“In Treatment” series: therapeutic fiction or reality?
Relational therapy in action
Paul Veston appears to be a very empathic person. Every patient is unique, so is Paul’s treatment plan. Life circumstances, stressful life events, family relationships and history. Paul does not perform psychological profiling, he reconstructs personalities upon his conversations with patients, not upon results of some standardized tests. He always looks at personal relations rather than personality features per se. Analysing emotional reactionsis s very powerful tool when combined with analysis of the environment triggering such responses. Being involved in patients’ life is by far not a sign of Paul’s lack of impartiality. On the contrary, living through hispatients’ emotions allows Paul to better understand and treat his patients.
Paul is not immune from emotional breakdowns himself; his feelings for Laura, one of his patients, unresolved issues with his father, and troubled relations with his wife are good examples of Paula’s own vulnerability. Which is however quite normal; after all, therapists are normal people in flesh and blood. No need to play heroes; everybody, including therapists, get hurts, emotionally reacts (sometimes too strongly) and makes mistakes. Gina, Paul’s mentor, is a good example of it as well; she may just hide her vulnerabilities a little better than Paul is willing to.
So what kind of therapy Paul practices exactly? Relational therapy, we are getting closer. But what does it mean in practice?
Oliver: mess or ignorance as parental style?
Oliver comes to therapy with his parents who currently go through divorce. Hi is overweight, exhibits depressive symptoms and seems to be upset about everything in his life including both parents and school. He feels lonely when his parents struggle between each other and invent ways to hurt each other the most. Oliver is depressed, is this however anyhow pathological? His situation is very difficult indeed, none of his parents actually want to take care of him; simply put, he does not get enough love and support from his family. That not only hurts his feelings but it makes his life dysfunctional thus depressive symptoms appear. Paul does not regard it as a “usual” depressive disorder; in fact, nothing is usual for Paul. Uniqueness of each patient’s situation, prehistory and personality as well as wellbeing of his patients make much more sense for Paul than any clinical classification one can refer to. Which, ultimately, makes sense: after all helping our patients is what matters the most, regardless diagnosis.
Sophie: being strong or simply being confused?
Sophie, a successful young gymnast and Olympic hopeful, comes in with a request for assessment after an accident. She is very independent and quite oppositional, yet her life situation is not really transparent. It takes time for Paul to understand that Sophie feels very lonely, having been feeling unsafe and lacking social support after her parents’ divorce. Sophie refuses her mother’s support as a result of an internal conflict as she loves both of her parents and feels really hurt being trapped in between. Feeling attracted to her father she however rejects his actual figure, and substitutes his image with an imaginary dad who is always there for her. Her mother, who Sophie considers weak and incable of managing her own life, becomes a constant source of family conflicts which lead to Sophie becoming more and more distant. Paul does not want to simply put a diagnostic tag on that case and easily ‘solve it’ by assessing Sophie as suicidal and depressive. Instead, even though Sophie initially rejects the idea of therapy and simply wants to ‘pass the test’ and get the required mental health assessment done, Paul makes Sophie realise that she actually needs help. For Sophie help means shaky grounds; she is terrified by the uncertainty and the necessity to depend on others. On the other hand, she really wants to depend on others which leads to her relationship with her coach, Sie. The relationship which has yet another name… in fact, Sophie is being abused. She is, despite her remarkable maturity, does not see her coach as an abuser; she depends on him and his opinions, and follows his orders. Paul has a very difficult ethical dilemma; he decides not to report Sie to the authorities and feels that he needs to keep working with Sophie to help her get through the crisis involving early maturity, parental divorce, sexual abuse and feelings of guilt and pity with regards to her family situation. Analysing Sophie’s relationships with her relatives, coach, other gymnasts she trains with and, most importantly, herself finally results in her realising who she is and what she wants to achieve in life.