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, May 03, 2009
With Love to ClinkShrink: More In Treatment: Mia & April
Paul is a wreck--he's unshaven, uncombed, and his eyes sink deeper in his head than ever before. Mia is intrusive (so what else is new?) and grills him on how much he must be distressed--she's talked to his lawyer and knows his father died. She repeatedly asks him how he's doing? Is he lonely? And she speculates on aspects of his personal life and tells him it shows in his eyes that he's lonely. Oh, and she's pregnant by an unknown man. She asks Paul to celebrate with her, asks him if sex with his wife was as good after she gave birth, fantasizes about meeting Paul in a bar and running off to Las Vegas with him to get married. She wants to know if he'll be there for her, as she debates the pros and cons of becoming a mother.
Mia is cloying. I want to go home. Paul is good about distancing himself from her intrusions, but she is right that he's not ready to be back at work, and I can't help but wonder if he should continue treating her (or if he ever should have re-started after their first meeting in her legal office). She would be devastated if he refused to treat her, and her devastation would be understandable. But, is he safe with a patient who is asking questions of his lawyer, fantasizing marriage, and repeatedly asking if he'll be there for her in a way that sounds like she wants so much more than a therapist? And is he safe with such a patient, given that he's already professed his love for another patient last season, and admitted to his therapist that he could see himself with a woman like Mia? Not sure where the plot is taking us, but if this were real life, it would be going no where good.
April is now getting chemo and she tells Paul she loves his eyes and they are "bottomless." What a life, women falling all over him. Apparently Paul was in the OR when they put in April's port. I don't think they let visitors in the OR in real life. They smile at each other a lot and the session has a flirtatious edge--- is this my imagination>? April falls apart when she hears that Paul doesn't plan to keep taking her to chemo-- one more patient he isn't there enough for-- and she puts it back together when he tells her his father died last week. Enough, it's bedtime.
Posted by Dinah on Sunday, May 03, 2009
Labels: In Treatment
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Once again I only watched April's episode, and I didn't see all of it. So I missed the part where she told him his eyes are bottomless and where it became known that he was in the OR when they put her port in. That's awfully fast - do they usually put the port in at the first chemo session when the patient shows up in off the street? I thought there was usually a strategizing session first where you met with an oncologist and they discussed your results and what the plan is. Did she do that step already and somehow I missed it?
Right but anyway. The rest of what I saw of the episode, I didn't view as flirtatious. But what I did see was what I expected. She lost it - and it was preventable. He set up the expectation that he would be there to take care of her in multiple ways at the session prior. Then he cancelled on her (even if it was for a good reason), so she felt he was unavailable to her when she needed to call. And now he's not going to take her to chemo. Even if he DID take her to the first chemotherapy session, he should have said that he would not be able to do this in the future. He left that one open-ended probably out of his own avoidance of wanting to hurt her feelings or cause her to back out of going altogether the first time if he had told her that he wouldn't take her again in the future.
I expected nothing less than a meltdown of rather epic proportions, and that's what we got. Whereas if he had just been up front in the first place... He should never have set the bar so high that he could be there to take care of her when the reality was, that could never happen - even if his father hadn't died, there may have been other reasons to cancel an appointment or not be able to answer the phone if she had called and needed him urgently.
And she was pissed at him by the end. Sure she felt bad for him that his father died, and I think she was trying to show genuine empathy. Twice in the episode she told him to stop analyzing things she said and to just take it for what it's worth. That was awesome. But she completely disconnected from him by the end. She allowed herself to open up and trust that he would be there for her, and he burned her. It may seem like a small thing to him - he was being kind, and in a reasonable world of course he couldn't be expected to be the person to continue taking her to chemotherapy. But that's not what she thought, and that's all that matters in this one. So now she views him completely differently - and I saw her reaction towards the end as completely detached and shut off. Sure, she smiled and was kind and appropriate, but you could tell she was done. He hurt her, she lost it, and now she's externally over it - but she's not going to let him in again. She's trying to hurt him back by not dignifying his request for her to call him when she's found someone else to take her to chemo. I'd take bets on whether or not she even shows for the next chemo session at all. Not because she's scared or any other reason - but now she wants to prove a point. It's all the control she has in this relationship.
All this could have been easily prevented if he never set the unreasonable expectation that he would be there for her when he cannot possibly be. Sure, be there for her in the designated appointment time, and be somewhat available if she needs to talk to him via the phone at other times during the week. (Likely not immediately available, but will be able to return calls within a day or two in most cases.) He's the one that initiated the expectation, and now he's the one who is taking that expectation away. She may not react in a mature, reasonable way since now she appears almost vindictive by refusing to give him the peace of mind that she's found someone to take his place in caring for her, but that is *one* way to respond to hurt and disappointment, even if it's not the best or most productive way.
That's my analysis of that episode!
So I don't agree that Paul is 'responsible' for April's distress and disappointment because he didn't clarify that he was taking her to chemo one time only.
He spent weeks trying to get her to tell someone and get treatment. He knows she will die without treatment (and maybe even with it). He's very upset about this, watching his young patient deny her fatal illness. At the end of the session, in the heat of the moment he agrees to take her to Chemo and they walk out together. Paul doesn't have time to think this through, April is willing to go and they go. We think he thought this all through? (okay, okay, it's a TV show...) And even if he did, what's he going to do, say, "Just one time only," and risk that April, now fully informed, will say, "Oh, if you're only going to take me once, then what's the point?" April is passing out in front of him, she needs cancer treatment, and Paul impulsively agrees to take her, because she's going to die if she doesn't get care. Blaming Paul for April's subsequent reaction and meltdown reinforce the idea that therapist's are something other than human, and that he "wrong" to do what he thought, in the pressure of the moment, was the right and kind-hearted thing to do.
Ah, sorry to rant on you, Carrie! Glad you came to visit and you could be writing the posts!
Mia's session: Oh my! I'm always surprised at how many question's Paul's clients fire his way. They also walked around the office. Is that common? Do clients really walk around their therapist's office? Why didn't Paul have time to shave? Did he unconsciously want Mia to feel sorry for him. He cleaned up pretty good by Tuesday.
We see the full circle of life in this session. She's pregnant again and is full of the same(expected) conflict from 20 years ago.
Question for professionals: Isn't it okay to tell your client that there was a death in the family? Why be so evasive? I think (as a client) I would like to know. It is a relationship - albeit a boundaried one - but I would like to know so I can be appropriate with her absence (patient, caring).
Do we think Mia's pregnancy is real? And/or will she miscarry? I agree with Mia, these were one night stands, why tell the "father". It was meaningless sex.
April: We all saw her reaction coming. No surprises. Neonurse - yes, she did mention a visit to an oncologist in a prior sesson that set up her chemo schedule.
I think she was slightly flirtatious but not in a Mia sort of way. I thought there were some real therapy-like moments in this session.
I think it is OK to say there was an unavoidable family emergency.
Taking time for yourself is a lesson for patients as well as being there for them.
You could teach a course on boundaries by watching these episodes.
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