Dear Glen, Phil, and Joel,
Glen, I may be a tough “supervisor,” but it doesn’t mean I lack compassion for our Sopranos clinical crew! Both Jennifer and her therapist, Elliot, are certainly accomplishing some productive work with their patients. But situations like this–where the patient is “in extremis” and the therapy is only moderately helpful–do call for a reassessment of the treatment situation. Is the therapeutic match an optimal one? That is, are the patient and the therapist (personally or in terms of his/her technical approach) the best possible fit to get the most done for this patient? Do the liabilities inherent in that particular therapeutic relationship (and there are always difficulties) outweigh the benefits of it, or do these two balance out in the long run? Just as important, is the structure of the treatment optimal? (That is, is it the best frequency and length of session? Would fewer or more be better?)
I think this episode raises major questions about whether Melfi is well served by seeing her shrink only periodically (at least, I get the impression it’s only here-and-there, or once a week at best), rather than being in psychoanalysis with him (that is, seeing him three or four times a week). I also think he may not (temperamentally) be able to offer her the kind of strong, steady presence that would enable her to delve more deeply into her aggressive and dependent feelings. Were he able to do so, and were they meeting more frequently in a more intensive treatment, she might be able to work out her feelings in the context of her relationship with her own therapist, rather than working so much of them out with Tony, her patient. But, admittedly, I’m talking about an ideal scenario, which isn’t always practicable. With the explosive clinical situation that is Tony Soprano, one would hope for the ideal therapy setup!
Peggy
