The Psychotherapy of Doc Martin, by Dr. Rachel Timoney

(This is a form of fan fiction, solely for educational purposes, that combines events from the Doc Martin TV Show, Season 7, with stuff I make up.)

Dr. Rachel Timoney was looking forward to her first session with the eminent Dr. Martin Ellingham. She didn't know much about him, other than he was rumored to have abruptly resigned his prestigious position as head of vascular medicine at Imperial College London. Chance would bring them together for an initial psychotherapy session. Dr. Ellingham (Doc Martin, to the locals) had taken a position in Portwenn, an isolated fishing village on the Celtic Sea. And she was spending a few months in Portwenn, writing and seeing a few patients.

Rachel Timoney was once considered a prodigy in her field. Nine years ago, at age 23, she was granted a doctorate in psychotherapeutic theory. Her research had gained a moderate bit of fame, even getting into a few newspapers at the time. Even she knew that being highly regarded as a psychotherapy expert at age 23 would be beyond stupid: Mathematicians do breakthrough work at 23. Physicists do breakthrough work at 23. Even those in the arts do breakthrough work at 23. Counselors do not do breakthrough work at 23. There are certain things you can learn through only experience, and if anything, those gifted in academia have typically sacrificed life experiences in order to excel in studies. There's an age between infancy and senility that someone can become a good therapist, and it ain't 23.

In the years following receiving her doctorate, Timoney has worked on living up to her reputation. She's done well, but from what she knew of him, she believed that having Dr. Martin Ellingham in therapy would be a novel challenge. It proved to be that.

Doc Martin

Seconds after he sits for their initial session, Martin informs Timoney that he expects she'd diagnose him as having attachment disorder. Timoney notes silently that Martin describes himself as if he were a third party. Martin explains that he was "an unwanted, unloved child," and gives a brief account of his upbringing by his cold and self-centered parents. (Later, Timoney would recount to her mentor that if Harry Potter had Doc Martin's parents, rather than give their lives for his, they would have swapped him to Voldemort for a MacDonald's breakfast Groupon.)

Martin makes it clear that he is aware of his interpersonal shortcomings. In discussing his marital difficulties, he accepts the entire blame. Responding to Martin's depiction of his life, Timoney comments that he is as blunt with himself as he is with others. Martin had never considered that and feels his body relax into the thought.

At the close of the session, Timoney suggests that it's rare that one member of a couple is the sole source of conflict and asks that his wife Louisa come for an appointment.

Louisa

Dr. Timoney learns from their session that Louisa is an accomplished, articulate Portwenn schoolteacher. What Louisa is not, is eager to be in the session. She makes cracks about Timoney's youth, implying that Timoney is inexperienced and naïve. Louisa contends that her martial problems are entirely due to Martin's deficits in sensitivity, and that he should (as the English say) get them sorted without her involvement.

Responding to Dr. Timoney's questions, Louisa states that her parents were "fine, normal as you like," moments later adding that her mother abandoned the family when she was 12, but "I didn't really need a mother by then." And, by the way, her father "spent some time in prison," when she was a young child. After listeining to herself describe her childhood as normal as you like, with reluctance, Louisa agrees to attend couple counseling.

Initial sessions

In Martin and Louisa's first couples session, Louisa begins with an account of their relationship. Louisa describes their awkward courtship: boy gets girl, boy loses girl, boy marries girl, girl has baby, boy loses girl. If it were a TV show, Louisa explains, it'd be the usual get-them-to-watch-the-next-season stuff. But it's not a TV show.1 Martin and Louisa don't stay apart because of contrivances. They don't miss a reconciliation because one of them is seen hugging an attractive stranger who turns out to be a sibling, while viewers yell explanations at the TV screen. Their problem is straightforward and never-changing. As much as Louisa wants to be with Martin, she's constantly frustrated by his interpersonal limitations.

Experiments

As Timoney has learned through her training, struggling couples often have repetitive interactional patterns that result in seemingly irresolvable conflicts. Commonly-used interventions or experiments (as she prefers to think of them) can be used successfully with many couples. For example, have them experiment with a small (but designed to interrupt) behavioral change in the middle of a pattern of conflict. Or, if one or both members of the couple believe that conflict is bad, and have no way to deal with anger and resentment other than to withdraw (after all, avoiding conflict worked for their parents, right up to the divorce), the therapist can design a practice for successful conflict resolution.

As we shall see, commonly-used interventions don't work for everyone. And they do not for Martin and Louisa. Their pasts have left Martin with a limited repertoire of behavior and Louisa with small boundaries of trust. Their situation calls for a specialist, not a general practitioner. Timoney attempts three homework experiments that fail:

(1) Homework: Timoney has figured that Martin and Louisa have problems with physical intimacy, they are told to hug three times a day, while stating something nice about each other.

While it's true that Martin is not a toucher, he does like holding Louisa. In this case, the not touching was an effect, not a cause of their psychological distance, and the homework just creates additional awkwardness. To add to the awkwardness, Louisa never thinks of anything positive to say to Martin.

(2) Homework: Because Martin is a control freak (affirmed by both Martin and Louisa), they are told to have an outing in which Louisa is in total charge. In theory, this will help balance their relationship.

Louisa decides on a picnic to the beach, where Martin is uncomfortable with the random elements of a beach and a picnic, but tries to give Louisa a normal family outing. The outing is eventually interrupted by a medical emergency.

(3) Homework: Martin and Louisa did not have a typical courtship, that is, they didn't date. Timoney suggests some conventional courtship outings. Martin and Louisa plan a restaurant date.

In just minutes spent at the restaurant (because of yet another medical emergency), Martin and Louisa experience the whole of their relationship awkwardness.

There's a smorgasbord of reasons why these homework assignments were doomed. Leave room for dessert:

First, two of the assignments were exercises to get Martin and Louisa to engage more. That's more, not better. More, not different. There wasn't anything in these exercises that would help them engage better.

Second, they all were bound to make Martin feel even more awkward and more vulnerable. Martin's increased awkwardness exacerbated the very things that Louisa finds unattractive in her husband. That is not a recipe to increase intimacy.

Third, characterizing Martin as a control freak is simplistic. He's compulsive — habitual and tidy, beyond what most consider practical. But he's not trying to control the behavior of others, he's trying to control his environment in which other humans happen to be present. Being habitual and tidy is a common adaptation for those who have dealt with psychologically chaotic circumstances, especially in childhood. Even more significant, as Martin desperately wants to be with Louisa, she has the most meaningful control, control over his happiness. Martin is in control of nothing beyond his medical practice; he's the most psychologically fragile person in Portwenn.

Fourth, Timoney misses an opportunity (which I'll explain below) to cast Martin in a more positive light, which could have contributed to a major improvement in their relationship.

In Timoney's mind, if her tried-and-true conflict-resolution schemes don't work, it can't be her fault. She salves her shrinking-ego (pun intended) through the time-tested technique of blaming her clients. After Martin and Louisa inform Timoney that they won't be returning, she tells them that they're "one of the most challenging cases I have ever come across."

Dr. Timoney gets a Mulligan (in golf, a do-over)

After Martin and Louisa decide to end counseling, Rachel Timoney feels relief, guilt, and regret — relief that she won't have to watch herself struggle with her work, guilt that she feels that way, and regret that she did not help her clients. Timoney decides to confer with her old professor. Sure, he's past his prime. He babbles too much, repeats himself, but now and then, he still conjures some inventive advice. But before she calls him, Timoney has a WTF moment. She knows what he'd say. Instead of calling her professor, Timoney contacts Martin and Louisa, apologizes for her last remarks, and states that she has some fresh ideas. Surprised by the apology, they agree to give counseling another try.

Anticipating the call to her professor, the conversation Timoney had with herself betrayed that her interventions reeked of this worked in the past, so why be creative? She was being lazy: the experiments were designed with the relationship in mind, but not with the people in the relationship in mind. While couple counseling can counter interactional patterns that lead to relationship problems, that doesn't mean you can ignore the distinctiveness that individuals bring to relationships.

Couples Therapy: it's not just for couples anymore

Timoney notes that Louisa was right; she should have started with Martin. But not because he's the one who needs to get his problems sorted. Despite the notoriety that Timoney got for her research, she forgot to implement her own hard-won knowledge. What her research yielded2 is that, when engaging in couple counseling, confronting a resistant client is rowing upstream.

Due to the influences of substance-abuse treatment and early family therapy, confronting clients became fashionable in the 1970s. When parents brought a child for treatment, they were told that the child's behavior was usually a symptom of a dysfunctional marriage and poor parenting. A child client became labeled as the identified patient; the real patient, the parents were told, was the dysfunctional family, with the unspoken (and sometimes spoken) message that the parents were at fault. While confrontation made for dramatic teaching videos — therapist as action hero — the approach too often chased away the clientele.3 After all, if the clients were willing to face their own problems, there wouldn't have been all those identified-patient children in the first place.

Given the above, Timoney decides that the best course is to hold off on working directly with the relationship. As both Martin and Louisa feel that the major relationship problems lie with Martin, to avoid needless friction, Timoney opts for one-person couple therapy, the other leg of Timoney's research.

Timoney (as have many before her) found that a change in one member of a couple can have a profound and positive effect on the relationship. Timoney knew that therapists have been practicing one-person couples therapy for decades, but have been intimidated against stating so by the family therapy mafia, who define family therapy by who comes to the session. That's silly and never should have happened. Many family therapists apparently never moved past Piaget's concrete operational stage of development: once family therapy moved from the psychodynamic model to systems theory, it should have been obvious that if the client lives in a family, all therapy is family therapy.

Therapy with Martin

In discussing goals with Martin, he agrees that he would like to become more comfortable — fluid is the word agreed on — in his interactions with Louisa and with his infant son. He wants to make sure that he doesn't recreate the relationships his parents had with him and with each other.

The experiments with Martin commence:

If you live in a cosmopolitan area where men commonly wear business suits, or you have watched episodes of Mad Men, you'll notice that the men always unbutton their jackets when they sit and button them when they stand. A well-tailored suit jacket has no give, so a buttoned jacket pulls at the waist when the wearer is seated. Timoney jots this in her memory, because it provides an inroad into a subtle experiment.

From the time he rises to when he retires for the night, Martin dresses precisely the same, in a suit with the top two buttons fastened on his three-button jacket. And you'll observe that he never unfastens his suit jacket buttons, even when building a sandcastle with his son on the beach. A change in dress will give Martin the experience that nothing catastrophic will happen if he changes one habit.

In order, over several weeks:

To help Martin have the experience of overcoming a compulsive habit: (1) Timoney asks Martin to unbutton his jacket whenever he sits. (2) Next, she has him leave his jacket unbuttoned all day. (3) Last, she asks Martin to buy and wear casual clothes on his non-office days (presumably, the weekend). While change in one habit may seem trivial, the experience of that change can be a dramatic confidence builder.

To help Martin expand his repertoire of interpersonal response and range of affect, Timoney exploits Martin's desire for an enhanced relationship with his son: As stated, above, it's obvious that Martin wishes to be involved with his son's upbringing in a manner that sharply contrasts with how he (Martin) was raised. But he needs instruction and encouragement. While Martin gladly holds and bathes James, he does not exchange facial or noise expressions. We can assume that Martin's deficit is a result of being neglected in infancy, that no facial expression mirroring took place between Martin and his parents.

(1) Timoney asks Martin to exchange facial and noise expressions with James. As James has learned to smile from his mother, Martin has the opportunity to both initiate and respond. (2) Rather than exchanging hugs (as above), Martin and Louisa should trade smiles. (3) Timoney asks Martin to progressively expand his gestures of relationship beyond his son and wife. First, smile at his aunt (the one other person for whom he has affection), then his receptionist, then patients. This mildest demonstration of affect can teach him to better interact with others.

Marital grad school

After the above experiments, Timoney asks Martin and Louisa to come in together, once more. The experiments yielded a larger shift in their relationship than expected. To Timoney's surprise, Louisa discloses that when she first met Martin he was more outgoing and considerate. While never the life of the party, he was sensitive and generous to many in Portwenn and is acting that way again.4 Timoney realizes that she had made an assumption that Martin had always been this inhibited in his mood, sensitivity, and affect. Not learning otherwise was a rookie mistake.

Many couples have trouble in their relationship because they had no model of a good marriage. As both had parents with poor marriages, this could describe the experiences of both Martin and Louisa. However, some react the opposite of what you'd expect. Rather than stay away from marriage, because they experienced poor models, they idealize what a good marriage would be like. Timoney asks each of them what a normal marriage is like. After some discussion, both admit that, while they have fantasies of a normal marriage, they guess that no such thing exists. Timoney states that fantasies of the extreme, positive or negative, usually get in the way.

Wrapping up: In their solo session, Timoney had suggested to Louisa that, given her background of abandonment by her parents, she (purposely) married someone who would leave her. As we find out, Louisa believes the exact opposite, that Martin is the most dependable and loyal man she'd ever meet. Given her background of abandonment, it's easy to see that she picked Martin, not because he would leave her, but because he wouldn't. If Timoney had made a better effort to bring this to light, it could have changed the context of their marital relationship. If every time Louisa glances at Martin and sees not someone who has a limited range of sensitivity and affect, but someone who loves her without reservation and will always be there for her and their children, Louisa's entire attitude towards their marriage could shift.5

In the final session, Dr. Timoney, Louisa, and Martin discuss the wide variety of successful marriages. They conclude that Louisa chose Martin for his loyalty, and Martin chose Louisa because he saw in her that he could get the warmth and connection he desired.

Notes

  1. Well, yeah, it is.

  2. I'm making this up. The specifics of Timoney's research were never brought up in the TV show.

  3. Reminds me of the old joke: The operation was a success, but the patient died.

  4. In early episodes, Martin comes off as a fish out of water, like Dr. Joel Fleischman from Northern Exposure. In recent seasons, he comes off as a fish swimming in the Aspergers tank.

  5. This change in point of view is a cornerstone of appraoches influenced by the famous hypnotherapist, Milton Erickson, and in various cognitive behavior approaches.

Gary Bloom

Counselor/therapist, writer, coffee home roaster, Husband and father.

Greater Seattle http://gebloom.com

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