For the past two seasons, a hit drama on HBO has been gathering steam. All the signs of a tipping point are present, as the show is being talked about everywhere, from the grocery store to online listservs to academic conferences. The show is In Treatment, a seven-week long drama that is giving therapy a miraculous facelift. In Treatment takes place almost exclusively in the therapy session between Paul, the psychologist, and his four patients and supervisor. Such an honest and sophisticated portrait of one of the most challenging and strange of professions has piqued the interest of an avid and proliferating following.

This past Sunday marked the final day of HBO On Demand access. The following post is a running diary of the final episode - the climactic session between Paul and his supervisor, Gina. If you haven't seen the show that's ok, nobody's perfect.

30:00 The show opens with Gina reading a letter written by Paul. This letter is an admission of guilt to the father of a former patient who committed suicide in season one. Paul admits to metaphorically aiding and abetting in the suicide of this patient, Alex. Gina is understandably horrified as such an admission opens the litigation floodgates. If therapists were successfully sued every time a patient decided to commit suicide then there would be far too few psychologists leftover. Gina looks intense. This brings me to the ‘therapy face.' A good therapist automatically communicates an expression of confident wisdom. It says, "I understand you and can help you." What has plagued therapy has been a tradition of poor 'therapy faces' that communicate perturbed bewilderment. Gina brings this neutral expression to a whole new low - expressing a face that combines steely objectivity, mild confusion and that of someone with an explosive case of diarrhea. Therapists need a solid representative. We want the Dalai Lama and instead we get Gina. Great...

29:22: Paul enters therapy ready to answer the major questions of the second season: will he lose his license; will he quit practicing even if he doesn't lose his license; will he and Gina get it on?

29:00: Right off the bat, Paul notes that she is dressed up and says he'd ask her where she's going after the session, but he knows she would never tell him. Her ‘boundaries' are too impenetrable. They are nice professional boundaries. They resemble metaphorical white picket fences. Paul has always disliked Gina's assumptions that his boundaries are made with something akin to half painted, rotting wood. She would never tell him where's she's going lest he begin to generate some sort of Gina-based sex fantasy in his mind. The implication is that she is more rigid and silly than a catholic school girl. A subtle zinger: Paul 1, Gina 0.

27:23 Paul declares that he will not mail the letter. I love how he attributes this decision to his daughter, Rosie. He'll ignore the advice of Gina or his legal counsel, but he'll do an about-face on his decision when it's the sage advice of his drug-addicted, emotionally unstable and estranged adolescent daughter. Talk about poor clinical judgment.

25:03: Now that the first five minutes have been sufficiently wasted on high brow literary observations - waiting for the phone call from his lawyer is like being trapped between heaven and hell according to Paul - we can actually get down to business. Gina gets paid to help Paul with his personal demons and his patients NOT his legal strategy. Let's get down to therapy, baby...

24:32 - Paul makes a pass at Gina for...if my notes are correct...the seventeenth time. This is confusing. Paul is a professional, not a member of The Real World, Cancun edition. It gets really steamy when Paul reflects on his time as her graduate student. "We were all so in love with you," he says. Considering Gina's ‘therapy face,' I'd bet good money that Paul can safely speak only for himself. Her face cannot launch a thousand ships...perhaps a couple of dilapidated sailboats. At the climactic moment of this exchange Paul says, "We wanted to know everything about you!" Ooh, therapist dirty talk. It's getting hot in here. Is that porn music I hear in the background?

22:09: It's been a few minutes and nobody has said anything negative yet. Gina is starting to shift uncomfortably in her seat...ah, here we go. Gina lists a handful of dysfunctional things in Paul's life and suggests that they pick one to discuss. Can't waste anytime being happy, as that would imply fierce resistance to the psychic digging of repressed, negative material that is supposed to be happening.

21:45: Paul's lawyer calls. He's off the legal hook. As Paul thanks the lawyer he says the word ‘appreciate' with that distinct Irish lisp of his, prompting my girlfriend to poke her head in from the other room. Yes, he does sound ridiculous when he does that. Yes, he pronounces ‘issues' like ‘tissues.' We agree that it's a miracle he's stayed in business for this long.

21:39: The lawyer waves off Paul's apology for being so difficult a client. The lawyer says that everyone is difficult when they are being sued. I think this is the most insightful instance of perspective taking in the entire episode: Lawyers 1, Therapy, 0.

21:08: Gina seamlessly transitions from "Great, you're not being sued," to "Now you can continue to practice with your patients?" Ah, a seamless transition to more anxiety-provoking, avoided material. Well done. Paul 1, Gina 1.

19:22: Gina is taken aback that April has terminated therapy (the college student with cancer that he see's on Tuesdays). She is even more taken aback that Paul is ok with it. This is a cross that therapy all too often bears. Inherent in the psychodynamic theory that Paul and Gina subscribe is the notion that ending therapy is in fact a covert communication of resistance to the process of uncovering hidden psychic conflicts and shameful motives. Ending therapy does not have to mean that one is being guarded or cowardly. It may just mean that therapy isn't helping. Paul 2, Gina 1

15:05: My girlfriend has been half-listening in the other room and yells out, "transference...projection." She is referring to how Paul is misperceiving his patients. It goes like this. Paul has just confessed that he has an incessant desire to rescue people. It's what drives him to be a therapist. This statement comes in the same breathe as is description of last week's session with Walter (the suicidally depressed ex-CEO). Paul has interpreted Walter's core problems as an incessant need to save others. This inability to live a happy life in regular, retired guy mode is behind his unhappiness. There is much less evidence for this interpretation then there is for a far simpler explanation - just a few short weeks ago he was a successful, wealthy CEO and now he is a disgraced retiree with no purpose, all because of a freak, international health crises. In supervision, the essence of Walter has become unintentionally fused with the essence of Paul. This is projection and the result is an inaccurate conceptualization of Walter...let's call him Paulter.

13:03: Paul argues that an effective therapist must be sufficiently screwed up, so that he/she can understand the patient in crisis. Gina is an Ice Queen, much too normal (and apparently sexy) to be a good therapist. This argument is concerning for two reasons: a. Being screwed up should not be a criteria for good therapy b. Empathy is not about experiencing what the patient is experiencing but about imagining that experience and genuinely communicating it. Paul 2, Gina 2, Therapy -1.

11:19: Paul says that he is terminating therapy. Bam! Although this happens periodically, this time Paul seems perfectly calm, composed, in touch with his personal truth. Gina is thrown off-balance and defaults to her ‘therapy face.' I don't know whether to offer her a tissue or a piece of toilet paper. She makes the same mistake that Paul makes at least once a session, where she says she is not taking it personally, but her body language is screaming, "Fuck you. I have your stupid Irish capriciousness." Paul 3, Gina, 2.

10:37: Gina is grasping at straws trying to keep him in supervision. He must be angry at her for being ‘abandoned' by two patients this past week, so now he is 'abandoning' her. Well, judging by Paul's calmness and her flustered discomfort, it seems that she may be the one with abandonment issues. Maybe she could work on this in therapy: Paul 4, Gina, 2.

9:45: Gina continues to count the ways. He always questions and blames her; she has become his boundary cop. Hmm, I think Paul just started fantasizing about Gina in a cop uniform. She continues to attack his rationale for termination. I can't tell if he's rolling his eyes or looking around for the whiskey.

8:01: His composure remains intact. Normally, he'd be yelling about Gina's disingenuous, wooden stance with patients by now. But instead he's relating to her. This is Paul 2.0.

7:22: Gina's final move of desperation: the law suit has just ended and now he's ending supervision. A coincidence, she thinks not! Paul's getting a headache. No, that's projection. I'm getting a headache.

6:30: Paul wants to discuss how he hates that office chair he sits in all day, every day. Finally, some legitimate displaced anger to unravel and all Gina can do is laugh with that damned ‘therapy face:' Paul 5, Gina 2.

5:52: They talk about Paul becoming a supervisor for other therapists. Gina thinks he will be great, though she almost fell off her footstool trying to keep the straight face. Will Paul become the new Gina? He can make interpretations about the supervisee's interpretations of the patient's interpretations...My head is spinning.

5:11: Paul is getting in touch with his inner child. He wants to stop analyzing and start living. Wow, even the therapist is sick of therapy. April's termination has inspired him. It seems he's learned more from his patient then his supervisor/mentor. Paul 5, Gina 2, Therapy -2.

4:53: They are discussing Paulter and the agreement to step up his treatment to resolve the hero wish issues. Now, Paul gets to save Paulter from his dysfunctional desire to save everyone around him. A hero wisher's ultimate fantasy - perhaps Gina would mention this but we know how she feels about people ending therapy.

3:47: Paul could stand to step into the 21st century a little bit more. First there was the whole not keeping notes thing (this became the most significant mistake as far as the malpractice lawsuit was concerned). Considering that every graduate of a 21st century clinical psychology program has this ethical practice drilled into their minds deeper than the question, "So, how does that make you feel," Paul is looking pretty archaic. Now, he's complaining that there is no way to concretely gage successful therapy. A new methodology has emerged called process research that abandons the traditional drug trial format and tapes a single therapy session in order to zoom in on the precise moments that galvanize positive change and growth. Paul could start videotaping sessions in this vein. Just imagine the possibilities. Remember that session awhile back when he asks Mia (the histrionic, high powered lawyer he sees on Monday) to describe her sexual fantasy of him in more detail...this could easily end up online. Paul's secret therapy sex tape! The tabloids would have a field day.

2:30: Boundaries till the bitter end, as Gina does admit she is going on a date but refuses to say with whom. I think Paul just vomited a little in his mouth. I bet she got dressed up just for him...and the date is with a bowl of Ben & Jerry's and The Sisterhood of the Traveling Pants.

Final 20 seconds: Gina says that she would normally say that her door is always open, but... All that training and experience has made her a master of the final word: Paul 7, Gina 3.

Final 5 seconds: The door closes and Gina is alone. Just her and that whacky little footstool...Gina needs a cat. Yeah, a cat to stroke in-between ‘therapy faces.' I wouldn't recommend a cat for Paul. He'd get lost in interpretations of the cat's meowing and forget to feed it.

About the Author

Jeremy Clyman Psy.D.

Jeremy Clyman, Psy.D., is a forensic and clinical psychologist.

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