Tuesday, March 11, 2008

“In Treatment” should be in therapy.

On February 29, 2008, Lynn Smith, Los Angeles Times staff writer published an article about HBO's half hour daily soap, "In Treatment." The show, which purports to take us into the intimacy of talk psychotherapy, is based upon an Israeli television series. In this talking heads show dialog is everything, yet apparently what we hear is largely translated from Hebrew.

I've made a number of films in Israel and communication is often difficult. It’s a Middle Eastern country peopled by the descendants of Jews from all over the world and more Arabs than you might think -- by definition a culture clash. Because they live under threat, Israelis can be aggressive. It is the only place where a driver tried to push me off a mountain road for daring to pass.

Hebrew adds to the confusion, because it’s an ancient language with nuance suited to life in a desert tent. Almost everyone in Israel speaks English, but emotions often do not translate. I briefly went out with a former Miss Israel and can attest. Considering the conflicting meaning of words between the two languages, basing a show on Hebrew dialogue is reaching pretty far down into the barrel.

It cannot be determined from the credits if anyone in charge of the show has experience with what can be healing in verbal therapy. The apparent naïveté of the producers leads to a misleading and often confusing presentation. Even if talk therapy in Israel is practiced in this manner, the words don't translate into therapy that has a chance of succeeding. It's all about clever "interpretations" and entertaining emotional battles that would never take place in even the most mismanaged therapeutic environment.

There could not be a presentation that better confirms my aversion for exclusively talk based therapy. What we see here is “wordplay,” spouted rapid fire by terrifically smart actors, sitting face-to-face -- reading more from each other's faces than the spoken words could possibly convey. How confusing for the poor patient, who is in therapy because he or she is confused enough. If the actors are familiar with therapy that heals, working on the show must be excruciating.

"In Treatment" presents the brilliant Gabriel Byrne, playing Dr. Paul Weston. I assume the doctor has substantial malpractice insurance, because much of how he treats his patients is cockeyed, and some of it is dangerous. He lives in a nice house in a nameless suburb and works in a highly personalized room, cluttered with artifacts. Just crap to confuse his patients. All that's missing is the common pre-cancer picture of Sigmund.

To add to his patient’s confusion, Paul’s office, is also his sometimes bedroom. His patients unrealistically get up and use the bathroom in the middle of a session. A young patient attempts to commit suicide with pills he incompetently left in his medicine cabinet. After that I would think about going into some other profession.

When the office toilet doesn't work and a patient arrogantly demands to be allowed to enter his house and use the toilet there, he stammers helplessly. Doesn’t this supposedly highly analyzed fellow know how to say no? Not even when saying no would benefit his patient. His dissatisfied wife hovers, knocks on the door, leaves for Rome to have an affair. They have children off in other rooms who sometimes appear mysteriously in his office when the doctors is not there. Lately Paul has been having semi-realistic heart to heart talks with them.

We are told Paul is the product of an "Institute" referred to in once a week sessions with his “supervisor,” played by the always believable Dianne Wiest. What kind of institute could this be if in every session we see Paul with his patients and Paul with his supervisor, crossing every conceivable human boundary? The so called therapy presented to us is a confused mess -- barely worthy of criticism. Humane people don't treat each other like this, even if they aren't in therapy.

In couple’s therapy with Paul’s supervisor, we never learn anything about the source of his wife’s rage. She seems to be saying that her husband, with his highly practiced, know it all “analyst ways,” is distant and inadequate. But why should she accept couples therapy with her husband's therapist -- someone with whom he has had a long relationship, not involving her? There is enough suspicion and confusion in couple’s therapy without adding bias. They need someone neutral who could stand up to his attacks.

In couples therapy Paul is pathologically controlling. This man’s working personality could not be the result of arduous years of competent therapeutic training. We learn nothing of what must have been his disturbed childhood. It would not take long to fill us in, but the series producers probably don't know themselves. His wife flits rapidly between being seductive, confused, irrational, and feeling inadequate. Michelle Forbes, the actress playing her, presents these confusing and inhumanly conflicting emotions beautifully.

The couple is confronted by a wall of "knowing," in which, based upon her prior intellectually incestuous working relationship at the Institute with Paul, Dr. Wiest smoothly, and at great length articulates her "understanding of the problem." These scenes do a terrible disservice to what can be accomplished in skillful and healing couple’s therapy. Her hammering simply alienates. When will we learn that simply "explaining" to the conscious, has almost no effect on the unconscious that is causing the problem? My conclusion is that the producers don't have a clue to what heals.

To further confuse the audience, Paul is hostile, all-knowing, and contradicts almost everything his supervisor says both alone and in couple’s therapy. We have seen him be reasonably capable with the young gymnast who is his patient. No trained therapists, even a poorly trained one, could be this unaware of himself.

Years ago I was in psychoanalysis with a conventionally trained young analyst -- probably one of her first full scale, four times a week patients. She was attractive, confident and tiny. When sitting in her chair, something I rarely saw, because I was lying on the couch, her feet didn't touch the floor. She unfortunately crossed many boundaries. I know that she and her officemate actually painted the place themselves before they moved in. Later, her office was in a small, rented home filled with white furniture on white carpets. Her kids continually damaged her car so I could trace the course of our work by the wreck it eventually became.

As I said in another blog she got me to finance a screenplay she wrote with an associate. Substantial money changed hands, and the screenplay went nowhere. Yet, clumsily, laboriously, taking what seemed forever, she did help me. Had she been better trained in today's methods she might have helped more, faster. But my substantial check every week must've been very welcome.

I learned the value of not being able to read your therapist’s feelings on their face. It's hard enough dealing with your own emotions, without dealing with your therapist’s. When Paul gets fiercely angry at two of his female patient’s abusers, his feelings deprive them of getting in touch with theirs. It made me wince. Therapy is not a conversation between equals. How dare he make himself righteously comfortable at his patient’s expense? Worse, his anger sidetracked the path they should be on, back to the original abuser.

Operating here is what one might call it the "Oprah Syndrome,” OS. In it, an adult patient remembers terrifying, relatively recent abuse in vivid detail. I've heard similar stories many times, and I'm not a therapist. I lived with such a woman for years, who in spite of excellent psychoanalysis was never able to get in contact with the primal abuse in her infant life. In the OS, the story is -- a stranger on the street, a janitor, a neighbor, an uncle -- raped or abused them in their teens or early 20s. Working through this remembered material should allow the patient to relieve their symptoms.

If they had been binge eating and yo-yoing up and down in weight, it should stop. If they had been uncontrollably promiscuous and destructive in their relationships with the opposite sex, that should begin healing. If they had been incapable of having a pleasurable sexual relationship, they should now be able to have one. If they had been incapable of feeling joy about their bodies, that should end. If they are unaccountably and endlessly depressed, even without medication, the depression should lift. If they are men, they should be able to cease destructive womanizing.

More often, if you suffer from the OS, superficial talk therapy changes nothing. Working through the recent memory, real vivid and painful, does not bring about complete healing. Then assuming he or she has the training, and it's not so common, the therapist must go deeper into what the recent abuse has been masking. This is most likely early pre-verbal abuse from a parent. Tragically, this might have affected as many as half of us.

Some of the drama in "In Treatment”, as viewers know by now, derives from the human and common weaknesses of Dr. Paul. Failures that in a friend or acquaintance would be harmless can be devastating in a therapist. Gabriel Byrne must struggle with the incompetent they have created for him to play. My training in the Actors Studio in New York, and years in the theater, taught me that it is impossible to play a role you do not believe in. You don't have to love the person, but it is the writer's responsibility to write someone plausible.

Paralleling the story in the show, I had a chance encounter with a beautiful patient of the incompetent and probably mentally ill Psychiatrist I saw in my early 30s. I mentioned him in a previous blog. To remind you, he was an M.D., Associate Clinical Professor at a major university.

It was easy prying out of my therapist everything I needed to know about her, including his proud statement that she was “in love” with him. This male therapist and his lovely female patient fulfilled the standard cliché. At least my therapist had the brains and training to not say that he was "in love with her" also. And even if he was "in love with her," I think his training was sufficient that he would never tell her.

Paul makes the same claim about Laura, the beautiful, dissatisfied woman we meet in the first segment. We soon discover that she “loves” him and he “loves” her. Don't the folks making this show know that the so-called "love" one encounters in therapy is not love at all? It is a product of transference and counter-transference that even a modestly competent therapist should not be confused by.

Melissa George, plays Laura with a fine seductive flair. Her unique, plastic face allows her to play emotions with her lips alone -- perfectly capturing the deep, old need to control and manipulate men of the early abuse victim. Marylin had it, as do many stars, male and female. It's not even about physical looks. The need -- the deep unfulfilled need -- is what draws one in -- and can be confusing for the object. The moment you take them up on their promise -- it disappears.

Laura tells Paul everything he needs to know so that he might avoid making a devastating life path error for both of them. She is disdainful of his patient she seduces and tells him about in detail. She is spiteful in her description about how the poor fellow made love. She admits she is usually inorgasmic and ends up masturbating, humiliating the man, by rubbing against his leg.

The writers have made it clear -- for good reason, Laura hates men. For her flirting is exciting and sex is agonizing. She makes sure it's the same for her partners by not responding -- or responding only superficially. Too many married men experience this nightly. Do none of the producers understand that her symptoms and the display presented, match exactly those in women suffering from PTSD from early childhood sexual abuse?

Laura eventually describes a teenage encounter with a much older man, a friend of her father, claiming that she seduced him. She says her father was in the room next door and later tells her he was aware of what was going on. Perfectly normal in the best of families. I am waiting for the show to get to what happened 20 years earlier with her father, but since they are working with words therapy only, and it happened before she could speak: we will probably never know.

By week six Laura has left therapy. But she arrives at Paul's, in time for her appointment, all dolled up, hot to trot. In an excruciating scene we see him violate this tragic young woman's boundaries by sitting next to her on the couch. She's smart enough to comment on this. Some part of her does want be healed -- wants it more than mediocre sex with another middle-aged man. Then Paul takes advantage of her concern for her father (what if he dies before she can confront him?) and takes her hands in his. It's so lovey-dovey.

This woman's was raped repeatedly as a teenager. Was probably raped previously in her infancy -- perhaps more than once. She doesn't need to be taken advantage of again by someone whom therapeutic transference has placed in the position of a loving and caring father. It is not loving and caring for Paul to hug, caress and embrace her -- or any other patient. It is not loving and caring for him to confess to her his confused and agonized feelings of "love." Are the producers going to show us the devastating and inevitable aftermath of this stupefying breach?

Proof of her damage -- as soon as he says he cares for her, she turns on him. How dense can this poor fellow be? She's told him she doesn’t orgasm easily -- if at all. Considering how we bring up girls in this country, that's not uncommon. Does he imagine that in a few hours of loving her he will transform a lifetime of empty sex? Unfortunately, it just don't work that way – though lots of men wish it did. Thankfully Paul comes to his senses and leads her out the door.

Earlier, in the most cockeyed writing I've seen in 20 years, we see poor, paralyzed Paul arguing with his supervisor, trying to get her approval to have an affair with Laura. He says he simply cannot understand, after all of his (what one must assume is psychoanalytic) training, why such an affair would destroy them both. This in spite of endless anecdotal history dating from Freud about the physical and practical disaster of allowing counter-transference to overtake the therapist. I know women who have married their therapist. The guy lost his license and the marriages were disasters. What in the hell are they up to in Israel?

Paul, dear fellow, this "love" is the very basis upon which what ever good there is to be derived from therapy comes about. Should you succeed in your wishes, you’d be out of business and she'd run off, half mad -- after having seduced her father, and or his best buddy, again. This would certainly end whatever good any kind of therapy might ever do for her, and it could conceivably kill her.

To return to the tale: my therapist’s patient was a resident at a major hospital, heading for a terrific career. She was as beautiful as models I had foolishly been dating and was brilliant. We had a year long emotional friendship, during which we were intimate only a few ecstatic times. My therapist had told me that having pleasurable sex with her would be impossible, based on the expurgated truth about her life she told him. He thought he knew how she made love. Pure, inhibited and sweet. Boy was he wrong. I never told him anything. Some good came of it though. Within a short time both of us broke off our therapy.

The Los Angeles Times article says that some therapists are addicted to the show. Who could they possibly be? It is an affront to their profession. Perhaps the purest treatment depicted is that of Paul and a young, hostile, terrified, suicidal gymnast. In the first few moments a conscious viewer realizes that the gymnast is a product of early sexual abuse by her father.

We are soon told that she acts this out by having sex with her middle-aged coach and any boy who wants to. She tries to get Weston to undress her, but he wisely refuses. We learn that sex for her is a means for getting even, but her descriptions of the act are so vague it makes one wonder if she's not making them up. A sure sign of abuse, she has no pleasure in it. It is inconceivable that the producers do not make it clear to us that the therapist knows this too.

The article says the show has become a guilty habit for those familiar with the subtext of therapy. Reportedly, among the most addicted are therapists who admit to intense feelings, pro and con, about the drama. How could they have feelings, other than horror, because most of the therapy depicted is classically wrongheaded, intrusive and incompetent?

Apparently some analysts scheduled an "In Treatment" panel for March 9, with show runner Rodrigo Garcia and others, on "Responding to Erotic Transference" at New York's Mt. Sinai Hospital. Another New York group was supposed to have held a "psychoanalytic salon" to discuss issues raised by the television show. Please, folks, have you nothing better to do? Perhaps you should organize a group reading of all of Alice Miller, Melanie Klein and Heinz Kohut.

There is only one way to respond to erotic transference. The therapist must treat it as the figment it is. Only an utter incompetent would acknowledge his feelings about a patient, no matter how strong they may be. What do a therapist’s feelings have to do with healing his patient? The patient’s feeling as are confused enough as it is. Even feelings of hatred and disgust must be masked, otherwise how is the patient’s superego to redevelop itself in a healthy, nondestructive way? You may read more about this in Melanie Klein.

Years ago I routinely sent friends to the Los Angeles Wright Institute, an outstanding institution where therapists in psychoanalytic training treat those in need, under close supervision, for low fees. It's made a difference in thousands of lives. Curiosity brought me to know some supervising analysts. This led to parties where I saw that therapists were as vulnerable as anyone to human frailties of ego and greed. Their social life was largely made up of other therapists. In a short while endless jargon became boring.

As a filmmaker, I was invited to speak to the Board of Directors of one of the major Psychoanalytic Institutes of Los Angeles. Together we created a team whose goal was to interview all of the prominent analysts in Southern California. These early interviews were some of the most fascinating I've ever participated in, because they revealed the deep personal schisms in the Southern California therapy profession.

In one interview, an eminent analyst, who is married to an eminent analyst, wept openly at the pain his "theoretical" conflicts with his fellow analysts had caused him. If analysts can’t get along, or agree on how to practice their profession, what chance has the rest of us? Power struggles within the group disillusioned me, and I dropped out. If these interviews continued they have created a priceless archive.

The leader of our team spoke freely about his belief that it was necessary for him, as a psychoanalyst, to reveal to his patients if he was sexually attracted to them. He spoke of treating one woman in particular with this method. I wonder what happened to her. I later videotaped a raucous meeting where he presented a carefully written paper justifying his complicated theories around his “method.” A hundred or more angry, out of shape therapists shouted him down. You would not believe that those folks, who’s life work is to sit calmly in chairs, could become so agitated. I understand, now that I've experienced different forms of therapy, how dangerous the depiction of Paul Weston is.

Another of Paul's patients is an Americanized version of what probably was an Israeli fighter pilot who mistakenly fired rockets into a children's school in Palestine. Not a single sentence that passes between them could be called therapy. The pilot displays almost no human traits whatsoever, and is almost completely masked. Far from narcissistic, he's invisible. Nobody's home. From sentence to sentence he contradicts himself. I've known lots of fighter pilots, and being inhuman does not come with the trade.

The pilot speaks only superficially about remorse -- and clever as Blair Underwood is, I never got the feeling he even knew how to fly. He says words, but they aren't his. The confusing character he plays is also pathologically controlling and manipulative. Early on he forces a complex and expensive coffee maker on his therapist, insulting him in the process. Paul seems helpless to define the space between them. In any language this is BAD therapy.

One of the goals of therapy to teach your patients the boundaries that their parents failed to do. There is only so far you can allow them to go in acting out insane rage from something hidden in the past. No competent therapist would've allowed the coffee maker to remain. Later, Paul observes the pilot, outside his office, being seduced by his own love object, Laura. One can see the producers chuckling. What fun!

However, to make this kind of nonsense work, the therapist has to be an absolute ninny. It is impossible for Gabriel Byrne to play an idiot, and he chaffs at the restraints. His emotions flow all over the place, as the dialogue forces inhuman contradictions from moment to moment.

In one episode, the pilot, claiming some higher, insanely implausible intelligence source, confronts Paul with the fact that his wife has run off to Rome with another man. The pilot taunts him so viciously that poor Paul is driven to physically attack a vastly more fit, younger man, throwing coffee in his face.

I hope no viewer believes such a nutty scene could ever take place in the real world. Dear Paul, there are things you may not allow your patients to do. They may not threaten murder without being reported to the police. They may not hug you, kiss you, stroke you, or stand too close. They may not bring you outrageous presents and plunk them down in your already too cluttered office. They may not eat, smoke or compulsively use the bathroom. They may not verbally assault or spy on you.

Dealing with these manipulations for what they are, would be healing -- but you do not. If a patient invades your privacy, that’s the sign to show them the door. While you're at it get a restraining order so this crazy pilot can never come near you again.

Paul discloses so much about himself and crosses so many boundaries that he becomes an unbelievable character. He allows his patients to be pathologically aggressive and resistant, never even attempting to point this rage at where it belongs. His supervisor is less compassionate than he. Perhaps because of their history together, she is far too intrusive and critical to be helpful. But then Paul is desperate. After 20 years of working at being a therapist, has he nowhere else to turn? Has he no close friends?

The reported interest in the show by therapists and their confusion about it, illustrates the said state of therapy. The show is nonsense, so why even try to make therapeutic sense of it? It has hardly any viewers because, brilliant as all of the acting is, the show is painful to watch. It's directed according to a weird syntax of screen direction I’ve found impossible to decipher. Often times the why of where the camera is placed is, to me, more interesting than what the people are saying.

Yet, as the article says, in a time when pharmacology has “gained ground” in treating problems, what happens in intimate therapy still has the power to fascinate. I take exception to the notion of gained ground, because pharmacological treatment comes with side effects which may prevent forever the patient being able to discover the source of his problem.

Alarmingly, the article says some therapists try to make sense of the nonsensical dialogue. One says he has noticed "parallel process" in Paul's mimicking Laura's complaints in his sessions with his supervisor. My guess it's a coincidence. The article says that therapists may plan to use clips of the show in postdoctoral courses to illustrate professional issues that arise in real-life sessions: Should therapists make coffee? Or start a couple's session when only one person has arrived? Or have wild sex with an attractive patient in a nearby hotel?

In movie and television psychotherapy, dramatic convention calls for the patient to dramatically recover repressed, emotionally cathartic memories. I had such an experience and it was nothing like that. In fact my therapist was almost completely unaware of what was happening to me until I described it – weeks later, after I had processed it on my own. I am appalled by books like “Prince of Tides,” which, though beautifully written, present a totally cockeyed image of what tragedy arises from broken therapeutic boundaries.

The article says that part of Paul's struggle comes from the sort of therapy he's shown to practice. It comes out of an old tradition in psychotherapy where 'the customer is always wrong.' Whatever the patient says is suspect. So on the one hand, Paul caringly gets them to open themselves up to him, and then he plays gotcha. But the problems go deeper. It seems that no one associated with the show knows how to write dialogue appropriate to real therapy. Meaningful chat will not do.

At one time I considered doing a television series called "The Impossible Profession." I had a list of the brilliant analytic advisers who would help write it. I now know that by adding the latest developments in nonverbal therapy we would have had an even more fascinating series. Real therapy is amazing when it works. The results are physical and immediately visually apparent. My book "Backlight" is about this. Too bad the waters have been muddied. “In Treatment” is a lazy and careless presentation of an important human interaction that is precious and healing. Though brilliantly acted entertainment, it does not serve the audience well.

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