Saturday, February 16, 2008

In Treatment: Episode ?....Paul Continues In Supervision With Gina, Sort Of


For those of you tired of In Treatment, there's a "real" post below. And Roy promises me he's putting up our heated to-benzo-or-not-to-benzo post today [20:31 ET: I'm working on it now. -R]. The end of this post talks about the differences between psychotherapy and clinical supervision.

So Paul returns to Gina for supervision. Every word out of her mouth, he jumps on. Why is he going? He blames her for encouraging him to terminate with Laura, the patient who wants to sleep with him, and he finally admits what we all knew: that he does, indeed, fantasize about Laura.

Every exchange between Paul and Gina is charged, aggressive, angry. These people want to be in a room together why?? They call it "supervision" and Paul talks about his fears that his urologist will think he has small genitalia. It all seems more like psychotherapy to me, not supervision. Angry psychotherapy without a clear agenda and purpose, at that. Paul is as defensive a supervisee as one could imagine any patient being. It's not fun to have this session on my TV screen, I personally, wouldn't want this guy in my office. Did I once say he, as an actor, is hot? I take it back. He started the series as a warm and likable therapist. Most of what happens on this show, no longer feels like anything that happens in my office. For this, I'm grateful.

One of our readers asked the difference between psychotherapy and supervision. Psychotherapy...well that's hard enough to define, but let's just say it's talk therapy to address a problem. We've been there in lots of posts before. It's all about the patient.

In supervision, a psychotherapists consults with another psychotherapist, usually someone older & wiser, about the treatment of patients. "Supervision" implies to me an ongoing process, while "consultation" can be a one-shot deal. The topic of discussion is generally limited to the patient and the interactions between the two of them. Certainly, the supervisee might bring up issues in his own life that feel relevant, but that's not main focus, and discussions of intimate personal matters aren't generally part of the discussion--- if the therapist needs that, a formal psychotherapy is more appropriate. Supervision isn't, by definition, cold or impersonal-- I always ask people I work with about their personal lives in some form-- how they are, if they have families, where they went for vacation, and they often ask the same of me. If a supervisee has been ill, they may chat about that, but it's generally determined by how much we 'click' and polite conversation.

Paul and Gina, the TV characters, can't decide what they're doing or even why they're doing it.