Yes, I admit I hold Melfi to high standards, and that it certainly is easier to Monday morning (or Sunday night) quarterback someone else’s treatment than to do the best thing with one’s own most difficult patients. It wouldn’t surprise me if there were some gender issues operating in my own harshness with Jennifer (she’s a female like me, so I identify with but also perhaps compete with her), but also in my two male colleagues’ defense of her. (Would you be as forgiving of her functioning if she were male, and therefore not “other”?)
I do concur that it’s excellent that Melfi “gets” Tony’s “sad clown” presentation for its remarkably defensive element. However, I’m sure you’ll agree that even though one may grasp the potential hypocrisy in a patient’s denial or dissociation, one has to pick one’s moment carefully for being confrontive about it to maximal therapeutic effect. I had the feeling that she would have gotten more mileage with an empathic than with a confrontive approach at this point in Tony’s development, but who knows? The proof will be in the pudding—that is, we’ll see if he can make use of Jennifer’s in your face, accurate intervention. And this “empirical” approach (what happened next?) is so often the only way we can gauge the “correctness” of our work.