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.