Dinah, ClinkShrink, & Roy produce Shrink Rap: a blog by Psychiatrists for Psychiatrists, interested bystanders are also welcome. A place to talk; no one has to listen.
Sunday, April 26, 2009
In Treatment: Season 2, Mia's Sex Life & April's Cancer Treatment
Mia bursts in with breakfast and charges into Paul's kitchen despite his objections. She talks quickly and tells of her sexual escapades over the weekend. No sleep, she's drinking a lot, has acrobatic sex with a young band member and then David the cop, a guy she met at a bar. Paul wants to return to the office and Mia says, suggestively, "So you want me on the couch?" I'm wondering how safe Paul is alone with her.
Mia talks about her relationships with men, it moves back to her relationship with her father. "I'm 43 and I'm entirely alone. Who do I have in my life-- You?" She talks about her loneliness.
I guess I'm wondering if Mia has untreated bipolar disorder? --She's gone days without sleeping, she's intrusive, talks rapidly, promiscuous, maybe hypersexual, and her mood is labile. Paul looks at her behavior from a psychodynamic perspective only, and I'll wonder if there isn't something biologically driven to it all.
April is back, she hasn't told her mom she has cancer and she hasn't gotten any treatment. She's sick, she's tired. Her autistic brother, Daniel, tried to commit suicide, again. She talks about Daniel. April thinks she's depressed. They talk about this and Paul tells April when she feels badly, she should call him, any time of day or night.
April sounds like the neglected child, her mom "gets overwhelmed, she needs to vent." April sounds hopeless about Daniel's prognosis. Paul points out that April will eventually be responsible for caring for Daniel, a burden she clearly doesn't want, but oops, she may be dead long before such a day arrives.
Paul wants to talk about chemo but Daniel calls and April needs to go get him. She faints in Paul's office. Paul gets angry, he screams at her. She tells Paul, "It's okay that you can't handle this, you panicked." They scream and shout at each other. The phone rings, it's April's mother, April stands up to her and says she can't go get Daniel, and mom hangs up on her.
They run over on time, April keeps pointing this out and Paul keeps saying there is more time. "What if I come with you to the hospital?"
"Would you? Now?"
He leaves with her and shuts out the lights.
The episode is advertised in it's TiVo'd blurb as Paul crosses a boundary. I thought the boundary was screaming at the patient. But he leaves with her, takes her to negotiate cancer care.
Paul is portrayed as human, he's frustrated and feels helpless. His patient is a ticking bomb. She's destined to die if she doesn't get care now (oh, and maybe even if she does). So off to the hospital they go. Yes, I think it's the 'right' thing to do, or at least I don't think it's 'wrong.' What do you think? Yes, Clink, I know it's a TV show.
Posted by Dinah on Sunday, April 26, 2009
Labels: boundaries, In Treatment, psychodynamics, sexuality
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I haven't started watching season II yet - I have my own therapy issues to work out before I start on In Treatment's therapy issues... but in regards to the "boundary issues" that Tivo refers to, I don't think that there's anything in the summary of April's episode that alludes to boundary crossings (at least based on how I'm interpreting your summary)... I'll check back next week, when I've caught up!
On the other hand, Paul seems unable to put his foot down with Mia and gain control - which in itself is somewhat of a boundary violation, no?
And yes, Dinah, I would agree with you that her behavior does reflect something of a manic episode - it was the first thing I thought of when I read that paragraph.
I know you're not a psychologist, but don't all psychologists get training on the DSM, regardless of their theoretical perspective? So in theory, Paul should be able to recognize her (potential) mania, and refer to a psychiatrist/GP for psycho-pharmaceutical intervention, in addition to whatever psychodynamic approach he wishes to take.
Why is Paul treating Mia at all? It seems that between the history of their relationship and the work/boundaries issue with his legal case, this case should be a 'refer on'.
As for April, I don't think he has crossed any boundaries by taking her for care. He is being compassionate.
Yes, I agree that Paul taking April to the hospital for treatment was the right thing to do this time. She is going to die unless she gets treatment. Having said this, Paul's challenge will to get her to find someone else to be there for her. It's not a role he should continue. I'm assuming April is over 18 - so Paul cannot call her parents - right?
I'm not liking April as a peson. I don't find myself rooting for her as I did Sophie. April has rough edges and pushes everyone away.
Mia, on the other hand, is crazy but likeable. I did notice how he left the kitchen door ajar last week --- looming foreshadowing.
I think Paul can treat Mia. Their past is a clinical history, not a personal one. She is no longer his attorney. She breached the boundaries by opening up Laura's deposition. As long as Paul can keep the therapeutic frame (which is not his strongest attribute as a therapist) he should continue to treat Mia.
Seriously? He's got no interest in her, just to guilty to abandon her again. She's right that she's not pleasant to be around but she could start with not invading his affairs.
She's also right that drummers and guitarists are two completley different animals if I may sterotype.
As for April I do enjoy those sessions, they seem very real and unforced as can be expected. Seems likable enough to me. Glad he took her because it didn't look like getting the family involved, scolding, reasoning. empathy or yelling was getting through to her.
I liked April a lot...but there's an upcoming episode where I was really rooting for her to sue him!
I love this show. And I hate it. And I hate loving it and love hating it. I am ambivalent about In Treatment. Come see why.
Just stopped by to see if you were still recapping In Treatment! I never ended up watching the entire 1st season - just couldn't keep up with it after awhile. This season, I have watched all of April's episodes but only a few random ones of the other characters. I like April. I think the only boundary Paul really crosses is in becoming too personally invested here and allowing himself to be the one she relies on. It's nice that he wants to take care of her, but he won't be able to in the long term, so it almost sets her up for disappointment. He says to call any time she feels as bad as she did when lying on the bathroom floor - will he really be available to answer his phone any time she calls? Doubtful. So why even bother to say that in the first place? Why set up some unreachable expectation for her? Maybe he could have said to call and leave him a message any time she feels like that, and he'll get back to her as soon as he can. (Which in real life may be on business hours Monday to Friday. That's a reasonable boundary, isn't it?) That's probably a bit more realistic. The girl has nobody else to lean on right now - but can Paul really provide her what she needs? Someone who will truly take care of her? Not just for a half hour a week or however long the theoretical sessions run for. Because what happens to her the rest of the time?
I guess that's why I see he has crossed some boundary. Taking her to the chemo in and of itself wasn't crossing a boundary, but he sets up multiple times in that episode the expectation that he will be there to take care of her when she needs someone. And I have a feeling that this isn't really going to be the case. It is a nice intention, but if it can't be held up sincerely, it is best not offered in the first place. Having good intentions but a lack of resources or capability to back up what you've promised or implied can be more painful than not promising or implying anything in the first place!
Just my take on it... :)
Wow, our commenters could write the post!
The new-second HBO "In Treatment" series presents a variety of interesting boundaries dilemmas. Before I list the boundaries issue in the new season we need to remember that there a big difference between boundary crossing, which are appropriate, ethical and helpful) and boundary violations, which are harmful.
Here is the short list of the boundary crossing presented in the first four episodes:
- Multiple Relationships: Paul is involved in `client-initiated' sequential dual relationships with Mia.
- Transparency: Paul deliberately self-disclosed meaningful personal information to all four clients, Mia, Walter, Oliver, and April
- Leaving the office: Paul was engaged in out-of-office activities (i.e., left the office) when he accompanied April to her first chemotherapy treatment and visited Walter in the hospital after a Walter's failed suicide attempt.
- Serving food: Paul fed self-starving young Oliver.
- Touch (non-sexual): Paul appropriately touched Walter and Oliver.
- Cell Phones: Paul allowed-tolerated Walter and April use of cell phone during sessions.
So far (i.e., week four of the second season) all of Paul's boundary crossings seem to be clinically-driven and ethical. For a more detailed discussion on boundaries in "In Treatment," go to http://www.zurinstitute.com/intreatment_hbo.html.
Ofer Zur, PH.D.
Director, Zur Institute
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