In Treatment: a review

I’ve been watching some of the episodes of a TV show called In Treatment.  The set up for the show is that Gabriel Byrne is a therapist, Paul Weston, working in New York, and each episode consists of a single therapy session – those he has with his clients, and those he has with his own supervising therapist.  I know, I know, it sounds hokey, and earnest, and dreadful, doesn’t it?  To be fair, I can’t speak to the quality of the show as a whole, because I’ve only been following one of the story arcs.  On the one hand, the fact it’s on HBO makes me think it might be quite good; on the other, the fact it’s exec-produced by a man famous for wearing deeply unflattering underpants and recording an awesomely naff record makes me think it might not be.

Still, the episodes I’ve been following, which are focussed on a 16-year-old gay teenager called Jesse, are pretty good, and are in large part rescued from awfulness by the fact that both actors (Gabriel Byrne and Dane DeHaan as Jesse) are really good.  The writing is also pretty good, at least in terms of the dialogue, if not the underlying construction.  I’ve found it quite interesting to look at it just as a TV programme, but also as someone who’s been through therapy myself, once as a teenager not a whole lot younger than Jesse, and once as an adult.

As you’d expect in a TV show, everything is heightened and compressed to an extent that would be wildly improbable in real life.  Jesse is a troubled teenager, so he’s about as mixed-up as it’s possible to imagine – he has ADHD, he’s into drugs and promiscuous, risky sex – and the ‘breakthroughs’ in therapy come at a fast and furious pace.  It’s still probably, though, the most accurate portrayal of therapy I’ve seen in a film or TV show.  There’s not too much emphasis on grand epiphanies – though Paul Weston must be the most insightful therapist ever to have lived – and they get the sense of surging and unspoken sub-texts pretty much right.  The only thing that’s missing are the lingering, uncomfortable silences.  They do have brief ones, which I guess is probably as much as can be expected in a TV show, where dead air equals people turning off in droves.

If I have a criticism of the story arc from a psychiatric/ psychological point of view, it’s that it’s far too neat.  We know Jesse has ADHD; other diagnoses aren’t discussed (or haven’t been yet), but the programme-makers seem to be heavily implying that he has borderline personality disorder.  The problem, from the perspective of creating a rounded, believable character, is that he fits that diagnosis way too perfectly.  (For the purposes of this review, I’m assuming that BPD is a valid diagnostic category, and I’m also taking as-read the widely held belief that people with BPD are emotionally manipulative, although I know both assumptions are controversial.)

So, for example, Jesse has extremely rapid mood-swings (from anger to despair in the space of a few minutes).  He by turns venerates his biological mother as a saint who will sweep in to rescue him from his unhappy life with his adoptive parents, and demonises her as a bitch who abandoned him.  He engages in highly manipulative behaviour (deliberately injuring himself at the beach, then telling the lifeguard he’s an orphan on the run from an abusive care home; telling the owners of a gay bar that he’s homeless) in order to secure the sympathetic attention of older men.  He experiences low-grade psychotic symptoms (auditory hallucinations of static) at moments of stress.  Really the only thing missing is overt evidence of self-harm.  All in all, it’s pretty clear that this isn’t a character who evolved naturally, but one who was created backwards from the pages of a diagnostic manual.

Another, related, criticism I have is that Jesse’s BPD derives from extremely transparent psychological causes, and seems likely to be readily amenable to psychological treatment.  So, for example, Jesse’s abandonment issues stem partly from the ‘psychic wound’ of being adopted (which seems over-egged – so far as I know, most adopted people don’t experience it as a desperate, primal trauma), and secondarily from the fact that he believes his adoptive parents have become emotionally distant from him since discovering he’s gay.  It’s already clear that Jesse is surprisingly receptive to the possibility of considering alternate explanations for his adoptive parents’ emotionally distant behaviour (though this may be an aspect of his BPD, in that he thinks the best of them at some points, and the worst at others).  It’s also clear that, with Paul Weston’s slow, patient help, Jesse is already well on the way to being capable of forming stable attachments to both his adoptive and biological parents, and the different roles they may have in his life.  All of this is plausible, but it does rather seem to lack the messiness of real life.  (Of course, I come at this mentalism stuff with more knowledge than the average viewer would, so what seems crushingly obvious to me might seem more intriguing and nebulous to them.)

With all this criticism, it sounds like I’m setting this story arc up as a turkey to be avoided at all costs, doesn’t it?  The fact is, though, if I take off my mentalist hat, it actually makes for pretty good TV.

A lot of that comes down, I think, to Dane DeHaan’s performance as Jesse, which manages to energise what might otherwise seem like a collection of clichés into a living, breathing character.  The malicious pleasure he takes in discomfiting Paul Weston by talking in crude terms about his sexual adventures is particularly well-played, I think.  It would also be fair to say that, although the writing is fairly heavy-handed in the way it sets up Jesse’s psychological problems, the quality of the dialogue is pretty good.  The characters speak in a way that seems reasonably plausible; in particular, the programme-makers manage to avoid giving Jesse lots of embarrassingly mishandled ‘yoof speak’ dialogue, which is often one of the biggest traps that dramas with teenage characters fall into.  Also, the various twists and turns of the therapeutic relationship are pretty well-handled, with Jesse’s rather obvious psychological problems emerging in a plausibly indirect and fractured way.  Something I particularly like is the way Jesse clearly takes advantage of his ADHD diagnosis to abruptly change the subject when it gets on to areas that he’s uncomfortable with, but Paul Weston usually succeeds in looping the conversation back to tackle the issue from a different angle.

Probably the thing that I like best about the programme, though, is just it’s format as a TV show: two people (usually – other characters pop up briefly and from time to time) sitting in a room talking for 30 minutes, with no action, and very little incidental music.  It’s the kind of TV there used to be more of when I was younger, I think, and I’m pleased to see that it hasn’t completely disappeared.

I’m generally a big fan of the BBC, and I’d rather stick needles in my eyes than become one of those dreary people who bleat on about the dumbing down of television, but I am struck by how few risks the BBC take these days when it comes to drama.   In sitcoms, their record is much better – to use an example of something that’s on air right now, Getting On pushes the sitcom genre so far as to make it feel like something that belongs to a completely different universe than My Family.  But in drama they seem to be stuck in the over-familiar genres of soap, or popular action series, or unchallenging costume drama; even on BBC4 (where the most interesting sitcom stuff tends to be) the drama is pretty much limited to fairly straightforward biographical drama.

I’m sure, once upon a time, a series something like In Treatment (though with fewer episodes, and hence less intricate) would have had a chance of being made by the BBC – the broadcaster who put out a series of 30-minute monologues on primetime BBC1, after all.  I think these days, though, HBO are probably the only broadcaster in the world, certainly the English-speaking world, who would make and transmit it.  That seems like a shame to me.

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3 Responses to In Treatment: a review

  1. It sounds pretty interesting. I think quite often when TV presents mental illness, it does it in a way that makes it almost clichéd, so it is unsurprising that the BPD-ness is so clear to see, but I like the idea of an accurate representation of therapy. The only other representation of therapy in TV I can think of is Effy’s experience during Skins and that was far from representative, what with the therapist becoming a jealous murderer later on in the series!

    I also know what you mean about the BBC and drama. Even “Lip Service” which was meant to be an edgy British Lesbian Drama (Scottish answer to The L Word) played very safe at times and wasn’t as ground-breaking as the BBC would like to think it is. I enjoyed it, but it certainly could have challenged stereotypes a little (or perhaps a lot) more.

  2. Thanks for writing this review. I’ve been following In Treatment since season 1. I would like to point out with regards your comment that, “I think these days, though, HBO are probably the only broadcaster in the world”, that the first 2 seasons were almost direct translations of the Israeli show B’Tipul – only a few details were changed, such as the fact that the pilot from the first season was switched to being from the US air-force, and therefore the location of the bomb he dropped was changed to Afghanistan (for fairly obvious reasons).

    I’m watching Season 3 with interest (I’ve only reached week 2 thus far) because this is the first season which is original rather than translated (B’Tipul got cancelled).

    With regards the whole diagnosis thing, in past seasons, it’s been fairly unclear exactly what “diagnosis” would be given – there’s a few characters who’d probably get slapped with BPD for various reasons, but I like the fact that it has been more about the individual than the diagnosis, I really hope this hasn’t changed in this new season – last thing I want to see is Paul writing prescriptions….

    Take care,

  3. Prozacville says:

    I am a huge In Treatment fan, though the third series has felt a bit more sitcom-y than the other two, I feel. Saying that, the last episode has haunted me for days…

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