In Treatment: TV Hype or the Real Deal?

The most empathic therapists have worked through their own struggles.

Posted Oct 24, 2010

As a psychiatrist, I watch this show with mixed feelings. I'm drawn to the drama of some of the characters. I empathize with the therapist, knowing first-hand the emotional challenges and rewards of treating difficult patients. Sometimes I'm appalled when he crosses the line and let's his own feelings and conflicts interfere with the treatment. The good doctor is supposed to understand his own emotional reactions to his patients and not act on them to serve his own needs. In the series, we're led to believe that talking to his own therapist at the end of the week makes it all okay. But this is therapy, not Confession, and all is not okay.

What I find most intriguing about the show, which parallels my own new book, The Naked Lady Who Stood on Her Head: A Psychiatrist's Stories of His Most Bizarre Cases, is that it gets inside the doctors head. The viewer has a sense of what the therapist is thinking and going through. Some people view therapists as wizards who can magically peer into their minds and know their deepest thoughts and mental anguish. But that is not the case, as shown in both this series and my book. Therapists are just people with their own emotional struggles, and part of their job is to put aside their own emotional needs in order to help their patients.

The realization that a psychiatrist or psychologist might have personal issues frightens many patients. That's part of the patient's transference - they are transferring feelings they have toward other people in their lives onto the therapist. As children, we often have this kind of magical thinking about our parents - that they are all powerful and can fix everything. What often heals patients in therapy is gaining insight on their transference feelings. They learn how they distort their perception of the therapist and gain perspective on how they distort their other relationships.

So is In Treatment the real deal or just TV hype? In many ways, it is as close to the real deal as scripted TV can get, which is one reason so many people are drawn to it. But most therapists don't cross the line and enter their patient's personal lives. In television and film, this has become a stereotype. The patient often falls in love with the therapist, and the recently divorced therapist responds in kind. The therapist meets is own needs and temporarily gratifies the patient. The patient gains a temporary lover, but loses their doctor and the opportunity to resolve his or her conflicts.

The therapists I respect the most are those who have had personal conflicts and resolved them. They don't get personally involved in their patients' transference reactions, but help them understand them. They are often the most empathic psychotherapists because they know the pain and anguish that their patients experience.

So I am eager to see what happens this season on In Treatment. In many ways, it is the real deal. Sometimes it makes us squirm; other times it's a little boring. TV, and therapy, often get that way.

Gary Small, M.D., is a Professor of Psychiatry at UCLA and the co-author (with Gigi Vorgan) of The Naked Lady Who Stood on Her Head: A Psychiatrist's Stories of His Most Bizarre Cases.

Copyright Gary Small, M.D.

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