Monday, April 22, 2013


I decided to tackle Season One of InTreatment, HBO's programming about a therapist, his patients, and the therapist's therapist. The show was set up in five 20 to 25 minute segments, four with the therapist dealing with his patients, and one with the therapist talking to his consulting therapist about dealing with each of his patients. So an evening could last more than two hours, but you could bail out after each half hour segment. Or watch them one at a time like bon-bons, if you'll excuse the mixed metaphor.
          Full disclosure at the outset, my father was a Freudian psychoanalyst, the talk therapy founders, a rare breed in this day and age of dose 'em with drugs and send them on their way. Also, lots of people are calling themselves analysts these days who don't qualify, in my opinion. 
          Psychoanalysts [in the olden days] were first trained as psychiatrists. So they were doctors. They could prescribe medication, if necessary. As docs, they could also distinguish between a psychosomatic illness and an organic one. Does she have M.S. or conversion hysteria? Diagnosis and treatment. One-stop shopping. 
          Most, if not all, the psychiatrists who planned to become psychoanalysts were usually board certified. So the bar had been raised fairly high before they started training to be an analyst. The next step was to attend an Institute for Psychoanalysis [NYC or Chicago were the ones I remember] for four years, give or take, undergo analysis themselves [I think my dad b.s.'d his way through his] and pass more tests.
          These days, you can be accepted into a psychoanalytic program without even being a medical doctor or a PhD/PsyD. But don't expect your B.A. in creative writing to get you in -- clinical social workers with a minimum of a master's degree are at the bottom of ladder. You still have to go through analysis and four more years of school, but entrance standards seem to be different now. Okay, lower. 
          Meanwhile, as smart as my father was -- he skipped his senior year of high school after taking the entrance exams for the University of Chicago and placing in the Top Ten finalists for the freshman class -- I probably learned more about human behavior from my mother, who was successfully analyzed [seven years, three times a week] by Theresa Benedek, a renowned Hungarian analyst at the Institute for Psychoanalysis in Chicago. That's because my mother was grounded in common sense, not esoteric jargon. So with all that in mind, I have some biases about therapy. And psychotropic drugs. Which boil down to this, in a nutshell: Do therapy. Or do therapy and drugs. Don't do drugs alone.
          With my background, I knew it would be hard to start watching InTreatment. Would the show break any of my cardinal rules of shrinkage? Would I cringe at the therapy? Or the therapist?
          And, voila! Yes. Yes. And Hell, yes. The very first episode was a classic stereotype. The therapist was male [Gabriel Byrne]. His first patient was female. You can probably guess the rest, but first, allow me to digress to another one of my biases. 
          Whenever I have a friend seeking therapy, I always tell men to see men and women to see women. Gay or straight. Doesn't matter. Same sex is the way to go. 
          Why? Because too many therapists [predominantly male] are susceptible to patients of the opposite sex. Imagine phone sex, live and in person. AND those horny therapists get PAID to listen to it. The history of the profession is littered with temptation. They've even made movies about the assholes who succumbed  -- A Dangerous Method, anyone?
          But the patients may be even worse. I have known women in their forties and fifties who have told me they were actively trying to seduce their shrinks while in therapy. WTF? First of all, ladies, you're not that good looking. And you're insane. Come on. Shrinks have standards, too. 
          Of course, some shrinks have a different problem. They don't know when to cut a patient loose. That regular paycheck is so appealing. I know one patient [an attorney in real life] whom I have called a "lifer." To his face. He's still seeing a therapist once a week after more than twenty-five years. Hello? Haven't you got any friends? I told him to pay me. I'd be his friend. He still has the same problem he's always had with women. They're certifiable. Only now that he's wealthy, they're just younger and better looking. 
          Meanwhile, whaddya know [thanks for waiting for it], the story line for Gabriel Byrne and that very first female patient is the same old tired cliche -- the young, beautiful bitch is trying to seduce the therapist and, it turns out, he wants to do her, too. I could barely finish the episode. 
          Next patient? A handsome, Top Gun pilot who wiped out a school in Iraq, killing sixteen children in a pinpoint raid. Right after the incident he decides to run more than twenty miles, without training, which precipitates a heart attack. Sounds like he's trying to kill himself out of guilt, but, of course, he's in denial. Meanwhile, because of the heart attack, the Navy grounds him as temporarily unfit to fly. And he comes to the therapist. This particular story line is the most interesting of all. But, sadly, it ends predictably. On his first flight after deciding to leave therapy, the pilot crashes his plane, making no attempt to eject or save himself. 
           I should mention that the pilot is African-American, because, in addition to choosing a therapist of the same gender, I would add choosing a therapist of the same race. I think there are so many cultural nuances that affect our psyches that commonality of racial history or similar ethnicity helps eliminate incorrect assumptions and illuminate the right ones. 
          With one exception. There is a theory that the quality of the relationship between a therapist and patient, not the type of therapy practice, is what benefits the patient most. So, in lieu of a perfect match, race and gender-wise, I would recommend a therapist of any race who is a female social worker or Psy.D/PhD. But not a female psychiatrist or psychoanalyst. Women are [generally -- oh, hell -- always] more empathetic than men. But I think female psychiatrists/psychoanalysts lose all vestiges of empathy the higher up they go on the food chain. Sometimes education isn't necessarily a good thing. 
          After the therapist on the show has crossed both gender and racial lines with his first two patients, his next one is a teenaged girl. Like that's going to happen in this day and age. There are no generalists in shrinkland. Everybody's got a specialty. Adults OR children. Not both. Plus, a teenager in therapy is usually dealing with sexual and/or suicidal issues. Not to mention a fucked up mom and dad. Just like this kid. [Not to mention a pedophile priest, coach, or scout leader.] Quelle surprise!!!! 
          Little Miss I'm So Full of Angst is followed by an unhappy couple. Holy crap, this guy's a family therapist, too? I don't think so. And these two are having such terrible problems just talking to one another, I would have told them to call a lawyer and not ever come back. But that's just me. Guess what? After many months, they decide to call a lawyer and never come back. Thank you, I'm here 24/7. 
          Finally, each week, after seeing these patients, the therapist goes to see a supervising analysand. Basically, she's a second opinion. Since shrinks work alone and are accountable to no one, I think a second opinion should be a requirement for all of them to keep their jobs. Not going to happen. She was his supervisor for eight years before they had a falling out, but now, because he's floundering around trying to figure out what to do with his pathological menagerie, they've reconnected so she can help get him on track. 
          If only he'd asked me.  

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