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.