Tag Archives: therapist boundaries

Jun 10

“Mistresses”: Therapist Ethics Go Right Out the Window

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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.”

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 Genzlinger, New 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.”

Mar 13

“Side Effects” Spoiler: Shrink Boundaries and Ethics

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Previously I posted a preview of Side Effects, a new film directed by Steven Soderbergh. That, of course, was before I’d seen it; now I want to say more. Major Side Effects spoiler ahead: Read this post only if you’ve already seen the movie and/or want to know how psychiatry is portrayed in it.

First, The Not-So-Big Revelations

It’s actually no revelation at all that medication “side effects” that may have led to a murder are a significant factor in this film.

On the other hand, it may be a revelation to some viewers just how enmeshed the relationship between psychiatrists and the pharmaceutical industry can be. It’s a common viewpoint and one that’s succinctly put by psychologist Tyger Latham in his post “In Bed with Big Pharma“: “…(T)he psychiatric field has allowed itself to be co-opted by the industry and failed to fully question the scientific merits of those psychoactive drugs which they prescribe.”

A related issue presented in Side Effects is the ease and quickness with which some shrinks make psychiatric diagnoses. Kelly Patricia O’Meara, author of Psyched Out: How Psychiatry Sells Mental Illness and Pushes Pills that Kill, points out in her movie-related post that “the psychiatrist merely has to briefly listen to the patient’s life complaints and, voila, the psychiatrist is able to determine the exact alleged mental disorder.”

Bigger Revelations

Read reviewer Rex Reed‘s strongly negative critique and without warning, he spills a huge Side Effects spoiler: “What started as a cautionary thriller about drug abuse…now turns into a battle between two psychiatrists for the soul of their patient—one who keeps her medicated, the other who turns out to be her lesbian lover.”

Well. As we know that Jude Law’s character, Dr. Banks, isn’t the lesbian lover, hmmm…who could it be? The one well-known star that every critic mentions is another psychiatrist but then barely says a word about? The former shrink of Emily, the homicidal patient of Dr. Banks?

Anil Vora at Bi Magazine describes this Side Effects spoiler thusly:

The ‘surprise’ plot twist in the final act is that Victoria Siebert (Catherine Zeta-Jones) is bisexual. By this point in the film we have also learned that Siebert is self-serving, a corporate sellout, and a hypocrite. But she has also done something completely unethical. To get her to confess to this crime, Emily Taylor (Rooney Mara) seduces her. We learn that Taylor had previously seduced Siebert when she was Siebert’s client in therapy. Siebert had allowed herself to be seduced and had sex with Taylor.

What many viewers may not realize is that it’s the shrink who is always responsible for setting the boundaries. It doesn’t matter who seduces whom. Crossing this line is considered exploitative and highly unethical.

Siebert also plots to commit murder—an infraction so obvious it doesn’t need to be spelled out in ethics manuals. In the mind of internist Dr. Frank Spinelli, as expressed in his post titled “Harmful Side Effects,” another aspect to this situation that sucks is that “(i)n perpetuating the stereotype of the crazed gay killer, Soderbergh marginalizes gay people.”

Fellow member of the psychiatry specialty Helen M. Farrell writes in a Psychology Today post regarding some other ethics violations in Side Effects. For one, shock treatment is used as a threat against the patient, Emily; another is that, in an entirely vengeful act by Dr. Banks, Emily is eventually committed against her will to a mental institution .

Dr. Sasha Bardey, the specialist in forensic psychiatry who served as the movie consultant, has apparently indicated that the film’s plot is largely based on real cases or incidents. Therefore, Psyched Out author O’Meara asks: “…(O)ne has to wonder who is the real-life patient that has been committed to a mental institution because the psychiatrist wanted revenge?” In other words, does this actually happen? Do all the other things? How often?

And how about other actions of Siebert such as blackmailing another psychiatrist (Banks) and committing securities fraud?

In Conclusion

Don’t get me wrong. When I saw Side Effects, I was interested in the plot and didn’t always mind that psychiatry was being lampooned and criticized. I’m also okay with some Hollywood-type stretching of reality, whatever the topic.

But will the movie makers out there ever give shrinks a break? Present a more balanced picture? Can’t they lay off the tired ethics breaches, particularly that of becoming sexually involved with a client—especially when little is done to point out how wrong this is?

In the finale, after all, what are the actions that get Siebert into trouble? The securities fraud and conspiracy to commit murder, not having sex with a client. Because the latter is only an issue when the patient complains—and this never happens in popular movies.

Nov 01

“The Prince of Tides”/”A Dangerous Method”

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Kind of continuing the Halloween theme, today I present clips from two movies, The Prince of Tides (1991), and an upcoming release, A Dangerous Method (2011). The scariness today, though, relates to therapist boundaries.

#1.  The film adaptation of the best-selling novel The Prince of Tides by Pat Conroy could have been better in many ways. But, even though many readers were disappointed, it did receive a good number of film/acting award nominations. Here’s the trailer:

So, did you get the picture from that? Nick Nolte‘s married character, Tom Wingo, travels to New York and tries to help Dr. Lowenstein (Barbra Streisand) help his suicidal sister. In essence, he’s a family member also receiving therapeutic services from Lowenstein—but can you tell that she doesn’t appear to see it quite that way?

The following brief clip zeroes in more closely on a pivotal point in the evolution of Wingo and Lowenstein’s inappropriate relationship:

This film is scary because (A) Nick Nolte actually earned a Golden Globe for this, (B) many of the movie’s fans thought it was a great romantic drama, (C) the film was actually billed and marketed as a romantic drama, or (D) the therapist violates major ethics.

If you answered any or all of the above, well, at least you agree that this clip is scary.

#2.  A Dangerous Method is new and won’t be released in the U.S. until 11-23-11. Its plot borrows from a chapter in psychoanalytic history when Freud mentored Jung. This excerpt from the Variety review (the film was seen at the Venice Film Festival earlier this year) further introduces it:

Less concerned with the treatment of mental illness than with the way social norms encourage the suppression of human impulse, Christopher Hampton’s exceptionally coherent, literate script (adapted from his play “The Talking Cure” and John Kerr’s 1993 book “A Most Dangerous Method”) hinges on an unorthodox experiment Jung undertook with Sabina Spielrein, a Russian Jewish woman whom he treated for hysteria, and who later became a significant psychoanalyst in her own right.

Now, watch the trailer to see what kind of “experiment” was allegedly undertaken:

Reviewer Shaun Monro recently called this movie “…a well-acted skewering of overreaching psychology.” Overreaching. Good word.

Interesting that we have so few movies that attempt to represent the field of psychotherapy, and when we do, so few of them are not about the violation of therapist boundaries and ethics.

And that’s scary in and of itself.

Oct 21

Therapist Boundaries (Violence): Two Movies

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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 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.