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A first-impression review of the new HBO series 'In Treatment'

Mark Dombeck, Ph.D.

photo of actor Gabriel Byrne in HBO's series In TreatmentI had a chance to watch the first five (Tivoed) episodes of HBO's new series "In Treatment" the other day. This new show, which I have mixed feelings about, is basically a series about doing psychotherapy and being in psychotherapy (or at least the particular kind of psychotherapy known as psychodynamic psychotherapy). You can watch the show online through the HBO website itself, if you don't have HBO but are interested in following it. Each episode is 30 minutes long, and one episode airs each night of the work week such that the same patient is featured each day of the week. On Monday we are viewing Laura's therapy, on Tuesday, it's Alex, on Wednesday we sit in with Sophie, on Thursday it's married couple Jake and Amy, and then finally on Friday we view the therapy sessions of our intrepid therapist (Paul) himself.

Having watched two and a half hours of this show so far, I can say that I like it very much but I'm not sure how many other people will. Real life therapy involves a process of non-judgmental witnessing, and that witnessing process always requires authentic intimacy. The true core of all psychotherapy is always the intimate relationship that forms between therapist and patient (or client depending on what term you like best). What drama there is in psychotherapy comes alive in the context of this intimacy (or desire for intimacy). It's just hard to make that real drama work when the intimacy is staged.

There is a lot of drama and emotion inherent in psychotherapy (and in other forms of intimate relationships), and you'd think that this would make for good television but it doesn't necessarily transfer to the small screen intact. Therapy is dramatic if you are experiencing it from the inside (e.g., if you are the patient or the therapist). It's also dramatic when you're watching it live and you know it's real (as I have done many times behind a one-way mirror for training purposes). The reason this is true is because you know that the intimacy that is happening is real. When you are watching it on television and you know it is just a dramatization; when you know it is fake it loses much of its impact and power. Though the problems the show's patients illustrate are relatively real in nature, they don't quite ring true somehow as translated into a script and acted out. This problem is present despite the fact that the actors and writers involved with the show are all pretty good at what they do.

Part of the problem is that the problems we are exposed to on the show are exaggerated or, more to the point, selected so as to be maximally dramatic. For example, the show starts up with Laura confiding in her therapist how much she is in love with him. Well, this sort of thing actually does happen in real life and with some frequency. However, it seems to me to lead with it is overkill; trying too hard.

Like most all therapy dramatizations, this one suffers from stereotyping and Hollywood whitewash, but not too badly. First, there is the distortion of the therapy office. Unlike any therapy office I've ever seen outside of television, Paul's office is entirely too huge and well appointed. Offices tend to be small and the furniture tends to be old in real life, thank you very much. In Treatment, all the therapy patients are white and good looking except for Alex who is black and good looking. In real life, patients are, shall we say, more normally distributed with regard to race and beauty, as are therapists. Television show writers (or executive decision makers anyway) always seem to distort these things towards the beautiful and rich (and the white), I guess, thinking that too much reality would not make for good television. I'm okay with it but it does need to be pointed out.

IMHO, the show got better as the week rolled on. In addition to Laura (suffering with an "erotic transference" as Paul so nicely puts it – basically she is somewhat impulsive, ambivalent about her live in boyfriend and thinking her problems would go away if only her perfect handsome therapist would bundle her up in her arms), we have Alex (top gun fighter pilot with anger and control issues and possible narcissism), Sophie (angry teenage gymnast with parent and coach issues – there's gonna be some abuse theme happening here, I'll bet), and couple Jake and Amy who are dealing with infertility and mismatched life goals and temperaments. All of this is okay if feeling exaggerated so far. But we have to give it time to mature and for us to get to know the characters. The problems each patient is dealing with are actually all plausible so far if coming across too silted and scripted so that everything important gets said just so in 30 minutes (that is just not how it works but editing does need to happen for television).

The client who I'm most personally identifying with is Paul the therapist. I especially like the part where he talks about being overwhelmed by his own problems and how he is struggling to keep his own problems separate from his patient's problems. This scenario is entirely authentic and right on the mark. It's not that Paul is some sort of incompetent therapist. It's just that he is also a human being with a complicated life. There is a discipline to being an effective psychodynamic therapist, and that discipline involves a constant balancing and separating process so as to keep personal stuff detached from patient stuff. Paul is bound by his training and his duty to not bring that stuff into the room with him but it's getting difficult to do that. He's on the early point of burnout in the show and his predicament feels realistic to me.

An actual case serves to illustrate. A therapist I met once described rejecting a patient after a single meeting because he had realized that the patient's issues were too close to his own. Like Paul, this therapist felt that he couldn't be sure that his responses towards the patient wouldn't be biased by his personal concerns. Unlike Paul (so far), this therapist decided to excuse himself from working with this particular patient and instead referred him to another therapist who could be more objective. True stories like these illustrate how the sort of work/life conflict Paul is starting to deal with on In Treatment do indeed happen in real life. It is nice to see television get this much right so far. Though not every therapist will demonstrate the insight needed to know when they need to excuse themselves from work, it is also nice to know that some do.

Anyway, I like In Treatment and hope it will stick around for a while if only to serve as a catalyst for discussion of people's real life problems, and to serve as a vehicle for helping people to understand what therapy is, how it works (how it really works), how helpful it can be in people's lives, and what its limitations are. I'm encouraged so far, and just hope they don't make the show too unrealistic, implausible, and (in a word) fake in an attempt to drive audience. That will surely kill the thing. What we need instead is something smart and real. We need something that feels real.