The Shrink Rap

At last, a realistic TV portrayal of psychotherapy: In Treatment.

Blair Underwood and Gabriel Byrne in In Treatment

Depictions of psychotherapy and psychotherapists on TV—and there have been many—have always had to deal with one central problem: Psychotherapy ain’t showbiz. A videotape of an actual therapy session, replete with silence, evasion, and idiosyncratic references to people and places, would bore the average television viewer in approximately 18 seconds. Given that, it’s all the more surprising that HBO’s new half-hour drama In Treatment manages to be both riveting and the most convincing psychotherapy seen on television yet.

Based on the hit Israeli series BeTipul, In Treatment invites viewers to eavesdrop on private therapy sessions, as Paul Weston (Gabriel Byrne) treats a different patient (or, in one case, a couple) four nights a week, with the fifth weeknight devoted to getting help for himself from Dr. Gina Toll (Dianne Wiest). Dr. Weston is not idealized. He struggles with erotic feelings for a patient like most therapists do from time to time. He misreads the suicidal intent of an adolescent patient. But his heart is in the right place, and he consistently helps his patients see things about themselves that are outside their awareness.

Psychotherapy has served as a convenient plot device for scores of films and television series because it offers the audience this window into an otherwise hidden part of the protagonist’s world. But such scenes tend to work for audiences only if they’re interspersed with action-filled sequences or laced with melodramatic undercurrents, resulting in a fictional version of psychotherapy that is unrecognizable to real-life therapists and patients. Psychotherapists are popular targets because they’re thought of as smug and pompous. (Have you heard the definition of a psychoanalyst? One who pretends he doesn’t know everything.) Hence, audiences delight in fictional therapists who seem just as screwed up as their patients.

The thorny problem of making psychotherapy entertaining was apparent from the earliest attempts to place a shrink at the center of a dramatic television series. In 1970, ABC aired Matt Lincoln, a show about a darkly handsome shrink played by Vince Edwards (of Ben Casey fame) who ran a telephone helpline with hip young assistants. Unfortunately, watching people talk on the phone is not inherently interesting to viewers, and no audience led to midseason cancellation.

Portraying psychotherapists as comic figures has been another strategy to hold an audience’s attention, while also making them far less threatening and intimidating (some still worry that analysts are reading their minds at cocktail parties). Both Frasier and humorous depictions of group therapy with Bob Newhart drew substantial followings, but the writers’ primary interests were getting laughs, not creating a semblance of real-life therapy. Even when a comedy series has dipped into melodrama for an episode, the presentation of psychotherapy has roamed far from what actually happens in the therapist’s consulting room. Dr. Sidney Freedman turned serious in the last episode of M*A*S*H when he took Hawkeye through an emotional catharsis by uncovering a repressed traumatic memory that he had inadvertently played a role in a woman killing her baby. This episode drew some 50 million viewers, but the therapeutic technique was as close to real-life psychotherapy as General Hospital is to modern hospital practice.

Then, in 1999, something extraordinary happened: HBO aired The Sopranos, and its centerpiece was an improbable psychotherapeutic relationship. Dr. Melfi (Lorraine Bracco) took on an impossible antisocial patient, Tony Soprano (James Gandolfini). She struggled with his code of silence, her fascination with his celebrity, and his professions of love for her. She sought out help from her own therapist (Peter Bogdanovich) and occasionally took a nip of vodka before her sessions with Tony, but she did a creditable job of psychotherapy. To be sure, it was a treatment made entertaining with the use of flashbacks, crosscutting, and extraordinary threats on her physical safety. But since complete accuracy is next to impossible, the central issue is how writers can approximate true therapy while still holding audiences’ attention, and The Sopranos pulled it off, for the most part.

The success of The Sopranos naturally led to some copycats. Last year, Lifetime brought us State of Mind, in which Lili Taylor’s talents were wasted as a therapist who works in a house with a veritable personality zoo of other therapists. The show was so concerned with illustrating that therapists’ lives are as unruly as their patients’ that viewers never got to know any patients in depth. Showtime’s short-lived series Huff made the same mistake. HBO attempted to deal with the dullness of psychotherapy by pushing the envelope this year with Tell Me You Love Me, in which private couples’ sessions conducted by an aging therapist (Jane Alexander) alternate with soft-core pornographic scenes starring characters from the show. The sex is meant to keep the audience involved, but it turns out to be remarkably boring. Guess you had to be there.

In Treatment has admirably learned from its predecessors’ mistakes. The writers wisely play to viewers’ attention spans, compressing the usual 50-minute therapy session into 30. It has the courage to keep the camera in the office to let the audience hear what a therapist hears. (And, as a result, the audience starts to care about the patients.) Like most therapists, Dr. Weston is occasionally off the mark when attempting to offer interpretations of his patients’ experiences. When his marital problems flare up, he finds himself thinking about the parallels between his own struggles and those of the couple he sees. He begins to unravel a bit, and he wisely seeks help from Dr. Toll.

To be sure, the psychotherapy is not (thank God) an exact replica of what happens in real therapy. Each patient draws us in by gradually revealing a secret to Dr. Weston as the therapy unfolds—a narrative more common in Agatha Christie novels than psychotherapy, where things are more prosaic. One patient overdoses in Dr. Weston’s office. Another brings him an espresso machine. Yet another propositions him. And everyone gets up to use the bathroom. (In fact, more patients relieve themselves midsession in one week of therapy with Dr. Weston than in 30 years of my own practice.)

But In Treatment stops short of outrageousness—what happens is unusual, yet plausible. Moreover, one of the most accurate features of the treatment portrayed is that the patients resist the therapist’s help. As Freud noted nearly 100 years ago, most patients seek help but then end up fighting off the therapist’s efforts. Dr. Weston deftly manages their resistance, and engages them in a therapeutic alliance, the most powerful predictor of a good outcome. But don’t jump to conclusions: This is not real life—it’s HBO.