One Therapists’ Thoughts on the HBO Series IN TREATMENT |

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One Therapists’ Thoughts on the HBO Series IN TREATMENT

One Therapists’ Thoughts on the HBO Series In Treatment

BLOGGER: MARK J. HILSENROTH, PhD

I’m a big fan of the HBO series In Treatment and think it provides the general public with a fairly good representation of one type of psychotherapy, primarily treatment from a Psychodynamic orientation. The show’s protagonist, Dr. Paul Weston, discusses being a Psychoanalyst at the Washington (DC) Psychoanalytic Institute, which really exists, as well as having received his Ph.D. from the New School for Social Research, again a real Ph.D. program with a Psychodynamic orientation. A Psychodynamic orientation is a focus of treatment that examines a persons’ relational patterns from childhood through the present and how this pattern plays out in the relationship between therapist and patient. In addition there is a focus on the experiencing and expressing of emotions-especially in the moment during the session, as well as increasing insight, understanding and perspective on themselves and others. This is important with regard to Adelphi because the Derner Institute has a long and distinguished history of training and service to the community from this approach to treatment.

It is clear that the writers, directors and producers of the show have consulted with people in the field and have likely been in treatment themselves. This intimate knowledge of the interior of psychotherapy sessions translates into several well developed story lines and rich interpersonal narratives. These stories are brought to life by award winning actors and has garnered the series both critical and popular acclaim.

Now, while I enjoy the show and think Dr. Weston portrays what I believe to be fairly good treatment with many of his patients, that doesn’t mean he’s perfect. In fact, far from it as he struggles to deal with a wide assortment of issues in his personal life, not the least of which is the end of his marriage. I think what makes the show so compelling to watch and why people might connect with Dr. Weston is the open window into his struggle to balance his personal life and work, while exploring these issues in his own personal therapy. The show provides a unique perspective not only how a therapists’ own life events, strengths, weaknesses and vulnerability might affect their work; but also how the work with one patient may impact the work with another. Sometimes this confluence of issues can be very useful to facilitate the treatment process and sometimes it can be particularly detrimental. These negative effects can be especially pronounced and harmful to the treatment when the therapist is under high levels of stress. The show also demonstrates a phenomenon well known in the field regarding therapist burn out and an over identification with the caretaker role. When this occurs, therapists may use their work as a form of escape from problems in their own personal lives.

Regarding what Dr. Weston says and does during the sessions I find myself agreeing more often than not for much of the session, with most of his cases. Although in some of his cases I think he makes some errors that range from rather mild to very serious. This, I think, is another reason I like the show so much because again it portrays a complex perspective of therapeutic work. The “good,” the “bad” and the “I’m not exactly sure what to say or do” aspect of doing psychotherapy. And this is mirrored in research that demonstrates even with very good therapists there can be substantial variability across their caseload. That is, even the best therapists are not always as effective with all the people they treat. In sum, there are no perfect therapists, but many are “good-enough” to make a meaningful impact on the lives of those with whom they work.

As far as the reception to the show in the field, that I’m aware of, it tends to be mixed. I find that very many of the graduate students and trainees I speak with enjoy the show very much. They often report finding it useful to watch a therapist deal with different issues and intervene in different ways. As shocking as it may sound it’s not so often that trainees get to view other therapists’ work. This can often be very useful by having multiple reference points on how you could communicate different interventions to people seeking help for a variety of problems. With my more experienced colleagues, I hear far more varied opinions on the show and several that are very negative and critical. I get the sense from these colleagues that they seem much more focused on the less effective interventions or problems aspects in Dr. Weston’s work, as well as expressing a concern that the show might undermine the faith people may place in their therapist. In addition, I have heard criticisms that some of the issues portrayed in his personal life and their impact on his work are often exaggerated for the drama of television. While these concerns are certainly reasonable, in the end I believe the show will have a positive impact on psychotherapy in general, and psychodynamic psychotherapy in particular, because it affords the public one perspective of what therapy “might be like” for themselves. That is, it may make some people curious about the possibility of psychotherapy to help improve their lives. I think anything that creates curiosity for a person to try and understand themselves better is a good thing and think most therapists, including Dr. Weston, would agree.

To read Dr. Hilsenroth’s other blog “ How to Find a Good Therapist”, click the link below.

http://blog.imagineage.com/how-do-i-find-a-good-therapist-a-few-practical-suggestions/

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