The dialogue among four real-life psychoanalysts about the psychotherapy subplot on The Sopranos continues.
The four of us, as professional shrinks, keep raising a nagging
question, but none of us has thus far tried to answer it in detail.
Namely, does it make sense to try to treat a sociopath like Tony
in therapy? For one of the maxims of clinical experience that
everyone repeatedly hears in their training is that it is extremely
difficult, if not impossible, to treat sociopaths
psychotherapeutically. Although the meaning of this adage may be
clear to us–and I’m not sure that’s even true–we can’t just
assume that the readers of our exchanges know what we are
getting at.So I will take a stab at trying to put the problem in nontechnical
terms. The question we have to ask ourselves about all our
patients is whether there is a healthy enough core to their
personalities–formed through the experience of being loved and
cared for as a small child–for them to become engaged in a
psychotherapeutic relationship.
The way analysts think about treatment is that it is the elucidation of unconscious processes — motives, conflicts — that improves a patient’s life, but that there is profound resistance (also unconscious) on the patient’s part to examining such issues. In psychoanalytic psychotherapy and classical psychoanalysis (which is not depicted on The Sopranos, and is more intense, involving sessions several times a week often using the “classical” couch, free association, the silence and impassivity of the analyst etc.) the therapist’s skill lies in knowing how to help the patient to get better despite her/his profound attempt to subvert the effort. This relies in large measure on entering into a relationship with a patient which will inevitably recreate all the patient’s dilemmas and conflicts in negotiating all their relationships, while the therapist remains aware enough of her/his own unconscious issues in doing business with others that they do not interfere. The shorthand terms for these two aspects of the relationship are, respectively, transference and countertransference. Examination of the patient’s complexities of feelings and reactions in this context is how learning and change take place.
These four psychoanalytic commentators find the TV depiction, in a sense, trite, because there is so much “acting out” on the part of the patients —
in other words, they are avoiding any sort of in-depth
look at their complex feelings (envy, hostility, dependency,
longing, etc.) toward their therapist and the therapeutic
relationship by seducing someone who’s the “next best
thing”–another patient of their therapist’s.
— but also on the part of the therapist, who “inadvertently” double-booked Tony and the Annabella Sciorra character, with predictable consequences. One would interpret this as representing Dr. Melfi’s unconscious way of extricating herself from the erotic bind between herself and Tony, and it compounds her actions of the previous week in sending Tony’s wife Carmela to a “hatchet man” therapist who, in premature bluntness unthinkable to any seasoned therapist (but presumably expectable to Dr. Melfi, as he was her teacher), pushed her to leave Tony.
The question is raised whether the writers are competently depicting an unsophisticated and out-of-control therapy or incompetently attempting to depict a sophisticated one. In any case, if you’re interested, you’ll learn alot about how psychoanalysts think by listening to them muse about the same show you’ve watched; scroll down to the first of the readers’ comments at the bottom of the column for an astute comment about what you might learn about yourself too. [Is this — by which I mean both the psychiatric plot and reading the commentary on it — interesting to any viewers of this show besides mental health professionals like myself? One FmH reader has already weighed in emphatically in the negative…]
Slate
