HBO’s IN TREATMENT: Can good drama be good therapy?

Recently, I participated in a terrific discussion group about this season’s HBO series, IN TREATMENT. The group was held in NYC and was led by two analysts from William Alanson White Institute, Claire Basescu and Don Greif. For our final meeting, Claire and Don asked us to respond to questions that addressed whether the show was a good portrayal of therapy. Below are the questions and my responses. Please share your views on these questions.

Did your view of IN TREATMENT as a showcase for therapy change over the season?

I think this season of IN TREATMENT provided great drama and wonderful personal stories. However, a showcase for therapy it was not. My perception about its showcase worth changed over the season. It gradually became less and less so as the personal flaws of both therapists were exposed. While I thought Paul improved somewhat once he was in treatment with Adele, he seemed too restless, angry, and tortured in his own life.

For many prospective patients, I could see this feeding into one potential stereotype about therapy: that the doctor will be crazier than the patient. People considering going into therapy might wonder, “are these my choices: on the one hand, someone who will need me more than I need him and will be working out his own issues with me; or, on the other, a steely, at times robotic, person who adheres so rigidly to her theory, that she misses the unique needs of each patient. And, because of her allegiance to a 1-person view of analysis, does not take ownership of the problems she herself creates?”

What Positive and Negative images of the profession does the show present or reveal?

Negative Images:

• Therapists will answer my questions with questions
• The doctor is crazier than the patient (see above)
• I will be shamed
• Therapy is a game of “gotcha” if I am avoidant/resistant

Positive Images:

• I can say anything in a therapist office: swear, rail, talk about sex
• Therapy may be about connecting to your true, creative, lively self
• Wow, dreams do mean something and can help me understand myself (Paul’s dream)
• There is an unconscious: many of my thoughts, feelings, behaviors and relationship choices may be out of my awareness. Now, because of this show, I am curious about finding out more about my unconscious.
• My confusing behavior and repetitive patterns can be untangled as they are replayed in transference.
• Therapists are humans too (but with training)
• I can have some very attractive person focused exclusively on me for 45 minutes!

Are you proud to be identified with the therapists in the show?

No. I was prouder in the last 2 seasons. Not this one though. Several of the treatments might be considered “failures.” Also, the doctor may be crazier than the patient (see above).

What misunderstandings and/or correct understandings about therapy do you think people might glean from the show?

Possible misunderstandings:

Therapists will know better than me about me. They will tell me what I am thinking and feeling and why. Therapy is an exchange between a flawed “me” and an objective other.

Correct understandings:

Therapy can be a very intimate and emotionally charged experience. Therapists really think and feel so much about their patients outside the consulting room. Therapy is only as good as the human being who provides it. Ultimately, no matter what the theory, my problems will be viewed through the subjectivity of the therapist. Finding a “good fit” with someone is important.

Is the show a good vehicle for exploring clinical process & technique?

Yes. I think it is a terrific vehicle. It illuminates so much about: the frame, boundaries, dual relationships, the transference/countertransference matrix, enactment, different meta-theoretical approaches to interpretation, resistance, the classical and contemporary views of neutrality and abstinence, dream interpretation, termination, psychopathology and character disorders.

And, of course, it highlights the importance of a therapist’s own analysis so that the doctor is not perceived as crazier than the patient (see above).

Sally Rudoy, LCSW