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Talk Therapy: Week 6 - Jesse

Though therapists have supervision (recall Paul's sessions with Gina), one thing they don't traditionally get to do is watch the "game tape" of a session. We've enlisted experts (read their bios and find their comments from prior weeks) to weigh in on select moments with Paul and his patients. What's said, implied, or deeply buried? Let's go to the videotape...

(The content in these discussions does not reflect the opinions of HBO.)

Joseph Shay, PhD


Where exactly does one look for a savior when religion is not an option?
To one's parents? To one's partner? To one's therapist? To oneself?

Jesse is struggling mightily with this question because he feels so damaged  "am I that awful?"  and he knows he needs help. Poignantly so in this episode because it is his 17th birthday, and his disappointment is evident at the opening when he toys with Paul's departing patient (his rival? his "sibling"?) he meets in the waiting room. He can't turn to himself because he's in such tumult. Neither can he turn to his adoptive parents because he has yet to find a connection point that will sustain him. (Maybe in the final episode?) He has no partner and has recently been beaten up by the man he was hoping would love him. And his biological parents have just rejected him, or so he feels, so that's a dead end as well.

Jesse, then, turns to Paul. Many people who arrive at the therapist's office hope to be rescued there. (Even therapists who come for therapy as we have seen.) Just last week, in his hour of deepest turmoil, Jesse came to Paul's home at 10:23pm for rescue.

While the relationship between Jesse and Paul is a dependable one and an absorbing one, it cannot become the primary one. No matter that the patient and the therapist may both unconsciously conspire to create the experience, or the illusion, of ultimate safety and protection, the patient must leave the office and return to the world outside. Even Jesse knows this when he supervises Paul early in this session, telling him, "you should have just kicked me out."

In the clip here, Jesse names RISD as his savior. They'll hear his story, feel sorry for him, waive tuition, and he will finally be at the place that was "made for me," or as Paul describes it, "a place where they'll finally appreciate you and embrace you. The true home you've been searching for." Paul then challenges this assumption, angering Jesse. Paul persists, however, as he is wont to do with patients, and makes a marvelous intervention that reminded me, frankly, of the famous theme from 'The Wizard of Oz,' "There's no place like home." Paul says, essentially, wherever you go, there you are, so you have to deal with this pain right here.

This makes sense to Jesse, but whenever Paul makes such sense, it seems to activate Jesse's underlying yearning that Paul become his rescuing father. Earlier in the session, Paul offers a brilliant insight explaining Jesse's envy of Barrett of the big nose and the perfect family and the confident father with the big nose. Jesse's reply: "That sounds smart. Thanks." By the end of the session, then, Jesse has overcome his earlier skepticism in which he compares the therapist to the guy who sells fake Rolexes on Canal Street! (This is a view, by the way, we have heard before, from Laura in Season 1, and also from Paul in many variations when with Gina.)

Jesse now understands himself a little more deeply, may yet contact his birth parents again, and is not going to run away. But it's still his birthday, and he is still alone. Naturally, then, he asks if Paul will take him for ice cream, hoping to enact his fantasy at the opening of the episode when he told the girl in the waiting room he was visiting his uncle Paul who was going to take him out for his birthday.

Paul pauses. After three years, we know Paul. We know he is distressed here and wants to say yes. We know he thinks this would, at one level, be healing for Jesse, to not be alone on his birthday. But Paul has perhaps learned from the painful ending of therapy with April in Season 2 which he believes is a direct result of having taken her to the hospital for her cancer treatment. There is nothing wrong with the wish to rescue. It is the attempt to rescue that can create therapeutic havoc.

Jesse is crushed by Paul's rejection: "You so obviously don't get it. Nobody gets it." Paul replies, authoritatively, "Jesse, look at me. I get it! I get it!" Paul truly does get Jesse's loneliness, his sense of being damaged, his desire for rescue. And by holding still with Jesse, he is hoping to have Jesse realize that there are genuine options available to him, options that are available in the outside world that can last longer than 50 minutes a week.

Randy Paulsen, MD

Jesse is having a sad birthday party for himself at Paul's office. Before this clip begins we have seen Jesse wearing a Happy Meal crown in the waiting room. He tells the eating disordered girl leaving the office that he is Paul's nephew from Milwaukee and Paul is taking him out for his birthday. In the midst of these fantasies he says, "I think you're beautiful, just the way you are." He's giving her the gift he wants so much for himself, to feel beautiful and loved just the way he is. Jesse can wish for this gift, but he keeps crashing his own party. He is in a teenage nightmare  every time someone loves him, it feels like it means someone else does not. Every time he feels a moment of belonging in one world, it means that he has been kicked out of another. Anton Kris, a Boston psychoanalyst, refers to this as divergent conflict  conflict that feels like it is pulling one's self apart, that one cannot go down one road without giving up the other. He says that the back and forth work of therapy in this landscape is like the work of grieving. One is mourning the loss of unchosen roads, of selves not realized, lives not lived  in order to live the one life that you have. Jesse and Paul walk this diverging path. Yogi Berra once said, "when you come to a fork in the road, take it." Easier said than done.

At the start of this clip, Jesse is planning to take the money Roberto, his adoptive father, gave him for his birthday and buy a train ticket to Providence to visit RISD, the art school that was "made for him." He's going to show the admissions people the pictures that he took of the kids in the yard in Westchester, the home Jesse does not belong to. The gift money from Roberto, the pictures of biological siblings who know nothing of his existence, these emblems of Jesse's alienation, these will be Jesse's ticket to his new home, to a felt sense of belonging. It is true, sad but true, that Jesse needs to make a home for himself in the world. "If you don't have a dream, how you gonna have a dream come true?" sings Bloody Mary in 'South Pacific.' Not all Jesse's dreams have to die. Some of them need to be realized. Thus, his dream of RISD. But he also needs to come to a place of feeling at home within his self. Jesse is focused on the external world. Paul is focused on the internal world. This is the tinder for the explosion.

Paul, "Do you see what you're doing here?"

Jesse, "Go f**k yourself."

Jesse needs to go. Jesse needs to stay. Paul urges working something through so that he can feel a sense of belonging. He has said that a therapist is not supposed to tell a patient what to do, but as a person who cares about Jesse, he is telling him to go home to the people who love him, to Roberto and Marisa who have raised him. Jesse wants a companion who will go with him into his future. He wants to be adopted by Paul for real. He invites him to an ice cream place on the waterfront. Paul suggests that Jesse ask Roberto which leads to the next explosion of, "You so obviously don't get it. Nobody gets it."

What is it that Paul doesn't get? Possibly it is that Jesse knows he can't go home. That he is at the point of separating psychologically, existentially. He is facing the fact that his life is up to him, to what he makes of it. Going home to Roberto and Marisa doesn't solve this dilemma.


What is it that Jesse doesn't get? Perhaps it is that he will take this homeless feeling with him unless he comes home to his own self. That is the paradoxically amazing thing about grief  in the emotion of sadness, a person is taking in a sense of connection. When a person learns to tolerate sadness, they are actually less alone - there is now a felt connection, an emotional bond, where before there was not. Before he sets off into the world, Paul is trying to get Jesse to experience a transformation of his inner sense of emptiness, of being "kicked out,"  a kind of 'In Treatment' birthday, after all.

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Ep. 101 - Talk Therapy

In Treatment

TV14 Duration 2:32 :

Week 6 - 101: Jesse

Season 3

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