Nov 17

“The Shrink Next Door”: Wrong Therapist

When it comes to finding the wrong therapist, there’s “wrong” as in not the best match, and then there’s “wrong” as in unethical and/or criminal behavior on the part of the shrink. It’s the latter that is the theme of the new fact-based Apple TV+ mini-series The Shrink Next Door starring Paul Rudd as Dr. Isaac (Ike) Herschkopf and Will Ferrell as Marty Markowitz, the client who had the misfortune in real life of choosing this psychiatrist. Despite the comedic talents of these stars, this is not really a comedy but a tragicomedy.

Another key character is Marty’s sister Phyllis (Kathryn Hahn), who’s apparently responsible for encouraging Marty to seek therapy but who then becomes estranged from Marty because of Dr. Ike’s control.

The Truth Behind The Shrink Next Door

Herschkopf, per Dave Itzkoff, New York Times, was ultimately “ordered in April to surrender his license to practice in New York after a committee convened by the State Health Department found him guilty of multiple professional violations” against not only Markowitz but others too.

How bad was it from Markowitz’s point of view? Kai Green, Parade, reports that he told the New York Post a couple years ago that he’d felt like he was in a cult. “He took over my life very quickly…It was one ethical violation after another.”

Markowitz had no reason to suspect Dr. Ike would be like this; he was well-known on the Upper West Side of Manhattan, counting Gwyneth Paltrow and Courtney Love as two of his clients. Paltrow even attended a party at Markowitz’s home, reportedly. The story came to light when Bloomberg columnist Joe Nocera moved to the Hamptons and was invited to a barbecue at the house next door by someone who he thought was the gardener. Meeting the host, ‘Dr. Ike,’ Nocera was invited back for another get-together, where the good doctor insisted on having a picture of Nocera to add to his pictures of celebrities like Brooke Shields and OJ Simpson. However, Nocera ultimately discovered that the man he thought was the gardener, Martin Markowitz, was the actual homeowner—even though Dr. Ike acted like he owned the place. And that’s just the beginning of the shocking truths Nocera ultimately came to learn about the ‘shrink next door.’

Nocera went on to do a podcast about this true story. Additional information about Markowitz’s case has been reported by Debra Nussbaum Cohen, Forward.com:

New York State’s Department of Health, in its decision, found 16 specifications of professional misconduct – from fraudulence to gross negligence and gross incompetence as well as exercising undue influence and moral unfitness. The decision was based on records and testimony from three of Herschkopf’s patients. Markowitz is ‘Patient A…’

Markowitz says that he is ‘much happier now’ than when he was under Herschkopf’s care. ‘It’s my 40-year ordeal. It was 29 years under his power and 11 years seeking justice. I finally got it.’ What matters most is that ‘I got justice. That’s what I wanted.’

The TV Series

Kristen Baldwin, ew.com, describes the essence of Dr. Ike’s destructive actions:

Using manipulation, mind games, and precision-guided guilt, Dr. Ike inveigles his way into his patient’s business affairs, and even his grand summer home in the Hamptons…At first, therapy seems to do Marty some good, as Dr. Ike encourages him to ‘grab the reins’ to his life and stop living in fear of conflict. But it’s all in service of a larger plan: Herschkopf operates like a one-man cult, slowly alienating Marty from Phyllis, his loyal employees, and anyone else who suggests that the shrink’s methods are suspect.

Dave Nemetz, tvline.com: “It’s almost like What About Bob? in reverse, with the therapist becoming attached to his patient like a parasite.” (See my previous posts about What About Bob? here and here.)

Watch the trailer below:

A second trailer reveals more about Marty and his sister’s rift:

Nov 10

“Ted Lasso” Charges Therapist With Fee-Based Caring

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 highly enjoyable series Ted Lasso.

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.

Sep 08

Therapist Self-Disclosure: Appropriate, Powerful Uses

Several therapists have written and spoken publicly about the topic of therapist self-disclosure.

One prominent psychologist who’s done so is David Treadway, whose late-stage cancer became the subject of a memoir, Home Before Dark: A Family Portrait of Cancer and Healing (2009). It includes contributions from his wife Kate and his two young adult sons, Michael and Sam.

Treadway’s previous Dead Reckoning: A Therapist Confronts His Own Grief (1996) was similarly self-disclosing about the effects of his mother’s suicide. It included (Publishers Weekly) “parallels between what Treadway’s patients are experiencing and his own problems; revelations of his own therapy; excerpts from his family’s painful recollections; and incidents from his own ongoing life.”

Whether as a therapist or in his writing, Treadway views such openness as a carefully chosen act that can be helpful to others if used appropriately. In Andrea Bloomgarden and Rosemary B. Menutti‘s 2009 Psychotherapist Revealed: Therapists Speak About Self-Disclosure in Psychotherapy, you can find his chapter on what he calls “clinically constructive self-disclosure.”

Another psychologist, Ofer Zur, has said that “(T)he decision to self-disclose is based first and foremost on the welfare of the client.” He acknowledges four types of therapist self-disclosure (“Self-Disclosure and Transparency in Psychotherapy and Counseling“):

  1. Deliberate–such as having a family photo on display in the office or responding  with personal reactions to clients’ statements
  2. Unavoidable–when things about the therapist are observable, e.g., approximate age, ethnicity, gender
  3. Accidental–for example, a client and therapist run into each other at a community event
  4. Clients’ Deliberate Actions–when questions are asked or when info is tracked down, e.g., on the internet (very common these days)

The thoughtful therapist is aware of different ways in which personal info might be revealed and works on ways not to have self-disclosure interfere with a client’s work. Above all else, it should not be about the shrink trying to get his/her own needs met.

Possibly the only shrinks today who don’t sometimes use self-disclosure or at least deal with it to any significant degree are the traditional analysts, those who may still subscribe to the “Don’t just say something, sit there” strategy and who believe in a strict interpretation of the “blank screen” approach, i.e., “only if I am inscrutable to you can you do the important work of projecting your childhood stuff onto me.”

Psychoanalyst Linda B. Sherby addressed this in the process of writing Love and Loss in Life and in Treatment (2013), which is about the grief process related to the death of her husband George. Although she anticipated condemnation from other analysts regarding her self-disclosure she felt “it was important…to demonstrate how a therapist’s present life circumstances affects the therapeutic relationship because I do believe that particular aspect of the patient/therapist interaction has been largely ignored.”

States Janine Roberts, Ed.D., an author and scholar who’s studied therapist self-disclosure (Psychotherapy Networker):

Hundreds of therapists in workshops I’ve led in the United States, Europe, and Latin America have said they share personal information to strengthen the therapeutic alliance, demystify therapy, and reduce the power differential between themselves and their clients. Given that research has found that the quality and nature of the therapeutic relationship–not the specific model or method–account for up to 30 percent of the variability in therapy outcomes, they’d appear to be on to something.

Furthermore, Roberts cites research indicating “that clients working with therapists who don’t self-disclose often describe the experience as problematic.”

Increasingly, I think that clients expect or want from their shrinks more personhood and less unknowability. Very often they’re working themselves to be more open and better understood—so isn’t it useful for therapists to model this in appropriate ways?

May 18

New Season of “In Treatment”: Uzo Aduba As Therapist

Uzo Adubo portrays the central figure, therapist Brooke Taylor, in a new season of  In Treatment, an update fans may say is long overdue. The setting this time around is Los Angeles during COVID.

For info about the first three seasons (2008 to 2010), in which Paul Weston (Gabriel Byrne) was a therapist in therapy himself, see my previous post.

When In Treatment resumes on May 23rd (HBO Max), its 30-minute episodes will air back to back on Sunday and Monday nights.

In addition to Adubo, the cast of the new season of In Treatment includes the following:

  • Adam (Joel Kinnaman), the guy in Brooke’s conflicted love life
  • Eladio (Anthony Ramos), a home health aide for a wealthy family
  • Rita (Liza Colón-Zayas), Brooke’s close friend
  • Colin (John Benjamin Hickey), a white-collar criminal recently released from prison
  • Laila (Quintessa Swindell), a teenager dealing with family expectations

Will Brooke, as In Treatment‘s prior therapist Paul Weston, seek her own therapy? Not sure, but viewers will definitely see that she has her own issues, at least in part via her conversations with friend Rita. “The press release says the therapist is dealing with ‘a life-altering loss,’ and her on-again, off-again boyfriend has resurfaced to complicate her life. As a Black woman, she also faces challenges in the field that Weston certainly never had to contend with” (Looper).

Kelly Lawler, USA Today, reports that Aduba and the series producers recently spoke at a conference about “the importance of bringing the series back with a Black woman at its center, which allowed them to explore new topics.” As therapy stigma is prevalent in communities of color, this is a welcomed approach. Related to this,  Aduba herself has been publicly relating her personal experience with therapy.

More from Lucy Feldman, Time, about what you can expect to see:

In the space of a few episodes, Brooke has to coax out the nuances of a young caretaker’s feelings of abandonment, help embrace a teenage girl’s Black and queer identity, and navigate a privileged man’s dishonesty. The show doesn’t shy away from contemporary tensions, pushing into violent racial fantasies and toxic masculinity. Watching Aduba’s performance in these scenes, it’s easy to feel Brooke’s frustration, unease, even danger. ‘This is a Black, female psychologist treating people through the lens of the world as she sees it,’ Aduba says. ‘There are a lot of unknowns of how that day is going to go, and why people have arrived there.’

Watch the trailer below:

May 07

“In Treatment” (HBO): Therapy for the Masses

With a new and fourth season of In Treatment coming to HBO Max later this month, starring Uzo Aduba as the therapist, I’m posting today about the first three seasons (2008 to 2010). This series about Paul Weston (Gabriel Byrne) both providing therapy and receiving it was based on Hagai Levi‘s Israeli series Be’Tipul, which ran two seasons.

As reported by Gaby Wood, The Guardian, Be’Tipul‘s Levi was motivated by a desire to reduce mental health stigma in Israel. Levi felt that whereas in the U.S. “people mention their therapist at the drop of a hat,” not so in Israel. The series went on to become popular among clients, therapists, and many more, including those discovering acceptable therapy depiction for the first time.

In the American-made In Treatment Paul Weston’s therapist is Gina (Dianne Wiest). While Paul is a “boundary-challenged, deeply conflicted, terribly appealing psychotherapist” (Michelle Orange, New York Times), Gina “[cuts] through Weston’s self-absorbed obsessions” (Peabody Awards).

Clinicians and critics had varying but mostly positive opinions about In Treatment‘s portrayal of therapy sessions, viewed in 30-minute segments as opposed to the standard therapy “hour.” Psychologist Ryan Howes, self-confessed lover/hater of the series, listed his pros and cons in a Psychology Today article titled  “In Treatment Ambivalence.”

Excerpts from a sampling of Howes’s cons:

    • …Paul often begins sparring with new patients before they take off their coat…
    • Paul attended a psychoanalytic institute, but his therapeutic approach doesn’t always appear psychodynamic. It’s more like Rogerian reflection and withholding, which results in the frustrated patient demanding advice, followed by Paul’s defensive reaction and howitzer-like interpretation.
    • In each episode you’ll hear several variations of an accusatory: “so you’re telling me…” or “you think I’m saying…” or “what’s that supposed to mean?” followed by an infuriating misinterpretation. Wait a minute, I’ve got an idea: Introducing The In Treatment Drinking Game: take a shot every time someone makes an assumption, questions the validity of therapy and/or storms out of the session early.

A sampling of pros:

    • The writers may not have Ph.D.’s, but they get a lot right about therapy….
    • It reveals the “layers of the onion” in therapy incredibly well. The patients enter therapy with an immediate and obvious complaint. As the weeks unfold, you see how the problem has roots that extend deeper and deeper.
    • I’ve heard unsubstantiated rumors that complaints are made to licensing boards about Paul’s behaviors. If this is true, I love this….

At the start of the second season Jeremy Clyman, Psy.D, wrote in Psychology Today, “At last the field of clinical psychology has a show free of melodrama and full of the detail and depth necessary to realistically represent the therapeutic process. Predictably enough, patients all across the country are discussing the show in therapy and therapists are discussing it with each other.”

Because Be’Tipul only had two seasons, the third In Treatment season was created from scratch. Furthermore, it involved Paul having a different therapist (Amy Ryan). A fitting summary from Nancy Doyle Palmer, HuffPost:

Ryan plays Adele, Paul’s end-of-the week analyst and foil, who at first glance seemed perhaps too young and fresh-faced for the task — but quickly took on him, his patients’ issues of the week and his 30 year plus roster of mommy/mentor/tortured Irish issues. She’s pitch perfect in a completely new way and knows just how to handle him…

While demonstrating the finest qualities of a therapist Monday through Thursday – deeply caring, observant, benevolent and wise – Paul comes to Adele (as he did to Weist’s Gina) often in a rage – harsh, condescending, duplicitous and game-playing – basically giving credence to the fact that doctors are the worst patients ever and shrinks, well…