“In Treatment” (HBO): Therapy for the Masses

With a new and fourth season of In Treatment coming to HBO Max later this month, starring Uzo Aduba as the therapist, I’m posting today about the first three seasons (2008 to 2010). This series about Paul Weston (Gabriel Byrne) both providing therapy and receiving it was based on Hagai Levi‘s Israeli series Be’Tipul, which ran two seasons.

As reported by Gaby Wood, The Guardian, Be’Tipul‘s Levi was motivated by a desire to reduce mental health stigma in Israel. Levi felt that whereas in the U.S. “people mention their therapist at the drop of a hat,” not so in Israel. The series went on to become popular among clients, therapists, and many more, including those discovering acceptable therapy depiction for the first time.

In the American-made In Treatment Paul Weston’s therapist is Gina (Dianne Wiest). While Paul is a “boundary-challenged, deeply conflicted, terribly appealing psychotherapist” (Michelle Orange, New York Times), Gina “[cuts] through Weston’s self-absorbed obsessions” (Peabody Awards).

Clinicians and critics had varying but mostly positive opinions about In Treatment‘s portrayal of therapy sessions, viewed in 30-minute segments as opposed to the standard therapy “hour.” Psychologist Ryan Howes, self-confessed lover/hater of the series, listed his pros and cons in a Psychology Today article titled  “In Treatment Ambivalence.”

Excerpts from a sampling of Howes’s cons:

    • …Paul often begins sparring with new patients before they take off their coat…
    • Paul attended a psychoanalytic institute, but his therapeutic approach doesn’t always appear psychodynamic. It’s more like Rogerian reflection and withholding, which results in the frustrated patient demanding advice, followed by Paul’s defensive reaction and howitzer-like interpretation.
    • In each episode you’ll hear several variations of an accusatory: “so you’re telling me…” or “you think I’m saying…” or “what’s that supposed to mean?” followed by an infuriating misinterpretation. Wait a minute, I’ve got an idea: Introducing The In Treatment Drinking Game: take a shot every time someone makes an assumption, questions the validity of therapy and/or storms out of the session early.

A sampling of pros:

    • The writers may not have Ph.D.’s, but they get a lot right about therapy….
    • It reveals the “layers of the onion” in therapy incredibly well. The patients enter therapy with an immediate and obvious complaint. As the weeks unfold, you see how the problem has roots that extend deeper and deeper.
    • I’ve heard unsubstantiated rumors that complaints are made to licensing boards about Paul’s behaviors. If this is true, I love this….

At the start of the second season Jeremy Clyman, Psy.D, wrote in Psychology Today, “At last the field of clinical psychology has a show free of melodrama and full of the detail and depth necessary to realistically represent the therapeutic process. Predictably enough, patients all across the country are discussing the show in therapy and therapists are discussing it with each other.”

Because Be’Tipul only had two seasons, the third In Treatment season was created from scratch. Furthermore, it involved Paul having a different therapist (Amy Ryan). A fitting summary from Nancy Doyle Palmer, HuffPost:

Ryan plays Adele, Paul’s end-of-the week analyst and foil, who at first glance seemed perhaps too young and fresh-faced for the task — but quickly took on him, his patients’ issues of the week and his 30 year plus roster of mommy/mentor/tortured Irish issues. She’s pitch perfect in a completely new way and knows just how to handle him…

While demonstrating the finest qualities of a therapist Monday through Thursday – deeply caring, observant, benevolent and wise – Paul comes to Adele (as he did to Weist’s Gina) often in a rage – harsh, condescending, duplicitous and game-playing – basically giving credence to the fact that doctors are the worst patients ever and shrinks, well…

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