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?

Oct 13

Hedda Bolgar: Oldest Living Therapist?

Update: The video clip I’d previously embedded here I’ve now removed because of problems with access.

The above clip from TV’s The Doctors is now dated. This practicing therapist, a vibrant woman who thinks “being alive is a lot of fun” is actually now 102. And this year she received an Outstanding Oldest Worker Award given by an organization named Experience Works.

According to the Experience Works website, Hedda Bolgar actively sees patients in her Los Angeles office and also lectures, writes, and appears in videos. On a website called The Beauty of Aging, in fact, she’s featured along with other older women in their DVD trailer.

Ms. Bolgar has had a distinguished career and apparently currently has no intention of retiring—she loves what she does that much. According to the Experience Works site:

She looks at the future with ideas, hope and curiosity, but lives very much in the present and tries to be aware of the impermanence of things. She says that when you get to the age of 100 and over, wisdom comes from not being too attached to things and learning to live with complexity.

Whether you want to retire younger or older, are male or female, are a shrink or not, what a role model Ms. Bolgar is for us all.

Oct 12

If Your Therapist Pathologizes: This May Be a Problem

Yesterday’s post took a macro view of the issue of pathologizing. Today I look at the micro view—what if your therapist pathologizes?

For example, say you’re in therapy for depression. You happen to kinda mention that you bite your nails. Look at these nails—gross. Maybe you really want to fix it, maybe not. Some people are nail-biters. So what. Who cares?, as Saturday Night Live‘s imitation of Joy Behar goes.

But your shrink jumps right on it. Or even worse, you’ve never even said anything about your nails, but it’s your therapist who makes a point of it. I see that you bite your nails. Either way, your shrink takes this info and runs with it—maybe he/she sees in your future a lengthy analysis of your oral fixation habits rooted in infancy. Or maybe he/she assesses anxiety as the source of your nail-biting and suggests yet another medication. Or maybe he/she prescribes a behavioral plan.

Either way, you’ve been unnecessarily pathologized. And you go home wondering what happened to dealing with the fact that you’ve been unable to get up in the morning to go to work.

Whether your shrink sincerely believes in his/her methods and suggestions or whether your shrink is just trying to bilk you out of your inheritance, you as the client are left with needing to decide if this is really worth your while.

A possible analogy is that you notice that the tires on your car are kinda flat. You think, maybe I’ll stop by the garage and put some air in those things. Or better yet, maybe I’ll leave it up to my mechanic. The next thing you know, you’re waiting a couple hours for your car to get four new tires it doesn’t need, and you’re out a big pile of money.

See what you think about this brief clip below in which TV’s Frasier Crane, a psychiatrist, tries to help Woody, the bartender at Cheers (which ran from 1982-93). Is this relevant to the above perspective on pathologizing? (If not, I hope you enjoy it anyway.)

Oct 11

Pathologizing Can Mean Big Business for Drug Companies

Pathologizing is basically about making an ordinary enough life problem into a mental health diagnosis. An example of this was the subject of the 2007 book Shyness: How Normal Behavior Became a Sickness, by Christopher Lane. I believe the title speaks for itself.

Lane shows how a pharmaceutical company can use pathologizing towards unscrupulous ends and concludes in his book, “Before you sell a drug, you have to sell the disease. And never was this truer than for social anxiety disorder.” Paxil anyone?

Also on the topic of Paxil, Alison Bass wrote Side Effects: A Prosecutor, a Whistleblower, and a Bestselling Antidepressant on Trial, which Arnold S. Relman, M.D., from Harvard Medical School called “a richly detailed account of the disgraceful self-serving ties between drug companies and the psychiatric profession.”

A 2010 article by Tyler Woods, Ph.D., reports that 68% of members of The American Psychiatric Association’s task force that is writing the next (2013) edition of the DSM admit to “economic ties with drug companies.” How do you think this might affect their opinions regarding whether something belongs in the DSM as a mental disorder?

Some of the “conditions” that some factions in the mental health field protest as being pathologized and thus inappropriate for inclusion in the revised edition of the DSM are sex addiction, gender identity disorder, premenstrual dysphoric disorder, female sexual dysfunction, parental alienation syndrome, and obesity. Some of these are already in the current edition of the DSM.

If not all of these are controversial because of iffy connections with Big Pharma, some are. As therapists and clients become increasingly aware of the implications of pathologizing, perhaps we can be more careful ourselves about not “buying into” the costly and misguided labeling of our problems.

Oct 10

Malingering (Faking It): When Mental Health Stigma Isn’t The Issue

Whereas most people who seek therapy or treatment for psychological disorders are on the up and up, some are not—they may actually be malingerers.

Malingering, as defined in the DSM-IV-TR (Diagnostic and Statistical Manual of Mental Disorders), involves “the intentional production of false or grossly exaggerated physical or psychological symptoms” for some kind of desired external result. It’s not considered a mental disorder but a condition “that may be a focus of clinical attention.”

When such individuals show up at your therapy door, in other words, they don’t really want or need your help of the therapy kind; they want to manipulate you into getting something else—something they presumably feel they can’t get otherwise.

There’s Corporal Max Klinger, on the TV show M*A*S*H (1972-83), for example, whose plan for getting out of the Army involved trying to prove that he was psychologically unfit. Despite all his bizarre antics, however, he couldn’t achieve his goal and eventually gave up.

And then there’s Liz Lemon, played by Tina Fey on the current TV sitcom 30 Rock. Her goal is to escape jury duty.

A malingerer presenting at a mental health setting could also be driven by such motives as getting out of work, obtaining disability insurance, and seeking drugs.

According to an article in Scientific American last year, though, a recent study showed that a person who fakes symptoms of mental illness can actually start to believe the illness is real. Put into action, this means Klinger would start to really believe that he can fly (in his pink bathrobe and slippers), while Liz Lemon would settle into the delusion that she’s a Star Wars character. Sheesh—isn’t malingering already hard enough to detect?

On a more positive note, psychologist Elizabeth Loftus is quoted in the same article as envisioning:

…therapeutic potential in the new study, musing on a hypothetical strategy she calls ‘feigning good,’ which could motivate patients by helping them believe in improved cognitive skills and diminished symptoms of illness. ‘Should clinicians be prescribing a form of feigning? You wouldn’t want patients to feign anxiety, but maybe they could feign the opposite. Maybe they could feign crystal clear concentration.’

Let’s see now…Maybe I can feign writing an effective way to end this post.