We have now come to the end of S7 on AcornTV, and that means I feel free to publish my thoughts on a number of things about it. Here is the first of several posts:
During the promotion for S7 marriage counseling/guidance was brought up as a key facet of how Martin and Louisa would be dealing with their marital problems. Since “Doc Martin” is a dramedy, we would be surprised if there were a lot of lengthy counseling scenes; however, in the operating room scene at the end of S6 we heard Martin tell Louisa that he needed help from her to become a better husband. Prior to that we heard Ruth tell Martin that if he wanted to get Louisa to return to him, he would have to work hard to change. It didn’t seem like too much of a leap to expect some real effort to use marriage guidance to improve their marriage.
We have been through 6 series that have contained many medical emergencies and lives saved. We’ve learned about a myriad of rare medical disorders and all have been treated properly by Martin Ellingham with an expertise that demonstrates his superior medical knowledge and skill. We would expect no less from any depiction of marriage counseling. Sadly, that is not what we get. The following is my view of the marriage counseling and where it disappoints. Whereas we can learn about how to diagnose and deal with a variety of medical conditions from watching this show, we should not accept what we see in S7 as a good representation of marriage therapy. (Abby and Santa, regular participants of this blog, reviewed what I wrote and provided me with feedback and their professional experience. Abby is a practicing therapist who sees married couples for counseling and Santa is a retired therapist. They have written some previous posts on psychological aspects of the show and its characters.) This post is intended to focus on the accuracy of the therapy sessions first. I will add a few thoughts on the purpose of the therapy scenes at the end. Please bear with me on this because it’s going to be a long post.
In series 7 each episode includes a brief look at therapy sessions. We have to keep in mind that what we are shown is only a couple of minutes of each therapy session that is scheduled for one hour. I would like to think that what they choose to show us is the most important exchange of each session, but no 2-5 minute interlude can give us a sufficient amount of information. We are left with many unknowns about the therapy. Nevertheless, I don’t think it’s fair to excuse the problems with how the therapy is depicted simply because of the brevity of what we’re shown.
Our first introduction to the therapist recommended by Ruth is that she conforms to how Ruth described her, i. e. she is a no nonsense, direct person who has set standards and practices and will not change them for anyone. She demands that Martin shut off his phone and leave it at the entrance to her office; she tells him that being late for any reason is unacceptable and could lead to a termination of their sessions; and she won’t be deterred from treating his problems by any questions he poses about her background and reason for being in Portwenn. She won’t allow him to usurp her role as leader in this setting. These rules seem a little too rigid because he is the only doctor in Portwenn. According to Abby, it would have been better for them to clarify what constitutes the kind of emergency that would be an acceptable reason for him to arrive late for a session. Dr. T wants him to make therapy a priority and the act of discussing this issue would be a good way to convey that message.
Her approach appears to work well with Martin and he exposes more of himself to her than we’ve heard him tell anyone else, including Louisa. He recognizes that due to his being an unwanted child he has an inability to form adult attachments; he exhibits poor communication skills; he has unrealistic expectations of others, and a blood phobia. Of course he’s done his homework and decided what her diagnosis will be, but she is quick to brush off his easy judgement and makes clear that therapy is not like surgery; it’s a process. Although Dr. T appreciates Martin’s effort to arrive at a diagnosis, she doesn’t dispute it. Abby notes that “the first order of business, other than taking a history, is to establish a therapeutic alliance.” We can now look forward to watching the process proceed. We have set before us a series of issues that Martin has delineated and that we would assume will be how Dr. Timoney will plan her therapy.
Dr. Timoney begins quite understandably with asking Martin what he is coming to her for. He tells her, after asking her about herself, that he wants his wife to return to him, that he wants her to be happy, and that he blames himself for her unhappiness. Dr. Timoney’s first command for Martin is she wants to meet Louisa. That seems reasonable since Louisa plays an important role in the direction of the therapy. On the other hand, Martin probably has no idea when Louisa will return and appears to have neglected to tell Dr. T that important fact. Fortuitously, Louisa returns soon after, and that night over dinner Martin has a chance to inform her that he’s been seeing a therapist and that she wants to meet Louisa. Luckily, Louisa agrees to meet Dr. T even though she has some reservations. She figures she’s going to shed some light on Martin’s problems for Dr. T. In other words, we start therapy on tenuous footing including that as far as we know Martin has only seen the therapist once prior to Louisa’s return, due to time constraints he needs her to agree to see Dr. T on the same night that they are reunited, and he tells her nothing about his session with Dr. T.
When Louisa meets Dr. T for the first time, we see her enter the building but it appears that we pick up the conversation sometime after it begins. By the time we are brought into the conversation, Louisa is in the act of explaining that Martin has a hard time expressing his feelings, although she’s sure he loves her. Louisa then makes some derogatory comments about Martin’s parents, all deserved. She is especially clear that Martin’s mother is very cold and that she can understand why Martin is emotionally repressed. When asked about her parents, Louisa identifies them as normal, but she does reveal that her Mom left home when she was 12 and that her father was incarcerated when she was a child.
Since the show has made a fairly consistent effort to inform us of the childhood traumas of both Martin and Louisa, we have been led to believe that these are critical to the formation of these two characters. We’ve met all four parents over the years and, through a dream sequence that Martin has one early morning after James has been born, and probably triggered by a butterfly crib mobile, we know that Martin has suffered from the harmful effects of a bad tempered father when he was young. We also know that he’s been punished by being locked in a space under the stairs and by physical means, and that he wet his bed until he was 11. Thus, when the counseling sessions begin with Dr. T learning some intimate tidbits about their parents, we anticipate more inquiry into the parent/child dynamic. Childhood is when the most significant impact on our lives occurs and we deem it crucial to this couple. But that is not to be after all. Dr. T does not pursue this line of analysis and we do not hear her ask much about their childhoods after this. At the very least a good therapist would have explored how these experiences may have negatively impacted how Martin and Louisa relate to each other. The best therapy would have delved into their childhoods and considered how these experiences shaped them.
Instead, even though Dr. T wonders whether there is some connection between how Louisa’s relationship with her father might correspond with how she deals with Martin, she decides that it would be best for them to enter couples therapy. There is no transition during which she looks into Martin’s individual concerns. Since he made the initial contact, she might have wanted to probe more deeply into Martin’s feelings about why things were difficult before Louisa left. What does that mean anyway? Moreover, we see Louisa immediately resist the notion of couples therapy. We also note that Louisa is not receptive to the suggestion that both parties may be in some way responsible for the problems. Nonetheless, Dr. T moves on with couples therapy without a second individual meeting with either of them. Once therapy transitions to couples counseling, the objective changes. In couples counseling it is the marriage that is effectively the client and not any individual. The mission is now to set goals for the marriage to reach a satisfactory level of success for this couple.
Our introduction to couples therapy with Martin and Louisa begins with E4. When we join the conversation, Martin and Louisa are already seated facing Dr. T and Martin appears to be answering a question about whether he thinks environment has a strong impact on personality development in children. For some reason he mentions that his parents would leave him with his aunt every summer as related in some way to his conclusion that environment is important. Once again, Dr. T does not follow up and asks nothing about his relationship with his aunt or about what visiting her might have meant to him. (From what we’ve seen, we would think that it was a very positive experience during which he received the love, affection, and acceptance he had been missing at home.) He has mentioned that he was an unwanted child, which is pretty significant, but has left out the abuse and neglect he suffered. Most therapists would have wanted to know what brought him to the conclusion that he was unwanted. But here Dr. T moves on to asking Louisa if she’s uncomfortable. (Abby writes that she would have asked Louisa what it was like for her to hear what Martin is revealing. She notes that “it is important to develop empathy between them” and that Dr. T’s question about Louisa looking uncomfortable could have been a good way to transition to this. Unfortunately there is no follow up that takes place.)
Both Martin and Louisa look uncomfortable, and the seat they are asked to use certainly seems very hard and stiff itself, but also they are estranged and have never been extremely prone to overt expressions of affection, especially in public. Martin asserts that he appreciates Louisa, which is more evidence of Martin trying to change and become more expressive. This leads to Dr. T asking whether Louisa considers Martin appreciative. She rightly says that to her he is usually quite nice but not so much to others. Dr. T appropriately cuts Louisa off once she gets going on listing all the things she finds troubling about Martin, and we get the impression that Louisa has a lot of pent up criticism about him. It may be a sign of Dr. T’s observational skills that she notices their self-containment and asks them to list three positives about each other. Louisa is able to produce three things fairly quickly, and they are telling in that they are rather impersonal: Martin is a good doctor, he dresses smartly, and he keeps the house tidy. This last item is strange to find on Louisa’s list because she usually isn’t so happy about it. Then it’s Martin’s turn and his list is much more personal: Louisa is a good and caring mother, she’s active, and she’s very beautiful. Their choices represent well what is important to each of them. For Louisa Martin’s outstanding medical ability has always been preeminent. She is also attracted to his outward appearance and professional attire. After that she seems to struggle for a third thing to add. For Martin Louisa’s interest in being a good mother is preeminent and why he has nothing to say about her achievements as headmistress. Being active matters to him on a health level, and we know he has considered her beautiful from the moment he first saw her. Louisa seems flattered despite the omission of her ability as a headmistress.
What follows is an assignment to hug three times a day and say something positive to each other every day. As I wrote in my post on Hugs and Kisses, this assignment makes sense because it asks them to add physical touching, and that can be extremely effective in bringing people closer. It also requires them to think of something they can say to each other that should be complimentary. It switches the emphasis away from the negative.
As always, we know that watching Martin and Louisa hug three times a day will be both amusing and endearing, and it is. This was precisely what I hoped therapy would do for the show and this couple. By the end of E4, we see a lot of progress even though Louisa still struggles to find something positive to say to Martin. Therapy is making a difference despite being relatively lacking in thoroughness.
E5 starts with Martin already having a bad day due to an unpleasant confrontation with a young girl and being shadowed by Buddy. They arrive a bit early for their therapy session and are seen waiting in their car by another patient, something they both appear to dislike. Dr. T asks about how the hugging assignment went and Louisa answers that Martin has trouble with spontaneity. Martin immediately accuses her of the same. But we are quickly off to Louisa asking about doing something with Martin’s blood phobia. Louisa has finally raised that condition with Dr. T. because she would like to redirect therapy to make it about Martin. At this point, according to Abby, most therapists would acknowledge the importance of Martin’s haemophobia but make sure the hugging exercise wasn’t neglected. There was too much material involved with the hugging for the therapist to simply move on without spending more time on it. Dr. T can’t really address the haemophobia specifically with Martin if she is focusing on the marriage, but she suggests the blood phobia is connected to Martin’s desire to be in control, and despite his disagreement with that, she sticks to her analysis and gives them another assignment. (There is some dispute here about the origins of the haemophobia because we’ve heard Ruth tell Martin that this sort of phobia often has roots in childhood trauma. Abby would be inclined to agree with Ruth even though Martin certainly has control issues. As a person who needs to feel in control, Martin probably felt safe until the event that brought on the blood phobia took place. The onset of the phobia was enough to bring on significant anxiety and make him terrified. Since then, he has found a way to maintain control, but each time the phobia reappears, it reminds him that he isn’t in control and he is thrown into another state of fear.)
This time their assignment is for Louisa to take charge of an activity and Martin must do whatever she asks of him. The odd thing about this is that he’s trying to do even more than that already and has chosen to live in an unsavory place so that Louisa and James can stay at the surgery. He also offers to bathe James regularly and to take care of James when Janice is unavailable. He’s very cognizant of not impinging on Louisa’s privacy and treads lightly around her. But both Louisa and Martin agree to this assignment without objection either.
The picnic Louisa chooses as her activity is disrupted by Angela Sim having a mental breakdown at the beach and that breaks up the family occasion. On the other hand, Louisa is grateful that Martin was there to help Angela and the episode ends with both of them entering the surgery together, which should be a good sign. Then again, there is no mention of how that assignment went to our knowledge but we join the session near the end this time. (Abby finds this assignment strange because Dr. T should have noticed that both Louisa and Martin have control issues. Louisa has tried to take charge of most of the sessions. “If she gave them this assignment to show how Louisa sets Martin up, then why wasn’t the assignment explored the next session? Why did you choose a picnic? Is it something you thought Martin would like? What food did you pack? Were there things both of you like? So much valuable material that could have been gleaned from a discussion like this.”)
Once again Dr. T decides to give them another assignment which entails going on a date together. Dr. T makes a valuable contribution when she comments that Louisa may equate love with being left alone, since her parents left her when she was a child, and now she has fallen in love with a man who she says she didn’t think would last in Portwenn. Her comment that Louisa sets Martin up for failure is also so that she can continue to be disappointed in him. Abby notes that Dr. T was planting seeds that she hoped would germinate either during therapy or afterwards. Each time in the world of Dr. T’s therapy, however, there is so little follow up that we can only be frustrated, and that shows poor practice methods.
It is here when Louisa admits that falling in love with Martin was not a conscious act in any way connected to how she might conceive of the emotion of love. Perhaps that is a nod to the incomprehensibility of choosing Martin as the man she wants to marry. We can’t explain what leads us to fall in love and love is rather mystifying. Again, as far as we can tell, Dr. T just leaves that hanging too.
Dr. T provides very few guidelines for the date so it’s particularly nice to see Martin bring flowers for Louisa, make reservations at the location where they first met and make special note of that. They have a slightly tense conversation about Louisa’s impression that Martin wouldn’t last 5 minutes in Portwenn. Then Martin brings up Danny and confronts Louisa about telling Danny about their private lives, but Louisa is honest in her answer and quick to apologize. For me her behavior is conciliatory and she hopes to have a nice dinner. The disruption comes when Louisa takes a call from Danny that causes her to feel compelled to leave. It is understandable that she would leave her phone on to be available for any calls about James, but she should never have accepted a call from Danny, and he should never have called her.
When Dr. T sees them next, Louisa describes the dinner date as a disaster, but that seems a pretty extreme appraisal. Again, Dr. T does not ask Martin to venture his own feelings. Martin’s anger at Louisa for divulging their marital problems to Danny is not similarly played out with Rachel. Time and again Dr. T allows Louisa to be the one to give her evaluation of each exercise with no effort to balance what she says with what Martin thinks. Quickly Dr. T comes to the conclusion that Martin and Louisa should make a list of what they like about being on their own, and tells them they should not consider a decision to separate as a failure. (Abby can’t help having a strong reaction to this procedure, and I decided to include it all: “This scene is so far from good practice that I cringe at the thought that people will think this is what therapy is. First of all, she doesn’t explore why Louisa found that date to be a disaster. ((Santa would add, “If there’s anything that’s not typical of therapy, it’s letting pass a pregnant comment that ‘it was a disaster.'”)) She didn’t elicit Martin’s view on the evening. She didn’t explore the entire assignment: How was the date arranged? Who asked whom? Did Martin pick her up? How did that go? What was the drive like? Where did they go? How did they feel sitting at the table with each other? What did they talk about? Where did the evening break down? Was there a better way they could have handled it? There was so much that could be gained from such a post mortem that it is frustrating for me to see it just dropped. And then to suggest they think about the positives of being separated after such a short time leaves me just dumbfounded. One might wonder if she was using reverse psychology here, but that would be a very dangerous game.”)
It is also very bad practice to have never explored the history of their relationship and the course of their short marriage. We have no evidence that she ever has tried to investigate these areas.
What we have then is several short-lived efforts to spend time together, hardly any review of what took place during those occasions, usually a willingness to hear only one person’s assessment of the assignment, and ultimately a suggestion that perhaps saving their marriage is not such a good idea, and that that would not be considered a failure.
The final time Martin and Louisa go out to see Dr. T takes place after Dr. T’s car accident and head injury. She acts very erratically and chooses an exercise for right there in her office. It seems a bit silly as she asks Martin and Louisa to march in place. We can no longer take her seriously as a therapist.
When we make a final survey of the therapy, it is hard to be very impressed by it. The length of time they spend going to therapy as a couple is probably 5 weeks. Over that period Dr. Timoney has learned that both Martin and Louisa had childhood experiences that were damaging and are likely to have caused some residual harm. In Louisa’s case she has concluded that Louisa interprets love as being intertwined with being cast aside; we don’t know how she looks at Martin’s childhood. What she thinks about Martin is that he likes to be in control. She notices that they are self-contained, at least around her. Hopefully she also realizes that Louisa has a good deal of bottled up anger toward Martin based on how easy it is for her to express criticism of him. She should also notice that Louisa is usually the first one to give her impression of how each assignment went, and that she often does not reciprocate Martin’s efforts to offer compliments. We see almost no follow-up after Louisa disparages each assignment, and there is very little probing of either Martin or Louisa. Without asking for more information, how can you trust that what’s reported is accurate? (I would argue that it isn’t accurate or reliable.) Needless to say, I would expect a therapist to inquire why Louisa is so angry at Martin and possibly elicit from them what it would take for her to be able to get over her strong vexation with him. It seems clear that Louisa is the barrier to any reconciliation. Furthermore, as Santa notes, “they were never coached in how to talk to each other, which I would think would almost immediately have been identified as a significant issue for them.” Martin has admitted to having poor communication skills. We know that this show is built on Martin and Louisa being unable to complete most conversations for many reasons. It would have made sense to address that.
There are many other problems with the therapy and its short term basis. Most therapy lasts for several months, not several weeks. The marital troubles have built up over a fairly long time and dealing with them cannot be expected to work so quickly. Certainly, any couples therapist would do her best to find a way to keep the couple together, especially since that is why they have engaged her. To give up and advise them to separate after such a limited time trying to help them, would be a sign that this therapist is lacking in proper skills and not gifted as advertised. Both Santa and Abby concur on this point.
(As often happens, I read an article in the NYTimes that seems pertinent and wanted to share it with you. It’s helpful that the article provides both sides of therapy and this therapist is loathe to end therapy when she feels there is still much to work on. Importantly, she notes her own failures in treating this patient and hopes to be given another chance to help. Unlike Dr. T, she does not tell the patient that she is an extremely challenging case and she never implies that the situation is hopeless. What Dr. T says is extremely unprofessional, according to both Abby and Santa. To quote Abby: “You do not tell a couple that they are the most challenging case you have ever come across, especially when the therapy has not been successful. This is very blaming, and in a more sensitive client could induce shame. It is important to end with something positive, if only with an invitation to return when and if the client feels the need to do so.” Santa adds: “We understand dramatically why she said it — to build suspense about whether they can reconcile — but it’s just dumb.” Having this doctor behave in an obviously grossly unprofessional manner and say something plainly stupid puts in question how Ruth portrayed her originally. Maybe this therapist wasn’t such a good choice after all.)
I would be remiss if I didn’t write anything about how the therapy sessions function as a plot driver. Anytime a particular activity is used repeatedly, it’s worth determining how it contributes to the plot. In this series each episode except for the first one begins with some interaction with Dr. Timoney; therefore, the therapy sessions are given some importance. The key role each session has is to tell us what the episode will be about; it drives the action. Another way it operates is to get this couple into the car together and spending at least one uninterrupted hour together. On the other hand, the time spent in therapy substitutes for the more valuable use of time during which they could have talked to each other. Dr. T both creates a space where they can express themselves, something they have trouble doing, and interferes with their ability to relate. If she used the time wisely, she could lead to a greater closeness between them. Finally, like any other outsider, Dr. Timoney brings another character into the village and into Martin and Louisa’s lives. She challenges their preconceptions and unites them, even if it is at her expense.
Alternatively, Dr. T is unknown to the town until she crashes her car; Ruth knows of her but they don’t seem to have interacted much based on their coincidental meeting in the pharmacy in E7; and no one other than Morwenna and Ruth knows that Louisa and Martin are seeing her until she tells Sally after her head injury. This time the outsider stays one. Even her departing scene is exceptional because they make a joke of it, although at least they agree.
All in all, we are given a pretty dim view of therapy. Santa states, “As both Abby and I have said, therapy isn’t really all about the presentation of illuminating, penetrating insights by a therapist, but that is the impression that you get.” Indeed, therapy is depicted as unsuccessful and it is the random thoughts of a variety of characters, many of them dimwitted, who appear to be of more value. The art teacher tells her daughter she loves her as she is; Mrs. T makes a few pointed comments about marriage to ME; and Janice tells Louisa she knows Martin better than anyone. Finally, Mrs. Winton conveys the power of love and commitment despite being in a rather crazed state. The message seems to be to trust in the folksy wisdom of people around you rather than in professionals, a position we wouldn’t expect from a team that has been characterizing Martin, and some other doctors, as professional, highly knowledgeable and capable of saving lives.
(Oh, one last thing…we hear Martin advise patients to seek counseling several times throughout the show and that appears contradictory to how therapy has been handled in S7. What good is it to have someone evaluated if you have very little confidence in the process? I’m not sure what to make of that exactly, but his view that Mrs. Tishell would not have been released unless the professionals were sure that she was under control is certainly disproven. By the end of S7, Sally seems to have arrived at some place of acceptance that Clive is who she should be with, but she never stops stalking Martin and making inappropriate comments to him. The evidence against therapy is stronger than that in favor of it.)
Originally posted 2016-08-02 09:05:10.