul is her supervisor, they do not talk regularly and she does dodge him. In this way, she echoes Paul’s dual relationship with Gina. Brooke’s friend/sponsor, Rita, cannot provide all of what Brooke needs. Just as Paul did not get a firm handle on what he needed and wanted until he enters therapy himself with Adele, so Brooke is not getting what she needs though in the closing scene of the season she does call Rita and say she is ready to stop drinking. And that is great but only part of what she needs to do.

One of if not the best episode of the season came in week 5 when Brooke was to meet with Paul. Paul cancels at the last minute which leads to the device of Brooke, the therapist, meeting with Brooke, the patient—a little gimmicky but overall it works. We learn the most about her in this episode as she confronts herself. For me, it pulled together a bunch of things. In a sense, the three patients can, as in a dream, be seen as aspects of Brooke herself. Eladio and Laila both suffer, as indeed Brooke does, from mothers who cannot give what they need. Brooke’s mother was an alcoholic and just didn’t see her really. Like Colin, Brooke contorted herself in an effort to get her mother to like and want her. 

Mother — mother absence, mother problems — is the dominant theme of the entire season. Brooke, who is motherless, gave up her only child at birth and those became absent to her own son. 

Eladio wants Brooke to be his mother, the mother his own could be. He wants unconditional love, which Brooke cannot give him. She can see and feel his transference but every time the emotions become strong and he evokes a big feeling from her, she bolts — literally leaving the room, referring him to a psychiatrist, then to another therapist. She is correct when she tells him she is failing him, but it is not at all clear that she can see it is her own unresolved mother complex and her drinking which underlie her failure.

With Colin, there is a massive boundary violation which she tacitly accepts. He shows up at her house unannounced and proceeds to act as if they should have a session. And, she does not make him leave. The next week, when he returns, they spar and he then attempts to engage her sexually. She doesn’t acceded to his desire but she does not make him leave either. To me, that was mind-boggling. There is no way to remain neutral and objective once that boundary has been crossed. That she agreed to continue to see him is a problem. This is a situation in which I believe the better course of action is to refer him elsewhere and end work with him. Brooke seemed unable to see how deep manipulative Colin is, imagining somehow that she could penetrate his thick defenses. He would momentarily look like she had found her mark but it never lasts. Colin isn’t motivated to do the work of therapy, was only there because the court ordered it. What this case did was provide a platform for some heavy handed talk about  privilege and race that entirely missed the real issues with Colin.

More than once Brooke launched into mini-lectures about theory and technique or ethics. She does this with Eladio, Colin and Laila. With Laila, instead of saying she, Brooke, is concerned that Laila might be having suicidal thoughts, she says the law requires her to ask. That feels clumsy to me and a bit impersonal. When Colin tries to engage her sexually she talks with him about erotic transference!

These things are problems with the writing. As I said before, the actors, especially Uzo Aduba as Brooke, are superb.

Reboots often fail to live up to the original. This is no exception.

So, what did you think?

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?