Oct 14

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

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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.

What I learn is 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 and therefore haven’t seen this popular movie.

Well…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. 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.

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, it’s 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?

Update: Well, now I can tell you from actually seeing it myself.

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 in her professional capacity. 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, for instance.

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.

Sep 28

Is Your Therapist For Real? Practicing Without Credentials

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Is your therapist for real? As in practicing with appropriate licenses and/or credentials? I mean, there can actually be “therapists” out there who lack the necessary education and credentials and/or licensure to practice.

When I worked in various agencies before entering private practice, it was never required of me to prove to my clients that I was indeed a therapist for real—I worked there, so obviously I was. Or was I?

Yes. I was. Looking back, though, I wonder how many of my employers even actually verified all of my credentials.

When I began my own practice, every now and then a client did ask about my education or experience. Whereas I freely shared this info, for the longest time I didn’t think it was necessary to display my diploma and other certificates in my office. Wouldn’t that be kinda showy?

Actually, no. Simply put, clients have the right to know that you’re for real. So now, all the framed evidence of the “letters after my name” hangs in my waiting room. Ha, joke’s on you—they’re fake! Anyone with access to the internet can…

Kidding.

In the 1999 film Mumford a man relocates to a small community—named Mumford—where he pretends to be a psychologist named, oddly enough, Mumford. It seems that in his previous life, Mumford—the man, not the town—had learned something about relationships even in the midst of some serious drug problems:

For some reason, probably because I was too stoned to talk, everywhere I went people would talk to me. Tell me everything. Their problems, their inner most thoughts. Sometimes they needed advice, but most of the people just wanted someone to listen.

Rehab then taught the man not yet named Mumford even more about how help is given and how help is received.

When he moves on to become a fake shrink in Mumford the town and Mumford the movie, Mumford the man is remarkably successful—and greatly appreciated for his shrink-like capabilities. As you may have already guessed, no one has bothered to check out the credentials of this likable newcomer.

Eventually, though, in Mumford the movie and in Mumford the man and in Mumford the town, things do fall apart—as they should, given the deceptive circumstances.

Sep 26

President In Therapy: Fictional “West Wing” One, That Is

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I’m feeling bad for President Obama these days. So much stress—and possibly no therapy. How does someone in his position manage it all? Has there ever been a president in therapy?

At a professional forum in 1999, Kitty Dukakis, social worker and wife of former Massachusetts Governor Michael Dukakis, reportedly stated, “If you’re running for public office and expect to be elected, forget about letting it be known that you’ve been in therapy. It’s a tragedy that it’s come to this.” Moreover, she was grateful her husband didn’t get to become the president, as it enabled her—as the wife of a politician—to seek treatment for her addictions.

Has much changed since then? Has anything? Has any politician at a higher level ever admitted to being in therapy while in office?

My own internet research came up almost empty. The exception? It turns out there was a U.S. president who consulted a psychiatrist during office—he was fictional, however.

On the TV series The West Wing that aired from 1999-2006, Martin Sheen as President Josiah Bartlet saw Dr. Stanley Keyworth, played by Adam Arkin. At least once, possibly more.

In the story represented in the clip below, Bartlet has experienced a serious bout of insomnia following a conversation he’d had with staffer Toby about his abusive father, who’s deceased. Toby had suggested that Bartlet had never felt his father’s approval and thus still might be seeking it via winning votes.

I think it’s an interesting take on what it could be like to be a U.S. president in therapy:

Sep 09

Bob Newhart As Brief Therapist in Hilarious Spoof: “Stop It!”

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Before Fiona Wallice’s three-minute sessions on Web Therapy, there was Bob Newhart as a shrink offering a different brand of brief therapy called “Stop It!”

In the Madtv comedy sketch of several years ago, the shrink played by Bob Newhart is considerably more old-fashioned. Whereas Fiona takes advantage of the internet, not seeing her clients in person, Newhart’s shrink sits behind his desk, his client on the other side. Mo Collins plays the bewildered, not-at-all-amused client.

For those of you short on time, you’ll need over six minutes to watch the full clip below—longer, actually, than the type of therapy advocated by this shrink. If for some reason you’d rather read the script, scroll down below the video:

According to Realtime Transcription, the following is the actual script featuring Bob Newhart as Dr. Switzer:

KATHERINE: Dr. Switzer?
DR. SWITZER (Bob Newhart): Yes, come in. I’m just washing my hands.
KATHERINE: I’m Katherine Bigmans. Janet Carlisle referred me.
DR. SWITZER: Oh, yes. You dream about being buried alive in a box.
KATHERINE: Yes, that’s me. Should I lay down?
DR. SWITZER: No, we don’t do that anymore. Just have a seat and let me tell you a bit about our billing. I charge five dollars for the first five minutes and then absolutely nothing after that. How does that sound?KATHERINE: That sounds great. Too good to be true as a matter of fact.
DR. SWITZER: Well, I can almost guarantee you that our session won’t last the full five minutes. Now, we don’t do any insurance billing, so you would either have to pay in cash or by check.
KATHERINE: Wow. Okay.
DR. SWITZER: And I don’t make change.
KATHERINE: All right.
DR. SWITZER: Go.
KATHERINE: Go?
DR. SWITZER: Tell me about the problem that you wish to address.
KATHERINE: Oh, okay. Well, I have this fear of being buried alive in a box. I just start thinking about being buried alive and I begin to panic.
DR. SWITZER: Has anyone ever tried to bury you alive in a box?
KATHERINE: No. No, but truly thinking about it does make my life horrible. I mean, I can’t go through tunnels or be in an elevator or in a house, anything boxy.
DR. SWITZER: So, what you are saying is you are claustrophobic?
KATHERINE: Yes, yes, that’s it.
DR. SWITZER: All right. Well, let’s go,Katherine. I’m going to say two words to you right now. I want you to listen to them very, very carefully. Then I want you to take them out of the office with you and incorporate them into your life.
KATHERINE: Shall I write them down?
DR. SWITZER: No. If it makes you comfortable. It’s just two words. We find most people can remember them.
KATHERINE: Okay.
DR. SWITZER: You ready?
KATHERINE: Yes.
DR. SWITZER: Okay. Here they are. Stop it!
KATHERINE: I’m sorry?
DR. SWITZER: Stop it!
KATHERINE: Stop it?
DR. SWITZER: Yes. S-T-O-P, new word, I-T.
KATHERINE: So, what are you saying?
DR. SWITZER: You know, it’s funny, I say two simple words and I cannot tell you the amount of people who say exactly the same thing you are saying. I mean, you know, this is not Yiddish, Katherine. This is English. Stop it.
KATHERINE: So I should just stop it?
DR. SWITZER: There you go. I mean, you don’t want to go through life being scared of being buried alive in a box, do you? I mean, that sounds frightening.
KATHERINE: It is.
DR. SWITZER: Then stop it.
KATHERINE: I can’t. I mean it’s —
DR. SWITZER: No, no, no. We don’t go there. Just stop it.
KATHERINE: So, I should just stop being afraid of being buried alive in a box?
DR. SWITZER: You got it. Good girl. Well, it’s only been three minutes, so that will be three dollars.
KATHERINE: Actually, I only have five so —
DR. SWITZER: Well, I don’t make change.
KATHERINE: Then I guess I’ll take the full five minutes.
DR. SWITZER: Fine. All right. What other problems would you like to address?
KATHERINE: I’m bulimic. I stick my fingers down my throat.
DR. SWITZER: Stop it! Are you a nut of some kind? Don’t do that.
KATHERINE: But I’m compelled to. My mom used to call —
DR. SWITZER: No, no. We don’t go there.
KATHERINE: But I —
DR. SWITZER: No, we don’t go there either.
KATHERINE: But my horoscope did say —
DR. SWITZER: We definitely don’t go there. Just stop it.What else?
KATHERINE: Well, I have self-destructive relationships with men.
DR. SWITZER: Stop it! You want to be with a man, don’t you?
KATHERINE: Mm-hmm. Mm-hmm, yes.
DR. SWITZER: Well, then, stop it. Don’t be such a big baby.
KATHERINE: I wash my hands a lot.
DR. SWITZER: That’s all right.
KATHERINE: It is?
DR. SWITZER: I wash my hands all the time. There’s a lot of germs out there. Don’t worry about that one.
KATHERINE: I’m afraid to drive.
DR. SWITZER: Well stop it. How are you going to get around? Get in the car and drive you, you kook. Stop it.
KATHERINE: You stop it. You stop it.
DR. SWITZER: What’s the problem, Katherine?
KATHERINE: I don’t like this. I don’t like this therapy at all. You are just telling me to stop it.
DR. SWITZER: And you don’t like that?
KATHERINE: No, I don’t.
DR. SWITZER: So you think we are moving too fast, is that it?
KATHERINE: Yes. Yes, I do.
DR. SWITZER: All right. Then let me give you ten words that I think will clear everything up for you. You want to get a pad and a pencil for this one?
KATHERINE: All right.
DR. SWITZER: Are you ready?
KATHERINE: Mm-hmm.
DR. SWITZER: All right. Here are the ten words: Stop it or I’ll bury you alive in a box!
Sep 07

Burnout Versus Compassion Fatigue: Latter Sounds Better

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Have you ever felt like you’ve become completely fed up with your responsibilities—your job, your relationships, parenting, etc.? And then felt like you just can’t do it anymore? And now you don’t want to get up in the morning and can’t stand the thought of facing a new day? And you’re afraid that what used to be doable is now downright overwhelming? Even reading this is a major chore? You might have burnout.

Burnout is what I describe in the form of a fictional character’s circumstances in my novel Minding Therapy.

But the term has its problems. Burnout, in the minds of many, describes people whose flames have died out. Burnout is ugly, depressing, unhealthy. Boring. Uninteresting. Old—as in, Hey man, whoa, like, you’re a real burnt out dude, ya know?

Wouldn’t you rather have a nicer sounding problem?

Well, compassion fatigue is here to save the day. If you’ve got compassion fatigue, you’re tired because you’ve over-cared, over-helped, over-loved. Isn’t that a whole lot better?

So, next time someone remarks on how haggard you look, how your temper has flared once too often, how you don’t seem to want to do fun things anymore, don’t say it’s because of your burnout—say it’s because of your compassion fatigue. You’ll still feel like crap—but people will respect you so much more.