Therapist/Patient Boundaries In “50/50”

If you read my post last Friday, I wrote about the new movie 50/50 and my efforts to find out what’s up with the therapist/patient boundaries via reading scads of reviews. Now I’ve actually seen the film and have my own perspective (as a therapist) to share.

As many of the reviews have indicated, it’s made very clear from the outset that therapist Katherine (Anna Kendrick) is only 24 and still working on her doctorate. Most of what she says and does as a newbie therapist is contrived and awkward.

And Adam (Joseph Gordon-Levitt), newly diagnosed with cancer, is only her third client. He knows better than her that she’s fumbling as a shrink, but he needs her—or someone—to help him get through this ordeal. Thus, it felt quite unfortunate to me that the professional boundaries that Katherine tries to create in the beginning of Adam’s therapy later start to dissolve.

Spoiler Alert: If you haven’t yet seen 50/50 and don’t want more details, it’s probably time to stop reading this.

Adam’s unexpected breakup with his girlfriend, who has cheated on him, and Katherine’s own admission that she’s pining for her recent ex are factors involved in each of them starting to notice the other as fuller individuals, that is, as not just therapist and client. We can see that Katherine knows she shouldn’t reciprocate Adam’s interest, but we don’t see her consulting a supervisor, for example, or showing her internal conflict in a significant enough way. This stuff can happen when someone’s as inexperienced as she—but that doesn’t make it okay.

By the time Adam is told his cancer isn’t shrinking and that he needs a major and highly risky surgery, Katherine’s presence in the waiting area with his family and best friend seems much more personal than professional. At his bedside, this is even clearer.

Before 50/50 ends, Katherine meets Adam at his home to start their first date. His best friend, who has hated all of Adam’s previous girlfriends, approves of her. The implication is that Adam, a nice guy, has finally found his match. Isn’t that sweet.

I should note that the onus of maintaining appropriate boundaries, which are there to keep therapy safe for the client, is solely on the therapist no matter how a client feels or what he expresses to her.

If Katherine and Adam were in the non-movie world, I would like to see Katherine managing her own attraction somehow and continuing to support him through his ordeal with cancer. Then, when Adam no longer needs to be in a medical setting on a frequent basis, he could be referred to another therapist who’s competent enough to help him with such things as figuring out why he makes such poor choices in mates.

Although it’s made to look in 50/50 as though nothing bad could come of such nice young people finding each other, that’s not what many clients-who’ve-become-lovers-with-their-shrinks in the real world will tell you. Issues of betrayal of trust and/or exploitation of trust, for instance, commonly arise in the dynamics of romantic relationships that started out as therapeutic ones.

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