50/50


This week we will look at the movie 50/50. Briefly, this is a movie that follows the protagonist Adam (played by Joseph Gordon-Levitt) through his diagnosis and fight with cancer. He finds out in the beginning of the film that he has a rare form of cancer in his spine. In the film the audience meets his social support system comprised of his best friend Kyle (played by Seth Rogan), his parents, and his therapist Katherine (played by Anna Kendrick). Throughout his medical treatment he sees Katherine who is a student working towards her Ph.D in clinical psychology.

This movie has an interesting take on therapy as a whole for two main reasons. The first, is that Katherine is a student therapist. She is seeing Adam most likely for an internship or working towards her clinical hours. Student therapists, or the process to become a psychologist is not depicted in many films. The second reason is that Adam has no diagnosed pathology. He is not seeing her for depression or schizophrenia, he is seeing her because he is going through a major life event and is having difficulty coping and adjusting. Often times there is stigma associated with going to a psychologist that something is "wrong" or someone "has something". It was a bit refreshing to see that Adam could see Katherine under different circumstances.

During Adam and Katherine's therapeutic relationship the audience learns a lot about the two characters. The first time Adam meets Katherine it is a bit awkward. Katherine looks extremely stiff and uncomfortable. It comes out during the session that Adam is Katherine's third client. Ever. He tries to shrug this information off, but it becomes apparent through some of his statements that he is a little worried. From a clinical perspective self-disclosure can be a positive and a negative. One needs to know their client and know what information they are disclosing. In this case it worked, but it was a major risk that could have backfired. For the patient's comfort it might have been wise to disclose that she was a student, not a licensed psychologist, and leave the number out of it.

Katherine being a student also lead to her seeking feedback from Adam about certain techniques. Katherine came off quite well read and well versed in empirically supported treatments, which all psychologists should be. However, she was not so great at making clients feel comfortable. There are several scenes in the film where she attempts to place her hand on Adams arm because she read that patients often found it comforting. She is too stiff and it makes Adam feel awkward. The patients are there for therapy, not to validate her skills. It is understandable that a young therapist could be nervous, but she should have been asking about how therapy was going, or checking in regarding treatment, not her personal skills.

Lastly, the therapeutic relationship got into dangerous territory. Katherine did several things that are considered unethical and within bad practice for psychologists. It should have been the first thing she learned about in school. There were several infractions she committed. First, she gives Adam a ride home. There is controversy about this topic among psychologists and some do it, some do not. However, she took the ride home too far by self disclosing about her ex-boyfriend and letting Adam help her clean the garbage out of her car. One should never be too personal with their clients. Katherine also gave Adam her personal cell phone number. Many psychologists have a separate phone for clients to call them on so they do no accidentally get their phone stolen, or mix clients and friends. Adam calls her late at night when he has a bit of a breakdown before his surgery and the discussion is extremely personal on both ends. This also crosses an ethical line when it comes to personal relationships with clients. At the end of the film Katherine and Adam end up dating. The APA code of ethics states that a therapist can be personally or sexually involved with a client after two years if no harm comes to the client. Many psychologists make it a point to never be personally involved with a client. Katherine definitely did not wait two years. This is a major ethical violation and could have cost her her clinical licence.

Overall, The topics of student's conducting therapy, and Adam not having a diagnosable mental illness are interesting. However, the film could have done much more to show them in a more positive light. Katherine breaks way too many rules and makes students look incompetent and unprofessional. Ideally, in real life she would have a supervisor who was watching her more closely and would warn her against these behaviors.

Reality TV/Dr. Drew & The Real Housewives

Thus far on this blog, we have looked at the role of psychologists in fictional TV shows. This week, I am going to briefly discuss how psychologists are portrayed in reality TV shows in general. In recent years, the number of reality shows on TV has increased dramatically. Sometimes, these mental health workers are peripheral characters that appear sporadically during a series. In other cases, the reality show is based specifically around mental health treatment.

I would like to discuss the latter first. Dr. Drew offers his therapeutic services mostly to celebrities, but has become just as well known as many of his clients because of his presence on TV. In 2008, Dr. Drew’s show Celebrity Rehab with Dr. Drew premiered on VH1. It has run 5 seasons to date. The show features “celebrities” with substance abuse problems (mostly C- or D-list celebs whose claim to fame is other reality shows, but also some bigger-name celebrities who have fallen out of the spotlight) and documents their journey through rehab for their various addictions. This includes recording their therapy sessions with Dr. Drew. In a spin-off of Celebrity Rehab, VH1 aired one season of Sex Rehab with Dr. Drew. As you might gather from the name, the show used the same premise and principles but applied them specifically to minor-celebrity clients with sex addictions. Dr. Drew is actually an MD who is board-certified in internal medicine and as an addiction medicine specialist. His shows often showed him engaged in one-on-one conversations with the clients, like therapy, where he would usually offer very basic advice or rules and some support for the client at best. At worst, he would often push clients to talk about traumatic events in their background. While it can be argued that this might be a “scripted reality” show, and that the patients’ therapy sessions are exaggerated or staged, if we are to assume that there was actually a degree of reality to these shows, such treatment could potentially re-traumatize patients. Even if the celebrity patients engaged in this knowing full-well what was in store for them and completely consenting to have their private therapy sessions televised, it is unethical to take advantage of someone who is already in a difficult situation (addiction recovery) and exploit them by offering them money or a second chance to be on TV if they agree to go through this very private process publicly. Dr. Drew’s VH1 rehab shows are no longer on the air, although the last season of Celebrity Rehab just aired last year. Dr. Drew has received a great deal of criticism about the show from other professionals and even from those outside the field of mental health. He has been criticized for the treatment that he is providing to clients on the shows, which is often inadequate, as well as for exploiting the celebrities he is claiming to help. Even outside of these shows, Dr. Drew has a media presence on radio shows and as an author. He has received further criticism for offering unsolicited opinions on other troubled celebrities (like Lindsey Lohan) with regards to their psychological functioning. All of this is unfortunate, and because of his title and the way he portrays himself, Dr. Drew has come to be a representative of the mental health field when in actuality, he is a trained medical doctor with very specific certification in substance abuse treatment (which he apparently does not even do well) but has taken it upon himself to offer his impressions of others’ psychological functioning.

There seems to be a tendency amongst the Real Housewives (a Bravo franchise spanning multiple seasons from at least five different cities) to seek therapy, whether it is individual therapy for personal issues or couples’ counseling to address marital problems. These women are televised on their own shows season after season because they are wealthy socialites, and deemed interesting enough for people to keep watching them week after week. As evidenced by the success of the franchise, it seems that people are, in fact, watching. Because of that, I think that it is great that these women publicize the fact that they are going to therapy. Several women have admitted during the show to their friends that they are seeing a therapist for marriage counseling or to deal with changes in their life, etc. They are usually received well by their friends and are supported for seeking help for their problems, which could help change some of the stigma surrounding therapy. On one episode of the Real Housewives of Beverly Hills, one woman mentions at a dinner party that she and her husband have been going to couples’ counseling. Most of the women support her, but one woman’s husband dismisses therapy and invalidates her choice to get help. A central part of these two individuals’ later interactions is revisiting this argument and helping the husband to see that even if he doesn’t necessarily want to be in therapy, it is still a valid choice for other people. I thought that the show’s characters addressed this point well.

There are occasions during the Real Housewives franchise, as well as multiple other reality shows, where they will actually show a person in session with their therapist. For the show, it is a convenient plot device, because the individual can talk about all of their problems, emotions, etc, while maintaining a sense of ‘reality.’ However, the ethics of televising a therapy session ever, even when it has been consented to, should be questioned. 

The Secret Life of the American Teenager

This week we will be focusing on the ABCFamily show, The Secret Life of the American Teenager.  For those of you who are not familiar with the show, it is a show about a group of teenagers and their families living in a further out suburb of Los Angeles.  The show started out primarily revolving around the character of Amy Juergens, but has since expanded to place more focus on other characters.  During Season 1, Amy became pregnant at band camp by a boy who also attended her high school, Ricky Underwood.  Amy was only 15 and a freshman in high school at the time, so the show looks at her struggle of being a pregnant teen, and in the later seasons, her struggle to be a teen mother.
Ricky has a very dark past, both of his parents have been in and out of jail throughout his childhood.  When we meet him he is living with foster parents, who have been his only constant adult figures in life.  Ricky's parents were both addicted to drugs, and his father sexually abused him for years.  Ricky engages in a lot of acting out behaviors, but his primary behavior is being extremely promiscuous.  He tends to use girls and then have nothing to do with them after, which is what would have happened with Amy had she not gotten pregnant.  Here is Ricky when he first met Amy at band camp:

In an attempt to cope with his past as well as deal with his acting out behaviors, Ricky sees a therapist, Dr. Fields (who happens to be the father of one of Amy's best friends.)  At one point in the show, Ricky goes out with Dr. Fields's daughter, and when he finds out this happened, he comes to the school to confront Ricky, revealing to the students that Ricky is a patient of his.  This makes everyone in the school assume Ricky has a serious mental health condition, and damages his reputation in the school.  He also agrees to see Ricky and his girlfriend at the time, Adrian, in a joint session, where he uses techniques and provides advice that is not overly conducive to two 16-year-olds. 
In the sessions shown between Ricky and Dr. Fields, he never attempts to discuss how the abuse has impacted him, what symptoms he may be having or that could be causing his acting out behavior, or how any of this is affecting his role as a father.  While Ricky may not have a concrete DSM-IV diagnosis, he clearly has a great deal of anger in his life, and none of this ever seems to be discussed or focused on in session.
Dr. Fields also appears to have ignored other aspects of the APA Ethics code, particularly in the realm of dual relationships.  Amy's parents go through the process of divorcing in Season 1, only to get back together in Season 2.  In the Season 2 episode "Let's Try That Again" Anne (Amy's mother) asks George (Amy's father) to please go to couples therapy with her to work on their relationship before they remarry.  George is extremely resistant to therapy and believes he does not need to tell a stranger his problems, but remembers that Amy's friend's father is in fact, a therapist.  However, George does not want to go to therapy, so he asks Dr. Fields to go out to dinner with him instead.  After their dinner meeting, he agrees to attend couples therapy.  While watching this I could not believe that Dr. Fields would accept them as clients considering they knew each other well because of their daughters, and that he and George had just had dinner together, which is in violation of the dual-relationship aspect of the Ethics code. 
Overall, I was not very impressed with the show's portrayal of therapy.  The writers made it appear that you can go to one session and gain outstanding, permanent results and whatever problems exist in a relationship will be magically resolved.  They also did not discuss how therapy can be used to treat certain issues, particularly in Ricky's case.  As of midway through Season 2, it appears Ricky has been magically "cured" and no longer attends therapy, despite his many issues with anger and his still conflicted relationships and feelings with his parents.  I think the show could have done a much better job portraying therapy, particularly because it tends to be aimed at a teen/young adult audience who could most likely benefit from knowing more about the therapeutic process.

The Sopranos


This week we take a look at the HBO series The Sopranos which aired for six seasons from 1999-2007. Briefly stated the series followed the life of Tony Soprano who was a northern New Jersey mob boss. The television show focused on his life and work, and the intricacies of the mafia. However, in the first season of the show Tony suffers a severe panic attack and starts seeing a psychiatrist named Dr. Jennifer Melfi.

The therapeutic relationship between the two characters spans the six seasons of the show. Overall, the show did a good job of showing what it is like to be a therapist and what issues come up when one has a difficult client. The show also gives an interesting look into Dr. Melfi as a character and what she goes through seeing a sociopath. There are several episodes where she sees her psychiatrist and discusses her difficulties seeing Tony as well, which is realistic. Naturally, being a television show, there are some liberties taken, but overall this is a positive and realistic portrayal of therapy.

As a psychology student the fist things we are taught are the rules to breaking confidentiality and the importance of keeping therapeutic boundaries. These topics are hardly brought up in many television shows. In this therapeutic relationship these things are extremely important. Tony never explicitly states that he is the head of the north New Jersey mafia, but there is a silent understanding between the two about his business. Since part of his business involves harming others, Dr. Melfi brings up many times that she will have to contact authorities if she knows this information. When she references it, it is clear the two have had this conversation previously. It also puts her into a tight spot when she suspects something, but it is not clearly mentioned. In regards to boundaries, Tony attempts to call Dr. Melfi, date her, and show up for appointments when ever he pleases. The Sopranos does a nice job of showing why Dr. Melfi needs those boundaries and she explains to him in several therapy sessions the reasoning behind her placing these boundaries between them. These boundaries are especially important when working with a potentially dangerous client like a sociopath. There are some minor slip-ups made my Dr. Melfi like calling Tony's home and speaking with his wife without consent, however, this was most likely added for some television drama.

Watching their therapeutic relationship unfold it seemed like a realistic course of events. Tony came in for panic attacks and through therapy it was learned that there was depression, a history of panic attacks in the family, and deeper familial issues that clouded Tony's life. This is a realistic portrayal of what someone seeking therapy might expect. It is rarely a simple answer and sometimes therapy can go on for many years.

When Dr. Melfi sees her psychiatrist in several episodes it is clear that she is struggling with some transference and counter transference issues. During one of the seasons she gets raped by a stranger in a parking lot. She expressed that she wished for protection from Tony, because he could provide it, but would never ask for it. She also discusses her possible sympathies for him because she is also an Italian-American and understands the hardships immigrants had coming here and the role the mafia played in many families. During one season she contemplates how safe her other patients will be with Tony as a patient. Tony believes someone is trying to kill him so he has Dr. Melfi and his family change their routine and move. She moves her office and thinks about all her other patients being effected due to this issue. She worked out this ethical breach with her psychiatrist as well.

In the last season Dr. Melfi decides to stop seeing Tony for therapy much to his dismay. She does this because the newest research on sociopaths suggest that therapy actually hones their skills and makes them more manipulative in their lives because they can "practice" manipulating others with a therapist. This showed that Dr. Melfi was using clinically proven and up to date research to inform her practices. This is what psychologists should do and it was nice to see that the show included this in her reason to cut-off therapy.

Overall, The Sopranos made a realistic portrayal of a therapeutic experience and therapy in general. They did a good job of capturing all that is involved on the side of the therapist and complicated this relationship can truly be. It was positive that the show touched on things like confidentiality and informed practice as well. Lastly, the show showed the complications that exist when working with a client who is a sociopath.

The New Adventures of Old Christine

The New Adventures of Old Christine was a sit-com that ran for five seasons, ending in 2010. The show featured actress Julia Louis-Dreyfus as Christine, a recently divorced mother-of-one trying to balance work, parenting, and dating. Christine is often described as a “neurotic” character, and her many flaws are frequently the punch line for jokes on the show. A running joke throughout the series is her consumption of alcohol, which she uses to cope with loneliness, anger, and just about anything else. Other characters joke about her having a drinking problem and being an alcoholic, but her drinking is more of just a comedic device and she is never shown experiencing major problems as a result of her alcohol use.

It is not until the final season of the show that the field of psychology is featured rather heavily, and in a pretty poor light overall. First, there is Christine’s brother, Matthew. Earlier in the series, Matthew starts medical school, but later decides that he isn’t cut out for the medical field. Instead, he decides to become a therapist. One of Matthew’s first clients is a young female who, in the first session, confesses that she is attracted to men in power. There is some talk by Matthew about how he thinks she is attractive but can’t act on those feelings because she is a patient. He may even basically explain transference, and how that might be a factor for the patient. However, before the end of the session, he disregards everything he has said, and they end up dating for several episodes. This is obviously problematic. In this example, Matthew, the therapist, is clearly taking advantage of the reason that has brought his patient into therapy.

While Matthew is seeing clients, Christine acts as his temporary secretary. It is here that she meets Max, the licensed psychologist that is basically acting as supervisor for Matthew. Christine almost instantly begins spilling all sorts of personal information to him upon finding out he is a psychologist, which is consistent with the emotional lability of her character. Problem number one is that Max agrees to take her on as a client, which surely violates all kinds of boundary ethics in that Christine is technically his employee, and also related to his trainee. The show is set in Los Angeles, California, where there is definitely not a shortage of psychologists, and no reason for those ethical boundaries to be breached. There is no reason for Christine to be receiving therapy from someone so closely linked to her brother.

Christine seeks therapy for emotional issues and relationship problems, and is immediately attracted to the therapist. The audience later finds out that the therapist, Max, has had his license suspended multiple times for having relationships with patients. Christine and Max end up in a long-term relationship, and the series ends with them getting engaged. Like Matthew, Max does try to ignore feelings of attraction and focus on his role as a therapist, but not very successfully. He sees Christine as a patient for quite some time before telling her, basically, that he would rather date her than be her psychologist. The one time that the show features Christine in therapy, it is actually not terrible. At this point in the story arc, Max is still trying to maintain a boundary between he and Christine, and attempting to act as her psychologist. Max points out to Christine that she has a pattern of quitting things as soon as they get too hard for her. Together, they develop some homework for Christine: she is to set about finishing some tasks that she has been putting off for a long time, both at her job and at home. Even though the show does not go into depth about these things, it almost resembles something that would legitimately take place in a session. However, by the end of the episode, Max has decided that he would rather be in a relationship with Christine than treat her as a therapist.

Obviously, as a sit-com, the writing and relationships that take place are meant to be for comedic value. However, the show in general is written to be fairly realistic. It is not like some comedies that ask viewers to suspend disbelief or overlook important plot points that are not realistic. The general premise, relationships, and interactions that take place over the course of the show are meant to be realistic and be somewhat relatable for viewers. I think that this is why it is especially problematic that the show portrays psychologists so poorly. Representatives of our field show up frequently, especially in the last season, which could be a positive. In a way, it suggests that the stigma against seeing psychologists and seeking therapy is on the decline. For example, Christine’s character is one that exists in real life and could probably benefit from some therapy, and the fact that it was brought up in the show could have been a positive moment. The show could have used it as a situation where this usually "neurotic" character, who is the butt of most of the jokes on the show, is doing something good for herself and getting positive results for it. Instead, whenever psychologists were shown, they were portrayed as being almost predatory. They violated boundaries left and right, and generally took advantage of their patients. They exploited the reasons that brought their patients to therapy in the first place, such as relationship issues. The show even acknowledges the stringent boundaries that exist around these issues, and that these kinds of duel relationships are not healthy or ethically allowable, but then has the character choose to blatantly ignore them. It does not send a very positive message to those watching about the field of psychology. Personally, I am always surprised when I hear of ethically problematic situations like this arising in the real world, but they do. It is just a shame that a show on a major network starring a popular actress chose to focus so closely on these kinds of relationships and interactions in therapy. 

Welcome and Gleecap

Hello!  This is Abbey, Dianna, and Heather here, and we welcome you to our blog.  We will be posting weekly about a TV show or movie that features mental health issues/a character on the show in therapy.  We'll be critiquing and evaluating the issues featured as well as discussing how accurate/ethical the therapy session is.
First up on our show evaluation list is the show Glee.  For those of you unfamiliar with the show, it is about a Glee club in a high school in Lima, Ohio.  The show features the students in the club as well as the teachers at their high school.  Amidst the musical numbers and comedy, Glee also tackles some more serious and hard-hitting issues.  Today's post is going to look at the character of Emma Pillsbury.  Emma is the guidance counselor at the school, and she has been struggling with Obsessive-Compulsive disorder for the majority of her life.  Here's Emma engaging in her obsessive behavior, cleaning:

Emma's OCD has been an ongoing piece of her character throughout the series.  Emma's OCD is first discussed in episode 2 of Season 1, Showmance.  Will (the coach of the Glee club and Emma's potential love interest) takes on a second job as a part-time janitor and tries to help Emma overcome her cleaning obsession.  He talks with Emma about where her thoughts around cleaning began, and it is revealed that when she was 5 years old, she was visiting a farm with her family and her brother shoved her in a horse trough.  The experience of being shoved in the trough and becoming dirty set something off, and from then on she become obsessive about being clean all the time.  Emma is focused on cleanliness in all realms, from her food to being unable to have a real relationship due to her fear of becoming dirty.  Her OCD causes all of her romantic relationships to dissolve, including her marriage that occurs in the second season.  Emma's OCD truly comes to a point of extreme debalitation in episode 18 of Season 2, Born This Way.  The focus of the episode is accepting yourself for who you are, flaws and all.  Will is very encouraging of Emma to get help and overcome her disorder, but at times becoming too overbearing and trying to utilize techniques that are not healthy/affective, such as suggesting she wear a shirt emblazoned with OCD on it.  During this episode, Will also tries to have Emma eat unwashed fruit (Emma always washes her fruit before eating it) and becomes very mean to her about her behaviors.  Will's statements and attempts to help her finally work enough to make her want to change and get help, and Emma begins attending therapy toward the episode.  Emma spends her entire first therapy session cleaning the leather chair in her therapist's office.  48 minutes into the session, Emma deems the chair clean enough to sit down in, at which point her therapist tells her it is clear she has a severe case of OCD and talks with her about her symptoms and how therapy and medication can help her overcome her feelings.  After talking about stigma and how Emma's illness is severely debilitating, the therapist self-discloses that she herself suffered from post-partum depression.  She then prescribes an anti-depressant for Emma to help her begin recovering, and suggests she return a week later.  Toward the end of the episode Emma is shown taking her first pill, and then decides to fully embrace her disorder by creating a shirt that says OCD on it to show that is something she dislikes about herself but was born with.

The episode then closes with a performance of Lady Gaga's "Born this Way" and that is the end of the focus on Emma's OCD for quite some time, until a few episodes in during the third season.

I have a number of thoughts about the therapy session and it's portrayal during the episode.  First off, I think the therapist should have established some limits with Emma and stopped her in her cleaning routine before the end of the session.  Yes, it would have made Emma uncomfortable to sit in a chair she had not completely disinfected, but they wasted an entire therapy session where they could have been making some progress and the therapist could have been getting valuable intake information.  Also, I did not like the therapist self-disclosing that she suffered from post-partum depression.  I think that is a level of self-disclosure that oversteps the boundaries between client/therapist, and that it was extremely unnecessary to the therapy session.  It also featured the cliche line, "the first step is admitting you have a problem" which I believe is overused and not really effective in the therapeutic setting.  The therapist also basically just wrote Emma a prescription and sent her on her way, suggesting she come back in a week but not bothering to make another appointment or ensure Emma would really be coming back in.  The final issue I had is that the therapist simply suggested "behavioral" interventions.  While I think behavioral interventions are extremely important and have great results, particularly in a case like this, Emma has a number of deep psychological issues from her past that need to be looked at in the therapy session.  Her relationship with her parents, her experiences that led her to engage in her obsessive behaviors, her failed relationships; all of these are things that could be explored in therapy that would most likely help provide some understanding of why she engages in the behavior she does.

Overall, I think it was a better portrayal of therapy than I have seen on most shows, but I still had some problems with it, particularly the self-disclosure piece.  Please feel free to leave any questions or comments you may have on the episode, and we'll be posting again next week!