Four shrinks on the season finale of The Sopranos.

Dear Gang,

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I think we all recognize that one of the most important evolutionary steps in contemporary psychoanalytic thinking is that no matter what the patient brings by way of neurosis or character pathology, the central themes of his or her life inevitably play out in very unique ways from one therapist to the next. That is because the treatment is not constrained simply by the patient's personality, but is also always influenced by the therapist's as well. There is no way around this, though for many years psychoanalytically informed approaches to treatment were taught as if there were a standardized technique. Our humbling history has proven otherwise. So, even though we all do similar things with our patients, how we do them, when we do them, what we are capable of doing with them is influenced mightily by the dance that occurs between ourselves and them. Ultimately, the most profound illustration of this is the recognition by many in contemporary psychoanalysis that for the treatment to really work both doctor and patient must change and do so in ways often not readily predictable at the commencement of therapy. My preamble is obviously about that transformation in the character of Dr. Jennifer Melfi.

Of course we all recognize that she is a fictional character, lest any reader believe we think otherwise, but I think we four shrinks are also cognizant from what we hear from our patients that Dr. Melfi has become something of a cultural icon of psychotherapy. Fiction aside, like many symbolic forms, she takes on a kind of reality in many people's minds. For example one colleague told me recently that although she does not watch the show, she was surprised by the upbraiding she received from a female patient who discovered that at the end of her day, this analyst walked down an isolated stairwell to her parking garage. When she inquired about her patient's fury at her, the patient screamed, "That's where Dr. Melfi was raped!" So, if indeed Melfi is some sort of icon, it is with some gratitude that we must acknowledge how much she has changed; that is, how much she has grown in her work with Tony Soprano.

Consider this progression. During the first season Jennifer's grandiosity blinded her from seeing that the treatment she was offering Tony was essentially impossible due to the nature of his "business," a point that he repeatedly kept asserting. Disavowing this, she on one occasion rebutted his anxiety over being discovered in the treatment as testimony to his narcissism. Unwittingly, she perpetually put him in double bind, e.g., "You must say everything that comes to your mind, and hold nothing back" juxtaposed with "But if you tell me someone may be harmed, I have to breach your confidentiality and inform the authorities." Despite this impossible scenario, something was captivating enough in the first season of treatment (for reasons both ill and well) that the two slogged through up to the denouement of Tony almost getting killed for being in treatment and Jennifer having to end the season "on the lam." By the final episode, Tony had to take over and essentially protect Jennifer from herself. The return of the treatment in the second season finds Melfi powerfully traumatized. Like many unwitting clinicians, she had been swallowed into the belly of the whale. She wore her trauma poorly, though quite understandably. She had to drink to tolerate her time with Tony. Hell, she had to drink to tolerate her time even with herself. But throughout it all, she pressed on and continued to work with him. There is something honorable about this, as to do so she had to endure full fledge her own disparate emotions, not to mention defend herself against family members and fellow professionals trying to get her to terminate the treatment. By the third season, her attraction to and dependency upon Tony has started to become clearer to her. She could no longer exempt herself from her simultaneous intrigue and repulsion with Tony's violence. She faced the greatest test of this of all by resisting her impulse to "rat out" Jesus the Rapist and to have him readily "squashed like a bug." It was even harder for her to resist her more jealous impulses of having to share Tony with not just one fellow Italian woman, Carmela, but now with two, including Gloria. In this regard, her work this season has been replete with the malfeasances we have all documented. She crossed several questionable lines, from trying to cool things down initially by bringing Carmela in for conjoint treatment, to ending up referring her for individual treatment to Dr. "One-Shot" Krakauer, the psychiatrist who insisted on giving her a proposition she would have to refuse: "You have to leave your husband if you are going to work with me." She really messed things up by double-booking Gloria and Tony, thereby unconsciously staging her borderline doppelganger, Gloria, to aid her in finding out just how dangerous a liaison with Tony could end up being. Jennifer pulled off doing all of this from the safe distance of her consulting room. Maybe this last unfortunate enactment was what it took to help her to snap out of it, maybe this was what was required to make her change as well as to help Tony change by seeing the face of Mama Livia in that of tormented Gloria. But change Jennifer did, and as America's female therapist icon, it is important for us to recognize it. She seems to have moved demonstrably from enactment after enactment, wherein the patient and analyst act out their respective impulses (often a necessary stage of treatment), to helping them both move more into the realm of reflection. As she becomes more reflective, so too does Tony; by the same token, as Tony becomes more reflective, so too does Jennifer. So, it is particularly touching as you all have noted that when telltale-tear-Tony was able to be vulnerable enough to tell Jennifer that she "doesn't understand" that she was able to become equally touching in saying, "make me understand." She has changed considerably from her own omnipotent therapist's position of the first season to more of a fellow human being who genuinely wants to know and recognize the other. In this manner, maybe some of the narcissistic encrustation that Peggy noted of the Soprano family lineage will gradually soften and crumble, and perhaps the transgenerational killing field of the sins of our fathers that Glen and Joel noted has a better chance of ceasing. And maybe this is all wishful thinking that will be trammeled in a fourth season, but Melfi's encouraging transformation at this point can not be denied.

Phil

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