Nov 14

When Therapists Run Into Clients Outside the Office

How do therapists handle chance encounters with clients outside the office?

Such boundary-related decisions are regularly confronted. How we proceed, though, is likely to be unique to each particular therapist and client, as there’s a lack of hard-and-fast rules about this.

On the other hand, there’s no lack of guidelines. For example, social work ethics include avoiding dual relationships whenever possible and not becoming friends with or otherwise consorting with a client after a therapy episode. Regarding the latter, “Once a client, always a client” means being prepared for the possibility that a former client who’s not currently seeing you may want to return someday for additional help.

What informs our boundary-making other than the code of ethics? Resources might include reading, consulting with others, and taking courses and workshops—such as one I recently attended titled “OMG…Didn’t We Go to High School Together?” led by social worker Rachel Legend.

As I’m not originally from the state in which I practice, that kind of OMG is less likely to happen to me than to many others. More pertinent to me are those out-of-the-office unexpected sightings of each other, which Legend got us thinking more about.

Although most of my own instances of running into clients outside the office have felt relatively comfortable, I often can’t know for sure if the same is true for them (unless it’s someone who’s actively seeing me in therapy and we can therefore discuss it in a following session). And some situations have decidedly proven less than comfortable.

Some examples of circumstances I’ve encountered:

  • At a social gathering, a store, an event like a concert, or anywhere around town. My View: In this situation, it helps if this kind of potential occurrence has already been addressed in the office so I’ll know how a particular client wants to respond. Some would prefer not interacting, for instance; others will gladly wave or say hi. But if I don’t already know, I try to follow a client’s cues in the moment.
  • The gym. My View: It helps that this isn’t a social place for me—I’m always plugged into my music and focused on my tasks. And, unlike another participant at the workshop, I’ve never been naked in the locker room with anyone—because I go home to shower.
  • Community activities/clubs. Many years ago a client who’d seen me at a gay club noted in her next session that I “must’ve been drinking a lot” to be dancing the way I was. Oops. Caught. Not drinking a lot. Dancing. (Badly?) My View: I do my best to avoid certain places and circumstances. It’s probably just as weird for me to be in the “fishbowl” as it is for a client to feel that way. Which leads me to the next one…
  • I once showed up to a small house party at which there were the two hosts and, besides the three I came with, only a few other guests—unexpectedly, one was a recent but past short-term client. Everyone sat in the same room, and interactions felt laden with tension (at least for me); but the ethic of confidentiality, of course, meant being unable to share with anyone else what only I (and my client) knew. Years later I was invited to another little gathering with totally different hosts. Also totally different guests— except, that is, for that same client. Same dilemma, as I hadn’t seen this person since the previous time. My View: I try to avoid dinner-party kinds of situations if I don’t know the guest list.
  • A short-term client chose to go to the same hairdresser as me; although she told the hairdresser she knew me, she didn’t say how. When my hairdresser then wanted on various occasions to talk to me about my “friend,” I was unable to respond, which I imagine was pretty puzzling for her and felt terrible to me. My View: If a client now asks where I receive certain kinds of services, I might first explain the potential for awkwardness. In a recent example of this, a client opted for trying to get a “second opinion” from my dentist—but without mentioning my name.
  • One particularly memorable and positive experience involved a twentysomething client greeting me at a deli near my office. She then turned and saw my partner—whom, to the surprise of all three of us, she recognized. Turns out my partner, also a therapist, had seen the same client years earlier in a children’s unit. Our client was thrilled to see her—as well as us together!  My View: Although unlikely to ever happen again in my lifetime, I wish it would—it was a hoot!
May 19

Therapists On TV and In Movies: Common Tropes

If you’ve been reading my blog, you already know I believe therapists on TV and in movies are often badly portrayed. Today’s post organizes the types of therapists we’ve all seen into categories designated by TVtropes.org, a useful resource that describes itself as “a catalog of the tricks of the trade for writing fiction.”

According to TVtropes.org, therapists on TV and in movies tend to be shown in three different ways:

  1. The Harmful Shrink: “The worst kind,” of course. Possible traits include cruelty, lack of empathy, non-compliance with confidentiality ethics, pill-pushing, likely to cultivate dependency for financial gain.
  2. The Well-Meaning, But Dopey And Ineffective Shrink: Possible traits: liberal, highly empathic, a good listener, but with an inability to have a helpful perspective or strategies.
  3. The Awesome Shrink: “He can be compassionate and understanding where everyone before has been cruel to the protagonist. Alternatively, he provides the character in question with the kind of Tough Love he’s always needed. Regardless, he’s always smart, almost always cool and never resorts to drugs when they’re not needed.”

As with all typologies, there’s often overlap between categories. Also, many characters may not fit neatly into any one type.

Taken from previous posts, some examples are listed below.

The Harmful Type

  • Therapist Boundaries That (Hopefully) Go Without Saying, 10/21/11: What About Bob?‘s egotistical therapist (Richard Dreyfuss) tries to kill his annoying patient (Bill Murray).
  • Halloween for Therapists, 10/31/11: A now-deleted post had a couple video clips, first from the film Dead Bang and second from TV’s Dexter, featuring bad shrinks.
  • Hannibal Not-Yet-Known-to-Be Cannibal, 4/1/13: “Hannibal the new TV series offers a prequel kind of twist on Lecter. As described by Slash Film, ‘Hannibal follows Will Graham (Hugh Dancy) and Hannibal Lecter (Mads Mikkelsen) in their early days — back before the FBI profiler knew that the famed psychiatrist was actually a cannibalistic killer.’ Lecter is a forensic specialist working for the FBI in some capacity. Graham’s boss is Jack Crawford (Laurence Fishburne), head of Behavioral Sciences at the FBI.”

Well Meaning, But Ineffective

  • Two posts about 50/50 the movie, from October 2011, are here and here. Crossing of boundaries by an earnest inexperienced therapist (Anna Kendrick) places her somewhere between this category and potentially harmful.
  • “Prime” Therapy, 10/19/11: Meryl Streep as a therapist who seems to want to do right but can’t.
  • Silver Linings Therapy Playbook, 11/30/12: Dr. Patel tries to encourage client Pat to make healthier choices but doesn’t model this very well himself.

Awesome

  • A President in Therapy, 9/26/11: Adam Arkin helps President Josiah Bartlet (Martin Sheen) on The West Wing.
  • The Therapist’s Day Off, 10/20/11: In the video clip it’s seen that as a client “Monk” (Tony Shalhoub) is a challenge; his kindly therapist has trouble being firmer, but overall he’s a good shrink.
  • Meet Dr. Sidney Freedman, 1/11/12: The psychiatrist on M*A*S*H played by Allan Arbus. As stated in the post, “Although I’m a fan of Freedman’s wry sense of humor, progressive politics, and ability not to be fazed by things others may consider bizarre, I do need to point out that the schizophrenia joke written for this character has probably helped perpetuate the myth that schizophrenia consists of having multiple personalities.”

Multiple Types

  • Therapist Boundaries That (Hopefully) Go Without Saying, 10/21/11: The “good” therapist (Robin Williams) who achieves a breakthrough with Will previously chokes his client in Good Will Hunting. Is he both awesome and harmful?
  • One TV Therapist’s Scary Dilemma, 11/3/11: Dr. Melfi (Lorraine Bracco) on The Sopranos is generally considered competent, but her limits were also severely tested, leading to highly questionable urges.
  • A Charlie Brown Therapy, 12/23/11: “Peanuts” character Lucy Van Pelt is not a psychiatrist—she just pretends to be for “5 cents please.” But, oddly, her services can be helpful.
  • Grief Counselor: “Scrubs,” 1/26/12: TV Tropes says, “Sacred Heart’s grief counselor is portrayed as a great counselor, but is nonetheless seen as smug and annoying by the main characters, even when it’s them he’s helping.”
  • Psychiatrist Brothers on Drugs, 4/19/12, and Confidentiality Unbreakable, 10/25/12: Both Frasier (Kelsey Grammer) and Niles Crane (David Hyde Pierce), apparently reputable enough shrinks, continually have heaps of trouble in their own personal lives—and sometimes professional, as in considering breaking confidentiality in order to help their dear friend.

Additional examples can be found at the TV Tropes website.

Sep 30

“Enough Said”: A Romance For James Gandolfini and Julia Louis-Dreyfus

If you’ve heard anything about the new film Enough Said by writer/director Nicole Holofcener, you’re probably aware of the poignant presence of James Gandolfini. And this isn’t even his last movie project to be released posthumously; one more will be coming eventually.

For me, Holofcener’s movies—which include Walking and TalkingLovely and Amazing, and Friends with Money—tend to hit on themes pertinent to women’s development and interpersonal relationships in a way that’s relatively low-key but nevertheless interesting and meaningful. This one’s no exception.

The basic plot of Enough Said, per IMDB: “A divorced woman who decides to pursue the man she’s interested in learns he’s her new friend’s ex-husband.” And, it must be added, she doesn’t reveal her discovery to either one of them. She continues, rather, to let her new friend unknowingly serve as a sort of negative “TripAdvisor” for this dating experience and to set her new beau up for eventual humiliation.

Julia Louis-Dreyfus plays the lead Eva, a massage therapist. Gandolfini is the romantic interest Albert. Each has anticipatory grief regarding his/her only child (daughters) preparing to leave the nest for college. Catherine Keener is the new friend Marianne, who’s also a client of Eva’s.

A.O. Scott, New York Times, on the way things unfold:

To Eva, Albert is a sweet, sexy, affable slob, but his ex remembers him as a bore and a loser, clumsy in bed and incapable of taking care of himself. Partly because she is dazzled by the friendship of someone who writes incomprehensible verse, serves exotic iced tea and hangs out with Joni Mitchell, Eva absorbs Marianne’s perspective and tries, with obnoxious good intentions, to correct Albert’s faults.

States Justin ChangVariety, about some of the issues raised by this situation:

Suffice to say that Eva’s ongoing assessment of Albert, compulsively rearranging his pros and cons, leads her into a moral gray zone that forces her to grapple with some difficult if hardly new questions: Why are some couples compatible and others are not? How can one woman’s ex be another’s soul mate? Is self-improvement possible, or is happiness more a matter of acceptance and compromise?

Eva’s good friend Sarah (Toni Collette) happens to be a therapist who tries to discourage Eva’s participation in deceptive behavior. She’s also seen, in non-Hollywood-type fashion, showing appropriate therapist boundaries. When Skyping with Eva from her office, for example, she always ends conversations when a client arrives (which Eva notices first from the special light that comes on behind Sarah). In addition, Sarah resists playful attempts from Eva to get her to tell stories about her patients that would break confidentiality.

As A.O. Scott concludes, however, about Sarah’s marriage to Will (Ben Falcone), they “exist in a state of easy, affectionate tolerance that is often hard to distinguish from seething contempt.”

And Susan Wloszczyna, rogerebert.com, further notes that Sarah’s “a therapist who clearly might benefit from getting psychiatric help given her furniture-rearranging obsession and passive-aggressive relationship with her inept housekeeper.”

You can see the trailer below:

Some Other Enough Said Reviews

Chris NashawatyEntertainment Weekly: “Sure, it’s a coincidence right out of Three’s Company, but Enough Said is deeper and richer than that. It shows us how rare love is — and how we need to grab it and not let it go.”

Claudia Puig, USA Today:

With its heartfelt performances, intelligent writing and subtle humor, this is easily one of the most perceptive and engaging movies of the year…

Holofcener has much to say about the complexity of middle-aged love, with its fortuitous moments, nagging doubts and evolving wisdom.

 

A.O. Scott, New York Times:

The final scenes have such impact because Ms. Holofcener has struck a buried nerve, uncovered a zone of anxiety, fear and hope that has rarely been explored with such empathy or precision. Eva, like many of us, lives in a world where the rules and roles are puzzling — where parental authority is negotiable, marriage vows are revocable and social boundaries are never clearly marked.

Even so, the primal values of right and wrong — the requirements of compassion, honesty and honorable action — still apply. It is easy to make mistakes and hard to correct them, easy to be funny and hard to be good.

Aug 26

“Minding Therapy”: The Second Anniversary

On this date two years ago I began posting to my new blog Minding Therapy. A total of 523 posts, 522 consecutive weekdays—and one lone Saturday somewhere in there, the proud day I learned my novel of the same name had made someone’s “best” list.

An analysis of what’s been read most frequently on Minding Therapy (using WordPress statistics) finds that certain posts from the first year remain among the most popular. These include such movie/TV topics as the therapist boundaries in 50/50 and on How I Met Your Mother, “baby steps” in What About Bob?Saturday Night Live‘s Chantix spoof, the mental health issues of Charlie Brown and Lucy’s psychiatric assistance, and the special connection between a well-known singer/songwriter and his old friend, Jason Mraz and Charlie Mingroni.

Other hot topics this past year there have included a distillation of a magazine article (“5 Life Lessons from Psychology Today“) and pieces on introversion and detaching from one’s family.

And the post that’s soared the most mightily by far is one I never would have expected: “Therapy Office Design.” Although I’m guessing this interest is mostly from those wanting to decorate or redo their offices, maybe it’s actually from clients who wish they had better surroundings.

Far more posts than these seem appreciated to lesser degrees, and far more than that went almost totally overlooked as far as I can tell. But the sum of the parts is that there’s now a collection of two years worth of topics that may contain something someone someday might find interesting.

Who gets the most out of this blog? I think that would be me, very likely. I take topics of interest to me and as I research and write the posts I’m expanding my own knowledge—yes, so I can share it with others, but also for my own benefit. As it turns out, sometimes only for my own benefit, I think.

Although I don’t use social media (yet) myself, it’s so appreciated when you share my posts with the people on your radar. Please feel free to continue—below each post are buttons for this purpose.

Thanks, as always, for your interest and for reading and/or following Minding Therapy!

 

 

 

Jun 10

“Mistresses”: Therapist Ethics Go Right Out the Window

Last Monday night was the premiere of ABC’s Mistresses, an adaptation of a British soap-drama in which four female friends deal in one way or another with infidelity. A possible hint to its quality? Says the snarky “Bullseye” column of Entertainment Weekly, “Only one episode in and we’re already cheating on Mistresses.”

The itty-bitty Mistresses preview:

What caught my interest is that one of the four friends is a psychiatrist in private practice named Karen (Yunjin Kim). As I’ve neither seen it nor plan on seeing it, however, I have to rely on the reviews for further info.

If you’re looking for a portrayal that represents the field at its best or if you’ve been victimized by a therapist, beware. Karen has had a sexual relationship with her patient Tom who had terminal cancer. In addition, she’s prescribed him a lethal dose of morphine to assist in his choice of euthanasia.

By the way, Tom was married. And now that he’s dead, guess what? His son and wife are both receiving Karen’s “help.” As a result, there are further complications: Karen’s now stung from learning that Tom chose to spend the final moments of life with his wife, and Tom’s grieving son wants to figure out with whom Dad was cheating. Oh. And he’s hitting on Karen to boot.

A little over the top, just maybe?

Therapist ethics violations:

  • Having sex with a client–it doesn’t matter that the client was the first one to show interest; it doesn’t matter if he was single, married, whatever
  • Assisting in euthanasia of a client
  • Offering services to a dead client’s family members after such grievous as-yet-unknown-to-the-family violations

One saving grace: at least the script makes it known that Karen has screwed up, a matter often neglected in these kinds of shows.

It’s yet to be seen if Karen can eventually be redeemed in any way. (In the BBC series the character with a similar profile and behavior, Katie, was a general practitioner of medicine, not a shrink. If you happen to be interested in what happened to her, though, check out the Wikipedia article.)

What do the TV critics think of Mistresses? (They seem less than impressed.)

Jacob Clifton writes (Television Without Pity) that of the group of main characters, Karen is “the front-runner by a mile in terms of making ridiculously shitty decisions at all times during her waking life.”

Neil GenzlingerNew York Times: “Karen, an educated, intelligent woman, is made to sound like a naïve 20-year-old when talking about her lover’s death. ‘In the end he chose his wife: that’s who he wanted to be with in his last moments,’ she says. ‘Which means the whole time I was just’ — and here there’s a pause to allow her I.Q. to drop — ‘a mistress.'”

Cory Barker, TV.com: “Kim is saddled with the most ridiculous of the stories—going from the now-dead father to the grieving son is quite the journey—and she’s morose enough to almost make it work, but Karen’s choices were so poor that it’s going to be tough for people to root for her.”