Thursday, February 28, 2008

HBO In Treatment: Sophie is Bullied Out of Her Suicidality

Sophie comes to a session with her mom after overdosing on her shrink's sleeping pills. She is non-stop hostile to mom, insulting, rude, angry. Paul gets to decide if she can go back to the gym and Olympic gymnast training (with the coach she's slept with), and Mom is not happy when Paul says she can go back. Mom storms off, leaving Paul to follow a distraught and angry Sophie around his office and to sit down on the couch next to her. He tells her that her suicide attempt was her way of "testing" him to see if he really loved her, and he barely passed the test-- he talks about how he has to find something he loves in every patient. Sophie is uneasy with this, and she talks about her dad, the only person in the world who really loves her, and she lies to Paul saying her dad visited her in the hospital. This we learn when a tearful mom pops back in to say Sophie can't go back to the gym, and Sophie insists that if she can't train, she'll kill herself. Paul tells her he can't treat her with the threat of suicide hanging over, that she can never come back to therapy if...if what? he doesn't say, I guess if she's suicidal, and Sophie promises not to kill herself while she's in therapy.

So the only reasonable person here is the tearful, dramatic, "surgically enhanced" mother.

We're left to wonder what issues has with his daughter Rosie (the one who sleeps with drug addicts, per stalker patient Alex) and how he's playing them out with Sophie.

The list of what Paul's done "wrong:"

--1) He hasn't reported the pedophile gymnastics coach, though he has thought about it.
--2) He's gotten Sophie out of the hospital immediately after a suicide attempt, rather then leave her there where she can be kept safe and carefully evaluated for a mood disorder. And he's painted the hospital as a bad place to be rescued from for someone who may well need to be there at some point.
--3) He's allowed himself to be the decision maker about sending someone back to gymnastics. At least he should fully hear the mom's reasons for not wanting to send her.
--4) He's telling a sexually abused 16 year old that he 'loves' her as he follows her way too closely around his office. And he tells her he trusts her after she's overdosed in his bathroom--- now why would he trust her? And she lies about her father visiting her in the hospital, why believe she's truthful about anything else?
--5) The kid's now on her 3rd serious suicide attempt in a short period of time (2 car accidents, one overdose) and he's just shut down the option for her to tell him when she's suicidal. "You can't come back to therapy, ever" --I could see telling someone this if they perhaps have another Attempt (and definitely, no therapy ever if you succeed at killing yourself!), but he says he can't operate under the
threat of suicide. In other words, if you're thinking about it, keep it to yourself. It just doesn't cut it for psychiatric care.
--6) Paul tells Sophie why she tried to commit suicide in his office-- a theory he's now committed to (much the way Gina comes up with theories about his behavior), without even asking Sophie "why?" He's made a lot of assumptions and closed his eyes to other possibilities for her behavior.
--7) Paul is too invested in being liked by his patients and this blinds him from acting in their best interest.

Somebody remind me that it's just a TV show.


NeoNurseChic said...

I agree with everything you said, but I just had a different perspective on the "threat" thing. I don't feel like he's telling her she can't tell him if she's feeling suicidal. I think he's telling her that he won't treat her if she uses suicide as a threat to get what she wants. I think there's a difference between those two things. I think he would probably very much want to hear if she is feeling suicidal. But then she uses suicide as means of manipulation to get what she wants out of people.

Not sure how the best way to handle that one is - but that was just my take on it...

Take care,
Carrie :)

Anonymous said...

I am always reminding you it is just a TV showbut you don't listen.
Good post. Crappy show but good post.

Anonymous said...

I agree with Carrie. I also think that the suicide attempt in Paul's office wasn't necessarily a "serious attempt". If it were, why would she return to his office and pass-out there, where help is immediately available? I would think a person who was truly intent on suicide would pocket those pills and take them after leaving, or take them and walk out the front door. Also, it seems pretty opportunistic to could she know those pills would be there? Even if she had seen them the week before; that doesn't mean they would still be there.

April said...

I really don't think the coach is a pedophile. She's 16, not 6. Sixteen year old girls + middle-aged male coaches, that's not the newest story. Agreed the coach should have the moral fiber not to abuse his trust/power with his gymnasts, but that's not the same as being a pedophile. And maybe now Sophie is getting what she needs from Paul instead of Cy (not sex, but attention or whatever).

Just keep repeating: It's only a TV show.

Anonymous said...

I disagree with kbab about the coach's pedophile status. First, 16 is still a child in most states. And second, 16 year-old serious gymnasts don't look 16! They are very small and underdeveloped; they really look about 10-12. So I think being attracted to someone with that young of an appearance puts one squarely in the realm of pedophile.

Anonymous said...

I don't give a hoot about the psychiatric definition of pedophilia, which means love of children. It is illegal to have sex with minors and the kid is a minor. To aggravate the situation, the guy is in a position of trust and authority and power over her, not some random guy she happened to meet. It doesn't matter how old or young she looks only how old she is and what the relationship is and what the age of consent is in a given jurisdiction. People in positions of authority and power have run into trouble having sex or relationships with their students, mentees etc who are not minors due to the power differential. Obviously docs can lose their license, university profs are not supposed to sleep with students. I am sure the often do.It is not illegal but there are policies against it. sophie's case is clear cut. The guy does not have to be labelled a pedophile in order to have crossed the boundary and broken the law by having sex with a minor.

Midwife with a Knife said...

Depending on the state, Sophie may be of an age able to "consent". Where I grew up, the age of consent was 16, unless the kids were within 2 years of age of each other, in which case it was 12 or 14 (I don't quite remember).

Nevertheless, the coach is certainly abusing his status. I want Paul to work on that.

April said...

a) 16 is the age of consent in many places
b) I didn't say Cy's actions were okay, only that he's not a pedophile
c) "being attracted to someone with that young of an appearance puts one squarely in the realm of pedophile" ---?!?! as far as I know the laws apply to legal age, not appearance, and action, not attraction
d) "The guy does not have to be labelled a pedophile in order to have crossed the boundary and broken the law by having sex with a minor." Exactly, let's save the term "pedophile" for people who really deserve it. Cy can be a sex offender./creep/a-hole/scumbag without being a pedophile.

ClinkShrink said...

Technically speaking he'd be an ephebophile.

And I can't believe I'm commenting on this post.

Sarebear said...

I agree with Carrie. Dinah makes alot of good points though, geez what is he thinking!

Roy said...

Clink... we mentioned ephebophilia in Podcast #14 No April Fool.

Anonymous said...

Roy, you're alive! Ephebophilia--I think that could be diagnosed in most of the movie going, magazine buying population. You are over the hill at 18 in that world.

Suicide Malpractice said...

What data support any of the analysis claiming the errors of the therapist?

Anonymous said...

same kind of studies that show that sometimes the pilot does fall asleep in the cockpit. hardly shocking.

Gerbil said...

I'm kinda sad that I only have access to the first 15 episodes (via YouTube), but on the other hand, (a) I can "watch" episodes 16 and onward on Shrink Rap, and (b) I think I'd be terribly frustrated if I were actually watching the episodes. At first I was merely annoyed by the sheer number of yes/no questions Paul asks his clients--a no-no that was addressed in my very first semester of grad school!--but it appears Paul wasn't paying attention in ethics class, either.

Still, I've been wondering whether Paul is a Dr. Dippy or a Dr. Darling. He doesn't seem to be a Dr. Dangerous, as that implies malicious intent. Perhaps he's a Dr. Dumb.

'Tis only a show.

Anonymous said...

Actually one can be very dangerous and have no malicious intent.