HBO’s In Treatment Succeeds Despite Missteps in Long-Awaited Fourth Season

“This isn’t a results-oriented practice.”

Those words, spoken by Dr. Brooke Lawrence (Uzo Aduba) in the fourth season of HBO’s In Treatment, serve as a kind of mission statement for the type of therapy on offer here, and perhaps equally may be a barometer of your tolerance for that part of the story. And it’s a big part, of course. This is a show about therapy, where each episode constitutes one session, and the obstacles and breakthroughs of the talk therapy process provide most of the narrative drama. Uzo Aduba has replaced Gabriel Byrne as the star therapist, and it’s a small miracle that the show has returned at all. The last episodes aired a decade ago, HBO canceled the series in 2011, and it should be said that while this is technically a continuation, there is no need to have watched the first three seasons in order to dive into the fourth. Still, the question remains: Is there a good reason to bring it back?

There may be, but I’m not sure the therapeutic aspect is it. This is a touchy subject, but there have been a few recent studies that suggest pure psychodynamic therapy (aka “psychotherapy”), as distinguished from the cognitive-behavioral model, might not be as helpful to patients as popularly imagined. It is far from a settled issue, and there are a million nuances ranging from the type of mental illness being treated to the “fit” between therapist and patient, but broadly speaking, we seem to be living in a world where Freudian-style techniques have fallen out of favor and the more practical cognitive-behavioral approaches show the most efficacy both in the short term and over time. In Treatment very much relies on the trope of a probing therapist identifying hidden demons in a patient’s brain, teasing out the trauma, and sparking a slow series of epiphanies through this exploration. Especially with what we’ve learned in the last two decades, these forced revelations can feel quite hollow.

So it is with Eladio (Anthony Ramos), one Dr. Lawrence’s three primary patients (the show is structured so that throughout the season, we’ll see roughly six weeks of each patient, and six weeks of Dr. Lawrence meeting with her own therapist) who works for a rich family as a home health aide but dreams of the poetry of Bolano and Marquez and Paz, and can’t sleep. In the process of seeking medication, he meets a brick wall in Dr. Lawrence, who quotes Jung before offering up this piece of speculation:

“Maybe we stay awake to avoid the moment we have to come to in our lives… where the dream world falls away, reality sets in.”

Well, I’m no expert, but in my experience people with insomnia have wanted nothing more than to sleep, and if real life was such a burden, they’d want to escape it through sleep now and again, rather than being fully and constantly immersed in reality. Later, she tells Eladio that he’s “haunted,” and that this might explain his sleeplessness. Spoken in the patient’s second session, the words come across as presumptuous and a little condescending, as if the core belief here is that they can beat insomnia by digging into old memories. It’s a bit arrogant, and a bit old-fashioned.

In Treatment finds much more success when it veers from the therapeutic angle and focuses more on the characters. Aduba is very much up to the job as Lawrence, with a demeanor that is at once warm, incisive, and just the right amount of detached. Watching her spar with her second patient, a white-collar criminal named Colin, who’s there at the behest of the state and must pass muster to avoid returning to prison, is a delight. She immediately recognizes Colin as a charismatic bullshit artist dead set on avoiding any kind of engagement, and psychologically, this feels truer than anything we see with Eladio. For Colin, truly confronting his past brings out the demons of bitterness and extreme anger, and he’s loath to make that journey even as those demons torpedo his life. Dr. Lawrence absorbs his deflections, his flattery, and eventually his abuse, and forces him to be accountable and honest. That’s tremendously painful for Colin, and their conflict is riveting in a way that aimless Freudian speculation can’t touch.

Laila, an 18-year-old on the verge of graduating high school and Dr. Lawrence’s third patient, is led into the home office by her grandmother, who seems to want nothing more than for Lawrence to conduction conversion therapy to “undo” Laila’s lesbianism. It has the hallmarks of stereotype, but things soon grow more complicated; Laila is a kind of rich Will Hunting, full of surface intelligence that succeeds in letting her insult those around her, but also full of insecurities that she’s hellbent on keeping submerged. Again, watching the dance between her and Lawrence makes for effective TV, and stays clear of therapy cliche.

Two out of three ain’t bad, and even when the show is at its weakest, it’s very watchable. Whether it’s good enough to justify its existence after a 10-year hiatus is up for debate, but there’s enough here to call it smart, and measured, and almost always respectful of—and empathetic to—its subjects. It is not groundbreaking TV, nor is it the absolute latest in therapeutic thought, but it’s compelling on its own merits and largely smart. The dialogue can ramble on to redundancy—this show is fond of the patient stump speech—and the theatrical sensibilities can slip into a kind of staginess, but Aduba’s presence makes something worthwhile out of the minimalistic structure. Don’t expect a breakthrough, but sometimes, it’s enough to watch interesting people, in the thick of distress, talk it out.

In Treatment Season 4 premieres Sunday, May 23rd on HBO

Shane Ryan is a writer and editor. You can find more of his writing and podcasting at Apocalypse Sports, and follow him on Twitter here .

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