So I finally wrapped up the current season of HBO's In Treatment. I will try to be brief.
It is easy to take potshots at the show's ludicrous inaccuracies: the melodrama, the boundary violations, the additional boundary violations. In this show, therapy is aerobic exercise--patients and therapists jump up and pace, hurl objects, and/or run out of the office. Is this how they do things in New York? Where I come from, passive aggression works just fine--why work yourself into a tizzy when you can just lapse into sullen silence or fail to show up for your next appointment? But that sort of thing takes precious time on screen, and doesn't get the blood pumping.
Perhaps the most unrealistic aspect of the show is the fact that Dr. Weston ("Paul" of course to his patients) is a remarkably astute therapist, except for his Texas-sized blind spot as regards therapeutic boundaries. His formulations and his interpretations seem suspiciously on-target, considering how at sea he seems to be in his own therapy with Gina. And yet all his patients vociferously challenge his therapeutic authority--again, this comes across as somewhat contrived.
Considering that this is television, I suppose one can fault the cases for seeming too pat and tidy. I haven't seen the first season of the show, but in this second season the unifying theme seemed to be reversals of family responsibility, that is, children having to compensate for parents incapacitated by mental illness, grief, or a sheer inability to cope. This happens, to be sure, but does it happen this often?
For me, the single most piercing exchange of the series occurred in Paul's tumultuous penultimate meeting with Gina, in which he questions his entire mission as a therapist, and (jokingly?) expresses his intention to become a "life coach." He notes, as every occasionally despairing therapist must, that his patients seem to want love and/or pills more than they want what he offers, which is understanding. Gina's crucial comment is that even if he could, as their therapist, provide love to his patients, they would be unable to receive it, for that is why they are in therapy. If the offering of advice or "therapeutic love" amounts to feeding people fish, then true therapy is teaching people how to fish, as the saying goes.