We ask real British psychotherapists what they think of the hit TV show
Professor Andrew Samuels
In Treatment gives a very good impression of how therapists both benefit from, and are handicapped by, their own life experiences. Paul is able to use his issues with his own parents in his work; he feels that he was abandoned by his father and left to look after his depressive mother, so his training as a therapist really began in childhood. He's what we call a "wounded healer" ? he draws from his own experiences to give him empathy with and compassion for his clients, but at the same time, those experiences threaten to overwhelm him.
Paul is a very contemporary, up-to-the-minute therapist. He is very interested in the importance of the father in people's lives, which is actually a very modern approach ? Freud and the other founders of psychoanalysis were interested in the father, but from the 1920s to the 1990s, everything was about the mother.
My big criticism of Paul's approach is that he's much too quick to attribute reasons for his clients' behaviour to their subconscious.
For instance, early in season two, one of his clients, Mia, comes in late with two cups of takeaway coffee, one of which she then spills on the table. Paul makes a whole bunch of interpretations of her behaviour ? he implies that she has brought coffee for him because she used to drink coffee alone with her father in his store. I'd be very reluctant to make this kind of interpretation of something a client did just five seconds before. Most clients find it very difficult ? intrusive, even ? to be spoken to in this way.
Paul has a general tendency to get a bit dominant and preachy. But it's also made clear that Paul is far from perfect ? and that's why so many therapists like In Treatment. It doesn't show the therapist as so fucked up that nobody could regard them as credible. But neither does it show the therapist as all-knowing, omnipotent, and in control.
Professor Samuels is an analytical psychologist and Jungian analyst based in north London, and chair of the United Kingdom Council for Psychotherapy (UKCP), andrewsamuels.com.
Doron Levene
Initially I found it quite hard to watch this, because I'm familiar with the original Israeli version of the show. There are some significant cultural differences between the scripts. In the Israeli version, for instance, the fighter pilot that the psychotherapist is treating in the first series bombs a Palestinian kindergarten; in the HBO version, it's a madrasa in Iraq. I rather prefer the Israeli therapist, too ? he's even more passionate and tortured than Paul. But I did warm to Gabriel Byrne.
I've used parts of the Israeli version as teaching material on ethical dilemmas for psychotherapists. Clinicians have to establish boundaries between themselves and their patients. Paul crosses these boundaries quite often, whether by physically attacking Alex the pilot or by generally making himself too available ? he allows patients to cancel at short notice, often without exploring with the patients why they have done so.
Paul is a relational psychotherapist. This form of psychotherapy has become increasingly popular recently, and allows the therapist to engage more directly with their patients than is usually the case with classic psychotherapy. Empathy comes naturally to Paul ? he took care of his depressed mother when he was a boy. His capacity for empathy sustains him when dealing with his rather difficult patient, Mia, in season two. She's very jealous of his other clients ? she even imagines him having sex with one of them. Paul, to his credit, doesn't retaliate ? he just helps her connect her jealousy to her own pain.
The fact that In Treatment is so popular is quite amazing. You don't see much happening ? you're just watching two people in a dialogue. Usually TV audiences want cut, cut, move, move, action, action, and yet the ratings for this show are going up and up.
What I like about it is that you're seeing both the emotional tensions as well as the connections between therapist and patient. It reflects a lot of what goes on in psychotherapy behind closed doors ? and that's something that most people never get to see.
Doron Levene is a body psychotherapist based in north London, body-psychotherapy.org.uk.
Paula Hall
Watching this show is a bit of a busman's holiday. But I really enjoyed it. It highlights the challenge you have as a therapist: balancing a client's safety with their right to make their own decisions.
Early in season two, we learn that the psychotherapist, Paul, is being sued by the family of one of his clients, Alex, a fighter pilot whose plane crashed in mysterious circumstances.
The family think it was suicide, and that Paul should have stopped Alex from flying. But it's not as simple as that. In the UK, at least, there are only two situations in which a therapist has a legal obligation to inform the authorities about a client: if they say they're planning a terrorist act, or ? and this is bizarre ? if they confess to evading taxes.
If a client says they're going to kill themselves or somebody else, legally we don't have to do anything, because we have no proof of intent. But from an ethical point of view, whether or not you intervene depends on how likely you think the client is to go ahead with their threat, and whether you could do anything to stop them.
One of Paul's clients, April, tells him she has terminal cancer in their first session. The way she does it seems plausible ? she can't say the word "lymphoma" out loud, so she writes it down for him. People do often ask me to read written notes about their problems that they've prepared in advance; it can be very difficult for clients just to get the words out.
Paul's approach to psychotherapy is quite similar to mine: he's very human, and he lets his emotions show. But I wasn't sure he handled the divorcing couple he sees in season two as well as he could have. Divorces are difficult ? you often have three people in the room, each with their own set of priorities. Still, I'd have been much more directive than Paul is ? he doesn't emphasise to the parents enough how important it is that they collaborate for the sake of their son.
Paula Hall is a sexual and relationship psychotherapist based in Leamington Spa, paulahall.co.uk.
Dr Philippa Whittick
I was prepared not to like this show ? normally, when you see anything about therapy on TV or in the cinema, you're cringing and saying: "That's not how it really is!" But I did like the episodes I've seen; as a portrayal of one particular form of psychotherapy, they are very accurate. I just wouldn't want audiences to think that all therapy is like this. If you went to your GP here in the UK, and asked for therapy, you wouldn't get this. You'd be more likely to get cognitive behavioural therapy ? that would make an interesting programme in itself, but it would look very different.
I've had patients just like Paul's ? Walter, a high-flying CEO who's having panic attacks is a classic case. Walter keeps answering his mobile during sessions, which does often happen. I don't consider it unacceptable, but, like Paul, I'd be asking the patient why they were doing this: usually, they're trying to tell you something, like how important or indispensable they are.
I also relate to the fact that Paul doesn't take notes. I don't, either ? nobody was taught to when I started out 20 years ago, and I find that I can remember everything about a patient from week to week. But Paul's lawyer is spot-on when she explains to him that the notes are there to reassure you that you've done everything you can for a particular patient.
Like Paul, I've had a patient who took their own life. It was horrible, and I can see how having notes would help you to be sure that you've spoken to everyone you should have spoken to, and that there's nothing about their treatment that you would go back and change.
Dr Whittick is a transpersonal psychotherapist based in Bude, Cornwall.
? All four psychotherapists are UKCP-registered. For more information about psychotherapy, or to find a therapist, visit psychotherapy.org.uk.
Source: http://www.guardian.co.uk/society/2011/apr/26/in-treatment-british-psychotherapists
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