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In Treatment: Fantasy Therapy for All

In Treatment's Dr. Paul Weston (Gabriel Byrne) is all ears.

Explorations of the outer limits of the patient/ therapist relationship titillate viewers with the possibilities of what could happen.

Most of the memorable relationships portrayed in the movies or on television are, naturally, between lovers or friends or family members or coworkers. Occasionally, there’s the inspirational teacher / troubled student bond. Or the brilliant doctor / ailing patient one. But in recent years the most compelling relationships played out before an audience have been, hands down, between therapist and patient.

Nowhere has this been more affecting than on HBO, first with the edge-of-your-seat therapy sessions on The Sopranos, where intimacy always threatened to turn violent. And more recently -- and perhaps even more powerfully -- with In Treatment.

In the second season of In Treatment, which just ended, the scenes between the therapist, Paul Weston, played with enormous intensity by Gabriel Byrne and Mia, a smart, snarky, lonely attorney in her early 40s, played brilliantly by Hope Davis, were among the most riveting half hours of television, ever. As an example:

Mia: Can we talk about your patterns?

Paul: My patterns. Like…what?

Mia: You like to have a woman on the couch who thinks she’s in love with you. How you get off on that.

Dialogue like this, delivered with the bold directness that characterizes Mia’s dealings with Paul, conveys just a small sense of the dramatic tension that drove this storyline.

So what is it about the patient-therapist relationship that is so ready-made for gripping drama? I think that, as with romance and violence, Hollywood is doing what it does best: distilling our private fantasies and then projecting them onto the big (or small) screen. Except in this case, instead of peeping through the bedroom window or down the barrel of a gun, we’re invited to peer into that most mysterious of sanctuaries, the therapist’s office. And there two characters act out our spoken and unspoken desires for what we think we want from therapy.

Hollywood has a history of playing to those very fantasies. As anyone who has been in therapy knows, there is no one life-changing moment, no single flash of insight that will resolve all of your issues in a manic moment, allowing you to move forward in life with newfound wisdom, confidence, and tranquility. And yet one can’t help but long for the big breakthrough -- and Hollywood knows this.

In the 1980 movie Ordinary People, the adolescent, suicidal patient Conrad (Timothy Hutton) experiences an epiphany in which he realizes, with the help of his psychiatrist, Dr. Berger (Judd Hirsch), that he’s been unfairly holding himself responsible for his older brother’s death in a drowning accident. Following this breakthrough, Conrad comes to terms with his survivor’s guilt, begins expressing his feelings more openly at home, becomes more outgoing at school, and starts dating a girl who is warm and giving in the way his cold, blaming mother is not. It's simply irresistible fare.

A similar scene occurs in 1997’s Good Will Hunting, which seems to have borrowed much of its sensibility about therapy from Ordinary People. After Will (Matt Damon) has been in therapy for a short time his therapist, Sean Maguire (Robin Williams), ups the ante by pulling out Will’s file and reading off the list of abuses Will suffered. In response, Will lifts his shirt and exhibits his scars, trying valiantly to maintain his toughness while Sean keeps repeating, in mantra fashion, “It’s not your fault, it’s not your fault” until Will dissolves in tears and holds onto him as if his life depends on it.

After this climactic cinematic moment Will no longer needs therapy. He leaves the safety of familiar surroundings and his friends and drives cross-country in the hopes that he can win back the girlfriend he unceremoniously dumped when she’d wanted to get to know him better (before therapy turned him into a sensitive male).

Another common fantasy among therapy patients is that they mean so much to their therapist that he or she will come to their rescue whenever, wherever. Meeting with the patient outside the office or at unusual hours is a particular Hollywood favorite. In Good Will Hunting, Will and Sean sit together talking on a bench overlooking the Swan Boats at Boston’s Public Gardens.

In Ordinary People, Conrad calls Dr. Berger in a panic from a phone booth at night and Berger leaves the comfort of home and presumably family to meet him at his office. In keeping with, and even surpassing, this tradition, on In Treatment Paul brings April, his college-age patient who was recently diagnosed with non-Hodgkin’s lymphoma, to her first chemotherapy session, literally saving her life.

Then there’s the patient’s wish for the therapist to fall in love with and even desire him or her. It seems to be a foregone Hollywood conclusion that if the therapist is the opposite sex of the patient then this will naturally occur between heterosexuals. Movies dating back to Hitchcock’s Spellbound (1945) through more recent films like Lovesick (1983), Prince of Tides (1991), and Mumford (1999) all feature patient/ therapist romances.

However, unlike in the movies where the romance is sometimes allowed to blossom, on the grittier HBO shows, a sexual relationship is denied and yet the characters still suffer severe consequences. On The Sopranos, Tony’s therapist, Dr. Melfi (Lorraine Bracco), not only questions whether or not she is falling in love with Tony (James Gandolfino), she’s driven to drink by this possibility and is forced to confess her feelings for him to her own therapist.

In the first season of In Treatment, Paul falls in love with the alluring Laura (Melissa George), and although he never actually sleeps with her, he quite nearly does. As a result, he loses his marriage in part over his near-affair. Another patient of his, Alex (Blair Underwood), a troubled pilot who did sleep with Laura in order to hurt Paul, crashes his plane, perhaps purposely, and dies. And this leads to a wrongful death lawsuit against Paul by Alex’s father. Imagine the trouble if Paul had slept with Laura!

Perhaps television shows and movies that explore the outer limits of the patient/ therapist relationship serve the same purpose for therapy patients that fairly tales do for children or thrillers for teenagers: they titillate viewers with the possibilities of what could happen while they remain safe in the knowledge that their fantasies will most likely never become reality. And yet, just as we hope that our romantic lives can resemble those in the movies, maybe we can’t help but harbor a wish that our therapy sessions will take place in the Public Gardens -- or under cover of night.

Mia (Hope Davis) trying to explain it all to Dr. Weston.

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