Tag Archives: therapist confidentiality

Nov 09

“The Patient” Spoilers: Therapist Lessons?

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Sam, the killer, is the one seeking treatment, but by the time this drama is over, nearly everyone in this drama reflects upon past actions and decisions or dies trying. David Bianculli, NPR, regarding The Patient (Hulu series)

Don’t get any ideas, I jokingly told my client (patient) who had just raved about The Patient and was recommending it. If you’ve already seen the series, and I hope you have because this whole post is a load of spoilers, you’re aware that the premise involves a client (patient), Sam (Domhnall Gleeson), who kidnaps and imprisons his therapist, Alan (Steve Carell), hoping to be cured of serial killing.

Therapist Lessons Learned (Tongue in Cheek? You Decide)

  1. Never publish a book showing you’re an authority on therapy. Your supposed expertise could be your downfall when the next client comes a-knocking (you out).
  2. Never fire your clients for not doing the work. You might not be fired back—and your work just got a whole lot harder.
  3. Therapy provided under extreme duress does not work. Well, at least not for you.
  4. Sometimes involving a client’s loved one (or acquaintance) into his therapy backfires enormously. I mean, maybe you can handle certain people—your client’s cheating spouse, for instance—but his most recent blindfolded, hands-bound, kidnapping victim who’s now going to die because of you?
  5. Sometimes involving a client’s parent in therapy backfires enormously. Can you say Dysfunctional Enabler Who Doesn’t Want to Change?
  6. Helping your client gain insight isn’t all it’s cracked up to be. I mean, when he then strangles his abuser to the point of near-death is it really such a great breakthrough?
  7. A therapy bond, once made, can be hard to break. Or kill.
  8. The ethic of confidentiality can actually be breached. You do NOT have to keep your victimization by a client confidential. That is, if you can actually find someone to tell.
  9. Dead (or otherwise gone) therapists can still be helpful. Imaginary sessions can often lead to deep insights—if not particularly long-lasting.
  10. Never lie to your client about his prognosis. If you pronounce that your uncured, still-murdering client has in fact made great progress so it’s time to end, you just might be forced to stay around forever.
  11. Never offer your honest appraisal of your client’s need to be locked up. He is not going to want that.
  12. Accept that you’re unlikely to ever know the positive therapeutic effects you’ve created for your patient’s post-treatment life. Huh, he’s actually listened to you. And now you’re dead.

On a more serious note: “Can Serial Killers Be Rehabilitated?”

Lori Kinsella, J.D., Psy.D., answers this question in a recent Psychology Today article (not connected to The Patient). Check it out. Her main points as expressed upfront:

Serial killers prioritize rewards in decision making. Consequences are of little or no value to serial killers.

Research suggests that brains and neuronal activity of people with psychopathy are different from those of typical people.

In the future, drugs may help rehabilitate psychopaths by controlling neurons in specific brain regions.

Nov 10

“Ted Lasso” Therapist: Fee-Based Caring?

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Among the various possible challenges therapists regularly hear from prospective or new clients (or even long-term clients) is that it’s weird to have to pay someone to listen to them. I was reminded of this recently while watching the Ted Lasso therapist scenes.

Ted Lasso‘s second season actively deals with both mental health and sports psychology/therapy. To elaborate further (you probably should stop reading here if you haven’t seen the newest season), Coach Ted Lasso (Jason Sudeikis), who’s been experiencing panic attacks on a regular basis, supports his players getting therapy from Dr. Sharon Fieldstone (Sarah Niles) but is loath to accept it for himself.

Eventually desperate to feel better, however, he does make attempts to see “Dr. Sharon.” In his second of two very brief sessions (because he keeps bolting) Lasso accuses her of not actually caring for the people she treats because she charges a fee. (He blasts the profession in other ways too.)

Dr. Sharon’s response when Lasso returns again? Linda Holmes, NPR: “Finally, on his third try, she tells him that she doesn’t appreciate his attitude, particularly given that he is also paid to do a job in which he still legitimately cares about people. This brings Ted around a bit, and he finally sits down across from her to talk.”

The thing is, therapy is neither free nor a friendship—it’s a professional service generally offered by individuals who’ve chosen this as a career because they genuinely care about helping others.

In essence, if a therapist is actually serving solely as a “friend” he or she is doing professional boundaries wrong. Good therapist boundaries, which are established with the welfare of the client in mind, enable clients to develop trust and a feeling of emotional safety. Confiding in a therapist—who follows an actual ethic of keeping things confidential and is trained to be relatively objective and to understand human issues on a deep level—should feel differently helpful than confiding in a friend.

The therapist is not expecting the same in return from a client just as your roofer, to name just one instance, doesn’t expect you to now come over and do his or her roof.

In a friendship, on the other hand, each person might share thoughts and feelings in a back and forth kind of way. If it’s a healthy enough kind of friendship, this helps forge a mutual relationship involving neither payment nor obligation—but also sometimes lacking objectivity, insight, patience, consistency, effective listening skills, and other good stuff worth sometimes paying for.