Thursday, March 20, 2008

Some Very Good Television

I've had a good friend hounding me for 6 weeks now to watch some clips from an HBO show called In Treatment. It is a show that has been adapted from a popular Israeli series. It is a clever arrangement. Each day of the week Dr. Paul Weston sees a different client. On Monday he sees a distraught young anesthesiologist struggling with partner. Tuesday he sees an egotistical young navy pilot whose eventual death puts Dr. Weston in touch with his father. Wednesday his patient is a precocious teen gymnast who has come to see him for an evaluation for insurance to determine if injuries she's sustained have been self-inflicted or accidental. Thurs is a couple that has been trying for years to get pregnant and now are in struggling over the wife's unexpectedly exploring the option of abortion. And Friday he has supervision sessions with a retired therapist, with whom he has a complex past.

My friend that recommended this show has seldom steered me wrong, so when I was down with a cold this week, I took some time to check it out the show. HBO has a page where you can view the first three episodes of each character's story.

As a therapist it strikes me overall as being authentic. The patients seem like real people with some of the real problems that they come in with, both as far as current problems and in the longer term issues they find themselves coming up against. Like any movie or television show the drama is much more compressed and the everyday mundane aspects are filtered out.

The initial 3 episodes of In Treatment have been very interesting for me to watch, among other reasons, because Dr. Paul Weston does therapy quite differently than I do. A lot of this is accounted for by the fact that his character is doing psychoanalysis, a sort of therapy where the therapist tends to remain for the most part completely neutral in his demeanor, a blank screen where the patient play out the sort of relationships and attachments they have in their lives, represented in their mind. He makes very frequent interpretations of what they client is really saying, asking or thinking, because the assumption of psychoanalysis is that we are largely unaware of why we behave as we do, as the vast majority of our life is driven by unconscious motives, of which we have little to no awareness. The goal of psychoanalysis is to make the patient more aware of some of these unconscious motives. Because of this view he also frequently confronts his patients questioning their motives and asking them to do the same.

My approach to therapy is much more collaborative. On the front end of therapy, I am much more concerned with establishing a working alliance with the client than I am with remaining neutral as Dr. Weston does. That translates to my being warmer with clients. I also strongly encourage clients to be much more involved in selecting along with me what it is that we are going to spend our time doing...what topics from their lives they'll be exploring and what sort of approaches or exercises we might use to address the topics in a manner that fits who they are and what they're preferences are. I may express my professional opinion, even strongly at times, but the client gets the final say on where we head and how we proceed. Dr. Weston's character does say something similar about the client doing the steering, but this only seems to go so far. He always sticks to the same model, even if the client says they aren't finding it helpful.

I am generally much more free with the expression of empathy, letting the client know that I'm getting a sense of how they're seeing things and how they're feeling. I'm also much more apt to invite clients to look at something in a different way than I am to confront, as confrontation implies that I know what is actually going on, and that they do not. Finally, clients are much more apt to hear me ask, "How is this going?", or "Are we headed in the right direction here?" because I know that research shows that the client's opinion of whether we're making progress is very strongly correlated with clients actually succeeding in making the changes that they want to. All of this is not to knock a more traditional psychoanalytic approach. All types of psychotherapy, just as with anything else in life, have their benefits and their drawbacks.

The main question though is: Is this show realistic enough to tap into many of the complexities, joys and challenges of what work in the consulting room is like? For me that answer has been absolutely.
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