As my previous blog entry discussed concerns about depictions of therapists in the New York City Fringe Festival, it seemed sensible to follow that up with a similar consideration of depictions of therapists in commercial films. In fact, this is probably a more important focus given that films reach far more people than Fringe Festival plays do. In addition, I have DATA. No, not Brent Spiner, but systematically collected and analyzed ratings of popular films.
This discussion must start with a disclaimer, however: The data I am referring to come from a study of films now a decade or two old—films from 2000-2013. We cannot be sure they accurately represent more recent depictions, but I would guess that many of the same patterns remain apparent and that readers will be able to identify them easily in the films they have seen more recently.
A perusal of film descriptions and trailers enabled us to identify 53 films, with 65 therapist characters, released between 2000 and 2013. We then narrowed our focus to 22 films in which the therapist characters (26 in total) appeared on screen for 15 minutes or more, and we viewed and rated those characters. Many of the rated films are probably familiar to readers. They included such films as Anger Management, Analyze That, Basic Instinct, K-Pax, Red Dragon, Silver Linings Playbook, and Vanilla Sky. (The full methodology for this study—and a more detailed account of results—is described in a professional journal report: Wahl, Reiss, & Thompson (2016): Film Psychotherapy in the 21st Century, Health Communication, 33:3, 238-245).
The most common personal characteristics of the film therapists were positive. The majority were shown as intelligent, knowledgeable, and caring (Thumbs up!). However, equally common was the portrayal of the therapist as “unethical,” more than half of the film therapists (Thumbs down!). For example, fully half of the film therapists had relationships with clients outside of therapy, including temporarily moving in with a client, dating a client’s relative, and having clients visit their homes. Almost a quarter of the film therapists (23%) pursued a sexual/romantic relationship with a client. (Double thumbs down!)
One of the most significant concerns about repeated depictions of therapists behaving in these inappropriate ways is that they may generate incorrect ideas about what to expect in therapy, which, in turn, may interfere with therapy and/or make clients vulnerable to exploitation and harm. Viewers with a steady diet of films where such extra-therapy relationships are the norm may not recognize their inappropriateness and may accept — or even welcome—social/romantic relationships with their therapists. Blending personal and professional roles, however, especially entering a sexual or romantic relationship, is a significant and damaging breach of professional ethics. It is known to complicate — and to undermine — the therapist’s ability to help clients. In fact, such behavior is likely to harm client mental health, contrary to the goals of therapy. That is why ethical guidelines for mental health professionals strongly advise against such personal relationships with clients. (My spouse also has some strong restrictions about this, but that’s a different matter.) Fortunately, most therapists adhere to ethical guidelines, even if film therapists do not.
Film therapists also displayed behaviors that may reinforce common fears that people bring to therapy or that keep them from utilizing therapy. Clients often fear that therapists, with their assumed great psychological knowledge and skill, will exploit and/or manipulate them. They will not be reassured by film therapists, over a third (35%) of whom were portrayed as “manipulative.” Manipulations included scamming clients out of money, lying to clients about the purposes of treatment interventions, and putting pressure on clients because of the therapists’ own need for information.
Another common fear is that the deeply personal information clients share with therapists will be disclosed to others. While the principle of confidentiality is a core tenet of therapy and an essential foundation of trust for effective therapy to proceed, film therapists’ behavior (inaccurately) suggests that clients’ fears may be warranted. More than half of the film therapists (58%) disclosed client information to others. Film therapists discussed clients with family, friends, and even other clients, without their clients’ knowledge or permission. These film therapists provided a model that would surely be off-putting to audience members already worried about how their disclosures in therapy might be handled.
The (somewhat) good news was that film therapists in our sample were rarely out-and-out villainous, contrary to observations from previous studies (although Hannibal Lecter was one of our film therapists and certainly did his best to promote the evil psychiatrist stereotype). While mostly not dangerous, however, our film therapists were commonly unkind, even physically aggressive, to their own clients. They yelled at them (31% of the therapists), slapped or pushed them or worse (31%), and expressed unfavorable attitudes about them (23%). These are hardly the kinds of models that will overcome reluctance to seek therapy. And not the kinds of behaviors that ethical and effective therapists display.
It is tempting to underestimate the impact of such film portrayals as merely Hollywood entertainment. They are entertainment, of course, and, on a conscious level, we know they are fiction. However, social science research has shown that repeated exposure to similar film images and stories allows the regularly presented images and ideas to take root in the backs of our minds and influence how we understand and respond, even when we believe we are simply enjoying creative entertainment. Accordingly, we need to be vigilant, even as we enjoy, and actively remind ourselves that films are likely NOT reflecting reality, including what therapy and therapists are like.
Otto Wahl, Ph.D.
MHCT Development Committee Member
