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Saturday, May 10, 2008

HBO's In Treatment: 9th in a Series

Prof bug is putting the last touches on his two follow-up posts about the different kinds of psychotherapy --- insight-oriented and cognitive-behavioral --- with, please remember, those articles inspired by HBO's In Treatment, a creative breakthrough in televised drama. If you're new to the buggy site, you'd do well to read the initial article on that series. Found at the top of the buggy home page, it ranges widely and sets out the multiple reasons for prof bug's thumping praise.

In the meantime, you'll find a new follow-up on psychotherapy in the bugged out comments that follow . . . adapted word-for-word by prof bug from a lengthy post he left at the HBO forums on the drama. The topic? Paul Weston, the chief character in IT (In Treatment) --- played by Gabriel Byrne --- as a man and as a psychoanalyst who appears in all 43 episodes of the drama.



1) Paul Weston . . . yes, certainly a complex character and a difficult role for Byrne play: 1) full of insight and empathic help for his patients --- his therapeutic slant, criticized by Gina, is essentially relational psychotherapy, with a danger that empathy can erode boundaries between the therapist and the patient; and yet 2) totally at sea in his personal life, as full of self-deception as any of his patients and lacking emotional engagement with his wife or his children.

2) In both capacities, Weston's character required Byrne to limit his emotional range. In his personal life, he emerges as a drained, dissociated man, cut off from strong feelings and swept up in a mid-life crisis (AKA, existential crisis) that he hasn't the slightest insight into. In his professional life, he's more engaged, but lives indirectly by means of his empathic projections of his own mind into the minds of his patients.

His total confusion about Laura underscores something else about his inner life: he is lost in fantasies about her. Not just sexual ones, mind you: if anything, he shows himself incapable of any passion whatsoever in her presence, either when she's in treatment and sitting on a couch a few feet from him or when he's at her residence for a show-down in which, no sooner does he arrive, than he starts launching dissociated patter about abstract art and whatever else might distract from his presumed motive for being there: his professed love and yearning for Laura in all senses of the term.

3) Weston's fantasies don't stop with Laura, or a desire for her body and her adulation for him (he hopes). His mind is crammed with kinetically charged fantasies of a marked escapist sort: he wants to shove off his patients onto Gina, then run off with Laura to the Caribbean, where he will scuba dive during the day, drink cocktails with her on the beach in the evening, and fuck and suck her all night long until the imagined paradise repeats itself the next morning and the morning after.

These are the fantasies of a troubled adolescent boy, whose maturity is roughly equal (as In Treatment shows) to Weston's.

In the end, whether fully intended by the writers of IT or not, Weston emerges as a laughing-stock of sorts, a figure of fun.


4) Note, for one thing, that Weston is the only patient who repeatedly appears in IT who's left stuck in psychotherapy at the end of the series. All the others have taken responsibility for their lives, for good or bad, and left: Laura, Kate, Alex, Sophie, Jake, and Amy (reluctantly maybe: the dramatic series is ambiguous here).

For another thing --- to continue with these reflections about psychoanalysis --- the writers leave you with an impression that psychoanalysis is an endless pitfall, with no clear outlet until a patient decides it's time to move on . . . whether or not he or she feels much better. All that stuff about "insight" precedes change --- the hallmark of all psychoanalysis (and its offshoots) --- isn't clear at all from the little evidence we have. There may be change, but it may be coincidental; and if that occurs, it's more likely because the problems that brought the patient into therapy in the first place might not have been severe.

Note in this connection that IT's dramatic series is misleading here, however understandable that might be from a dramatic viewpoint.

In particular, psychoanalysis is prolonged and expensive, and digs endlessly into how the past relives itself in the presence (yes, even in the relational therapy of the Byrne sort), without any clear cure above and beyond a decision by a patient to stop and try to take control of his or her life. By that point, hopefully, the patient might not feel better about himself or herself --- witness Laura or Kate at the end of IT --- but will presumably have more free choice in his or her life about what to do next. The reason? The patient, so the psychoanalytical mantra goes, is now freed from the irrational (neurotic) compulsions lodged in his or her unconscious mind. Happiness isn't what psychoanalysis aimed at originally, and probably doesn't aim at it now whatever the version being practiced by analysts (unless they're self-deceived --- a fairly common problem among analysts). Despite what many claim these days --- including an insurance-company tailored psychoanalysis of 4 months! --- there is no clear evidence whatever that psychoanalysis of any sort leads to a "cure" except in a limited and usually subjective way . . . defined by the analyst as, say, not returning to analysis for a year after quitting.

                                                       PSYCHOTHERAPY AND SUCCESS

5) More generally, to clarify a little more, no psychotherapy of any sort --- whether insight-oriented (like psychoanalysis of various kinds) or cognitive-behavioral --- has a clear record of success. At best there are fragmentary and heavily biased accounts reported by analysts using thoroughly subjective criteria as to what their therapy has accomplished or not.

To the extent that the empirical studies of "success" --- always ambiguous, and subjectively defined --- show any promise, it is cognitive-behavioral therapies that do better: roughly 60% success . . . defined as a client (not patient!, a medical term) --- not returning within a year. Even here, the sample-size of the clients is small, the definition of success is subjective (if not arbitrary) -- why not three years or 10 years without the client returning (or why not survey the clients themselves to see if they are coping better) --- and the results questionable. Doubly so, moreover, for serious personality disorders. Cognitive-behavioral therapists claim they can handle successfully such severe cases, but there is no unambiguous track record here at all.

Relational therapy --- especially if it's non-psychoanalytical and stresses the here-and-now and the relations it studies are between the therapist and client --- seems, given the ambiguous data and sample-size and definitions of cure, to do better than any psychoanalysis itself. The latter's claims, moreover, are always far more subjective than even the cognitive-behavioral: an analyst's judgment of "success" derived from his or her limited patient base, with possibly a year's absence from returning to therapy after ending it thrown in as a more "objective" criterion.

                                            BACK TO WESTON AGAINST THIS BACKGROUND

6)In effect, Gina does what any good therapist would do: saves Weston at the end from recognizing he has made a total fool of himself in his fantasized relations with Laura, including the debacle at the end. She says it testifies to his sense of professional responsibility and dedication to his family. Of course, that's nonsense. He panics. He panics because he can't move from fantasies about Laura --- not just erotic ones, remember --- to emotional engagement with her sexually or otherwise. He can't, to put it more tersely, face up to reality.

And so he looks like a permanent patient for therapy with Gina, with no clear "end" in sight and of course no clear indication of what will happen to him and Kate. .

7) As for Kate and Laura, both of them --- the two women in his life besides Gina --- have shown far more insight into their problems than Weston ever has in the series. They have also taken responsibility for their lives and are trying to move on. Whether they're happier is another matter. Take Kate. She may be unhappy, but she knows her life hasn't ended. Weston thinks he will never love again, and emerges as a self-deceiving fool.

For that matter, Laura not only takes more responsibility in the end for her life, she proves to have been a better therapist than Weston in two respects:

    1. she understands herself better than he understands hers --- she knows she's self-loathing and he says after a year that he didn't know that (even though she adds almost all men recognize that in her within an hour of acquaintance).

    2, She understands him far better than he understands himself. Hence that brilliant scene where they switch roles --- encouraged by one of Freud's disciples (Sandor Ferenczi and used again by some analysts) --- and she diagnoses his mid-life crisis crisply within a few minutes: he's burnt out, he's drained of emotional engagement in life, he's sexually played out, he can't connect with people except as a therapist (and he tells Gina he finds most of them loathsome), and his only emotional fire is one she set off in his mind in the year she's been with him.


                                                     SO WHERE ARE WE?

Right here in my view. Specifically, why anyone would want to know more about Weston than what we have found leaves me wondering whether that person understands Weston as he revealed himself, played by Byrne, this time around. He's something of a sad laughing-stock, and the series emerges --- whether fully intended or not --- as the revenge, it seems, of former psychoanalytical patients against their analysts.

Note that in Israel, psychotherapy means essentially psychoanalysis. Cognitive-behavioral therapies, developed mainly in this country (and to an extent in Britain), have come in only fairly recently. And psychoanalysis is calculated more than any therapy to traumatize a patient by stripping away all the multiple defenses against the unconsciously buried past --- dreams, unresolved conficts, fantasies, resentments, hatreds, and terrifying fears --- that are supposed to be at the root of the new patient's demoralized condition: his or her depression, self-punishment, excessive guilt, bitterness, anger (repressed or open), and despair.

Orthodox analysis even claimed that the point of all analysis was to create a soaring transference-neurosis that the analyst would then concentrate on, the resolution of which (never clearly defined: nothing is in psychoanalysis if that means empirically verifiable) was the long-awaited "cure". Such traumatizing can leave lots and even most psychoanalytical patients worse off than ever . . . including years and years and years ofd dependence on an analyst may not even like them.

                                          GABRIEL BYRNE'S ACTING

All this about Paul Weston as a character and a therapist raises a question: how much struggle was it for Byrne to play Weston.

That is hard if not impossible to say, considering that I've seen him in only one other role besides in IT: his performance in the Coen brothers film, Miller's Crossing.

There, in that film filled with ruthless gangsters --- killers, mobsters fighting one another, killer-cops --- Byrne seemed oddly out of place: a survivor near the top of the Irish mafia, yet the exact opposite of a ruthless man who simultaneously is a gangster. Conceivably, the emotionally limited range of the Byrne character there parallels to an extent the Weston character in IT: Byrne may himself be a self-limited actor without a crackling inner life that, say, exists in his fellow countrymen like Daniel Day Lewis, Kenneth Branagh, and Collin Ferrell . . . all male actors of quality, with bursting emotional life.


Pinning down Byrne's acting is all the more difficult because of the fatuous, spun-out, and head-spinning eroticized fantasies about his person that have dominated these forums and infected virtually ever thread: whether about I could lick and suck Byrne, or the women characters in IT, or his therapeutic talents (as Weston), or even (to my astonishment) the short thread on psychotherapy.

It has not helped matters that a small clique of sex-starved, noticeably inane posters numbering about 12-20 --- mainly gay guys with serious identity problems and some women groupies egging them on --- have posted more than 95% of al the posts in these forums (save the thread on psychotherapies). Since the end of March, they seem to have accounted for 99% of the posts. Worse, , their posts --- when not filled with eroticized yearnings for union with little Gabriel (a non-threatening male who sets off fantasies of being helped and nurtured as a prelude to sex dominated by the gays and women) --- have mainly degenerated into girls-night-out-on-the-town gossip and yak yak. Poor Sciwriter at least came close to noticing that --- he alone, along with me, the only heterosexuals left in these forums, it seems, since mid-March.

Oops, maybe a wrong claim.

Quite possibly, in the period since I registered for these HBO forums --- late February 2008 --- sciwriter and I might have been the only heterosexuals around except for a sympathetic young fellow I corresponded with separately, and CW . . . a man full of rage and hatred for women whoM, fortunately, you seem to have silenced.

                                       LAST REFLECTION

Whether you HBO moderators have done what you could to discourage the confused gay guys and their groupies from endless tittle-tattle and backfence gossip is another matter. I can't say. I run my own web site much differently, and you have a perfect right to run this one as you see fit. I would say that you could have done more to prevent these gossip-mongers from acting as guardians of the group-think orthodoxy. Possibly, had you done more, then the threads might not have been infected so much by fatuous GB masturbatory fantasies and endless adolescent-retarded chitchat.