'In Treatment' Has Therapists on the Edge of Their Couches

New HBO drama may spur more people to seek psychological help.

February 12, 2009, 10:27 AM

Feb. 25, 2008 — -- Maybe therapy isn't so bad after all.

A cushy couch, freshly brewed coffee and even a handsome doctor are all part of the deal, at least for Paul Weston's patients.

Weston, played by Gabriel Byrne, is HBO's latest incarnation of a psychotherapist on the network's new drama "In Treatment."

The program airs frequently — 30-minute episodes five nights a week for nine weeks — and, now at its halfway point, has been lauded by many psychotherapists who say it's one of the most honest and accurate depictions of the profession they've ever seen.

"The writing in ['In Treatment'] is extremely credible from the standpoint of psychotherapy," said Glen Gabbard, a professor of psychiatry and psychoanalysis at Baylor College of Medicine in Houston. "The writers have been very thoughtful in trying to put one foot in real-life therapy and one foot in what works dramatically."

This isn't the first time HBO has featured a therapist in one of its dramas — there was the mob-advising therapist Jennifer Melfi in "The Sopranos" and the relationship guru and psychoanalyst May Foster in "Tell Me You Love Me" — but Weston's patients have little in common with Tony Soprano or the relationship-challenged couples Foster treated.

The series, produced by "Six Feet Under's" Rodrigo Garcia and based on a hit Israeli series, depicts a different patient taking a seat on Weston's couch each day of the week, allowing viewers to follow their progress from week to week.

On Tuesday, there is a young Navy pilot suffering the effect of a botched mission in Iraq and a subsequent heart attack; on Wednesday a precocious and suicidal teenage gymnast who also happens to be sleeping with her coach; and on Thursday, a couple arguing over their unborn child seek treatment.

Weston even visits a therapist himself on Fridays, venting about his patients and his own crumbling personal life — his wife is having an affair.

But it's Monday's patient, Laura, played by Melissa George, who has viewers and psychologists talking.

Laura, who is as appealing as she is repulsive, is madly in love with Weston, proclaiming her love for him in almost every session and even cornering him in a doorway to ask him if he "wants her."

The issue of erotic transference — when patients develop sexual feelings for their therapists or doctors and even try to seduce them — is not uncommon, and psychotherapists told ABCNEWS.com that Laura's plot line is yet another example of how "In Treatment" succeeds at providing the often wary and skeptical public an accurate insight into the complex world of therapy.

"It's common for a therapist who is listening sympathetically and focusing completely on the patient and their needs to become a love object to the patient," said Gabbard, who has not only begun studying "In Treatment" but is the author of the book "The Psychology of 'The Sopranos.'"

"Some patients never mention these feelings, others mention them with great embarrassment and a very small number demand or beg for a sexual relationship like Laura does [on the show]," Gabbard said.

A sense of intimacy is inherent in therapy, and speaking one-on-one with another person privately often invokes feelings beyond a typical professional relationship.

Peter Kanaris, a clinical psychologist based in New York City, told ABCNEWS.com that he has treated patients who have developed sexual or romantic feelings for him and, like HBO's Weston, has had to deal with the situation in accordance with the profession's ethical guidelines.

"The key is to bring it up and not to avoid it or dance around it," Kanaris said. "[A therapist] must help the patient understand the nature of the relationship and show that he has enough self-control that the patient feels safe and knows the therapist won't act on [any sexual feelings]."

But sometimes therapists cross the line, Kanaris said, and when they do it's considered a "terrible ethical violation."

"It can be devastating to patients, too," said Kanaris, adding that therapists who get involved with patients will lose their license to practice. "Even if they feel like they love [the therapist], it's the therapist that has to have his eye on the boundary and essentially protect the patient from themselves."

While Kanaris agreed that the show is "pretty darn good" in terms of accuracy, he added that he had concern that the relationship between Laura and Weston would make therapy seem too "sexualized" to unsuspecting viewers and added that HBO certainly amped up the dramatic aspects of therapy for entertainment value.

"People need to be aware that what they're really seeing is a condensed version of treatment that is highly dramatized," Kanaris said. "Treatment tends to be slower and not as dramatic session by session. Here they're jamming a lot of drama into a short period of time."

But Kanaris still thinks that the show could persuade viewers who have otherwise never been in treatment to consider it.

"This show shows you that there are so many misconceptions about therapy and demonstrates how it can really be a nonthreatening situation, and not only crazy people go to therapy," social psychologist Debbie Then said. "The characters' issues are everyday issues — romance, sex and parenthood — issues that every adult deals with."

Each of the character's issues stems at least partially from problems they've had with their parents, Then said, which is another common trend in therapy.

Gabbard told ABCNEWS.com that when he was studying HBO's "The Sopranos," the mental health field experienced an influx of male patients, and he suspects that more viewers will consider therapy after "In Treatment," too.

"Men came to therapy when they saw a big tough guy like Tony Soprano going," Gabbard said. "Hopefully [this show] will cause some people to get the treatment they need."

"There are a lot of people who have anxieties about therapy that keep them from going," Gabbard said. "And in our culture to a large extent what we see on television creates our reality."

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