Psychoanalyzing 'The Sopranos'

It's no surprise to Dr. Kenneth Settel , by now, when patients bring up "The Sopranos" in the course of their therapy sessions. Early on, the Brookline psychiatrist and psychoanalyst says, patients wanted to talk about Tony Soprano's physical attraction to Dr. Jennifer Melfi, the unflinching psychiatrist played by Lorraine Bracco . During season three, they talked about Melfi's rape and her debate over whether to use Tony's mob power to seek revenge.

And last week, after an uncharacteristically emotional Melfi kicked Tony out of her practice, shellshocked patients wanted to link the ordeal to their own lives, in ways that Settel viewed as psychologically rich. Some asked if he would ever reveal their own identities, which Settel saw as a two-pronged question: Would you violate my trust? And am I important enough to merit a violation?

It goes to show how many ways the HBO series, which wraps up tomorrow, has served the psychiatric profession -- as a tacit advertisement for a certain form of treatment, a fodder for discussion, a water-cooler subject among doctors themselves. ("I can't think of any other program that psychiatrists talk about more than 'The Sopranos,' " says Settel, who says the next hottest topic, among his Boston colleagues, is the ongoing psychodrama of the Red Sox.)

And in the past couple of weeks, as the show has taken unsettling turns on the way to its conclusion, professionals have been dealing with their own complex, emotional relationship with the show. True to form, some have taken to analyzing themselves.

"We, in a way, allowed ourselves to be seduced," says Dr. Leon Hoffman, director of the Pacella Parent Child Center of the New York Psychoanalytic Institute & Society. "And seduction is always followed by betrayal."

In the case of "The Sopranos," the seduction was deep and real, especially given the way Hollywood tends to treat psychotherapy. Most female therapists in the movies wind up sleeping with their patients, says Dr. Glen Gabbard, professor of psychiatry at Houston's Baylor College of Medicine and author of the book "The Psychology of the Sopranos." (Hollywood as a whole hasn't changed; consider Brooke Shields's role last season on FX's "Nip/Tuck.")

So to psychiatrists and psychoanalysts, "The Sopranos" was a revelation. Doctors say it was a fairly accurate portrayal of "psychodynamic therapy," which eschews quick-fix drug treatment in favor of long conversations, carefully built trust, and the knowledge that grand epiphanies don't come on a weekly basis. It portrayed a psychiatrist as an active, emotional participant in the process, dealing with her own issues with the help of a trusted colleague. (It's unclear, some doctors say, whether Dr. Elliot Kupferberg , played by Peter Bogdanovich , was Melfi's therapist or her "supervisor," a peer counselor who helps a therapist work through especially difficult cases.)

Gabbard says the series has certainly led new patients to therapists' offices. After he wrote his book, he says, he got "a slew" of e-mails from female psychiatrists, describing male patients who told them that "If Tony Soprano can do it, I can do it. And people can see it's not weak."

And therapists were quick to trumpet their approval. In 2001, the American Psychoanalytic Association gave Bracco and the "Sopranos" writers an award for their portrayal of the profession.

So when the show's psychiatrists started behaving badly last week -- first Kupferberg violated professional ethics by revealing Tony's identity to some colleagues, then Melfi abruptly abandoned Tony at a time of need -- many doctors found themselves stunned.

"Suddenly, everybody in the entire cast, including Melfi and Elliot, had turned into sociopaths," says Dr. Jane V. Kite , a psychoanalyst in Cambridge, who says she was especially disturbed to see Melfi succumb to Kupferberg's bullying: "It made the female therapist, after all of this, look weak and frightened and sort of in thrall to another male."

Some doctors complain that, after years of watching Melfi's relationship with Tony unfold, her sudden change of heart simply doesn't ring true. Gabbard notes Kupferberg's vehicle for shaming Melfi -- a study suggesting that sociopaths can manipulate talk therapy -- has existed for decades, and shouldn't have taken Melfi by surprise. And Dr. Jonathan Kolb , the immediate past president of the Boston Psychoanalytic Society and Institute Inc., says Melfi's treatment of Tony was intended to serve a different purpose.

"He didn't come to her to have his criminality treated," Kolb says. "He came to her to have his anxiety treated."

While psychiatrists disagree about whether Melfi was a good or mediocre therapist all along, they seem to concur that she has lost her place as a paragon of the field.

"If they proposed giving her an award after this show, there would be hell to pay," says Dr. Leonard Glass, another past president of the Boston Psychoanalytic Society.

Then again, doctors like Glass keep reminding themselves, Melfi doesn't actually exist. And if her recent behavior proves anything firm, it's the difference between serial drama -- even realistic serial drama -- and real life. After last Sunday, Glass says, some of his patients have reported losing faith in "The Sopranos" itself, which seems, in its final weeks, to be "killing characters and relationships off expeditiously."

"It could just be that the show needed to wrap things up and so she behaved in a way that, frankly, feels out of character," Glass says. And it's true: On TV, a valid answer to "why now" might well be that the writers only have a few hours left to work with.

Still, some psychiatrists who have loved "The Sopranos" for years are pining for a gentler break-up. Hoffman, for one, wonders if the show could have reached a satisfying conclusion while still being kind to its psychiatrists.

"Does every series have to end with everyone being destroyed?" he says. It's the sort of thing Tony Soprano might wonder, too.

Joanna Weiss can be reached at weiss@globe.com. For more on TV, go to www.viewerdiscretion.net.