Don’t Go There.


Sunday’s penultimate episode of The Sopranos felt like a warning to anyone who’s in therapy or ever considered it. Tony’s shrink Dr. Melfi, in a controlled rage akin to that of an aggrieved wife, dumps him, having been influenced by her colleagues (in some sort of shrink-on-shrink intervention) to believe that he’s a sociopath beyond help and that all she’s doing is “enabling” his criminal behavior. At this point, we know Tony better than that, and so should she. (That her colleagues learn the identity of her patient is alarming in itself. Despite wanting to believe in the whole “patient confidentiality” oath among therapists, I always somehow suspected it was bullshit, and Sunday’s show confirmed my suspicions. I suppose I shouldn’t take a fictional TV show as proof that I was right, but I do.) Even if Melfi’s response is out of bounds and atypical for the profession, the idea that a therapist could abruptly end years of work, kick a patient to the curb, because she finds him wanting or undeserving is enough to make me feel no patient is safe.

Now, therapists are human, and as subject to frailty as any of us. To expect them to be perfect is unrealistic. And we should judge them as we would any other service-provider, by their ability to produce desired results regardless of their own foibles. But therapists are different from other service-providers, in that their business is the sickness of the human soul itself. Would I hire an electrician who’s incapable of wiring his own house? Don’t think so. Well, if I’m trying to fix my effed-up nature, would I hire a therapist who hasn’t put his own psychological house in order? Since Sunday’s show had me considering the uncomfortable notion that there aren’t any therapists who are less effed-up than I am (Melfi getting caught up in the knickers of her countertransference is the blind leading the blind, and her titillated, passive-aggressively jealous colleagues weren’t an ad for mental health), it had me considering that the premise that anyone has the answers is an illusion. Sure, therapists are only human like the rest of us. That’s the problem.

Or maybe it’s not the problem; maybe it’s the solution. If no one has answers, maybe all we’re here to do is help one another not to be tormented by the questions. Maybe the very best person to lead a blind person is another blind person, making therapists uniquely qualified. Wouldn’t that be a kick in the head?

As I say, I am making inferences about real life based on a fictional TV show, which I probably shouldn’t, but The Sopranos is that good. It’s fiction—but great fiction has the power to be very, very persuasive. Not too long ago I came upon a quote from Eleanor Roosevelt (of all people) who said, “The reason that fiction is more interesting than any other form of literature, to those who really like to study people, is that in fiction the author can really tell the truth without humiliating himself.” The Sopranos is great fiction.

There is a lot of trustworthy research—tons of it—that says that despite the human frailty of therapists, talk therapy really works, really helps people. And, encouragingly, therapists are up in arms over this Sopranos episode, as this article makes plain. They find the behavior of Melfi and her colleagues egregious, beyond the pale. I hope they’re right. I want everybody who can be helped by talk therapy to be in talk therapy, and if a loved one of mine were suffering and could find relief in it, I would want him or her to get it. (And, let’s be rational here, David Chase has portrayed all kinds of professionals on the show–surgeons, attorneys, et. al.–as world-class a-holes, and that hasn’t convinced me that seeing a cardiovascular specialist in the event of a heart attack is a bad idea.) So I want with every fiber of my being to go on believing that talk therapy helps. But Chase, through his mastery of the fictional dramatic form, has me freaked out. Maybe I just need to talk to someone about it.


2 Comments on “Don’t Go There.”

  1. Neill Rosenfeld says:

    In all of the conversations that I’ve had with psychotherapists, I’ve never heard one mention a patient’s name. One psychologist I know has told stories about patients without identifying them, but sometimes in a derisive way; after that I wouldn’t recommend him to anyone, although he is fun to have a beer with because he has such engrossing tales to tell. As for a psychiatrist friend, in the close to two decades that I’ve known her she has never breathed a word about a patient or a patient’s problems, although she will bring her technical knowledge into a conversation in a way that reveals nothing about what goes on on her couch.
    The first thing that bothers about the final Melfi episode is not that she drops Tony as a patient. She has that right and, after learning about this study which finds that sociopaths hone their skills in talk therapy, she certainly could re-evaluate her continuing treatment. Rather, what’s disturbing is the way that she does it. It is standard practice for a physician who is terminating treatment to arrange for someone else to pick up the case — or at least to hand the patient a list of qualified practitioners whom he or she can interview. Melfi’s hostility and decision to throw him out the door were totally unprofessional. She should be brought up before state licensing authorities and reprimanded.
    The second thing that bothered me is that when Dr. Kupferberg (Peter Bogdanovich)starts talking about her patient — using information he learned under the therapeutic seal of confidentiality, since he was her shrink — that Melfi didn’t stand up and say, “Elliot, if you say one more word I’m walking out of here!” And if he didn’t shut up, she should have stalked out before he could let everyone know who her patient was. At least she wouldn’t have been there to hear it. Elliot Kupferberg should be brought up before state licensing authorities and reprimanded, too.
    I think that David Chase created a problematic character in Melfi from the start. She knows what Tony does for a living and she never really asks him any questions. When he comes in, from time to time, and talks about being relieved because he has taken care of a problem, are we to believe that she hasn’t read the local tabloid and seen the story that day about a mob hit?
    And why, when it’s evident for years that Tony has the hots for her (if memory serves, he disclosed his fantasies), does she continue wearing short skirts? I hope I’m not being prudish, but I’ve always found her dress style inappropriate for a therapist. I interpreted her decision to dress this way as intentionally provocative; as appalled as she is with this mobster, she’s also fascinated with him and may even be subconsciously sexually attracted to him. Indeed, could it be that there was sexual frustration behind her motivation for ending therapy, something triggered by a study about a patient manipulating the therapist? I guess we’ll never know, but I hope that Melfi breaks off her therapy with Elliot and finds some other shrink to discuss this with between now and when the Sopranos movie comes out.
    If David Chase wanted to sever the tie between Melfi and Tony — loosing one more mooring that is keeping him what passes for stable as his world collapses around him — it would have been more realistic and interesting if her conversation with Elliot had happened earlier in the season and if we had seen her struggling to come to terms with the study and its implications over several episodes.
    Every time that I read about a medical study, I find that soon after there are people who are poking holes in it. Melfi would know that a single study isn’t definitive, especially in the world of psychiatry, where so much is subject to interpretation. Wouldn’t Melfi want to test this study against the man she has been treating for 7 years? That could have led to some explosive questions and answers. And wouldn’t it have been more interesting if her series of probing questions had led Tony to break off with her because she was pushing him out of his comfort zone? For Chase, this would have left Tony just as adrift — and it would have been a situation of his own making, just as is the mess he is in with Phil Leotardo. But that’s another blog entry.

  2. tovorinok says:


    Great book. I just want to say what a fantastic thing you are doing! Good luck!


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