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.