Oct 21

Therapist Boundaries (Violence): Two Movies

Do a Google search about therapist boundaries, specifically therapists and violence, and you’ll find plenty about clients attending therapy for being violent.

But can you find any reliable info about therapists being violent? Against their clients? No? Do we have to (misguidedly) look to the movies for such things?

I. Good Will Hunting

Will (Matt Damon) in the movie Good Will Hunting (1997) is one character who has to attend therapy after an episode of violence. Finding the right shrink for Will, who trusts no one who tries to help him, turns out to be no easy feat. Well, maybe the less traditional, more directive kind of therapist we eventually find in Sean Maguire (Robin Williams) will fill the bill.

But before Will gets anywhere close to the meaningful catharsis the film wants him to have, he has to put Maguire through the usual hoops, in one instance meanly and provocatively maligning Maguire’s dead wife. What follows is this disturbing scene involving terrible therapist boundaries:

Lesson #1 (You Wouldn’t Pick Up From The Movies): It’s never okay to choke a client. (Or harm a client in any way.) (Unless, of course, in self-defense.) Even if the client then backs off and actually moves on to have one particular wowie-zowie life-changing therapy session.

JC Schildbach, LMHC, RespecttheBlankie.com: “Despite what the filmmakers would have us believe, this is not a valid technique for establishing rapport or ensuring appropriate transference with clients who have suffered abuse–even when therapist and client are both from south Boston and the client just shit-talked the therapist’s dead wife.”

II. What About Bob?

Next up, there’s actually worse things a shrink can do. In the film What About Bob? (1991), the psychiatrist played by Richard Dreyfuss goes nuts himself dealing with Bob (Bill Murray), his dependent client who follows him, uninvited of course, on vacation.

Lesson #2 (You Might Not Pick Up From the Movies): Even unsuccessful attempts at killing one’s (annoying) clients are not allowed.

Well, at least Leo Marvin’s “death therapy” doesn’t work, and while there’s an unhappy ending in store for him—catatonia and psychiatric hospitalization—there’s a happy ending for Bob, who marries Lily,  becoming Leo’s brother-in-law. And there’s more: We find out in the Epilogue that Bob goes on to get his psychology degree and to write the bestselling Death Therapy.

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 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.

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

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

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: