Oct 20

“Monk”: Episode in Which He Resists His Therapist’s Vacation

Thankfully, I’ve never encountered anything like what happens in the video below, which is taken from an episode of Monk, a TV show that ended first-run episodes in 2009. It should be noted that the main character, a detective (played by actor Tony Shalhoub), deals with extreme OCD and phobias.

Alas, how unfortunate that Dr. Kroger caves at the end. He had done so well with trying to end the session on time despite Monk being in the middle of his statement.

But managing the ordinary hour-to-hour time constraints is indeed different than managing vacation plans. And if Kroger, when faced with an unyielding client, can’t stick to his personal choice to have one significant and special day off, yes, his wife will probably be upset, but the one in the couple needing help might be Dr. Kroger—not his wife, as Monk suggests.

Oct 19

“Prime” (The Movie) Therapy: More Boundary Issues

Prime, a 2005 film billed as a romantic comedy, features a therapist named Lisa (Meryl Streep) who has a client named Rafi (Uma Thurman) whose new boyfriend happens to be Lisa’s son, David. Although Rafi is talking about David in therapy, she hasn’t yet put a name to him; thus, neither therapist nor client knows that the man in question is who he is to Lisa. A weird boundary issue not likely to happen in the real world. Could it happen? Yes. Likely? No.

Although it does happen on a regular basis that a client talks about someone the therapist knows, it’s usually not someone as close to the therapist as a family member or close friend. Sometimes it’s clear to both parties that certain connections exist, sometimes not. Sometimes the therapist hears about someone she knows but can’t disclose this to her client because that someone is also a client—thus, such info is confidential.

Back to Prime. When Lisa does inadvertently learn–outside the therapy office—that Rafi’s involved with David, she doesn’t know what to do. Rafi doesn’t yet know what Lisa knows. So she consults someone—her own shrink? her supervisor?—I’m not sure which. A decision is made for Lisa not to share with Rafi what she now knows. The reasoning is that it’s in the best interests of Rafi not to know her boyfriend is her shrink’s son because telling her could do more harm than good to the therapeutic bond—especially if the relationship with David winds up ending sooner than later anyway.

Just writing the above paragraph felt aggravating and tedious to me—which parallels how I felt about the movie at this particular juncture. Although the film was already iffy in my book, it became ruined for me as soon as Lisa knew Rafi was dating David and didn’t decide to disclose this to Rafi. Why, I wondered, couldn’t Rafi be allowed into the loop and given the chance to decide how she feels about both her therapy and dating relationships in the light of this new info?

Here’s what Roger Ebert’s review indicated about Lisa’s decision:

…when the characters have depth and their decisions have consequences, I grow restless when their misunderstandings could be ended by words that the screenplay refuses to allow them to utter.

…In my opinion, [the] responsibility is to declare a conflict of interest, but then I’m not a shrink and besides, then we wouldn’t have a movie.

I do declare, Mr. Ebert, even though you are not a shrink, you do make a good deal of sense.

If you’ve seen Prime, what did you think? If you haven’t, you might want to form your own opinion and get back to me. I mean, it does have Meryl Streep after all. Here’s the trailer:

Oct 18

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.

Oct 17

Therapy Boundaries Gone Wrong On “How I Met Your Mother”

As with the movie 50/50, two new episodes of the sitcom How I Met Your Mother (HIMYM) that aired recently feature a therapist who gets too involved with his client. I watched both of them because it’s one of my favorite shows though I’d never admit that so that I could further expound on the issue of therapy boundaries.

This time it’s a male therapist, female client. Actor Kal Penn, as Kevin the therapist, has reportedly been hired to be on a bunch of episodes in which he, according to multiple sources, will “play doctor” with Robin, a regular character.

Our first introduction to Kevin is when he’s interviewing Robin, who doesn’t seem to understand the seriousness of her situation.

As we go into the next episode, Kevin bows out of counseling Robin because he’s “moving to Alaska.”

Lie much, Kevin?

Of course he then runs into her at a diner, and because he’s caught not being “in Alaska,” he discloses the real reason he couldn’t be Robin’s therapist—he’s attracted to her. Presumably, he’s too weak to put such interest aside and put on his professional hat, which already makes his competence suspect in my book.

But, back to the story. Spurred on by Robin’s mutual interest, Kevin agrees to spend time with her; he even colludes with Robin to avoid calling it dating. Ultimately, though, he knows it’s unethical no matter what you call it. When he does face up to this fact, it’s over.

Well, that’s a big relief. Or, is it?

Of course not, silly. Kal Penn has a longer contract with the show, remember?

UPDATE, 9/17/12: A second video was inserted here that is no longer available. It showed Robin offering to be Kevin’s shrink too.

A creative twist, but it wouldn’t fly in the real world. It doesn’t really even the playing field if a client offers her shrink some fake therapy.

In my field, clinical social work, therapy boundaries in this kind of situation are guided basically by “once a client, always a client.” This means that a client who ends an episode of therapy should be able to return to the same therapist in the future as needed and still feel emotionally safe. Using HIMYM as a case example, it theoretically only took minutes, even seconds, in Robin’s first therapy session for her vulnerability to be exposed, and this could eventually be exploited by her therapist if he allows a relationship outside of therapy.

Well, one saving grace is that everyone else on HIMYM finds it “creepy” that she’s dating her shrink—even Barney (Neil Patrick Harris), who’s so not known for being appropriate or ethical in his dating behavior.

According to TV info available online, Kevin will be on tonight’s episode as “Robin’s new boyfriend.”

Watch it. See what you think. Or not. One thing for sure, I’ll keep watching because I always watch HIMYM, most of the time finding this show’s usual fare about young neurotic friends with whom I shouldn’t be able to identify clever and engaging so I can keep up with how the writers will be dealing with the ethics breach and how it will affect Robin.

Oct 14

“50 50”: Problems With the Therapist/Patient Boundaries

There’s a new movie in theaters called 50 50 about a young man, Adam, who is diagnosed with cancer. Joseph Gordon-Levitt is the lead actor.

 

I saw the trailer while at another movie, found it interesting–a mix of humor and seriousness—and proceeded to my next usual step, reading a synopsis. I learn that Adam sees a therapist post-diagnosis. Cool. And that she happens to be young and inexperienced in her career. Okaaay—tell me more. He falls for her. Yeah, that can happen, of course. It might be that she falls back for him. Aaarghh!!! Not another therapist-crossing-boundaries film!!!

I look up Roger Ebert‘s review. He’s had cancer himself. He hated The Bucket List, about two men dying of cancer, because it wasn’t realistic. I listened to him—I haven’t seen it.

And…ta da! Ebert likes it! But what’s he say about the therapist thing?

Anna Kendrick plays Katherine, Adam’s therapist, who gets just as involved as his oncologist is aloof. I know therapists are supposed to observe a certain distance, but in a case like this, I don’t see how one can. I would make a terrible therapist.

Okay, I won’t become a movie critic if you won’t become a shrink. But what about this over-involvement thing? I need to know more.

I turn next to Rex Reed. He and Ebert are the two movie critics I keep in my bookmarks.

Wow. Even snarkier than usual. He really does not like this movie:

When Adam undergoes his first chemo treatment, his duplicitous girlfriend (badly overacted by Bryce Dallas Howard) waits four hours in the car because she can’t stand the interiors of hospitals. His stressed-out mother (and what, you may well ask, is Anjelica Huston doing in this blunder?) acts like a cross between Lady Macbeth and Zasu Pitts. Eventually Adam gives up and falls for his psychiatrist (Anna Kendrick) in a sex game that is pure cardboard.

A what!? A ‘sex game’??? Oh crap—I had really wanted to like this movie. Ebert liked this movie. But more importantly, another bad depiction of a therapist?! Clearly something we don’t need in this world.

Women care about relationships—so I search for a female critic. I need one who’ll actually take the trouble to explain this 50/50 therapist/patient relationship to me.

So many many reviews I sift through. Over and over again, the therapist is “inexperienced”—really?! That’s all you’ve got?

I keep skimming. Finally, whoa…bingo! Carrie Rickey calls out the young shrink as “unprofessional”…But, just how unprofessional?

Are women critics just not into overly revealing a movie’s plot? More reviews….filter filter filter…skim skim skim…more reviews…

Blah blah “inexperience” blah “green therapist” blah “young” blah…Oh forget it. I like David Edelstein of New York Magazine—what’s he saying about the cancer patient and his shrink?

Willful perkiness has never seemed so poignant. You want him to survive so they can smooch.

Egad.

In desperation, I decide to go closer to the source—the actress who actually portrays the therapist. I find an article by John P. Meyer, in which he notes that Anna Kendrick:

…is fine as the strangely serene, somewhat enigmatic psych doc who seems to surprise herself by incrementally, inevitably slipping into a non-professional relationship with her third-ever patient.

There goes the code of ethics.

So. That’s it, then. She breaks the code of ethics. Exactly how she does this, I don’t know, but she does…Wait—how do you know this, John P. Meyer? Who are you? What are your qualifications?

I research him. Find out he’s the “film guy.” One of his very favorite movies is Bambi Meets Godzilla, the remake. Last but not least, “In his spare time, John enjoys sleeping.”

Yes, sleeping. Sigh. Clearly my work isn’t done. Yawn. Well, I guess I could drag myself to the theater—find out for myself. Stretch. Or, stay home—find movie “spoilers” online. Or…or…

Major yawn

Gosh. What would John do right now?