Recently I was watching the program In Treatment an American drama television series by HBO. I know, it’s funny isn’t it, a therapist watching therapy drama in his downtime … It’s actually a very compelling and somewhat true-to-life program, one which I can thoroughly recommend if you’re looking for something new to watch.
One of the main characters in Season 2 – April – caught my attention and imagination. April is a 23-year-old second-year architectural student who receives a cancer diagnosis five weeks prior to her first session with Paul (the therapist) played by Gabriel Byrne.
What is most compelling about this program is the way it makes space for complex things like trauma. Also, it names things, like attachment, rupture, and heartbreak. As a society, we are all too quick to gloss over difficult words. The very words that can help us in the work of repair and transformation.
Below is a summary of a few of the key elements witnessed by me in the first four sessions of April’s treatment. I hope you enjoy this reflection and please get in touch if any of the below resonates for you in light of your own situation.
Receiving news of a life-threatening illness can be seen as ‘Big-T’ trauma. A cancer diagnosis is often coupled with a sense of hopelessness, denial, and anxiety (Cancer Council NSW, 2019). In April’s case, she responds by isolating herself from friends and family, moving from one treating doctor to the next, Paul being her second psychologist post-diagnosis.
Of course, this diagnosis sits within and around her ‘Little-t’ trauma, which includes the ongoing interpersonal conflicts experienced in her family (a needy and demanding mother; emotionally absent and unavailable father; and an autistic younger brother with complex mental health). The pressure of being a compliant daughter, the stress of being a second-year University student, and her recent breakup with her boyfriend all compound her sense of distress and are all potentially traumatic.
All of this is interacting with the everyday trauma of ‘adulting’. This equates to physical, emotional, psychological, and existential distress (Epstein, 2013).
Viewed through the frame of attachment, April is complex and avoidant (Badenoch, 2017; Daniel, 2015). At first, April presents as social, curious, and intelligent. When pushed into distress – by situation, self or other – she encounters the world as unsafe (Van der Kolk, 2014), retreating into a fantasy world of mentalising, storytelling, and drama. She is distrustful, judgemental, and unregulated.
April in the Room with Paul
April shows a wide range of behaviours throughout the first four episodes. All in all, she is a pretty likeable character, but in her verbal interactions with Paul, she is combative, contemptuous of authority, and defended. From this defended position, April uses sarcasm to protect herself. Her swearing is disarming, both a push against authority and a test to see how Paul will respond.
Her language is ‘punchy’ (jab jab – swing, jab). It is playful, youthful (all the kids talk like this), relaxed, and informal; however, it also acts to conceal distrust and an insecure self.
Finally, I came to appreciate Paul’s paternal engagement with April. His last action in episode 4 – handing April a snack bar as they leave for her chemotherapy session – is fatherly and compassionate. Having not viewed any further episodes, I wonder how things work out for April (and Paul). Does her work with Paul deepen? Does Paul find a way to continue witnessing, mirroring, supporting, listening, challenging, and reflecting? I wonder if April finishes her university course?
Drama sometimes can be unbelievable and unrealistic. That said, I like to think that some of the stories that are told on television, film, and in the theatre can be, and are, true to life. In this way, the work models how we might move forward with a degree of hope and greater resilience.
Badenoch, B. (2017). The Heart of Trauma: Healing the Embodied Brain in the Context of Relationships (Norton Series on Interpersonal Neurobiology). WW Norton & Company.
Cancer Council NSW. (2019). Understanding Non-Hodgkin Lymphoma: A guide for people with cancer, their families and friends (Brochure)
Daniel, S., & Ebooks Corporation. (2015). Adult attachment patterns in a treatment context relationship and narrative (1st ed.). Hove [U.K.] ; New York: Routledge.
Epstein, M. (2013). The trauma of everyday life. New York: Hay House.
Siegel, D., & Solomon, M. (2013). Healing moments in psychotherapy (Norton series on interpersonal neurobiology).
Van der Kolk, B. (2014). The Body Keeps the Score: Mind, Brain, and Body in the Transformation of Trauma. Penguin Books Ltd.