The 50-minute psychotherapy hour may not offer the most obvious dramatic material for public entertainment. But in Israel, a television programme, In Treatment, which screened 50 dramatised therapy sessions with a series of different clients five times a week, has made such waves in the two years since it was broadcast that the American channel HBO bought the rights to make a version for the United States market and started screening it in late January. The Israeli programme has as its hero a troubled psychotherapist played by one of the nation’s acting icons, Asi Dyan, a man who in real life is known for his psychological difficulties, as well as his stated ignorance of anything related to psychotherapy. In the series he is seen with four clients who include a young athlete, a woman who has fallen in love with him, a couple expecting a baby and a pilot who suffers unconscious guilt about bombing Palestinians in areas of Gaza. The therapist, who is in crisis in his marriage as well as in his work life, is also seen processing his personal and professional struggles in supervision. Prominent among these is his erotic countertransference towards the female client who has fallen in love with him and his stated desire to leave the profession in order to make a life with her. The programme at one stage moves outside the consulting room to show him going to find her in her apartment – but suffering a panic attack and leaving before he acts out further.

Initially conceived as a programme likely to appeal mainly to psychology and psychotherapy students, In Treatment was shown on one of Israel’s minor cable channels and scheduled late at night after primetime viewing was over. So it came as a surprise to those involved in making it when it quickly became one of the most talked about phenomena in the media. Irit Paz is a clinical psychologist working as a therapist, and one of two psychological consultants on the show. ‘I think the main goal of the programme was to show how interesting it could be to see two people relating to each other in an intimate relationship, to prove that this could hold a drama,’ she says. ‘But the level of its success was a shock to all of us. Nobody thought that so many people would have the patience to follow it day after day.’

Filling the TV gaps
She believes that In Treatment filled a gap in Israel’s television diet; it was a programme targeted at educated viewers which touched on issues with which everyone could identify: love, desire, the forbidden, and ethical conflicts, including how Israeli citizens feel about actions performed during military service. And certainly the intensity of media coverage it has attracted both during and since its screening would suggest that it has had a powerful effect on the nation’s psyche – and perhaps also on the practice of psychotherapy. Amongst the articles published were several reporting that practitioners up and down the country had received calls from increasing numbers of people who had never previously been to counselling or psychotherapy. One article even suggested that the programme – in which the therapist charges above-average rates for his services – had encouraged some practitioners to raise their fees.

Meanwhile, excerpts from the programme have been integrated into parts of a psychotherapy course at the Hebrew University of Jerusalem that consider boundaries, ethics and family issues. So what do practitioners make of the impact of this phenomena?

Window on therapy
Paz believes that, because the programme reached many people who had not themselves experienced therapy, it has at some level further legitimised the profession. She feels that it has provided a window into a world which might until then have appeared to those outside it as frightening and mysterious.

In her own case, she says her parents reported that it had given them their first glimpse during the 18 years in which she has been in practice of what she actually does – and that they were shocked to have a sense that those who came to see her might not speak to a psychologist with the kind of respect usually accorded to someone like a doctor!
Meanwhile, as a practitioner working with couples as well as individuals, she is hopeful that what she sees as the programme’s realistic portrayal of a couple in counselling will have helped normalise the idea of seeking help for relationship issues.

She acknowledges there is no scientific research on what all this means to the public; her own views are based largely on personal feedback:

‘We felt the impact of In Treatment in the clinic. For example, people came to their therapy saying they wanted us to be different. They wanted someone more like the therapist in the programme – someone open, non-conformist and personal. He is also very well-known as an actor, so I think there was some confusion between the actor and the role he played. But basically, our clients began asking us to be more charismatic, more involved with them, more emotional.’

Heated internet debate
Sensing that powerful feelings had been evoked amongst viewers who were also clients, and having professional experience herself of internet counselling, Paz was instrumental in creating an internet space for discussion around the programme by opening to the public a part of a site called ‘Hebrew Psychology’ generally used by practitioners for professional debate.

Under the heading of ‘With you In Treatment’, this became a heated exchange over a number of weeks between some 50 people – clients using pseudonyms and named therapists – on more than 150 threads about a range of issues relating to the practice of psychotherapy, including its cost, the boundaries and therapist self-disclosure.

In many cases there were complaints from clients that their therapist didn’t operate like the one in the programme or, alternatively, that they didn’t want to see on the programme or even to be able to imagine the human face of a therapist struggling with his/her own personal conflicts. At one level, argues Paz, who moderated these debates, this was part of a parallel process to the programme, providing a space where issues such as the de-idealisation of the idea of a therapist could find personal expression and some form of working through. At another level, the programme and the internet discussion it sparked both reflect, in her view, a wider dialogue current in the psychoanalytic world of which she is a part about the place of intersubjectivity within the work. ‘I relate this to the debate between traditional psychoanalysis and relational psychoanalysis,’ she says. ‘The image of the therapist in the world is changing. In Freud’s time, it was the doctor who knows all who can tell you who you are and what to do. Today, the modern, more American-style psychoanalyst is a more democratic person on the same level as the client, more mutual.’In her view, the therapist in the programme, rather than being a model of the relational stance, is himself a model of the conflict. He uses more traditional psychoanalytic interpretations with his clients and yet we see and he acknowledges – at least in his supervision – the depth of feelings that he struggles with, as well as his own questions about what to do with them. Meanwhile, we have in his supervisor the model of someone working according to a more traditional psychoanalytic model. ‘I think that this film will represent a time of change,’ says Paz. ‘It will show a time of conflict between a model where one person knows the truth and a postmodern one that is more open to question.’

Assessing impact
For Roni Baht, the other psychologist consultant on the programme, the extent to which In Treatment has impacted Israel’s psychological culture is not yet clear. He sees it as some form of boost to the relational psychoanalytic stance, but also as a reflection of a culture that was already in the process of change – one which, for example, a year after the programme was broadcast, was ripe for the opening of a relational psychotherapy course at Tel Aviv University.

In his view, the very portrayal of this therapist as a basically good practitioner whose work is challenged by the significant crises in his life, is a way of highlighting the intersubjective aspect of what we do. It also raises the question of what it is to be a good therapist. ‘I don’t believe, for example, that a real erotic transference can happen without the involvement of the therapist,’ he says. ‘And falling in love with his patient and struggling to control his feelings is part of this therapist’s wider life crisis. We can say this happens to all of us. Because he is in a crisis, this therapist is scared all the time that he will cross ethical boundaries – and he nearly does so, or some might consider that he does, by going to his patient’s house. The interesting thing is that people who watched the programme were generally willing to be tolerant to him because they felt that he took responsibility for what he did. For me, being a good therapist doesn’t mean that you don’t have desires. The important thing here was to show that, having crossed a line, the therapist was able to walk back and talk about it.’

Boundaries
Baht, a psychology lecturer who integrates a relational perspective into his object relations model of practice, says that working on In Treatment has led him to think more than ever about boundaries in the consulting room. In the discussions he has had with other practitioners in the process of working on the programme, he says he has been surprised at times to hear details of the kinds of freedoms that some allow themselves in relationships with clients. The impact for him in practice, he says, is to be more rather than less vigilant. ‘I allow myself to bring my personality to the interaction,’ he says, ‘but on the other hand I feel that, because of this, I have to be more responsible and more critical of what I am doing than if I was working with a stricter model. I think that if you work in a way where you use self-disclosure, you do have to be more careful.’

Benefitting the profession
For clinical psychologist, lecturer and training psychoanalyst from the Israeli Psychoanalytic Society, Yossi Triest, the fact that Israeli television showed a programme about psychotherapy at all indicates how much society has progressed from a climate 10 years ago in which most people would not have openly admitted to going to see a therapist. And this particular portrayal of a therapist who is very different to the more one-dimensional character of American films, has, he believes, been of benefit to the profession. ‘For me this therapist represents a complex person with his own conflicts who is very emotional and who is trying heroically to keep to his role, who at one level fails, who suffers, but who is aware. It’s an interesting profile of a real person and I think in this way it made a rather good advertisement for the practice of psychodynamic psychotherapy. One can walk through the streets of Israel and say “Look, I‘m a psychotherapist” and hold one’s head high.’ Yossi Triest jokes that this kind of a portrayal also provides a rare reflection from the outside for us as practitioners of something approaching what we actually do in the consulting room.

On a serious note, he believes that it has modelled and so brought out into the open many of the feelings with which all practitioners struggle at times, including erotic countertransference – crucially showing someone processing this in supervision.

Benefitting clients
For clients, meanwhile, he believes that the programme has also opened doors. Many of his patients have spoken about scenes in which characters are shown expressing strong feelings like love and aggression towards their therapist – and one in which someone even uses the therapist’s toilet to throw up in the day after a drunken night out. The effect in many cases, he believes, has been to give a greater sense of permission, particularly to those who are inclined to be more defended in the therapy room.

As a practitioner who sits on a variety of ethical committees for his professional bodies, Triest says that the moral dilemmas faced by the therapist in the programme are not new to him. And the questions which it raises around how much interpretative work to do in the room versus how much to be a real person are issues with which he struggles every day. He thinks of these in terms of ‘how to be authentic in a role’: how to keep up his role as psychologist/ psychotherapist whilst being authentic as a real person. He is particularly interested in the relationship between these two positions – the role and the authentic person – in terms of the choice of person to play the therapist in In Treatment.

‘There is something a bit embarrassing, in a way, about the fact that Asi Dyan, who played this therapist, is so convincing in this role while he is quite proud of how crazy he is in his own life and he so clearly does not believe in psychotherapy,’ he says.

Coincidence? Perhaps – Triest suggests – the programme and the way it was cast have unconsciously revealed some important truths about our profession. A reminder, possibly, that the patient and the authentic person beneath the role of the psychotherapist are closer than we sometimes like to acknowledge.