Most likely it's a feedback loop (and one of many) in which the daughter acts out in response to relationship strain and so the relationship becomes more strained and so the daughter acts out and so the relationship becomes more strained ...

chicken, egg, blah blah blah

Cast from the other side of the story, the problem isn't that there's a strained relationship, or that there's something wrong with the mother. The problem is that the teenager doesn't know how to cope with strained relationships or problems with her mother.

I dislike the show, on the one hand, because Paul's therapeutic approach is of a kind that went out of fashion decades ago. His "the customer is always wrong" approach flies in the face of every major school of psychology (at least that I can think of) to have emerged in the field post-psychoanalysis. The therapist/client relationship is supposed to be a collaboration, not a never-ending lecture. Hell, even psychodynamic psychotherapy does not normally come off that one-sided. He just seems arrogant and his approach more about demonstrating his own brilliance than helping his clients to do ... well, whetever the hell it is he's trying to do for them.

When he argues with his (therapist? supervisor? what exactly is their relationship?) about how emotionally engaged he is with his clients, it makes no sense whatsoever to me because if anything he seems to have a hard time engaging emotionally with anyone at all. Except defensively. He's good at getting defensive. And when he does engage emotionally, his boundaries get completely out of whack. Even the warmth he occasionally shows towards the young gymnast gets pushed way too far at times, and then at others seems to retract completely. (And please, someone explain why he hasn't even thought of contacting child protective services yet? It's painful, truly painful). I truly feel for the guy's wife. And children. Though at least they aren't paying him $150/hour to be a cold judgmental bastard to them.

He seems so completely unable to reflect critically on himself and his work that it is a wonder he still has a practice (well,not entirely - I know one or two like that - but usually the word gets around about such people). On the other hand, I love the acting partially because of this - Byrne is forced to play such a restrained character, the way that we learn about his emotional life from the tiniest gesture or tonal change is fantastic. The show loses something when it's working too hard to forward plot and gets it's radiance back when action settles down and there's just a quiet moment or two between Paul and his client.

And while the show isn't much of a criticism of psychotherapy per se (it's really not about psychotherapy as it functions in the real world), it is a good illustration of the danger involved when a therapist neglects his or her own life. As his personal life unravels, Paul plays it all out with his patients, and that is both terrible and extremely fascinating to watch.

One thing I'm still mystified by, though, is how he is referred to repeatedly as a psychiatrist ... but there's no other indication whatsoever that he's an MD. He never prescribes medications, nor do his clients seem to be seeking him out to treat specific mental disorders. So why are they seeing a psychiatrist and not a psychologist?