In ‘The Sopranos,’ tension-filled therapy sessions between mob boss Tony Soprano and Dr. Jennifer Melfi have professional analysts hooked. What’s their diagnosis?

For the past two seasons, “The Sopranos” has examined mob life, family life, delusions, illusions, all manner of dysfunction, most of which has found its way into therapy. Indeed, therapy is one of the series’ more powerful dramatic themes, with the ever earnest Dr. Jennifer Melfi (Lorraine Bracco) treating James Gandolfini’s anxiety-ridden Mafia capo Tony Soprano, and Melfi herself seeking treatment from the paternalistic but well-meaning Dr. Elliott Kupferberg (Peter Bogdanovich).

Critics, New Jersey natives, real mobsters and a lot of ordinary HBO subscribers embraced the show. Many analysts too became intrigued--drawn in particular by the unfolding dynamic between patient and therapist.

The analysts claim to love the show for its sensitive portrayal of their profession, but they are the first to admit that there are always deeper reasons behind such intense feelings. While analysts’ lives tend to be all talk and no action, the studied contemplation of ambivalence, Tony Soprano offers the perfect antidote.

“He was trained to not be self-reflective, to be reflexive and to act,” says Dr. Mark Levy, head of the San Francisco Foundation for Psychoanalysis and leader of an informal discussion group about “The Sopranos.” Those actions, including the rageful whacking of his enemies, have potent and irreversible consequences--up to and including death. By contrast, analysts are often unsure just how much potency their actions--that is, their words--have on other people’s lives.

The fantasy, of course, the question that lingers is: How would they treat Tony Soprano if he landed on their couch? And do they believe that the capo could be cured? It’s clearly something they’ve considered.

To Dr. Glen Gabbard, professor at the Menninger Clinic in Topeka, Kan., and coauthor with his film-scholar brother, Krin Gabbard, of the book “Psychiatry and the Cinema,” “The Sopranos” represents “the most accurate representation of psychotherapy I’ve ever seen.” That’s a significant assessment, since Gabbard has viewed more than 400 American films and television programs in which some form of analysis appears.

Gabbard has found it “extremely rare for a female therapist to be shown,” as Melfi is, “competently treating any male patient.” And Tony may be the most challengingly conflicted male patient to yet appear on screen.

It’s not looking too good for Tony as the analysts see it: He’s got poor impulse control and an underdeveloped superego (or conscience).

He’s also got what Glen Gabbard calls a “vertical split”--”one part of him is capable of loving attachments and a completely disconnected, unintegrated aspect of the self is violent, without remorse, and antisocial.” If there’s hope for him it’s because “this man is not comfortable with who and what he is,” says Linda Goettina, an analyst and Los-Angeles based member of the San Francisco Psychoanalytic Institute. His discomfort is what led him to therapy and what may allow him to change.

But for now, his therapy is complicated by the fact that he’s not used to self-scrutiny, is prone to aggressive acting out and is possessed by a powerful erotic transference for Dr. Melfi--in other words, he’s convinced that he’s in love with her, hellbent on bedding her, and not used to being denied.

Melfi has also been in a lot of trouble. She’s taken to drinking vodka in between sessions and popping Halcions at night. In a drunken outburst against a smoker in a restaurant, she appeared to be turning into her patient. And the show’s executive producers/writers, Robin Green and Mitchell Burgess, confirm it--”Melfi has definitely been unraveling.”

Surprisingly, the analysts in the audience are not all that concerned; a certain degree of “decompensation” is expected when a sensitive, empathetic therapist treats such a demanding patient. Goettina has a take on what’s been happening in Tony’s therapy: As Tony gets more conscience, Melfi’s own conscience is being depleted. As Goettina explains it, as Melfihas “lent Tony her ego functions, that’s left hers wanting . . . [and] she, without being conscious [of it], begins to act like him.”

Series Resists a Cliche

His pathology is not all that Tony wants to press onto Melfi, either. The scene is familiar: Female therapist treating an antisocial male--after some mutual soul-searching and cloaked seduction in sessions, she succumbs to having sex with her patient, whose antisocial traits only make him more sexually irresistible. Then they are both magically “cured.” Typically, says Gabbard, the female therapist is depicted as having no life outside of her work and looks like the one with the problem.

So far “The Sopranos” has resisted this cliche. Instead, when Tony made a move to kiss her, Melfi explained his impulse in clinical terms--erotic transference: “You’ve made me into all the things you feel are missing in your mother and your wife. . . .”

In the last episode of the second season, the writers devised a sequence that makes it clear that Tony is a long way from being beyond therapy, or his feelings about Melfi. Obviously aroused, Tony threw Melfi down on the desk and had his way with her. But then, it was only a dream.

As much dissection as Tony inspires, Melfi also triggers a complex reaction from analysts. Little has been revealed about Melfi’s childhood--where therapists tend to look when sleuthing for problems--that might help explain why she’s so attracted to and simultaneously repelled by Tony, and why she’s so driven to keep treating him.

“I would imagine that there was some dishonesty and corruption that she struggled with as a kid in her own family that is still resonating for her,” Levy suggests.

Melfi will be all right, the analysts seem to concur, as long as she keeps taking these issues to her own therapist, Kupferberg, so she can work them through rather than acting them out. The analysts have no problem with a therapist needing therapy herself. They are used to these nearly biblical lines of progression: First Melfi treats Soprano, then Kupferberg treats Melfi, and next season maybe we’ll find out who Kupferberg “is seeing.”

To hear some analysts talk about it, pathology is a kind of hot potato: Tony passes it to Melfi, who hands it off to Kupferberg, and so on down the line. If there is one thing Melfi has going for her as Tony’s therapist, it’s her “capacity to stay with Tony’s aggression and to help him explore and understand its sources,” says Levy.

How far do the analysts think Tony Soprano has gotten in his two years of talk? “At the top of the list, he has a different view of his mother, whom he initially protected and kept on a pedestal,” Levy points out. When his sister Janet, catching an early-a.m. bus out of town after murdering her psychopathic fiance, asked Tony what was wrong with their family, Tony repeated Melfi’s indictment of their mother. “She’s a narcissistic personality incapable of feeling pleasure.”

Ah, Tony’s mother. The sharp-tongued Livia, brilliantly portrayed by the late Nancy Marchand, who had no empathy for her children’s pain, who always saw herself as the wronged party, whose psychological brutality at home outdid her husband’s brutality as the don, who ordered a hit on her only son Tony in the first season. At the root of Tony’s problems, the analysts and show’s writers concur, is his horrible, monstrous, infanticidal mother.

So is blaming mom all the self-awareness that one poor capo should have to bear? And what happens to Tony and his therapy when that larger-than-life mom dies? The sad loss of Marchand means that Livia will also die, and with her any chance for Tony to resolve their relationship in life.

Livia’s death is apt to occupy many therapy sessions in Tony’s future; Gabbard believes Tony’s going to feel both relief--after all, he wished Livia dead many times--and guilt--after all, he wished his mother dead.

But a larger question looms over Tony’s therapy: Is self-awareness enough to constitute mental health, or will Tony have to leave the mob life for that?

One of the show’s executive producer/writers, Mitchell Burgess, doesn’t think that the Mafia is the problem. “Tony comes in to see Melfi because of low self-esteem due to poor parenting. . . . He doesn’t present Melfi with problems about his feelings about whacking people. He’s a soldier, the whackings are part of the job.”

The analysts don’t see it that way. To them, being in the mob and whacking people on a regular basis are not compatible with mental balance. Instead, what Levy would envision for Tony post-therapy is a life of less drama and conflict, of quiet contentment with his family, which is, of course, the kiss of death for TV antiheroes.

The narrative arc of successful therapy is inherently at odds with the narrative arc of a dramatic gangster show. Tony is caught.

“If he continues in his present mob life, he’s apt to come to no good end,” says Goettina. “But if he . . . [comes to] understand all the crimes he’s committed against humanity, he’s going to feel so guilty that he’ll be at risk of falling into a suicidal depression.”

But in the final analysis, would any true fan want Tony’s therapy to succeed?

“With a real-life patient like Tony, I would consider it successful treatment if he could learn to sublimate his aggressive impulses into a more socially constructive career, like being a professional football coach,” says Connecticut analyst Morton Reiser.

“Oh, God, I don’t know about that,” responds Green. “I’d want something more than that for Tony.”

Besides, says Green: “For the purposes of our story, the minute we stop Tony from killing, he’s not a gangster anymore . . . and we don’t have a show.”

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Deborah A. Lott is the author of “In Session: The Bond Between Women and Their Therapists.”