The blog posts grouped under JOURNAL OF A THERAPIST are inspired by the HBO series In Treatment (starring Gabriel Byrne as psychotherapist Paul Weston). Each post will be a commentary to a situation presented in one of the Season 3 In Treatment episodes, which then will be applied and developed so that it is helpful for as many people as possible. Please feel free to share your thoughts and emotions in the comments section after each post (you do not need to reveal your identity). Your opinion is extremely important, as it stimulates a creative dialog. I look forward to hearing from you. 

There are ten years since I ask myself, under different circumstances and with different words, what is the nature of the therapeutic/counseling relationship? Of course, the easy way to answer is to refer to the theoretical orientation of the therapist. There are two poles and a huge range of options in between. On one hand there is the pure Freudian psychoanalyst, who tends to a have distant, almost indifferent, relationship with the patient, whom they benevolently supervise from somewhere above. On the other hand there are some of the humanistic therapists who do exactly the opposite: they tend to make themselves small, as they put the client on a statuesque pedestal, creating a relationship where they rarely challenge the client, since they are convinced they need to cater to every single need of their clients. In my opinion, both these polarized approaches to counseling and coaching have as a result an actual lack of genuine relationship. Behaving as a cold expert or as an over-concerned friend is not in the best interest of the client. 


One of the clients of Dr. Paul West is Sunil, a 56 years old male from Calcutta. His wife has died and he was brought to Brooklyn to live with his son and daughter in law. 
There are two issues I would like to point out here. 

1. Cultural Sensitivity and Cultural Appropriateness. 
Sunil experiences an intense cultural clash. He sees counseling suited just for mentally ill people and Dr. Weston decides to join with him at a different level than he does with the majority of his patients: he allows Sunil to smoke during his session, since he says that this is the only pleasure he has left. And he prepares Indian tea to share during their sessions. 
These gestures of the therapist are probably seen by most therapists as inappropriate, a crossing of the client-therapist boundary. 
Are they?.. How can we determine what is culturally appropriate in the counseling relationship? Is it ok to offer tea and cigarettes to a man arrived from a culture where these activities are a prerequisite almost to social relationship, a man who has great difficulties adapting to the extremely abstract social interactions from New York, USA?

The blog posts grouped under JOURNAL OF A THERAPIST are inspired by the HBO series In Treatment (starring Gabriel Byrne as psychotherapist Paul Weston). Each post will be a commentary to a situation presented in one of the Season 3 In Treatment episodes, which then will be applied and developed so that it is helpful for as many people as possible. Please feel free to share your thoughts and emotions in the comments section after each post (you do not need to reveal your identity). Your opinion is extremely important, as it stimulates a creative dialog. I look forward to hearing from you. 

"Adele-Week 4" is one of the episodes in which the therapist himself goes to therapy. It is what I call a "breakthrough session", in which Paul, the therapist become patient, has a cathartic moment. During most part of the episode Paul talks about feeling that everybody in his life, everybody but him, including his patients, have a passion, have something to believe in. He describes the lack of meaning in his life and then the discussion goes on about how he often is "holding himself back". 

It is this "holding-back" that I am interested in. Why are people holding themselves back? What makes people fearful of pursuing their passion, finding instead refuge into the safety, the security of jobs or relationships which often are meaningless? It is precisely here that I see one of the main sources for anger, manifested either as a chronic, lifetime frustration, or a temporary problem. This is what Adele tells Paul:
                            "It was miserable [for a 12 year old boy to be the caregiver of a sick                          mother], but it was also safe an familiar. And it kept you from having to find any real connections elsewhere. From risking yourself in the other side of the world. And it also had the convenience of allowing you to blame it all on your father. And it is really not so different than what you do to this day, isn't it? [...] 
You accept a growing paralysis rather than taking the risk of finding where or towards whom your real passion lies. Is it any wonder you haven't found what drives you yet?.."
(Anya Epstein & Dan Futterman, In Treatment, Season 3, "Adele-Week 4", directed by Paris Barclay).

There are a few issues that I see here. 
FAMILIARITY: Stimulating and Limiting One's Personal Growth.
Familiarity, comfortable surroundings, are essential for developing a sense of self and healthy Attachement-Separation behavior. 
But it is precisely this need for familiarity that sometimes ends up "imprisoning" us within what we perceive as a comfortable environment. It is the fear of unknown and the fear of change which sometimes enslave us. The result is a sense of powerlessness, which periodically erupts in anger and frustration directed at "the other": spouse, partner, friend, institution, job, etc. It is a vicious circle, since the fear and anxiety push one to make choices that might be "safe", or have the least risks, but which one knows that are not his/her passion. 

ANXIETY: The Need to Be Seen.
When a 12 year old boy "chooses" ( but how realistic can be the choice of a 12 year old?..) to take care of a chronically ill mother rather than living his life, to what extent can he be a child? It is his mother's anxiety that he internalizes, it is her illness that created the boy's view of the world as a dangerous place, and avoidance seems to be a comfortable way to deal with a dangerous, scary world. And it is the absence of a father who is also much more preoccupied to gratify himself with his work and affairs than to look at his child. Mother's illness and father's absence are the issues that attract all the attention and the resources, during a time when the child needed to be seen, looked at, and watched.  
 "You see me!", says Paul the patient to Adele the therapist, and as his story unravels we see how his life has become, has been reduced to, a desperate attempt to be seen, just the way he was. 

It is the reflection of ourselves as care-free children in the eyes of our caregivers that helps us develop a sense of Self, an understanding of our own individuality. When the mirroring in those eyes is constantly missing, chances are we will look for it for the rest of our lives. Chances are that the search for that look, for the missed gaze, will dictate many of our life choices: working hard to prove ourselves; anger towards (or fear of) spouse, partners and authority figures; anger towards our children when they try to assert their own individuality. 

"You are 57 year old, Paul", says Adele the therapist. "At a certain point you have to move past the stories you've assigned to your life, these steadfast explanations you've settled on years ago. You have to look at yourself for real answers. You have to take that risk."