May 07

“In Treatment”: 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…

Jan 29

“Maybe You Should Talk to Someone”: Therapy

In a previous post I introduced the 2019 highly regarded nonfiction book Maybe You Should Talk to Someone: A Therapist, HER Therapist, and Our Lives Revealed by Lori Gottlieb.

Now that I’ve actually read it, I’ve selected some Maybe You Should Talk to Someone quotes about therapy.

…(T)herapy is about understanding the self that you are. But part of getting to know yourself is to unknow yourself—to let go of the limiting stories you’ve told yourself about who you are so that you aren’t trapped by them, so you can live your life and not the story you’ve been telling yourself about your life.

Whatever the problem, it generally “presents” because the person has reached an inflection point in life. Do I turn left or right? Do I try to preserve the status quo or move into uncharted territory? (Be forewarned: therapy will always take you into uncharted territory, even if you choose to preserve the status quo.) But people don’t care about inflection points when they come for their first therapy session. Mostly, they just want relief. They want to tell you their stories, beginning with their presenting problem.

Until you tell me what’s really on your mind, you’ll stay stuck exactly where you are.

Being silent is like emptying the trash. When you stop tossing junk into the void—words,words,words—something important rises to the surface.

Say what you will about the wonders of technology, but screen-to-screen is, as a colleague once said, “like doing therapy with a condom on.”

Right now it’s all about one foot, then the other. That’s one thing I tell patients who are in the midst of crippling depression, the kind that makes them think, There’s the bathroom. It’s about five feet away. I see it, but I can’t get there. One foot, then the other.

One of the most important steps in therapy is helping people take responsibility for their current predicaments, because once they realize that they can (and must) construct their own lives, they’re free to generate change.

Changing our relationship to the past is a staple of therapy. But we talk far less about how our relationship to the future informs the present too. Our notion of the future can be just as powerful a roadblock to change as our notion of the past.

But many people come to therapy seeking closure. Help me not to feel. What they eventually discover is that you can’t mute one emotion without muting the others. You want to mute the pain? You’ll also mute the joy.

Remember Sartre’s famous line “Hell is other people”?…But sometimes—more often than we tend to realize—those difficult people are us. That’s right—sometimes hell is us. Sometimes we are the cause of our difficulties. And if we can step out of our own way, something astonishing happens.

…(O)ne litmus test of whether a patient is ready for termination is whether she carries around the therapist’s voice in her head, applying it to situations and essentially eliminating the need for the therapy.

Unfortunately, sometimes people leave just as their symptoms lift, not realizing (or perhaps knowing all too well) that the work is just beginning and that staying will require them to work even harder.

A supervisor once likened doing psychotherapy to undergoing physical therapy. It can be difficult and cause pain, and your condition can worsen before it improves, but if you go consistently and work hard when you’re there, you’ll get the kinks out and function so much better.

Apr 02

Lori Gottlieb: Therapist in Therapy

Lori Gottlieb has written a new book, Maybe You Should Talk to Someone: A Therapist, HER Therapist, and Our Lives Revealed, and it has some things in common with my book Minding Therapy. However, whereas the therapist-who’s-also-a-client story in Minding Therapy is fictionalized, her therapist-in-therapy tale is truth-based. Not only that, the therapist who went to therapy is herself.

Kirkus Reviews introduces Maybe You Should Talk to Someone as a book that’s also about Gottlieb’s work with clients “chronicles the many problems facing the ‘struggling humans’ in her stable of therapy patients. The intimate connection between patient and therapist established through the experience of psychic suffering forms the core of the memoir, as the author plumbs the multifaceted themes of belonging, emotional pain, and healing.”

Gottlieb entered her own therapy because of a relationship crisis. In the book she describes how her perceptions of the now-receiving-therapy role evolved over time. As one Goodreads reviewer states:

Gottlieb starts out thinking that she just needs a couple of sessions to get over this hump, as it were, but her conversations with Wendell make her see that she could actually use more help than she realized. It’s a jarring realization, but it’s also one that seems to make her a better therapist as it makes more clear the struggle some of her patients have in connecting the dots between their pasts and their presents, their problematic behaviors and the painful consequences, and being honest about things that don’t put themselves in the best light.

For more information, see this NPR interview, “A Psychotherapist Goes To Therapy — And Gets A Taste Of Her Own Medicine.”

Selected Reviews

Susannah Cahalan, author of Brain on Fire: “Shrinks, they’re just like us—at least in Maybe You Should Talk to Someone, the heartfelt memoir by therapist Lori Gottlieb. Warm, funny, and engaging (no poker-faced clinician here), Gottlieb not only gives us an unvarnished look at her patients’ lives, but also her own. The result is the most relatable portrait of a therapist I’ve yet encountered.

Lisa Damour, PhD: “With wisdom and humanity, Lori Gottlieb invites us into her consulting room, and her therapist’s. There, readers will share in one of the best-kept secrets of being a clinician: when we bear witness to change, we also change, and when we are present as others find meaning in their lives, we also discover more in our own.”

A.J. Jacobs, author: “Here are some people who might benefit from Lori Gottlieb’s illuminating new book: Therapists, people who have been in therapy, people who have been in relationships, people who have experienced emotions. In other words, everyone. Lori’s story is funny, enlightening, and radically honest. It merits far more than 50 minutes of your time.”

Jun 26

“My Mourning Year”: Therapist’s Grief Process

Andrew Marshall is best known for his self-help books, but his memoir demonstrates that mental health, even for experts in the field of psychology, is a universal struggle. Failed counseling sessions, spontaneous vacations, and romantic dates are all attempts Marshall makes in order to move past “the black holes of Thom.” Zane DeZeeuw, Lambda Literary, reviewing My Mourning Year

Although known in the United Kingdom as a top-notch couples therapist and author of 18 self-help books, Andrew Marshall‘s My Mourning Year: A Memoir of Bereavement, Discovery and Hope, about the death 20 years ago of his partner, may be his best writing, according to Zane DeZeeuw, Lambda Literary.

My Mourning Year is an almost unedited version of the diary he kept following Thom’s death. “He does not offer steps or guidance for how to navigate the mourning process; instead, Marshall uses his experience as anecdotal evidence that a person can survive and learn to live again after being affected by a tragedy.”

As Marshall explains in a Telegraph article, “When my partner Thom died 20 years ago, he was just 43 and I was only 37. I did not have the first idea how to cope with the grief that enveloped me.”

By publishing such a personal book, going against the usual privacy he’s maintained throughout his career, Marshall states, “I want to show that there is no right or wrong way to grieve and everybody – even therapists – make mistakes.”

One significant point Marshall makes in My Mourning Year (and I will continue to quote from Telegraph) is that “Bereavement has the knack of finding the fault lines in your life and blowing them apart. It exposed that my parents were not entirely comfortable with me being gay and I was not comfortable with their polite but distant way of showing they cared.” He needed to take some space from them.

And, adds Marshall, “the most important message of all: grief does not work to a conventional clock. Sometimes it feels like 20 months since Thom died and I still find new things to mourn. (Just recently, I wept about never getting to know him as an old man.) At other times, Thom’s death seems so long ago that it happened to someone else – perhaps because I’m not the same man I was 20 years ago.”

In the aftermath of Thom’s death there were certain things that failed to make Marshall feel better: a rebound relationship, for example—also counseling, it turns out. He actually tried it twice. This “was particularly upsetting because up to then, I’d thought of therapy as the holy grail. The problem was partly me. Just as doctors are terrible patients, therapists make terrible clients.”

(My own take on that latter statement is that it’s overly generalized and certainly not always true. I’ll accept, of course, that he is a therapist and that he feels he made a terrible client.)

Some of the things that did help Marshall’s grief process included the catharsis involved in attending theater, learning to be assertive about specific needs, taking a course in something new to him, and a one-year death anniversary dinner shared with close friends.

Eventually, moreover, he mended the rift with his parents that Thom’s death had provoked. Too, he was able to love again:

Bereavement is a wake-up call that none of us immortal. So I worked hard on improving my relationship with my parents and they have not only learnt to accept me but came to my wedding, two years ago, with joy in their hearts.
Perhaps this is the reality of mourning: you never get over the loss, but if you allow it to open you up to new experiences, you can transform your life into something that might be different, but still rewarding and meaningful.