TV Review: "In Treatment"

It has been awhile since I last posted. The reason was that I was under the weather and my doctor pulled me out of action. I am feeling 500% better now and ready to torture the brains of anyone who continues to read this silly blog.

I have watched way too much TV in the last few days, which probably made matters worse. I believe in all actuality that TV is for the most part very unhealthy as a hobby. It keeps you generally from thinking and feeling anything that is centered in the real world. TV tries very hard to imitate life and sadly there is a vice versa to all this. This brings me to In Treatment, the new HBO series that premiered this past week. This series is meant to open the door to a patient-psychotherapist relationship and the issues that are discussed in private offices behind closed doors. Hence life in it's most intimate details shown on TV. There are only four shows that I will watch on a regular basis that I think are thought provoking and interesting enough to waste my time on. I have tried In Treatment to see from my vantage point as a mental health professional whether or not it actually matches real life or is it really...just TV. I have been a therapist for many years and I hope for my sake that I can tell the real therapists from the ones that just play one on TV. So here I am writing my first TV review. I will admit that I am not a professional TV critic (this is obvious), but I am a mental health professional reviewing a show about an aspect of mental health treatment. Of course, this last sentence shows how self-absorbed I am and I am sure that I need someone to talk this over with myself.

In Treatment allows us to glimpse into the private practice of Paul Weston. Paul is a psychiatrist in a Southern California practice out of his own home. This brings up immediate;y two major problems. The first is that typical psychiatrists do not provide psychotherapy services. They provide scripts. They are medical doctors who look at symptoms and behaviors, categorize them into a diagnosis, and write a prescription for a medication to cope with or eliminate those symptoms. Matter of fact, "psychiatry schools" have in many places eliminated psychotherapy as a course. The mental health professionals out there who provide the talk therapy are generally social workers, professional counselors, and (to a lesser degree) psychologists. Secondly, no one should have a private practice running out of their own home with no sign of other providers or office staff. This leads to the potential for all sorts of ethical and legal problems. Problems like accusations of misconduct and dual relationships to name a few. When I worked in private practice it was in an office that was an office and there was always a staff person there. For everyones protection. I am guessing this lack of having anyone else around in this show will lead to big problems. This makes things more unrealistic as anyone who has the sense and brain power to go through med school should know better.

This brings us to Gabriel Byrne who has a lengthy acting resume of quality work. He plays our stupidly naive doctor (Paul Weston) who works out of his own home. Mr. Byrne gives us a performance that shows no range and appears more reminiscent of an actor that is trying our for his first part. He appears sadly amateurish and unprofessional as an actor in this role. This is unfortunate given the fact that this is an actor with a long history. He brings nothing of note to the character that makes the character believable beyond the actor playing him. As I watched the first four thirty minute episodes I knew I was watching Gabriel Byrne not Paul Weston. Mr. Byrne is not helped by the writing that makes him look like either a total idiot of a therapist or gives ill-timed one liners that sound like they come from the Dr. Phil show (not a compliment!!!).
On Mondays episode, he is working with Laura (Melissa George, who appears to be also acting as if in an acting try-out) who clearly has borderline personality traits with a taste of bipolar disorder. Laura admits that she is in love with her therapist, Paul. Now this actually does happen in real life in therapy. Unfortunately, this happened to me about three times in my career. It's never a good thing and tough to handle for all involved. Throughout the session, Paul gives no empathic responses that mean anything and gives off the impression that he is totally disinterested (bad body language, flat affect). This left me wondering whether or not it was Gabriel's acting, bad writing, or truly the nature of the character. I should not have to wonder about these things in a TV drama. Please do not get me started on how Paul responded to Laura's graphic description of her sexual fantasy of being with him. All I can say is that his response was creepy. Nevertheless, Paul responded in a manner I would have expected from first year graduate students not the seasoned therapist that the show makes him out to be.

On Tuesday, we got Paul working in an initial interview with Alex (Blair Underwood, practicing his monologue for another role with this role). Alex is a classic narcissist who is a Navy pilot who accidentally bombed a school in Iraq and who also dominates the entire session and continuously tests Paul's credibility. Problem is that this type of interaction would usually not happen to this level in the very first session (due to the need for the therapist to build rapport and information gather). Dr. Weston does a little better in this session but again gives shallow stilted answers and bland delivery of confrontational statements. As a therapist in this situation I would not be so confrontational early in the game and maybe not at all depending on the therapeutic strategy I employ. This brings me to another point. Does Dr. Weston have a strategy? Does he possess a theoretical frame work that will work with these patients? Ooops, I forgot that this was TV.
On Wednesday, we meet 16 year old gymnast Sophie who apparently purposely ran a bike in the middle of the road in front of a car. She comes in without her parents. This is another deviation from reality. Parents usually are needed to get vital clinical information and most importantly as parents they give consent to treat their child. I do support minors ability to seek their own treatment as needed and there are many situations where this would be valid even without the parents knowledge. However, this is not what is portrayed here.
In this session, Dr. Weston graduates to second year student in his mannerisms, body language, and interventions, and even begins to hint at a possible abusive situation that Sophie is involved in that many students may have missed. However, as this is an initial session there is little rapport building and quick confrontation. With teenagers this is a fatal move as rapport needs to be built and it takes a long period of time.

On Thursday, we get Mr. Byrne's best performance as Dr. Weston confronts and gives excellent analysis to John and Amy, a couple who appear to have both their collective feet in divorce court (believe me that this is also typical of my experience dealing with couples). There is more animation and range of character in this episode above all others. So there has been improvement in Mr. Bryrnes' acting and Dr. Weston's psychotherapy ability.

Overall, the acting is stilted at best with everyone looking like they are trying out for their first acting gig. The writing is unrealistic and dime-store psychology at it's worst. The plots are actually rather interesting. The premise of having a show about psychotherapy in thirty minute increments with the same character on the same day is a neat idea that I wish that I thought of first. In my version, the therapist would be more talented, have more range, and act more like Dr. House. That would make this edgy. Maybe this is coming, but we should not have to wait for it.

Grades:
Acting: C-
Writing: C
Plot: B

Total grade: C (GPA= 2.17 out of 4.00)