“Our last meeting was so impactful, that I wrote something about it on my blog,” I told Dr. Nesmith.

“Really? What about?”

“It was about my trip home from our last session. You see, when I was coming to you last time on the train, I noticed this rusty mark on one of the seats. It didn’t mean much to me until I went home, after therapy, and I saw the mark again on the train going back to Queens. I instantly knew that I was in the exact same train, the same subway car even. What are the chances of that? It felt like a Twilight Zone moment, so I wrote a piece connecting what happened in the train with that stuff you were telling me about how therapy helps you see the patterns, and that’s how you begin to change.”

“Interesting,” he said. “Anything else happen this week?”

“Yes!” I replied, taking out a piece of paper from my pocket. “I wrote something down that I wanted to discuss with you.”

“Go ahead.”

“On New Year’s Day, I finally finished watching The Sopranos. It was a big deal to me because I’ve been watching the show for six months now, and I really got into it. Remember, I even decided to go into therapy because of the subplot about Tony Soprano and his therapist.”

“Yes, you told me that story at our first session.”

“Anyway…” I continued, “I don’t know if you’ve ever seen the show, but in the second to last episode, Tony’s therapist, played by Lorraine Bracco, is being pressured by HER therapist, played by Peter Bogdonavich, to give up on Tony Soprano’s six years of therapy, because he doesn’t believe that sociopaths are helped through talk therapy.  He thinks they just use it to rationalize their continued sociopathic behavior. At first, Tony’s therapist is angry at him for suggesting this, because she’s a true believer in talk therapy, but at the end of the episode, she finally accepts that Tony will always be a brutal gangster and never change his ways. She tells him to leave, kicking him out of therapy.”

“I remember that episode.”

“Well, is that a real thing about sociopaths and talk therapy, based on real research, or did the writers just make it up for the show?”

“I’m not sure. I’ve never had a sociopath as a patient.”

“But make believe you did. Would you continue to give talk therapy to this guy, or would you say to him, “You will never change. Even if you are beginning to see the patterns, you will just hide behind your understanding of the patterns, and never change”

“I probably would not kick this person out. I would continue on with therapy, hoping that eventually he would be able to use what we talk about to better his life.  Sociopath or not.”

“That’s good to hear.”

“This is all interesting, but you’re not a mobster, or a sociopath, are you?”


“And you realize that the Sopranos is a TV show.”


“Yet you choose to spend your time in therapy talking about a TV show rather than yourself, even writing yourself a note to remember to discuss it with me today.”

“Well, that’s not all I’ve discussed with you.   I did tell you about that story I wrote last week about seeing the patterns on the trains.”

“True.  But you never said anything about what I was expecting from the story — some insights into your own patterns.  Did the noticing of the patterns on the train make you think about yourself?  Everything you mentioned about the patterns was more like general interest, mere fodder for a generic story, than a way for personal growth. Can you tell me anything about your personal patterns — the ones you say are so important to notice?”

“Uh, well. Uh, not really. I mean, I can’t find the right words to describe them yet.”

“But you ARE able to talk a lot about patterns of a character on a TV show. You even spent your first day of your New Year wondering if talk therapy could help a fictional sociopath on TV.”

“You think I’m avoiding stuff…. like a defense mechanism?”

“At least Tony Soprano is a well-defined character. In your story, it sounds like the main thing missing… is you.”

“Are you going to kick me out of therapy now?”