Is a therapist allowed to do that? - Macleans.ca

Is a therapist allowed to do that?

In the drama ‘In Treatment,’ Dr. Paul Weston seems to have a problem with boundaries

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Is a therapist allowed to do that?Early on in the half-hour HBO drama In Treatment, Dr. Paul Weston, a therapist portrayed with understated aplomb by the Irish actor Gabriel Byrne, is seen struggling to unclog the toilet in his home practice. Soon, Laura arrives, an alluring 30-year-old anesthesiologist who insists both that she is in love with him and that he secretly loves her. “I am not a realistic option,” Paul tells her, addressing an infatuation common to psychoanalysis called erotic transference. Suddenly, Laura stands. “I need to pee,” she says. “It’s blocked up,” replies Paul. Laura moves to the door to Paul’s home, domain of his wife and children. Paul grows uncomfortable. “I bet that didn’t come up in med school—a patient in love with the therapist asks to use a bathroom,” says Laura. “What should the therapist do?”

Actually, the question rarely comes up. “This is why I have ambivalence about the show, it seems like there’s a career’s worth of ethical dilemmas in every season,” says Ryan Howes, an L.A. psychologist who groans each time an episode appears in his TiVo cue, so much does it feel like a continuation of his workday. “I find myself doing a lot of backseat driving.” Yet he’s hooked, as are many therapists, who hail the drama as the most accurate depiction of their work yet to hit movie and TV screens. At once cerebral and earthy—how often do TV plots turn on a toilet plunger?—as well as gloriously talky, In Treatment, now in its second season on HBO Canada, is as close to theatre as it is to the 50-minute sessions it so faithfully reproduces. And it’s at least as prone to hyperbole.

So fraught is life for a psychotherapist, the show suggests, that it makes ethical minefields of everything, from the temptations of erotic transference to the perils of bathroom etiquette. Last season, patients paid frequent visits to the toilet, a rare occurrence for real therapists, whose clients seldom go.

Paul’s practice is exaggerated elsewhere too; he gets much wrong, particularly in setting boundaries for patients and in violating them himself. He fends off Laura’s advances (badly) and is flashed by a 16-year-old girl. He hugs patients, lends them his daughter’s clothes when theirs are wet, and accepts from another the loan of an espresso machine. He shoves a hostile male patient who spies on him (discovering foibles like a cheating wife), and carelessly leaves pills around, leading to a suicide bid. “He could have been sued for that—and he would have been liable,” says Cheryl Fuller, a therapist in Belfast, Maine. “If he didn’t make these errors, he wouldn’t be interesting.” This season he’s driven a patient who is sick with cancer to her first chemo session and briefly allowed a former patient to act as his lawyer in a malpractice suit—the first perhaps justifiable (she’s in denial), the second a strict no-no. No patients go to the bathroom this year, instead invading his kitchen. “I don’t have sessions in here,” he tells one as she barges in with takeout. “It’s not a session, it’s coffee,” she replies.

Interestingly, psychotherapists are not frequently sued, even in the U.S. Still, Paul’s smaller lapses—his failure to keep session notes, say—speak to a cavalier attitude. “What we call ethics now are really more about risk management than what’s best for the patient,” says Fuller. “It’s really about what’s the best way to keep from getting sued.”

Paul’s own treatment under Dr. Gina Toll (to whom actress Dianne Wiest imparts a cascade of devastating facial expressions) is what most exasperates therapist viewers—and not because Paul is as petulant and boundary-pushing with Toll as any of his own patients are with him. “It’s not determined whether she’s a friend or a therapist or whether she’s supervising him in his work,” says Howes, who notes they gossip and share a drink, muddying the therapeutic waters. It’s Toll who insists Paul terminate his therapy with Laura, with whom he’s become too involved. It’s the right move, too late taken, likely because the blurred boundaries with Toll let Paul get away with too much.

That fallibility enriches the show’s characters, so exquisitely rendered this season by the likes of Hope Davis, Alison Pill and John Mahoney, that watching can at times feel like indulging in a taboo—that we too are involved in ethical transgressions as great as Paul’s. “The camera is going where no cameras go,” says Howard Book, a psychiatrist at the University of Toronto. “People are seeing something that really is supposed to take place in private. It’s a fabulous example of a boundary violation.”