Tag Archives: therapist ethics

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.

Jul 03

“Anger Management” TV: Managing My Anger About It

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According to IMDB, Charlie Sheen‘s new series on FX, Anger Management, is “(a) TV sitcom-version of the 2003 feature film about a guy sentenced to anger management counseling with an aggressive instructor.” It premiered last week with the episode “Charlie Goes Back to Therapy,” and, as expected, it drew tons of viewers.

In brief, his character, Charlie Goodson, is a former baseball player with anger management issues who’s now an anger management therapist—with—guess what—continuing anger management issues.

Because there’s a group therapy focus, many reviewers have compared Sheen’s show to someone else’s from way back when.

Ken Tucker, Entertainment Weekly:

The locus of most of this show’s comedy…is the therapy sessions Charlie conducts. Watching him referee a group of recalcitrants and oddballs, you recognize the true template for this series: The Bob Newhart Show (1972-78), with its bemused therapist surrounded by his wacky clientele.

But they’re not as vividly drawn as Newhart’s patients…

Instead, the troubled souls in Anger Management are all less pleasingly complicated types, familiar to sitcoms current and past: the cranky old man (Northern Exposure’s Barry Corbin), the sarcastic gay man (Michael Arden), the sexpot (Noureen Dewulf), and a dope (Derek Richardson) who likes goading other people…

And for we therapists it just gets worse. Charlie’s best friend Kate (Selma Blair), with whom he’s having a sexual relationship as well, is also a therapist. And they try to be each other’s therapists before taking off each other’s clothes?

Where do I begin…???? The ethics against having sex with a client? The inability of a colleague-who’s-also-a-best-friend to be an objective-enough therapist? The no-way-can-your-client-also-be-your-shrink and no-way-can-your-shrink-also-be-your-client?

Apparently, here’s how this all develops: First, there’s Charlie’s realization that he needs his own therapy because of his still-unresolved anger stuff. The Washington Times:

‘Why do you need a therapist? You are a therapist,’ his neighbor asks.

Goodson responds this way: ‘Did you ever see a tow truck hauling a tow truck?’

Of course, Charlie being Charlie, there’s a problem.

‘There’s only one tow truck I trust,’ he sighs, ‘and unfortunately, I’m having sex with it.’

How ridiculous. A therapist actually believes he needs to have a developed and trusting relationship with his shrink before he starts therapy?!

When Charlie’s neighbor then asks why this is problematic, he replies, “It’s unethical for a therapist to have sex with a patient. They teach that Day One. It weeds out half the class.”

Ha ha. Good riddance to them. Charlie, it’s not too late for you to weed yourself out.

By the way, there are actually plenty other ways to make fun of therapy and therapists than to continually give the public the completely wrong impression that therapists may have sexual relationships with their clients.

What about Kate?

Jace Lacob at The Daily Beast points out that Kate: “…willingly throws away her professionalism and morality to continue to have sex with Charlie, even as she ‘treats’ him. She’s said to be brilliant, but we’re shown no examples of her intelligence, just her sex drive.”

In conclusion…

Refreshingly, David Wiegand, San Francisco Chronicle, aptly sums things up: “Two things are relatively safe bets about the new sitcom Anger Management…The ratings are likely to be strong, especially for the first few episodes, and Charlie Sheen probably won’t make the American Psychological Association’s short list to keynote its next convention.”

Well. Thank you for your support.