DR. PAUL WESTON looks normal. He lives in a nice house, where his patients come for therapy. He listens, he zeros in on their problem, he walks them to the door. But underneath, as viewers of HBO's "In Treatment" know by now, he might have as many -- or more -- problems than his patients.
Presented as a nightly soap opera, the show has become a guilty habit for those familiar with the subtext of therapy. Among the most addicted are therapists themselves who admit to some intense feelings, pro and con, about the drama.
"It's like liver and onions," said Encino psychoanalyst Phillip A. Ringstrom. "People either love it or hate it." Some love it and hate it. Some started out hating it and now love it -- and vice versa.
Already some analysts have scheduled an "In Treatment" panel for March 9, with show runner Rodrigo Garcia and others, on "Responding to Erotic Transference" at New York's Mt. Sinai Hospital. Another New York group held a "psychoanalytic salon" last week to discuss issues raised by the television show, which presents a fly-on-the-wall look at a troubled therapist's sessions with his troubled patients.
One real-life patient said he relates to the show's patients and compared his emotional growth favorably, said Beverly Hills therapist Cara Gardenswartz. "He is able to see objectively . . . what they are unable to see," she said. Others have introduced a personal issue indirectly by referring to one of the patients' issues.
On the other hand, some therapists worry that Weston (played to repressed perfection by Gabriel Byrne) behaves unethically and fear the nightly soap-style drama could hurt business by reinforcing stereotypes that therapists have as many, if not more, problems than their patients. "If managed care didn't wreck us, then 'In Treatment' will do the trick," said Rosalind S. Dorlen, a Summit, N.J., psychologist.
They say Weston discloses too much and crosses boundaries with his patients: Laura, a doctor who's mad about him; Sophie, a suicidal gymnast; Alex, a narcissistic Navy pilot; and Amy and Jake, a jealous couple caught in a cycle of rage and remorse. These patients are unusually aggressive and resistant, slamming doors, arguing, bringing in their own coffee makers.
And when at the end of the week, a visibly less compassionate Weston unburdens himself to Gina, a fellow therapist, she responds harshly.
"She's far too intrusive and critical to be a helpful therapist or supervisor," said Dr. Glen Gabbard, a professor of psychiatry at Baylor College of Medicine and author of "Psychiatry and the Cinema." He said therapists in his clinic told him, "I'd never go to someone who's so critical of me."
"In Treatment" has averaged only 320,000 viewers, not a large number even by cable standards. Yet in a time when pharmacology has gained ground in treating problems, what happens behind the closed doors of therapy still has the power to fascinate.
"Not since 'The Sopranos' have I seen so many therapists talking to each other about a show," Gabbard said. "If I walk down the hall, I'm stopped by four or five therapists asking, 'What did you think of last night's session?' 'What is going on with Dianne Wiest [who plays Weston's therapist]?' 'Is this therapy? Is this consultation? Is this supervision?' 'Is it chitchat between two people who hate each other and try to make up?' "
At first, therapist Gardenswartz found the show both depressingly realistic and annoyingly unrealistic. By the end of the third week, however, she had noticed "parallel process" in Weston's mimicking Laura's complaints in his sessions with Gina. "Now, we have something," Gardenswartz said.
Some therapists said they plan to use clips of the show in postdoctoral courses to illustrate professional issues that arise in real-life sessions: Should therapists make coffee? Or start a couple's session when only one person has arrived?
Because real therapeutic sessions are private, media portrayals inordinately impress the public, patients and therapists themselves, Gabbard said. "We tend to internalize the media portrayals and carry them within as internal templates," he said. The profession has complained about simplistic, clownish or evil therapist characters for years.
To find an unquestionably positive media portrayal, therapists had to go back to 1980's "Ordinary People" where Judd Hirsch's character helped Timothy Hutton's Conrad recover lost memories. "One young resident told me that he had used an exact line from the therapist in 'Ordinary People' and it seemed to work well with his patient," Gabbard said.
In movie and television psychotherapy, conventions call for the therapist to dramatically recover repressed emotionally cathartic memories, he said. "The therapist always has as many problems as the patients. And a woman therapist always sleeps with the male patient, with 'The Sopranos' being a big exception," he said.
Also, something has to happen besides two people sitting in a room, talking. "More people get up and use the bathroom in the middle of a session in one week of Dr. Weston's practice than in 30 years of my own practice," he said.
"The Sopranos' " open-minded and serious Dr. Jennifer Melfi (Lorraine Bracco) represented a pivotal turning point for therapists on television. "I heard that after 'The Sopranos' was running for a couple of seasons, more men started going into psychotherapy," said Ringstrom, who wrote a running commentary on Slate as one of the "Four Shrinks."
Until "In Treatment," however, many therapists didn't like the wave of television therapists who followed Melfi. According to Gabbard, " 'Huff' didn't get into the actual therapy or the patients' inner lives. 'State of Mind' was the same. The main focus was the wacky zoo that inhabited the house where a bunch of really screwed-up people with no boundaries did strange things played for laughs."
And HBO's "Tell Me You Love Me" "made the terrible mistake of showing explicit sex scenes in a highly clinical way," he said. "One of the good things of 'In Treatment' is that it shows how much more erotic it can be to talk about it."
Some of the show's flaws can be chalked up to the Israeli series from which "In Treatment" was largely translated. "When they translated the show into English, they left the words, but some of it comes across differently here," said Lewis Aron, director of the New York University postdoctoral program in psychotherapy and psychoanalysis. "They kept talking about the wall, and the violation of boundaries," that played out in Israel as a literary metaphor, he said. "The wall in Israel is the wall between the Palestinians and the Israelis. That's a country that's all about the violation of boundaries," he said.
What's more, part of Weston's struggle comes from the sort of therapy he's shown to practice -- what Ringstrom called a "method of suspicion" popular over the last 50 years. "He comes out of an old tradition in psychotherapy where 'the customer is always wrong.' Basically it's whatever the patient is saying is suspect. So on the one hand, he is very caringly getting them to open themselves up to him, and then he's playing gotcha."
Now, Ringstrom said, many therapists practice hermeneutics, in which what a patient says is understood as the best they can do at the time. "You're helping them deepen their understanding but not necessarily always suspecting they're trying to con themselves, or you," he said.
Aron, who sponsored the New York salon, said one reason he likes "In Treatment" is that it at least shows "seriousness and depth of thinking about life and relationships."
But that's not all.
"The main reason I like it is that I'm so relieved every night that those patients are his and not mine."