IN TREATMENT

Has anyone been watching the new HBO series, “In Treatment?” It’s on 5 nights a week for a half hour as it follows the scenarios between three individual patients and one married couple with their therapist (Gabriel Byrne) and then ends the week with the therapist having a session with his supervisor (Dianne Wiest). Two weeks into it, I have to say that so far, I’m impressed by the subtle intensity of the interactions between the characters, and by the presentation of therapists as “real” people.
It has taken the better part of a century for the western world to begin breaking down the wall between analyst and patient and start exploring in earnest the very human nature of this most powerful and unique type of bond. It is, in the final analysis (sorry, couldn't resist!) the relationship between patient and therapist that effects healing moreso than any particular intrapsychic and historical content that is discussed or examined. I have said many times to patients of mine that what we talk about in therapy is only a vehicle for what’s really happening in therapy.
It’s easier to understand this when you realize that many of our earliest (and worst) traumas hit us at an age when language with words was not our primary way of thinking or relating to the world. In other words, most of our character defenses and dysfunctional adaptations were created during a pre-verbal time, and therefore held mostly in our bodies, and in our feelings and emotions. That is why therapy had to evolve from the highly intellectual (and removed) process of psychoanalysis to more humanistic approaches in which the humanity of the patient and the therapist are understood to be part of the healing equation. Karen Horney, a famous psychoanalyst well ahead of her time over sixty years ago, once referred to the need for therapists to be “wholehearted” in their approach to patients. “In order to approach the ideal of wholeheartedness, we [analysts] must be able to surrender to the work, letting all of our faculties operate while nearly forgetting about ourselves. This is like surrendering ourselves to music or a work of art.” (I would add love to that list.)
Horney continued: “As our knowledge and experience become an integral part of ourselves, we are barely conscious of all that we are while at the same time being all that we are. We can extend the boundaries of ourselves and be more open to the being of others.”
In all relationships, there is an energetic attraction and connection that has brought two people together for a particular purpose, to mutually experience something. That purpose may be accomplished through different forms: parent-child, teacher-student, employer-employee, doctor-patient, colleagues, teammates, friends, lovers, etc. Each of those relationships are as real and valid for growth and learning what it is to be human as any other, even though the exchanges of energy in each may vary greatly.
In the therapeutic relationship, the format is that the therapist and the patient are both focused overtly on the inner life of the patient, with the therapist providing guidance and reflection and a nonjudgmental, accepting environment in which the patient may delve into those inner areas that are unconscious or too painful or frightening to experience alone. (I say “overtly” because the therapist in this situation must simultaneously be focused internally on his or her own feelings and thoughts, while outwardly helping the patient focus on their thoughts and feelings.)
The therapeutic relationship, again, is a real relationship. As in all relationships, feelings are stirred up in each participant according to the dynamics of the interaction and the internal dynamics of each person. As in all relationships in which the two people are not fully actualized, there are degrees of transferences made by each person, relating to the other in a way that is not in accordance with present reality. Ideally, in this relationship, the therapist is aware of his or her tendencies to make transferences to a degree that the patient is not at first.
As in all relationships, the deepest healing occurs when there is trust between the two participants, surrender to the nature of the relationship, and finally, when there is genuine love being exchanged between each person. In her book, “The Intimate Hour,” psychologist Susan Baur courageously posed the question of whether there can ever be a successful psychotherapy without love between therapist and client. The HBO show's characters pointedly debate this subject, and I would add my voice to the discussion by saying that love has to be distinguished from "erotic transference," which frequently occurs in therapy, and is more about the unmet sensual needs for affection from childhood than about real adult attraction. And yes, it is necessary for the therapist to maintain a certain level of anonymity in the therapeutic relationship about the details of his or her personal life so that the patient is not distracted from the purpose of self-reflection, but that does not mean that the therapist isn’t a real person to the patient or that the therapist isn’t really “there” as himself. What the therapist may share about himself personally must always be done with the therapeutic purpose in consideration. (i.e. - for teaching purposes, for challenging idealizations, for bridging a communication gap due to a fear of intimacy, etc.) At the right moment, sharing a personal experience or feeling with a patient can have a deeply healing effect.
So, back to our show, “In Treatment,” I feel that the creators, cast and crew are doing a good job of bringing us inside the once mysterious intimate hour, and I highly recommend it.
PL