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.
Monday, May 18, 2009
In Treatment: Rethinking Family
Mia is no longer pregnant (oh, soon we find out she never was). She's tired and she wants to go home or maybe have the session in the waiting room. This troubles Paul, but he sits down anyway.
Mia's mom came to visit her when she thought she was miscarrying--- suddenly mom is repainted in a more sympathetic light. She feeds Mia and she tells her about her own severe post-partum depression after Mia's birth. The events of the family's past-- where mom was always horrible and dad was always wonderful-- are now cast differently. Mia is angry-- her mom is just re-writing history in a way that makes her look better and makes her idealized father villainous. But Paul-- coming from his own father's funeral where he learned that his own evil, abandoning, philandering father had some virtues-- encourages Mia to be open to the possibility that mom wasn't all bad.
Paul tells Mia he knows from experience.
So what did I think? I often feel that when people paint another person as all evil with evil motives, that they may be missing something--- most people don't seem to want to willfully injure others. So I understood that Paul jumped on the opportunity to point out that some of Mia's mother's persona may have been something other than all bad---here she's the sympathetic mom with a tray full of food, confessing all sorts of family secrets, taking her daughter to the doctor. But when Mia doesn't want to see it all this way, Paul pushes the reinterpretation on her a little more strongly than I'm comfortable with. It's as though he's talking to himself, and not considering his patient's story.
April is angry with Paul. She was feverish and delerious and he called her mother and had mom come to the hospital. Paul points out to April that she has high standards and people let her down. She's quick to write them off for a single mistake, Paul included, even though his intent was for her wellbeing. They bicker. April talks about her childhood, about being the perfect child, about hiding her accomplishments from her mother. Paul wonders if she's repeating a pattern with him. She doesn't like this, but somehow, they come to a place of peace. The session ends and he helps her up. There's something vaguely tragic about it all.
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So I didn't watch any episodes yet - been a crazy busy week in my world. But Paul is saying she is writing him off for making one mistake and taking her to chemo? I think, going back to my earlier comment and your follow up comment, Dinah, that blaming Paul for her subsequent meltdown actually shows that he IS human - that therapists are human beings that can and DO make mistakes sometimes! He was well intentioned, but she was hurt by what he did.
I think the whole blank slate/transference thing is really what creates the idea that the therapist is an infallable human being. If a patient knows nothing about their therapist, and the therapist seems to be this kind/accepting/safe person, then isn't it that much more upsetting to find out that they can and do make mistakes sometimes? But then if the patient is upset with the therapist for something, then it must be transference - the patient is really upset at someone in their past. Why can't the patient just be upset at the therapist for doing something that upsets them? It doesn't mean that what the therapist did was right or wrong - it doesn't have to be right or wrong to cause hurt feelings.
A few years ago, I had a lengthy discussion with my psychiatrist about treatment decisions, and it was about a subject I was very uncomfortable with and reluctant to talk about. I only finally agreed to the idea because I trusted him and he seemed to present it in a way that seemed safe and reasonable to me. When I showed up at the next appointment, he told me that he called my neurologist (who I wasn't getting along with at the time - which is actually putting it mildly), and that my neurologist was going to be the one to handle the treatment. I was livid. He didn't even ask me if he could call him or notify me that he was calling him (even without asking me if it was okay first) - he just called him and reported to me a week later that he'd had this discussion and the decision had been made. And the fact of the matter is that if he had taken the time to ask me, I WOULD have said no! That would have roadblocked the treatment and prevented me from getting it. In the end, it did work out with my neurologist - even though I was extremely unhappy with it at first - I felt that my rocky relationship with him at the time was going to make the treatment a failure, whereas I had a more trusting relationship with my psychiatrist, and I felt that would have led to more open communication regarding this particularly difficult treatment decision that I was making.
So my psychiatrist was acting in my best interests by making the call, but it still hurt my feelings big time. I left the office to go to work, and I was hysterically crying to the point where I couldn't even hold it together when I first arrived at work. I was really really upset. He had good intentions, but that didn't change the fact that it hurt my feelings. I could argue both ways that what he did was both right and wrong. The end result was that it resulted in me getting treatment I needed, but I was very upset with him for awhile after that. So maybe hurt feelings are a small price to pay? I don't know...
But I think the whole point is that therapists ARE human - they DO make mistakes. The lack of disclosure about anything personal sometimes does allow the patient to build up an infallible image in their mind. In my case, it leads me to sometimes think that what my therapist thinks and says must be two different things because no person can truly be that non-judgemental and really mean it. The one plus for him is that he has said many times over the years that he wants to know my feedback - both positive and negative because it helps him learn how to be a better therapist on his part, too.
The fact that we can blame Paul for April's meltdown proves that he IS a human, fallible individual. To say that he cannot be at fault because therapists are not infallible beings doesn't make sense. He is at fault because he is a fallible human being. It shows that therapists are real people and can make mistakes! He DID hurt her feelings - it doesn't really matter if what he did was in her best interest. She may appreciate that someday, but for now, she's hurt - and that's okay. We can't dismiss her feelings just because what he did was ultimately the right thing to do. That may be the case, but he still needs to acknowledge the hurt it caused.
Sorry to rant away on your comment section! Especially when I haven't even watched the next episode! :-P
I do have some good news to share with you, however - I was recently accepted to one of your alma maters to continue my masters work in nursing! I'm actually doing a double masters - nursing and.....wait for it......bioethics! ;) I'm still in the process of applying to the bioethics program, but I hope to begin both programs this fall. I finally feel like I've found my "thing". I'm so excited to start that it is going to be hard to wait until the fall to begin!! I'll be working full-time and completing the programs over a 3 year period. Just had to share!
And please - feel free to rant again about what I've said - I really enjoy an active discussion! We don't have to see it from the same viewpoint to make it an engaging one!
Oh Wow, Congratulations on grad school! That's wonderful, sounds very exciting.
Paul...oh, gosh, he's a TV character. In real life, confidentiality generally trumps all but two things: life-or-death issues resulting from psychiatric disorder, and issues pertaining to child abuse (this may just be a Maryland thing).
Of course shrinks make mistakes. I figure I'm good for 2 a day. ClinkShrink and Roy hang out around 4 (....oh, I'm just kidding, they are perfect).
Paul is so wrapped around his own issues--- last season with his women, this season with his parents-- that it clouds his judgment. He openly admits it, when April gets angry that he contacted her mother, he says to her loudly and repeatedly, "You're not a parent!"
Should he have contacted her mother as she was dying? No. And how do I know this: because she didn't die and came back to tell him so. Was it malpractice that he did contact her mother? No, just some guy in a hospital with a maybe dying young woman who did what he thought was right.
OMG, it's a TV show. I need a life.
Someone tell Roy to blog from APA in San Francisco. He's moved on to Twitter and forgotten us.
Well, I've been avoiding these reviews of In Treatment as we don't have HBO so I will have to wait for the DVD BUT: had this comment on Mia (strictly on the basis of your "when people paint another person as all evil with evil motives" comment). Isn't she just borderline? And isn't this trait simply characteristic splitting, some people all good, some all bad. And which can shift in an instant, based on whether they satisfy the longings, hungers, fantasies of the hurting one? Obviously the actual roots in life history are worth exploring, but in some ways a red flag tendency, diagnostic? But what do I know....
I did not watch the show either, but this caught my eye in your write-up:
"She's tired and she wants to go home or maybe have the session in the waiting room. This troubles Paul, but he sits down anyway."
I am a psychotherapy patient. I have seen my psychiatrist for over a year. I OUGHT to be comfortable with him, and really in most ways I am, but I have always found his treatment room intimidating and him a bit intimidating as well. He's kindly, and empathetic, and non-judgmental and he really understands my personal situation and my feelings. The room, though, is just not set up in a way that makes me comfortable. He sits in a living-room style stuffed chair next to one wall and I sit on the opposite side of the room directly facing. I'd guess there might be 12 feet between us. It's too far and too directly squared, and I have told him that yet our only solution was to move my chair forward a foot. He's also a very formal person, wearing tweeds or cords, tie, jacket. He looks like a caricature of a psychiatrist or one from the movies.
Would it be appropriate to ask my psychiatrist to go take a walk or go for a cup of coffee during the session and conduct the session while walking or in a restaurant instead? I'd feel so much more relaxed and comfortable across a table in the restaurant downstairs or walking around the block. Do psychiatrists ever do such things or is it a completely unreasonable request from the patient to change the venue? I would not have trouble concentrating nor would I have a privacy issue, plus I haven't been sobbing in session for quite a while. How important is it to the psychiatrist to sit and watch the patient's face and body language? Would this be a boundary violation of some kind? Those were the thoughts that came to me reading this posting. I am aware that the bloggers rarely or perhaps never answer patient questions. Perhaps a patient would have a comment?
When I saw he talked to her parents, that really infuriated me. I hoped she'd turn around and sue him for that.
does anyone else think april might have borderline personality disorder? i know labels aren't particularly nice, but it seems to fit - neglectful parents, extreme emotions, black/white thinking ("spllitting"), etc. no idea if she has any self-injuring behaviors, but minus that, it sees almost perfect.
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