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The Shrink RapAt last, a realistic TV portrayal of psychotherapy: In Treatment.

By Glen Gabbard
Posted Monday, Jan. 28, 2008, at 12:00 PM ET
In Treatment. Click image to expand.

Depictions of psychotherapy and psychotherapists on TV—and there have been many—have always had to deal with one central problem: Psychotherapy ain't showbiz. A videotape of an actual therapy session, replete with silence, evasion, and idiosyncratic references to people and places, would bore the average television viewer in approximately 18 seconds. Given that, it's all the more surprising that HBO's new half-hour drama In Treatment manages to be both riveting and the most convincing psychotherapy seen on television yet.

Based on the hit Israeli series BeTipul, In Treatment invites viewers to eavesdrop on private therapy sessions, as Paul Weston (Gabriel Byrne) treats a different patient (or, in one case, a couple) four nights a week, with the fifth weeknight devoted to getting help for himself from Dr. Gina Toll (Dianne Wiest). Dr. Weston is not idealized. He struggles with erotic feelings for a patient like most therapists do from time to time. He misreads the suicidal intent of an adolescent patient. But his heart is in the right place, and he consistently helps his patients see things about themselves that are outside their awareness.

Psychotherapy has served as a convenient plot device for scores of films and television series because it offers the audience this window into an otherwise hidden part of the protagonist's world. But such scenes tend to work for audiences only if they're interspersed with action-filled sequences or laced with melodramatic undercurrents, resulting in a fictional version of psychotherapy that is unrecognizable to real-life therapists and patients. Psychotherapists are popular targets because they're thought of as smug and pompous. (Have you heard the definition of a psychoanalyst? One who pretends he doesn't know everything.) Hence, audiences delight in fictional therapists who seem just as screwed up as their patients.

The thorny problem of making psychotherapy entertaining was apparent from the earliest attempts to place a shrink at the center of a dramatic television series. In 1970, ABC aired Matt Lincoln, a show about a darkly handsome shrink played by Vince Edwards (of Ben Casey fame) who ran a telephone helpline with hip young assistants. Unfortunately, watching people talk on the phone is not inherently interesting to viewers, and no audience led to midseason cancellation.

Portraying psychotherapists as comic figures has been another strategy to hold an audience's attention, while also making them far less threatening and intimidating (some still worry that analysts are reading their minds at cocktail parties). Both Frasier and humorous depictions of group therapy with Bob Newhart drew substantial followings, but the writers' primary interests were getting laughs, not creating a semblance of real-life therapy. Even when a comedy series has dipped into melodrama for an episode, the presentation of psychotherapy has roamed far from what actually happens in the therapist's consulting room. Dr. Sidney Freedman turned serious in the last episode of M*A*S*H when he took Hawkeye through an emotional catharsis by uncovering a repressed traumatic memory that he had inadvertently played a role in a woman killing her baby. This episode drew some 50 million viewers, but the therapeutic technique was as close to real-life psychotherapy as General Hospital is to modern hospital practice.

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Glen O. Gabbard, M.D., is Brown Foundation Chair of Psychoanalysis and Professor of Psychiatry at Baylor College of Medicine. He is the author of The Psychology of The Sopranos.
Photograph of Blair Underwood and Gabriel Byrne in In Treatment by John P. Johnson, © HBO 2008.
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