These concerns about death, meaning, being and nothingness pervade the series, and Tony himself struggles with them in psychotherapy. Indeed, the fact that Tony is in psychotherapy allows viewers to penetrate his interior world, which would be otherwise unavailable to us. Psychotherapy often serves as a plot device in film. A novel's narrator can inform the reader about the protagonist's inner struggles, but a film has no such omniscient observer. One solution is to have the central character in a film visit a psychotherapist to reveal an inner monologue. In The Hospital (1971), written by Paddy Chayefsky, the audience finds out that the character played by George C. Scott is seriously suicidal when he stops in to chat with a psychiatrist colleague. In Klute (1971), Jane Fonda's high-priced prostitute talks to a psychotherapist about her internal struggles showing that she is more complicated than her call girl activities suggest.
Tony's psychotherapy with Dr. Melfi serves a similar purpose. The history taking of a first psychotherapy session conveniently paints a picture of Tony's life. Flashbacks illustrate what Tony is telling Dr. Melfi about his symptoms, his family and his background. The writers use this exposition technique to comic effect, juxtaposing the sanitized version of events that Tony reports to Dr. Melfi with flashbacks of the violent altercations that actually took place.
The comparisons between psychotherapy in film and in The Sopranos are instructive, but limited. One cannot capture the complexity of a psychoanalytic psychotherapy process in a two-hour feature film. One of the reasons the therapy in The Sopranos is so convincing is that over thirty-nine episodes in three years of viewing, the writers can illustrate the slings and arrows of outrageous transference, countertransference and acting out.
One reason The Sopranos is so satisfying is that it conveys life in all its complexity. The therapy scenes contribute to that complexity, because the coin of the realm in psychoanalytic therapy is multiple determination, where a symptom's multi-layered meanings unfold gradually as one layer is peeled off to reveal another. Consider the fear of speaking in public, a common phobia that brings many people to therapy. On the surface, it may seem to come from a dread of being exposed or of failing. But upon closer examination, therapist and patient often discover that fear of success, not failure, is actually driving the anxiety.
Nothing conveys complexity quite as directly as therapy, and therapy abounds in The Sopranos. Besides her sessions with Tony, Dr. Melfi goes to her own psychotherapist, Elliot Kupferberg, played by film director Peter Bogdanovich. Carmela has a confrontational consultation with one of Dr. Melfi's teachers, and she also attends sessions with Tony in Dr. Melfi's office. In the first season, a clinical psychologist evaluates A.J. for attention deficit disorder after he gets into trouble at school. In an improbable but amusing scene, Dr. Melfi, her son and her ex-husband appear in the office of a family therapist (Sam Coppola) to discuss what she should do about seeing a mob kingpin in therapy.