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How TV therapy took on the pandemic

With In Treatment and Couples Therapy, TV therapy took on everything from videoconferencing software to existential dread.

Uzo Aduba as Brooke Taylor and Dr. Orna Guralnik.
Uzo Aduba of HBO’s In Treatment and Dr. Orna Guralnik of Showtime’s Couples Therapy offered two different TV takes on pandemic therapy.
Emily St. James was a senior correspondent for Vox, covering American identities. Before she joined Vox in 2014, she was the first TV editor of the A.V. Club.

“They’re in my mess. I’m in their mess. The pets, the people, the children, the noises, the delivery people, the madness of being at home. Knowing that we’re in each other’s home creates this deep level of intimacy,” says Dr. Orna Guralnik, the clinical psychologist and psychoanalyst at the center of Showtime’s Couples Therapy. “There’s something about the trauma that we’re going through together. It’s no longer, ‘Oh, I’m the analyst analyzing what’s happening to those people over there.’”

Guralnik is one of TV’s top therapists at a time when TV therapy — both fictional and real — is seeing a mild resurgence. The second season of Couples Therapy, a docuseries that is exactly what it sounds like, and the fourth season of HBO’s In Treatment, a fictional show whose first three seasons ran from 2008 to 2010, debuted within a few weeks of each other. The return of In Treatment was a particularly notable event, given that the critically acclaimed series had received a soft reboot, and now focuses on a new character played by Uzo Aduba, instead of Gabriel Byrne’s character from the first three seasons.

Both shows have attempted to encompass the chaos and surreal nature of 2020. Both even delved into the nature of therapy over videoconferencing software. Each got at something fundamental about how hard it is to care for yourself when you’re supposed to be caring for others in the midst of a world-shattering event.

As vaccination rates rise and the world slowly tilts back toward something like “normal,” these seasons will stand as a testament to just how much the Covid-19 pandemic ruptured absolutely everything about our normal routines. TV therapy, no matter how realistic, is usually subject to the pressures of television storytelling. No matter how sound the psychological breakthroughs on Couples Therapy and In Treatment, the shows strip away many of the bits that lead to those moments, where patients slowly work their way toward a greater understanding of themselves. Compared to, say, the vague platitudes offered on the 1993 to 2004 comedy Frasier, they are practically naturalistic.

The pandemic forced In Treatment and Couples Therapy to be more real than they perhaps ever dreamed of being. Both shows push viewers uncomfortably into the personal spaces of both therapist and patient. And both have captured a tiny window into what living through 2020 was like for psychological professionals.

Learning the technology for remote therapy could be a pain for therapists both onscreen and off

Laila takes a selfie as Brooke watches.
Brooke Taylor (Uzo Aduba, background) works with troubled teenager Laila (Quintessa Swindell) in the pandemic-fueled fourth season of In Treatment.

An obvious change in pandemic-era therapy was just how that therapy was conducted. Instead of visiting the same office week after week after week, patients and therapists were connecting over videoconferencing platforms. That shift wasn’t always the friendliest one for real therapists, let alone fictional ones.

“I have never been a big computer freak. So I had to catch up on computer literacy really quickly,” said Pat Gillard, an independent psychotherapist in California. “And then I had to set aside my own angst and deal with the anxiety of my clients, who age from 18 to 80. The older clients were not always computer literate, and some of them don’t even have computers. I would have to help walk them through it. They would get an iPad, and I don’t even know how to explain how to use it.”

When it came to TV therapy, the Couples Therapy team not only had to figure out a way to pivot to video therapy, it also had to figure out a way to film that video therapy. The crew wasn’t allowed to enter the homes of participating couples, so video and audio equipment had to be sent to them, with instructions on how to make it work.

Guralnik expressed similar sentiments to Gillard regarding this process, but with an added layer of complication due to having to figure out how to also film herself: “It was stressful. I’m not great with technology. I don’t see, you know, where this cord goes. [I would tell the crew], ‘Can’t you just make it happen?’”

Yet looking at the show through the lens of pandemic filmmaking opened the series up somewhat. Couples Therapy season two is terrific, continuing to deliver the psychological insights that formed the core of season one but with a heavy sense of just how much the past year has become a psychic burden on many of us. The pandemic wreaked havoc on the show’s production cycle, with New York’s lockdown beginning in the third week of season two’s 20-week shooting schedule. But the need to figure out a new way to make the show resulted in stronger television all around.

“Our documentarian instincts kicked in. There was no question that we had to keep following the story. The thing you want as a documentary filmmaker is to be with interesting people when something extraordinary is happening. And that’s where we were,” says Josh Krugman, a director on Couples Therapy. “We happened to be already embedded in a really interesting place in our society to look at this pandemic. We had already found these incredible people who were dealing with issues in intimate relationships. We were able to then watch how the pandemic unfolded through that lens.”

In Treatment was less affected by this shift. While the entire season was produced under strict Covid-19 safety procedures, its presentation of video therapy was only semi-real. Uzo Aduba’s therapist character Dr. Brooke Taylor and her patient Eladio (Anthony Ramos) connect over videoconferencing software, and during filming, Aduba and Ramos really were speaking to each other across a digital gap, screen-to-screen. But both were on the same soundstage, separated by a few hundred feet, not several miles.

Still, the very structure of In Treatment — where each episode features a therapist talking to one of their patients — better catered to the closed-down and socially distanced sets of pandemic-era filmmaking than many other shows in production. The decision to revive the show wasn’t inspired by the pandemic itself, but the fact that it could be shot comfortably within Covid-19 restrictions certainly didn’t hurt when getting greenlit.

Thoughts about how the pandemic might have affected Brooke’s practice informed even the series’ set design. Where In Treatment’s first three seasons very clearly took place in a therapist’s office, season four takes place in Brooke’s Los Angeles home, with a view of downtown. Her patients sit on her living room couch, and she sits an appropriate distance away from them. It’s not strictly accurate — nobody on the show is wearing masks, where therapists in California were still required to wear masks for in-person visits until very recently — but it’s making more of a stab at verisimilitude than many other shows that attempted to incorporate the pandemic into their storytelling.

“Part of the practical consideration in making the show again was all about the fact that we could do it distanced,” says Joshua Allen, one of the season’s two showrunners. “But it sort of took on a character of its own because we realized pretty early on, on set, that we could use distance. We could use space to say one thing or say another thing or create intimacy.”

What the never-ending experience of 2020 taught therapists both real and fictional about why we need therapy

Orna Guralnik talks to two patients on a computer screen.
Dr. Orna Guralnik counsels one of the couples on Couples Therapy season two over video-chat software.

Working as a therapist through the pandemic — to say nothing else of the many major news and world events that unfolded during it — could be taxing. The whole world was going through the pandemic together, but because a therapist’s obligation is to their patients, it was possible for therapists to feel a little distanced from an event that was supposedly happening to everybody on Earth.

“In a certain way, I was in it with the patients. But I was also in it as a psychoanalyst. I use the analytic frame to process many things. It’s hard not to when you’re doing this for so long,” Guralnik says. “In a way, [the events of the last year] brought us together, my patients or the couples on the show and me. But there was an added layer of modeling a psychoanalytic investigation of what we were going through. You’re never just at one with the experience. You’re always on some kind of perch, reflecting on the experience, for good and for bad.”

The sad realities of the pandemic also touched the therapists who were meant to help their patients deal with those sad realities. For all of the ways in which television could capture at least some of the aesthetic appearance of a year in video therapy, it could never quite get at the sheer existential weight of so much grief. Gillard says that dealing with so much of that sorrow in her own practice came to be a little exhausting.

“I used to be a substance abuse counselor, specifically, which has a high mortality rate. Every time a client would die, I had to compartmentalize my own grief and loss and just keep going,” Gillard says. “That’s how I felt for the last year and a half. I had to put aside my own fear and challenges and just keep going.”

And there’s one aspect of our new therapeutic reality that TV just can’t capture, at least not yet: the part where we’re all slowly but surely returning to something like our normal lives. After all, we’ve gotten used to living a certain way. Leaving that familiar groove behind will be tricky, even if we’re replacing it with a groove that used to be familiar.

“[My patients are talking about] the fear of going out, social phobia when they didn’t have it before or performance anxiety when maybe they didn’t have it before,” Gillard says. “All of a sudden, it’s a multi-dimensional reality. They have to make sure they shaved this morning or clipped their toenails. Are they chewing gum so their breath is okay? All these dimensions of reality that you don’t have on Zoom.”

Already, these little details of life amid Covid-19 are starting to blur together into one big picture of a difficult moment. Our brains do this to protect us from the worst things that happen to us. But remembering those details can be an important part of processing pain and moving forward in life. When I watch Couples Therapy and In Treatment, I appreciate how much their commitment to capturing the weird intimacy of our year (plus) in quarantine serves as a time capsule for an experience many of us will be eager to leave behind. Even in a fictional therapist’s office, there’s something deeply satisfying about watching people grapple with the weight of that experience and finding some way to move forward.

“I didn’t know how much acting was therapy for me,” says Aduba, the star of In Treatment. “I didn’t know the healing that was going to come from something like this. The work was so needed. We’ve all been through something as a global family that we haven’t been through in over 100 years. I don’t think we even know what all we felt. But this project grew out of some of those feelings for me. It was deeply healing. It was the hardest job I’ve ever had, but also one of the most rewarding.”