Talk Therapy: Week 7 - Frances

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 three 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

Poor Frances.

I mean that.

So many viewers just don't like Frances. They don't like her because she's shown herself to be self-absorbed, to be shallow, to be theatrical, to be jealous of and angry at a sister even when the sister is dying, to be unable to sustain a gratifying relationship with anyone, even with her daughter. To be a narcissist. (Some viewers, especially those not smitten by Paul's blue eyes, have similar trouble with Paul. Do you remember when Gina said to Paul, in season two, week six, "you're a therapist who has remarkably little insight into your own behavior. You are so self-absorbed, you are so entitled. You come in here and you spout the same old bullshit.")

I didn't like Frances either. At first.

Then I realized that this was the point. Frances was not –at least initially – at all a sympathetic character. The writer's point of view, I believe, was that we were supposed to experience the same detachment from Frances that others felt from her and that, indeed, she felt from herself. This was rendered even more powerful by the placement of her episodes between the intensely sympathetic –until we got truly scared –Sunil, and the intensely present Jesse.

Were we to meet Frances at the 1 AM party after her evening's performance, she would undoubtedly relate to us according to our status or what we could do for her. We have all been dismissed or rejected or disdained by people like Frances, who were unable to see that they were treating us like disposable objects unless we provided a service for them.

We are experiencing Frances, though, in the therapist's office, not at the party. And it is in the office that she is finally beginning to relax, if not drop, the façade that has protected her from underlying despair all of her life. Am I imagining that this is the first episode in which we've seen Frances with less makeup and with her hair not completely done up?

Whether it was the lack of an authentic relationship with her mother (remember The Drama of the Gifted Child thesis of last week), or the early death of her father of whom she has only vague memories or memories she is not sure really happened, or her experience of being displaced by her sister both as a child and as an adult, Frances does not love herself – despite the appearance of her loving herself too much. In this episode, Paul reminds her, "I think that you judge yourself negatively most of the time. I think you expect people to think the worst of you." In this vein, in week four Paul interpreted to Frances, "…the more applause you get for playing other people, the more convinced you are that you have nothing to offer as yourself."

"I'll have no one. Nobody" says Frances, after her sister dies. Her childhood "won't exist anymore. It'll just be stories." This is the plight of Frances which we have discussed in prior weeks in the language of "there's no there there." She exists only in the reflected light of others. Whether it was the reflection in the eye of her mother or the eyes of the theater audience or the eyes of her therapist, Paul, Frances experiences herself as having no independent existence.

It's as though she is the lifeless moon that shines only in the reflected glow of the sun.

Patricia grounded her, says Frances, and believed in her, and told Frances she loved her. Without that she will feel completely alone. It is at this moment of recognition of fundamental aloneness facing her that she turns to Paul and asks if he will be there for her.

In a moment that cries out for the therapist to say yes, a moment which Paul has cherished all of his professional life given his wishes to rescue others – having grown out of his yearning for rescue for himself – Paul hesitates. He hesitates because he is having doubts about his own longevity as a therapist. Recall that at this moment, we don't know what has happened to Sunil.

By this week's episode, I was able to feel a real sense of connection to Frances, or closer to the truth, a connection to the suffering child Frances beneath the Frances sitting before Paul. Having this sense of connection, even if in imagination, allows the therapist to be present for the patient. And this allows the patient to gradually be present for herself. Paul has been guiding Frances in this direction for seven weeks now, and she has given evidence that she is ready for further efforts in this direction.

When sitting with patients who are self-centered or obnoxious or judgmental or demeaning, the therapist's task is to remember, everybody was a crying baby once.

Rachel Seidel, MD

Frances' show is closing. Paul tells Frances that he read the reviews and that her reviews are good. "Not good enough to keep it past the limited run," says Frances.

Patricia's life is in its final run. She was loved by Izzy, and (perhaps in a more complicated way) by Frances. Paul tells us he "cared for her a great deal; she was a striking woman." Patricia's life-run is extended briefly through extraordinary measures, and Frances wonders if she has done the wrong thing by hospitalizing Patricia. Frances may imagine that — if only she is good enough and can choose wisely enough among Trisha's end-of-life directives — she can keep her sister alive. The loss of Trisha will be huge for Frances: Through Trisha, Frances has gleaned some sense of herself as loved and therefore loveable, has held on to fragments of childhood memories, the truth of which she now admits seems uncertain but these are all she has had and, without Trisha, she anticipates feeling completely alone.

For the moment, Frances is not alone, as Paul reminds her. She has Izzy with whom he believes a loving relationship can be restored over time, and she has Paul. Paul and Frances have just shared a special "now moment," of real connection: Frances has asked Paul whether he knows what it feels like to lose someone who loves you and, after a pause during which Paul looks down in a body language that reflects grief while Frances looks at Paul with compassion, he answers emotionally, "yes." This connection — important for the real emotion Paul and Frances share — is something Frances has longed for.

Will Paul be there for her in future? asks Frances. Paul hesitates. Aware that Paul, in his therapy with Adele, has been questioning his life and his work, we viewers understand that this pause before answering Frances is significant. Patients sense distress in their therapists, especially when there is overlap in their concerns and issues, as there is for Frances and Paul. The future of their therapy is uncertain and, as we know on another level of consciousness, the limited run of this incredible show, 'In Treatment,' is about up. But, for the moment, at least, Paul is there for Frances.

In this episode, Paul helps Frances to face two important realities. The first is that Patricia will die no matter what Frances does, so that Frances' task is not to keep her alive but to execute Trisha's last wishes. The second reality is that Frances is the only one who can take responsibility for her own mental life, that is, that it falls to her alone to remember, to create her own life story, and to find ways of loving and forgiving herself. It seems that, with Paul's help, Frances' defensive armor has started to soften so that it is permeable to feelings, to connection and closeness; where bitterness and irony dwelt, sadness now can reside.

At the end, Frances leaves Paul's office and puts on her sunglasses. We have the sense that therapy has created a subtle but important change for Frances, has given her options: Now she can choose to wear the mask, but the mask doesn't wear her. This is a true developmental accomplishment for Frances.

Frances had tried to escape the reality of aging and death by using face paint, smoke and mirrors to fool herself and others, and by living in a fantasy first encouraged by her mother that we will never grow old, will live forever. At first, she refused to test for the BRCA-1 gene and she avoided visiting her dying sister. Paul Weston helped Frances see that the reality of death is inescapable, even for the Dorian Grays among us. By the end of season 3, Frances has begun to learn that, if we are to live our limited-run lives well, we have little choice but to accept uncertainty and loss, and in the face of that, to find and create ethical and meaningful love where and when we can, so that we can live our lives as fully and humanly as possible.

Randy Paulsen, MD

"I do want maximum pain relief," is the last of the clear instructions that Patricia has written in her living will, which designates Frances Greer as her healthcare proxy. "She wanted to die at home, Paul." But Frances' call to 911 has resulted in Patricia being on a ventilator in an ICU. Here, I think, Paul does some very nice psychotherapy. "I know you wanted to give your sister the death that she envisioned for herself. But it's a fantasy, and in that fantasy you get to redeem yourself, and that's what you cling to." He has made an interpretation bringing her attention to her underlying wish, to be redeemed. He's not saying she shouldn't have the wish, but that it is there, feeding her anguish about the outcome. When the wish behind an action is seen, the action is less imperative. We can live more easily with an imperfect reality if we at least come to know what we wanted from it.

Frances let's go of the fantasy about providing Trish a perfect death and drops to the level of grief. "What am I going to do when she's not here? I have no one, nobody." In reality Frances is talking about the paucity of real relationships in her life, her lonely apartment. Psychologically she is talking about not feeling connected to anyone, not letting anyone in. Before this clip, Frances asks Paul, "what is your job?" Paul answers, "my job to help you see yourself, and if you don't like what you see, to help you change." That is one side of the work: helping a person see, gain insight and then make choices. The other side, helping a person bear the pain of life, comes from the way in which you conduct yourself in the relationship, how you live within your real personhood. Frances says she cannot remember the last time anyone said "I love you," to her.

She asks, "You know what that feels like to lose that, to be completely alone?"

They look directly each other for a moment. "Yes," he says. Another pause.

In this quiet, connected moment they are less alone by virtue of having acknowledged their loneliness. This leads us to musing about the nature of therapeutic, or psychoanalytic, threads in the tapestry of people's lives. Frances has chosen Paul because he treated her sister twenty-five years earlier. In this last session it dawns on her, then, that when Trish dies, Paul will be Frances' link to Trish, and to her childhood with Trish, and therefore to her own early memories. Without these links, "it won't exist anymore, it'll just be stories. I won't even know which ones are real …" We don't know about an extended family, and how much Frances may or may not have drifted away from them. It also does seem that there is good reason to hope that the relationship with her daughter, Izzy, will improve; particularly if Frances can be less personally fragile (with Paul's help?) in the face of Izzy's adolescent trash talking and hyperbole. She needs Paul to remind her who is the mother since it's possible that Frances has unconsciously tried to set Izzy up as her (Frances') mother substitute (see 'Autumn Sonata,' Ingmar Bergman).

In the end I think Frances has been growing in this treatment. Paul is a seeing-eye guide dog for her, but he is also a kind of adoptive parent. He sees her capacities, he reads her reviews, "you can do it," he says. And when she asks him if he was in love with Trish, this time he answers, "I cared very deeply about her. She was a striking woman." In this way Paul's bond to Frances, Patricia and her family is both real, and yet also something they can continue to talk about "next week."

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