Psychotherapists on Film

"Like it or not, psychologists are often the butt of a lot of jokes and sarcasm on film. Half the time the screenwriters don’t know the difference between a psychologist, a psychiatrist, and a para-psychologist" - Janine Waclawski

It can be entertaining to watch a Hollywood interpretation of what psychotherapy looks like. But as a practitioner myself, it can also be a bit unsettling. Sometimes my profession is being portrayed in the ugliest possible light. In Hollywood depictions we're lucky if therapists aren't spouting some mushy new age mumbo jumbo or sleeping with their patients.

I'm worried about the negative stereotypes of therapists being presented on the big screen and the public's perceptions of these faulty images as normal therapist behavior. The therapists we see on screen aren't normal, they are wacky, unboundaried, and unethical.

In 1998 the American Psychological Association's Media division formed the Media Watch Committee, a special panel of psychologists who examine the way therapists are represented in movies, television programs, and books. The group has been working towards developing contacts with Hollywood producers, screenwriters and directors to encourage them to release more accurate depictions of the psychotherapy process.The group is particularly concerned that many fictional on-screen therapists whose actions violate the APA Code of Ethics, are portrayed as brilliant and even noble (Sleek, 1998).

But does the picture of a competent, caring mental health professional who respects appropriate boundaries and avoids romantic attachments to her patients actually spell out box office smash? Silly, reckless therapists who often appear more neurotic than their patients just seem more entertaining.

Let's take a look at some contemporary depictions of therapists in film, and you can decide how Hollywood has handled the image of psychologists:

A Clockwork Orange

Alex, the main character, is incarcerated after a series of brutally violent incidents he commits with his gang. In jail, he is offered a reduced sentence if he agrees to take part in a kind of aversion therapy where he becomes physically ill at even the thought of violence or sex. "Government as therapist" bent on social conditioning to cleanse society of its ills.

One Flew Over the Cuckoo's Nest

Randall Patrick McMurphy tries to get out of work and jail time by faking mental illness. He's placed in a mental institution and goes up against Nurse Ratched, the authority figure who uses all her powers to control the patients' psychotic outbursts, and squelch their spirits. "Therapist as institution" that finally lobotomizes McMurphy and removes his individualism, leaving him helpless and obedient.

 
The Prince of Tides

Therapist played by Barbra Streisand makes good progress with her patient but crosses ethical boundaries when she begins an affair with her patient's brother- who later also becomes her patient.

 

 

 

Silence of the Lambs

Hannibal Lecter as both psychiatrist and patient, homicidal maniac with psychotic penchant for eating the flesh of his victims. Clarice Starling emerges as strong female figure in the profession though still vulnerable to Dr. Lecter's suggestions because of her own troubled history and unresolved "daddy" issues, which Lecter learns after demanding personal information from Starling. He then exploits her disclosure of her worst childhood memories to his own advantage.

 

Ordinary People

This 1980 film stars Judd Hirsch as Dr. Tyrone Berger, a therapist who helps a boy named Conrad resolve his guilt about the death of his brother. Dr. Berger wears the same cardigan sweater throughout the movie, making him seem friendly and appealing, and indeed furthers our image of therapists as such. Dr. Berger does become like a father figure to the boy though he makes himself available to Conrad at all hours which slightly oversteps the bounds of a real therapeutic relationship.

 
Eyes Wide Shut

A story about two troubled psychologists who are also husband and wife. The therapists, played by Tom Cruise and Nicole Kidman, have extramarital affairs with their patients and shoot morphine. Cruise's character attends orgies for a little diversion on the weekend.

 

Good Will Hunting

Therapist played by Robin Williams made great therapeutic inroads with his patient but crossed ethical boundaries in the process. After many failed attempts to engage Will Hunting in therapy, and his making a mockery of each therapist's approach, his MIT mentor looks up old pal and psychologist now teaching at community college to take on this client because they are both from South Boston. Later Williams discussed his own personal issues with his patient and at one point physically threatened him.

 

Analyze This

The popularity of psychoanalysis seems to emerge in this film, with Robert DeNiro starring as a mobster suffering from panic attacks a la The Sopranos, and Billy Crystal as his reluctant psychiatrist. DeNiro's character is naive about therapy and many of the film's gags are poking fun at his misconceptions of what therapy is all about. They begin to establish a relationship both inside and outside the therapy room where sometimes they forget professionalism and act more like buddies.

A ratings system

Media Watch has initially developed a rating system that ranks the different ways psychologists are portrayed. The rankings will gauge the overall imagery of therapists being presented in the media. There are several categories of therapist stereotypes on screen, such as:

• 'Dr. Dippy,' who is crazier or zanier than his patients. Examples are Mel Brooks in 'High Anxiety' or TV’s Frasier Crane.

• 'Dr. Evil,' usually a corrupt mind-controller or homicidal maniac like Hannibal Lecter in 'Silence of the Lambs.'

• 'Dr. Wonderful,' the warm, caring, competent therapist who has endless time to devote to patients and often cures them by uncovering a single traumatic event. Examples are the psychiatrists in 'Ordinary People' and 'Three Faces of Eve.'

• 'Dr. Rigid,' who stifles joy, fun and creativity. The spoilsport psychologist who tries to have Santa Claus committed as a lunatic in 'Miracle on 34th Street' is an illustration of this stereotype.

• 'Dr. Line-Crosser,' who becomes romantically involved with a patient, like Streisand in 'Prince of Tides.'

But Media Watch members also want to keep a sense of humor. They plan to recognize lampoon-ery as lampoonery, they say.

'We want to be careful not to get too critical of things that are obviously satire,' 'Then we would come across as too self-centered and rigid. When the film is making fun of everybody, therapist included, we shouldn’t act overly offended.' (Sleek, 1998)

Citations: Sleek, S. (1998) How are psychologists portrayed on screen? APA Monitor, 29 (11).

To read the full APA article, click here.

  
  
  
  
  
  
  

Why is it always about you?
How to Deal with the Narcissists in Your Life

Nearly everyone has some narcissistic traits. It's possible to be arrogant, selfish, conceited, or out of touch without being a narcissist. The practical test, so far as I know, is that with normal people, no matter how difficult, you can get some improvements, at least temporarily, by saying, essentially, "Please have a heart." This doesn't work with narcissists; in fact, it usually makes things worse (Ashmun, 2000).

We all know at least one person who could be described as selfish, self-absorbed, competitive, envious, vane, a know-it-all, argumentative, power hungry, sensitive to criticism, callous, and unsympathetic. These are just some of the characteristics of the narcissists we know and try to love. Just because you have a bad day, or even go through a difficult year, and exhibit some of these traits does not make you a narcissist by default. Almost everyone has some narcissistic traits, but being conceited, argumentative, or selfish sometimes (or even all the time) doesn't amount to a personality disorder. Narcissistic Personality Disorder is a long-term pattern of abnormal thinking, feeling, and behavior in many different situations that has a negative impact on social relationships (Diagnostic and Statical Manual IV-TR, 2006).

The best way to tell if you are encountering a narcissist is to go with your gut. Allow me to illustrate. Once I was at a party and met a friend of a friend, Lydia*, an attractive young woman attending acting school who claimed to be the next Julia Roberts. She seemed to take an instant liking to me and had a charming air that drew me in, making me feel as if I was truly in the presence of greatness. Compelled by her grand stories about meetings with Hollywood stars and readings for major acting roles in Los Angeles, I listened in awe and felt so important that she would talk to me. I couldn't get a word in edgewise as she went on and on about herself, but finally I managed to drop in a few words about my own endeavors as a graduate student and how much I was learning about myself. Suddenly she said it was sweet I was so interested in my studies, but studying acting was the only way to really understand who you are. She turned cold, and after a few awkward moments, she left me sitting there feeling humiliated. Had I said something to offend her?

When I brought up the subject with our mutual friend later on, he wasn't surprised by her behavior. "She's always been like that," he said. "You see, Lydia believes she will be famous one day. She was accepted to an acting school but left after only a few weeks when it wasn't what she expected. She is convinced she could be the next Julia Roberts." Turns out that this woman had never even been to Los Angeles! I had been hit by her grandiosity, an inflated sense of self that is not consistent with real talents or abilities which characterizes many narcissists. When I made the mistake of discussing my hard work in graduate school, Lydia couldn't tolerate what she must have felt was direct competition with her fantasy, and she dumped all that shame and humiliation on me with a patronizing remark and abrupt departure. When I say, "Go with your gut" I mean to pay attention to the negative feelings that narcissists tend to dump on anyone who interacts with them. If you find yourself feeling an "ick" factor of insecurity, shame, or embarrassment after speaking to someone you suspect is narcissistic, they probably are. The main indicator to tell whether you are dealing with a narcissist is that you come away feeling bad about yourself. Shame and fear are the feelings that narcissists cannot tolerate, so they find creative ways to disown them, by shedding them onto the people who threaten their carefully constructed image.

Grandiosity. Which brings me to the all-important issue of image for the narcissist. Image is everything. It's all they are. Narcissists are grandiose. They live in an artificial self invented from fantasies of absolute or perfect power, genius, and beauty. These people act like they're in love with themselves. And they are in love with an ideal image of themselves -- or they want you to be in love with their pretend self (Ashmun, 2000). They have an exaggerated sense of self-importance that is not equal to actual achievements. Let me clarify. If a world champion boxer brags about being the best in the world, that is not being grandiose because the boxer has actually achieved that status. If an average boxer does it, then it would be an inflated self image because his achievements do not match the title. That's grandiosity.

Low empathy. Lacking empathy is a profound disturbance to the narcissist's thinking (cognition) and feeling (affectivity). They can pay attention only to stuff that has them in it. This is not merely a bad habit -- it's a cognitive deficiency. They cannot read or understand what other people might be feeling, and show little concern for other's emotions. Narcissists pay attention only to themselves and stuff that affects them personally. However, since they don't know what other people are doing, narcissists can't judge what will affect them personally and seem never to learn that when they cause trouble they will get trouble back. They won't take other people's feelings into consideration and so they overlook the fact that other people will react with feeling when abused or exploited and that most people get really pissed off by being lied to or lied about (Ashmun, 2000).

Entitlement. Narcissists feel entitled to whatever they can take. They expect privileges and indulgences, and they also feel entitled to exploit other people without any trace of reciprocation (Ashmun, 2000).

"I'm special". Narcissists believe they are "special" and can only be understood by, or should associate with, other special or high-status people or institutions (DSM IV-TR, 2006). They do think of themselves as intellectually or morally superior, and everyone who is not special and superior is worthless. By definition, normal, ordinary, and average aren't special and superior, and so, to narcissists, they are worthless.

Admiration. These people require, almost demand, excessive admiration. They crave praise, compliments, deference, and expressions of envy all the time, and they want to be told that everything they do is better than what others can do. Sincerity is not a huge issue for them, all that matters to them is the sheer amount of butt-kissing. They want it all the time.

Selfish, arrogant, and envious. Narcissists selfishly take advantage of other people to achieve their own ends, they may come across as haughty, arrogant, and contemptuous of others, and they may be envious of what others have or believe that other people must be envious of them (DSM IV-TR, 2006).

And to make your experience of dealing with a narcissist even more unpleasant, they are typically very sensitive to criticism or very critical of other people. They think that they must be seen as perfect or superior or infallible, anything less would make them worthless. In fact, if you say, "Please don't do that again -- it hurts," narcissists will turn around and do it again harder to prove that they were right the first time; their reasoning seems to be something like "I am a good person and can do no wrong; therefore, I didn't hurt you and you are lying about it now..." (Ashmun, 2000).

No matter how gently you suggest that they might do better to change their ways or get some help, they will react in one of two equally horrible ways: they will attack or they will withdraw. Narcissists will say anything, they will trash anyone in their own self-justification, and then they will expect the immediate restoration of the status quo. They will attack you and spew a load of bile, insult, abuse, contempt, threats, and then -- well, it's kind of like they had indigestion and the vicious tirade worked like a burp: "There. Now I feel better. Where were we?" They feel better, so they expect you to feel better, too (Ashmun, 2000). This is what we might call a narcissistic rage. It's not anger, because anger has a protective purpose and a rational direction: to stop whatever is causing injury. Rage has no target, it is irrational, and it can only be destructive. Sometimes you might catch a narcissist having a meltdown when he doesn't get his way. It looks a lot like a four-year old throwing a tantrum, but all the more disturbing because you're watching a grown up exhibit four-year old behavior.

Narcissists may be workaholics. Why would they work long hours if they are living in a fantasy world where they are already the stars? A narcissist may, in fact, hold himself to a grinding work schedule that gives him something like an addictive high so that, when wrought up, he can be sort of dazed, giddy, and groggy (Ashmun, 2000). Usually, this excessive busyness appears to be -- and some will even tell you this -- an attempt to distract themselves from unpleasant or inconvenient feelings. Here is the narcissists big secret, and one she has not yet discovered herself: inside, they are filled with depression. To slow down for even one minute means they might have to spend some time with themselves and look at who they really are.

So, how to deal. I got some great explanations and the bulk of this description from a website by layperson Joanna Ashmun called Narcissistic Personality Disorder (NPD):How to Recognize a Narcissist
If you would like to learn more, I strongly advise visiting her site by clicking the link. Also there are some good books that address the topic of dealing with narcissists out there, most notably "Narcissism: The Denial of the True Self" by Alexander Lowen, M.D., "The Drama of the Gifted Child" by Alice Miller Ph.D., and "Why is it Always About You? The Seven Deadly Sins of Narcissism" by Sandy Hotchkiss, L.C.S.W.

It is possible to live with and deal with narcissists on a daily basis, but you may need the help of grounding influences like a good social support structure, personal therapy, or a bit of reading such as from the titles listed above. Remember to determine your own self worth, and not to allow the narcissists in your life to dictate who you are and how you feel about yourself. That is the best medicine I can offer.

Not only are we grappling with serious and tragic events such as school shootings, natural disasters, and terrorist attacks, but our children are witnessing these events and trying to cope and understand what's happened.

These atrocities are obviously difficult enough for adults to comprehend, so how can we expect children to manage their feelings about things like Hurricane Katrina, the Iraq War, and the recent Virginia Tech shootings? We'd like to believe that children are too young to be affected, but they are actually like sponges: absorbing the news coverage, overhearing grown up conversations, and chatting to their friends at school. Often kids feel confused about what they see or hear because they haven't yet developed the cognitive ability to make sense of these harrowing stories.

Children are witnessing these tragedies and losses and it's important not to let them become secondary victims.
What may be especially upsetting for children are the images presented by the media when tragedy strikes, as photos and video clips of Hurricane Katrina, the War in Iraq, or the shootings in Virginia contain distressing pictures of dead bodies, violence, destruction, and families torn apart. Children who have been touched by tragedy (i.e. lost a family member or friend, school had to take precautions) are especially vulnerable. Those who have encountered a recent loss, such as a death, divorce, or separation from loved ones, may be more susceptible to troubled emotions without support from caring adults.

For some children coping with difficult events, especially those who have been directly affected by tragedy, additional support may be found through child and family counseling or other psychological services. For many parents, this kind of support may be vital to help them manage their own emotions and know the right things to help their children cope.

How to help your child understand tragic events really depends on your child's age and stage of development. For preschool age children, it may be best to steer them clear of graphic images often presented on television. If they do have questions, give a young child limited and age appropriate facts. Older children are more capable of understanding situations and may have more questions. They may be able to watch some news coverage with an adult present to field their tough questions. Find out what your older child already knows about the incident, and then use open-ended questions and look for their cues about how many details they need. It's common for children to seek reasons for tragedy, and to look to grown ups for reassurance that everything will be all right. Reassure them but be careful of making false promises. Try not to dismiss their concerns by saying, "Don't worry about it" or "Try not to think about it". They need to be able to talk openly about their fears and to know that it's okay for them to share their feelings with you.

Children often look to parents for cues about how to deal with tragedies. If you are extremely anxious or upset, they may feel guilty about burdening you with their fears, or they may feel even more afraid. On the flipside, if you hide your feelings then your child will likely follow your lead. It's okay to cry in front of your child, but it's not appropriate to show them you are overwhelmed with fear.

There are some warning signs when children are having major difficulty coping following a tragic incident or major loss. Post-traumatic stress disorder may be present when a child has experienced a trauma and requires professional help. Other symptoms to look out for include any changes in mood or personality (i.e. becoming more quiet, anxious, fearful, irritable), behavioral problems, fighting, sleep problems, bedwetting, nightmares, loss of appetite, or somatic complaints (i.e. headaches or stomach aches). If you notice major changes in your child's behavior that may relate to a difficult event, talk to your GP or pediatrician about getting support for your child and family.

It's may be very helpful to allow your child to do something to help victims or their families. Children often feel better when they have some control: they can't change the situation but they can do something positive in response. They might make a card or send a small donation via relief agencies like the Red Cross. Depending on your family's beliefs, with your assistance they might light a candle or say a prayer.

Remember that you can make all the difference by being a role model for your child and by providing a stable, supportive, loving home environment.

Could you or a loved one be depressed?
How to recognize the signs and symptoms of depression

Did you know: More than 14 million Americans, or more than 6 percent of adults, experience depression in any given year.

Some people say that depression feels like a black curtain of despair coming down over their lives. Many people feel like they have no energy and can't concentrate. Others feel irritable all the time for no apparent reason. The symptoms vary from person to person, but if you feel "down" for more than two weeks, and these feelings are interfering with your daily life, you may be clinically depressed.

What are the most common symptoms of depression?

Major depressive disorder, commonly referred to as "depression," can severely disrupt your life, affecting your appetite, sleep, work, and relationships.

The symptoms that help a doctor identify depression include:

• constant feelings of sadness, irritability, or tension
• decreased interest or pleasure in usual activities or hobbies
• loss of energy, feeling tired despite lack of activity
• a change in appetite, with significant weight loss or weight gain
• a change in sleeping patterns, such as difficulty sleeping, early morning awakening, or sleeping too much
• restlessness or feeling slowed down
• decreased ability to make decisions or concentrate
• feelings of worthlessness, hopelessness, or guilt
• thoughts of suicide or death

Q. I'm concerned I might have some symptoms of depression. Where can I find more specific information to know for sure?
   
    Take this Depression Questionnaire, 16 simple questions that may help identify common     symptoms of depression

What can trigger depression?

Depression has no single cause; often, it results from a combination of things. You may have no idea why depression has struck you.

Whatever its cause, depression is not just a state of mind. It is related to physical changes in the brain, and connected to an imbalance of a type of chemical that carries signals in your brain and nerves. These chemicals are called neurotransmitters.

Some of the more common factors involved in depression are:

• Family history. Genetics play an important part in depression. It can run in families for generations.
  
  
• Trauma and stress. Things like financial problems, the breakup of a relationship, or the death of a loved one can bring on depression. You can become depressed after changes in your life, like starting a new job, graduating from school, or getting married.
  
  
• Pessimistic personality. People who have low self-esteem and a negative outlook are at higher risk of becoming depressed. These traits may actually be caused by low-level depression (called dysthymia).
  
  
• Physical conditions. Serious medical conditions like heart disease, cancer, and HIV can contribute to depression, partly because of the physical weakness and stress they bring on. Depression can make medical conditions worse, since it weakens the immune system and can make pain harder to bear. In some cases, depression can be caused by medications used to treat medical conditions.
  
  
• Other psychological disorders. Anxiety disorders, eating disorders, schizophrenia, and (especially) substance abuse often appear along with depression.

Are there different types of depression?

Dysthymia is another mood disorder. People who have it may feel mildly depressed on most days over a period of at least two years. They have many symptoms resembling major depression, but with less severity.

Symptoms of depression may surface with other mood disorders. They include seasonal major depression (also known as seasonal affective disorder), postpartum depression, and bipolar disorder.

Seasonal Affective Disorder has symptoms that are seen with any major depressive episode. It is the recurrence of the symptoms during certain seasons that is the hallmark of this type of depression.

Postpartum Depression is a type of depression that can occur in women who have recently given birth. It typically occurs in the first few months after delivery, but can happen within the first year after giving birth. The symptoms are those seen with any major depressive episode. Often, postpartum depression interferes with the mother's ability to bond with her newborn. It is very important to seek help if you are experiencing postpartum depression. Postpartum depression is different from the "Baby Blues", which tend to occur the first few days after delivery and resolve spontaneously.

Bipolar disorder, another mood disorder, is different than major depressive disorder and has different treatments.

Where can I get help to manage depression?
Most people with depression never seek help, even though the majority will respond to treatment. Treating depression is especially important because it affects you, your family, and your work. Some people with depression try to harm themselves in the mistaken belief that how they are feeling will never change. Depression is a treatable illness.

• Talk to your doctor. If you are experiencing any or several of these symptoms, you should talk to your doctor about whether you are suffering from depression. As with any medical illness or condition, only your doctor or other qualified healthcare professional can provide a diagnosis of depression.

• Ask about anti-depressant medications. Anti-depressants work for many people- they can make you feel better, and improve or completely relieve your symptoms. But sometimes people have unrealistic fears or expectations about them. Some hope to feel better overnight; others worry that medications will change their personalities in ways they won't like. Both extremes are unlikely. The first step towards getting better and staying better is to take your medication exactly as prescribed by your doctor.

• Find a therapist. Psychotherapy, or "talk therapy", is one of the most effective ways to treat depression. Studies have proven that talking to an expert about your condition can help resolve it. While the results are not immediate, you may find that just expressing what you're feeling can bring some relief. Short-term therapy has become more common and may occur over a period of 10 to 20 weeks. Click here for more information on finding a therapist.
  

NOTE: If you are in an immediate serious crisis please contact your doctor or go to your local hospital or emergency room.

Citations:    Glaxo Smith Kline www.depression.com

                    WebMD http://DepressionResources.webmd.com

                    American Psychiatric Association www.psych.org

                    American Association for Marriage and Family Therapy www.aamft.org

Is there life after death?

Do people really have near death experiences? Does consciousness survive after our bodies cease to function?

I remember studying near death experiences in a graduate lecture on brain physiology and neurochemistry. We had a lecture on how neurotransmitters function. The lecturer explained that when the body experiences a trauma, such as being pierced by a bullet or going under the knife in surgery (if anesthesia fails to sedate and there is some consciousness), there is a physical and neurological response whereby the body is flooded with endorphins. He believed it was this "rush" that allowed a person to survive intense physical pain as part of human evolution. It's similar to hearing about a regular person who, in an emergency situation, has a surge of adrenaline allowing him/her to rescue another in a feat of extraordinary strength, like lifting a car. Going back to the idea that endorphin rush allows us to survive sudden physical trauma, this lecturer believed that the painful experience was also stored in areas of the brain devoted to physical and emotional memory, the hippothalamus and the amygdala. In his opinion, it was precisely the endorphin rush that gave the person a hallucinatory vision during the trauma, a sense of dissociation from the reality of pain: floating outside the body, seeing a tunnel, or moving toward the light. Upon resuscitation, the person often has a vivid memory of this "out of body" experience and can relate it to others.

Maybe kids have the answer?

That is one psychologist's view, and perhaps a cynical one, of the potential for near death experiences. But is there other evidence of an afterlife? I found this website that documents research studies being done into the topic. I also read an amazing account of children who report past-life experiences in the first person, called "Life before Life: A Scientific Investigation of Children's Memories of Previous Lives" by Jim Tucker, a child psychiatrist who has done years of empirical and anecdotal research into the topic, often travelling the globe to interview children and families reporting the phenomenon. It's a bit psych-heavy, but check it out if you are interested in the idea that some children, as soon as they develop speech, begin to relate accurate stories about individuals who previously died.

To read about a five-year-old who speaks to his mother from the first-person perspective of his grandfather who died prior to his birth is just bizarre. The grandfather had been stabbed in the line of duty as a police officer and subsequently died, his lung being pierced by the injury. And as I recall, the boy either had birthmarks on his back and chest that matched the grandfather's wounds or he was born with respiratory difficulties. At age 4 or 5, the boy knew nothing of his grandfather's death but one day made a statement to his mother to the effect of, "Mommy, do you remember when you were my little girl and I was your daddy?" He began to show similar habits and behaviors that his grandpa once had.

Some of these young children often identify with deceased individuals that lived hundreds of years earlier, or with people who live in different countries, speaking other languages. They often cried to parents and begged them to reunite them with their original families. When some parents did, the children would recognize their partners, relatives, or children from the previous life and call them by name, sometimes recounting old memories with them. They could recount how they died in detail. One young boy, who identified as a farmer with a wife and child in a previous life, angrily pointed out his murderer when reunited with his "previous" family, though it was originally believed that his death had been an accident. In cultures where beliefs in reincarnation are validated, as in South East Asia, these reunions are more commonly accepted, but it is also happening in Western countries.

I suppose that people's beliefs about the afterlife and reincarnation are heavily influenced by their unique perspectives, experiences, and religious affiliations. What do you believe?