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A Therapist's Take on In Treatment

One of my favorite shows is back on the air! In it’s 3rd season on HBO, In Treatment returned a few weeks ago with Gabriel Byrne playing Dr. Paul Weston, the slightly craggly, rough around the edges, but lovable therapist and a whole new cast of characters as his “patients”. If you have not seen this show, I highly recommend it! I love how the show develops the characters including that of the therapist. I love how riveting the conversations are – so much so that each episode actually feels longer than 30 minutes. Usually that might seem like a bad thing (like saying the show drags) but I think what actually happens is that I become so interested and engaged in what is happening and am so in the moment, that time seems to slow down.

It makes me very happy that there is a show out there that makes mental health supported by work in psychotherapy its central theme. I think this has great potential to do wonders for de-stigmatizing it. Yay! But, how realistic is the show? Is this how therapy actually goes? I thought it might be interesting to do a little compare and contrast – real therapy vs. the drama of television therapy.

In Treatment gets a lot of things right. Therapy is a place where people are free to come in and discuss what is on their minds with someone who is listening intently in a way that is rare and valuable. As a result of this listening, the therapist is able to offer observations with the goal of assisting the patient to better understand themselves and increase their awareness of what behaviors in their life might be undermining them.

Some of the things that strike me as being unrealistic about the show is the level of emotional intensity in each of the sessions. This is, of course, what makes the show so riveting, but in real life, therapy should be a safe place where opening up happens in a slow and gradual way, and at the patient’s own pace. Often the patients that come to see Dr. Paul Weston, are portrayed as verbal sparring partners with him – they are trying to hide from him, while he is trying to find them. I’m not saying this never happens in real therapy, but if this was the dynamic between myself and a patient, I would spend a lot more time talking about this process and building rapport and a connection, rather than searching for “gotcha” moments.

One last observation is about Dr. Weston’s style, he is very reserved and resists talking about his own experiences (even though in the end, he usually does share things with his patients). He is being portrayed as a “psychoanalytic” therapist in which the therapist is trained to be a “blank slate” for their patients to “project” all of their emotional issues onto the therapist so they can then be “analyzed”. A more relational approach has become more of the norm with therapists today (though there are still some who practice in Dr. Weston’s way) where therapists are less reserved, contribute more to the therapeutic conversation, and disclose personal details about themselves when it seems appropriate. (For example, if I have a patient who is struggling to begin practicing mindfulness meditation, I might normalize her experience by sharing that I struggled in the beginning as well.) However, I think something helpful to note is that every therapist has their own style and their own unique way of working with people, and in seeking psychotherapy, it is important to feel like you have found a good “fit”, someone you click and with whom you feel comfortable.

So, even though not all therapists work like Dr. Weston, and the drama factor is edged up for T.V., In Treatment contributes an interesting perspective on human beings and their struggles, and how therapy can be helpful in those struggles. As always, if you have any questions, or comments please don’t hesitate to contact me.

Thanks for reading!

p.s. There is a great interview with Gabriel Bryne on Fresh Air from last year. If you haven’t heard it, you can check it out here:

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