Early on in the half-hour HBO drama In Treatment, Dr. Paul Weston, a therapist portrayed with understated aplomb by the Irish actor Gabriel Byrne, is seen struggling to unclog the toilet in his home practice. Soon, Laura arrives, an alluring 30-year-old anesthesiologist who insists both that she is in love with him and that he secretly loves her. “I am not a realistic option,” Paul tells her, addressing an infatuation common to psychoanalysis called erotic transference. Suddenly, Laura stands. “I need to pee,” she says. “It’s blocked up,” replies Paul. Laura moves to the door to Paul’s home, domain of his wife and children. Paul grows uncomfortable. “I bet that didn’t come up in med school—a patient in love with the therapist asks to use a bathroom,” says Laura. “What should the therapist do?”
Actually, the question rarely comes up. “This is why I have ambivalence about the show, it seems like there’s a career’s worth of ethical dilemmas in every season,” says Ryan Howes, an L.A. psychologist who groans each time an episode appears in his TiVo cue, so much does it feel like a continuation of his workday. “I find myself doing a lot of backseat driving.” Yet he’s hooked, as are many therapists, who hail the drama as the most accurate depiction of their work yet to hit movie and TV screens. At once cerebral and earthy—how often do TV plots turn on a toilet plunger?—as well as gloriously talky, In Treatment, now in its second season on HBO Canada, is as close to theatre as it is to the 50-minute sessions it so faithfully reproduces. And it’s at least as prone to hyperbole.
So fraught is life for a psychotherapist, the show suggests, that it makes ethical minefields of everything, from the temptations of erotic transference to the perils of bathroom etiquette. Last season, patients paid frequent visits to the toilet, a rare occurrence for real therapists, whose clients seldom go.
Paul’s practice is exaggerated elsewhere too; he gets much wrong, particularly in setting boundaries for patients and in violating them himself. He fends off Laura’s advances (badly) and is flashed by a 16-year-old girl. He hugs patients, lends them his daughter’s clothes when theirs are wet, and accepts from another the loan of an espresso machine. He shoves a hostile male patient who spies on him (discovering foibles like a cheating wife), and carelessly leaves pills around, leading to a suicide bid. “He could have been sued for that—and he would have been liable,” says Cheryl Fuller, a therapist in Belfast, Maine. “If he didn’t make these errors, he wouldn’t be interesting.” This season he’s driven a patient who is sick with cancer to her first chemo session and briefly allowed a former patient to act as his lawyer in a malpractice suit—the first perhaps justifiable (she’s in denial), the second a strict no-no. No patients go to the bathroom this year, instead invading his kitchen. “I don’t have sessions in here,” he tells one as she barges in with takeout. “It’s not a session, it’s coffee,” she replies.
Interestingly, psychotherapists are not frequently sued, even in the U.S. Still, Paul’s smaller lapses—his failure to keep session notes, say—speak to a cavalier attitude. “What we call ethics now are really more about risk management than what’s best for the patient,” says Fuller. “It’s really about what’s the best way to keep from getting sued.”
Paul’s own treatment under Dr. Gina Toll (to whom actress Dianne Wiest imparts a cascade of devastating facial expressions) is what most exasperates therapist viewers—and not because Paul is as petulant and boundary-pushing with Toll as any of his own patients are with him. “It’s not determined whether she’s a friend or a therapist or whether she’s supervising him in his work,” says Howes, who notes they gossip and share a drink, muddying the therapeutic waters. It’s Toll who insists Paul terminate his therapy with Laura, with whom he’s become too involved. It’s the right move, too late taken, likely because the blurred boundaries with Toll let Paul get away with too much.
That fallibility enriches the show’s characters, so exquisitely rendered this season by the likes of Hope Davis, Alison Pill and John Mahoney, that watching can at times feel like indulging in a taboo—that we too are involved in ethical transgressions as great as Paul’s. “The camera is going where no cameras go,” says Howard Book, a psychiatrist at the University of Toronto. “People are seeing something that really is supposed to take place in private. It’s a fabulous example of a boundary violation.”
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It seems to me a key angle of this article is actually a red herring!
“In Treatment” is not therapy, nor is it a documentary about therapy – and it doesn’t pretend to be either. It is (mostly) a series of short two-handed works of fiction set (mostly) in the offices of a therapist. Timelines are truncated and character arcs are heightened for dramatic effect. Set options are extremely limited due to the premise of the show, so bathroom and waiting room scenes are likely included simply because some aspects of story-telling occur when the characters are not actually seated facing each other.
Critiquing the structure and story arcs of “In Treatment” against actual therapy sessions and therapeutic constraints is about as useful as evaluating the validity of the high voltage, jerkily shot, romantically entangled episodes of “ER” to the actual events that occur in a real emergency room in an inner city hospital. Comparing a television drama to reality is about as useful as comparing “reality TV” to real life.
I note you have not invited screenwriters, directors, actors and set designers to critique therapy offices and what occurs within them according to the rigours of producing a work of television entertainment…
Compare and contrast if you like, but don’t judge a work of art by the same criteria one would judge its subject. It can’t be done.
PS, “In Treatment” is indeed a superb work of television drama about a truly fascinating aspect of the human condition.
It’s the best show on TV. The acting is superb – Gabriel Byrne & Canadian Allison Pill, both deserve an Emmy nomination
Susan in Vancouver – very well put.
Thank you Brad,
I appreciate the support.
Cheers,
Susan
I appreciate In Treatment as drama — I see each episode as a fine one act play. That doesn’t keep me from also seeing it as the best portrayal of therapy I have seen on television or in film. I am not troubled by the ways it departs from actual therapy — showing actual therapy sessions would almost certainly not be engaging viewing. But it manages to capture the flavor of therapy and the interplay of conscious and unconscious elements that are always in play in therapy.
Besides the boundary violations, which are present understandably for dramatic effect, as is frequent “business” like getting water, coffee, etc., there is another aspect that is unrealistic. The therapeutic relationships are speeded up. Paul almost continually responds to his patients with interpretations about their unconscious motivations. He is portrayed as a psychological detective. While real contemporary analysts are referred to in discussions with Gina, there is little representation of the “holding” environment as is actually practiced by many contemporary therapists. The psychological “holding” that Paul does is accomplished instead by kindness and caretaking maneuvers that are the boundary violations people are confused about, like accepting the coffee machine and asking Laura if he can call her a cab, etc. There are ways to talk with patients in which the emotional truth of a session becomes apparent without polarizing into detective/suspect. in reality, practicing the way Paul does makes many patients defensive. I’m mentioning this not as a critique of the show. I think this speeding up is necessary for dramatic effect. However, people who might be interested in therapy might think this is what it’s really like. And it used to be more like this several decades ago until the postmodern movement started to become interested in how patients experience therapist interpretations, which can feel extremely invasive and even shaming.
I would love to know why my comment was deleted. If you have a minute you can write to me at AboutAffairs.com.
It's the most realistic portrayal of therapy ever on screen so it's bound to be a lightning rod for criticism. Regardless, it's a wonderful conversation starter and may encourage some to give therapy a try. For those who have no experience with therapy, this show might give a skewed view. But as they say here in the States, caveat emptor.
question…how does one report abuse from their psychologist?