Talk Therapy: Jesse - Week 5: Ep 97

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) 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

'In Treatment' is such a remarkably written show. I say this because we can observe Paul's excellent therapy with Jesse, feel persuaded that Paul has a profound understanding of Jesse, and simultaneously see, or more to the point, viscerally feel, that Paul's deep knowledge of Jesse's dynamics is, in part, a result of possessing similar dynamics, even though Paul doesn't yet know it. 

We've already commented that these "overlaps" also exist this season with the immigrant, Sunil, who lost his wife, and the narcissistic Frances, who is feeling the distance with her daughter. And recall Laura, who lost her mother at an early age and became prematurely sexual; teenage Sophie who was engaged in a lack-of-boundaries sexual relationship with her coach; Alex who has a critical father from who he was estranged; and on and on. (Please comment if you see other overlaps and parallels of which there are many.)

In this clip, Paul sees Jesse clearly. What a sophisticated interpretation of Jesse's sabotaging behavior with his birth parents: "You test everybody around you and you push them away like you did with Marisa and Roberto and Nate. Now it's your birth parents. You hurt the people who care about you so that they will turn away from you. And then you can prove to yourself that you're fundamentally unlovable."

Touché! Et tu, Dr. Weston?

Does this ring a bell? Hasn't Paul pushed away Kate, Gina, the analytic institutes he belonged to, his kids, his father? You know, we've never heard mention of a single friend of Paul's, and indeed, he lamented to Gina that he lives a solitary life, and told Adele he burrows into his office which is his home.

This clip also features Jesse telling Paul how he "f**ked up my f**king life" by taking Paul's advice to contact his birth parents-advice Paul never actually gave. This is a standard hazard of psychotherapy, namely, that the therapist asks questions about particular areas that, if read in a particular light, seem like suggestions to action which patients later blame the therapist for. (We don't yet know if Frances will follow Paul's forceful directive to action to see her sister, Trish, but if she does, which is predictable given the drama of it, she may be handing Paul his head on a platter. It could go the other way, also, but the point is that Paul had no business being as sure as he was that it would turn out harmoniously.)

Also of great interest to me in this clip is Paul's final comment to Jesse that his parents may have given him up at birth simply because they were just too young, at 17, Jesse's age, to raise a child. That makes sense to all of us, doesn't it? But there's an underlying message here, which is actually antithetical to the psychodynamic therapy project, seen from one direction. The message is that sometimes the more complex explanation should not be favored over the simple explanation. (What's that about a cigar?) 

Of course this is true about many aspects of life. One would have to be an ideologue to see it any other way. However, the entire thrust of the three seasons of ‘In Treatment' is that there are deeper underlying meanings to feelings and behavior, and that only in unearthing these meanings can the individual be liberated to choose a course of action rather than have that action determined by the unseen hand of the past. The way I teach this point to students is to say that the cardinal message of dynamic psychotherapy is that today is November 23rd, 2010. (You fill in today's date.) In other words, the therapeutic goal is to help the patient do what should be the simplest thing of all, yet turns out to be the hardest: to actually live in the present.

Rachel Seidel, MD

Even under the best of circumstances, adolescence is often a difficult time for children and parents. Add the anxiety created by parental divorce (Max) or the longings, questions and doubts that may be especially energized in adolescence for an adopted and homosexual child in our culture (Jesse), and I'd say you have quite a hot frying pan on the fire. Then put a teen like Jesse in therapy-where his worries, wishes and unbearable feelings may be exposed, his self-destructive and aggressive behaviors confronted, and his distancing strategies challenged-and that is like jumping out of an already sizzling frying pan into a fire.

In this episode, we have not one, but two teen-age boys whose feelings are expressed through actions much more often than with words. Max and Jesse are each managing a lot of confusing feelings that need sorting out. In order to get on with their development, they have much from the past that needs to be remembered feelingly and reintegrated into a cohesive life story, as well as numerous losses to grieve. It could be very helpful to have another mind to do this difficult work with.

Jesse's impulsivity and low tolerance for feelings or frustrations, as well as his expectation of rejection, make it difficult for him to form and maintain mutual, respectful and loving relationships with the adults who are in his life, as is illustrated stunningly and movingly in this episode. Max is encumbered differently, but we can see that he, too, is struggling in his relationship with Paul.

We learn much more about the vocal Jesse in this show, as Max must take a backseat to Paul's professional life. So, while my colleagues have focused their commentaries on the clip of the touching work Jesse and Paul manage to do together, I'd like to focus briefly on the parallel story of Max as we see him in this episode.

The opening scene shows Max and his father mixing up the ingredients for late-night pancakes. Max says little, but dumps the liquid ingredients into a bowl with a splash that startles Paul slightly. This is as aggressive and angry as Max can allow himself to be; his words are sparse, his feelings mostly contained, at least for the moment.

Then this domestic scene is interrupted by Jesse's insistent banging on the door. We are all startled. Paul leaves Max in the kitchen while he talks with Jesse. Left alone, Max burns the pancakes and sets off the smoke alarm. Paul leaves Jesse and races back to the kitchen to douse the flames and disarm the alarm. It is noteworthy that Paul-who has just sat with Jesse's superheated emotions, listening sensitively and empathically, and making a powerful interpretation about Jesse's aggressive and self-destructive behaviors, even putting a fatherly arm around Jesse's shoulder-does not hear the dramatic message of his own son's action, an action that speaks much louder than his words, about Max's need for his father's help. We might wish to rouse Paul, "Wake-up, dad, your son-being left by you for a patient-is as burnt as the pancakes. He is also burning with anger hidden by depression to an alarming degree."

However, Paul leaves Max and goes to look for Jesse in order to deal with the fire burning in Jesse. Perhaps Paul, aware that he is ready to send Max back to Maryland to live with his mother, is cutting his losses. With his heart mostly in his work, it appears that all Paul has left of himself to give to his son, Max, is a genuine but thin slice of tenderness and a pinch of reassurance: "Just a bit of smoke," says Paul, "that's all."

Randy Paulsen, MD

It's hard not to feel pretty devastated at the end of this clip or, at least, drained. The theme of parents and children, therapists and patients, adoptions and abandonments leaves us reeling as we watch Paul scramble down his stairs to sit next to Jesse on the porch of his house. Who belongs to whom? Who is responsible for whom? Jesse has had a disastrous encounter with his biological parents. "They threw me out." He has come to Paul's house in the middle of the evening, banging on Paul's door, while Paul is trying to make pancakes, and make a bond, with his shy, artistic son, Max. The two teenagers glimpse each other through the back door of Paul's apartment.

When the clip begins, Paul has listened to Jesse describe his visit to his birth parents' home in Westchester. There were children playing outside the house when Jesse arrived 2 hours early. One child in a wheelchair looks like Jesse - "a mini me." Jesse has walked around Westchester looking in vain for a diner, getting high, feeling confused by the sight of kids playing at this house. When he returns, all signs of the children have been removed, even to the extent of washing the chalk drawings off the driveway. Jesse senses that Paul is frustrated with him, and Paul does say that he thinks Jesse deliberately sabotaged the meeting, that he is testing everyone, pushing them away so he can prove to himself that he is unlovable. Jesse says, "I didn't know that I did that." 

Paul makes an effort to bring this pattern into Jesse's relationship with him. He asks, "Even coming over here now, it's late. It's not your session time. Were you testing me to see how much I care, what I'm willing to sacrifice? Will I put my kid's needs before yours?" Sometimes bringing conscious recognition to behavior, to action, will cause a person to stop, to reflect and become aware. But Jesse is still high, very distraught and in no position at that moment to listen. Instead, Paul's efforts blow Jesse's circuits and he abruptly packs to leave. He then claims the only reason he came was to tell Paul how much his bad advice has f**ked up his life. "I'm the one in trouble here, not you." It's very interesting to think about what is happening in this angry statement. Jesse has taken back the "trouble" into his own desperate self, ceasing the relentless projection of it onto Paul, the birthparents, the world.

Taking a person into therapy can be like a form of adoption. The one place Jesse chooses to go on this chaotic night is Paul's apartment/office. Paul makes a valiant attempt to conduct a therapy session. But in so doing, he has to leave his own son, his biological child, to fend for himself, alone in the apartment, separated from the office by the sliding door. A therapist is often torn between the compelling world of his practice, and the sometimes more difficult, less immediately rewarding life of his own family. Paul is struggling to make a connection with his own son. Neither Paul's son, Max, nor his patient, Jesse, are capable of living life on their own. They are in need of someone to depend on, to help them see their way, to protect them from their own destructive, at times, excruciatingly poor judgments. 

Jesse had stayed on the stoop where Paul could find him. When Paul sits down next to Jesse, the mood changes from rage to sadness. There is grieving and acknowledgment in Paul's statement that Jesse's birthparents had made a mistake in not telling him about the other children. And there is grieving in Jesse in his statement that "this has ruined everything." It is a sad statement. Sometimes more growth comes out of sadness, and grieving, than out of anger and projection. We'll have to wait until next week to see what comes out of this sad moment.

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