This HBO Show Gives Us an Accurate Glimpse Into The World of Therapy

 “In Treatment” is a critically acclaimed series that originally premiered in 2008 on HBO and ran for three seasons. It starred Gabriel Byrne as psychotherapist Paul Weston, and each season followed not just the work he did with three-to-four patients, but his life outside of the therapy room. The show has reemerged this year with a new star, new patients and a storyline that exists within the current world of COVID-19 and the Black Lives Matter movement for social justice.

This iteration of the show follows Dr. Brooke Taylor, played by the incomparable Uzo Aduba of “Orange Is the New Black” fame, and her three patients: Eladio, Colin and Laila. While this season does pay homage to the original version by referencing Dr. Paul Weston as having been Dr. Taylor’s mentor and supervisor, it stands on its own as a completely unique show and does not require seeing the previous seasons for it to make sense. Full disclosure: I did watch the previous seasons because I was curious as to how they compared and I found them both fascinating and brilliantly acted, but I’m kind of a “therapy connoisseur” when it comes to the media I consume so I don’t expect everyone to invest in that time commitment.

The genius of this show is its ability to offer the viewer a peek not only into what it’s like to be a patient in a therapy session but more interestingly into what therapists’ lives are like outside of the therapy room. It has a voyeuristic quality to it that makes it extremely appealing to anyone who has ever been in therapy or who has ever wondered what therapy is like. The writing this season, like the previous seasons, is masterful and the acting is absolutely superb.

What this season has that the original didn’t is the relevancy to issues that occupy the realm of our current collective existence. It deals with the challenges of therapy during the pandemic, including how telehealth therapy sessions can pose a unique communication challenge for certain patients, to the fact that Dr. Taylor has resorted to doing in-person sessions from her home since her office is still closed, which poses a completely different set of challenges. We see how representation matters and why it is critical for therapists of all intersections to exist, including those who are Black and those who are members of the LGBTQIA+ communities. And, we see how the personal lives of therapists can and do affect their interaction with their clients, particularly when they experience complex grief.

This season has 24 episodes, each episode focusing on one patient, with every fourth episode focusing on Dr. Taylor and her personal life. The arc of each patient’s story follows specific mental health challenges and themes with Dr. Taylor being the fourth “patient,” if you will. I’ll include a brief synopsis of each, but will focus on Eladio in more detail because of the unique similarities his experience has to that which I experienced with my now-ex-therapist.

Colin: Recently released from prison, Colin is a pro bono case that Dr. Taylor has agreed to. He presents her with unique challenges related to compulsive lying, a need to be liked and behaviors attributed to narcissism. His episodes are particularly contentious and clearly illustrate how a therapist can deeply dislike a patient and still do effective therapeutic work with them. Trigger warning for anyone who has experienced interpersonal violence as these sessions are very heated.

Laila: A young, Black lesbian woman who is processing trauma relating to corporal punishment, enmeshment with her grandmother, abandonment from her mother and an absentee father. She also struggles with reconciling her racial identity and discovering who she is as she becomes an adult. Her episodes deal heavily with suicidal ideation and could be potentially triggering.

Dr. Brooke Taylor: Dr. Taylor has recently lost her father and is in the throes of grief. We watch her turn to alcoholism to self-soothe and struggle with her identity. Her episodes with her AA sponsor Rita are poignant and heart-wrenching to watch. We see clearly how addiction relates to trauma and how unresolved trauma can lead one right back into their addiction. Her episodes could potentially be triggering for those with substance abuse issues or those who have recently experienced the loss of a loved one. 

Eladio: A 20-something Latino gay man who has a severe fear of abandonment. From the very first episode, we see how transference and countertransference can adversely effect the therapeutic alliance when it goes unchecked. Eladio desperately seeks a maternal figure in the guise of Dr. Taylor and she not only obliges but gets extremely engrossed in the dyad. His attachment to her and her affection for him results in poor boundaries, unclear goals for treatment and ultimately create an untenable situation that cannot continue. I struggled with exactly this dynamic with my ex-therapist in the beginning. Her ambiguous boundaries, insistence on my attachment to her and insertion into my life as a pseudo-mommy morphed into a trauma bond. It became a toxic relationship that was not only not conducive to healing my relational trauma but ended up retraumatizing me. Dr. Taylor eventually recognizes that she would do Eladio more harm than good by continuing to see him and ends up referring him to another clinician, something I wish my ex-therapist would have done. We see how, in spite of her own feelings toward Eladio or what she is going through in her personal life, Dr. Taylor is a caring and ethical clinician who ultimately puts the needs of her patients first. Frankly, I found these episodes with Eladio painful to watch because I could feel his desperation, confusion, fear and sadness at understanding that Dr. Taylor could never actually be his mother no matter how much he wished it to be so. It’s a black hole in your heart that feels like a vacuum and can never be filled. For anyone with developmental trauma associated with parental neglect, these episodes could be potentially triggering.

While I don’t think this show will accurately represent everyone’s experience in therapy, it certainly does a remarkable job of providing a template of what it could look like, particularly in a psychodynamic approach. And, for those looking for more insider information and analysis on the actual therapy conducted on the show, there is a companion podcast called “In Session” featuring a clinical psychologist named Dr. Janelle S. Peifer who offers a unique perspective on the sessions in the show both as a clinician and specifically as a Black woman practicing in a field that tends to be dominated by white males. The podcast features interviews with actors from the show as well as its writers discussing their own relationship to mental health and personal experiences in therapy.

For me, this was one of the most entertaining, thought-provoking, cathartic and emotionally satisfying shows I’ve watched in a very long time. I think for many of us who live with mental illness and have spent any time in therapy, there are very few concrete examples of what it looks like to experience mental health challenges or go to therapy. It can feel isolating at times. That’s why seeing our experiences so accurately and carefully portrayed is incredibly validating. It helps us to feel less alone, normalizes the idea of going to therapy and helps to eliminate the stigma, particularly in communities where mental health tends to be neglected or where seeking help is frowned upon.