Dr. Mona On Dr. Phil

03/28/2008 02:48 am ET | Updated Nov 17, 2011

Q: So, Dr. Mona, what do you think about Dr. Phil? Is he a real psychologist?

A: The question is in the air. It is being asked of me wherever I go and has been raised on television shows and in magazines. It seems the general public is wondering about Dr. Phil. Is he the real McCoy?

I know that everyone knows the full story, but let's just review the facts to make sure we are all on the same page.

1) Britney Spears has been "acting out" in various ways. No one seems to know exactly what is wrong. Could it be drugs, alcohol, depression, bi-polar disorder, or just a heroic sense of entitlement? Whatever the diagnosis, she seems to reel from crisis to crisis, has lost temporary custody of her two children and appears to lack any support system at all - a family she trusts or even close friends. In some sense, her isolation seems complete.

2) Dr. Phil went to see Britney in the hospital. Afterwards, he made a statement about her mental state, her fragility and her need for help. Britney responded with fury, saying she did not want his help and could do without her family's as well. The woman clearly felt betrayed.

3) Dr. Phil, who was in contact with the Spears family, was planning an episode about Britney for his TV program. It's not clear who came up with this idea. The Spears family says Dr. Phil contacted them and he says it was the other way around. It's not even clear what either party has in mind -a show, therapy, a "Dutch uncle" talk. We can only go on the most authoritative source on this matter, People magazine.

In People and other magazines, mental health experts of all sorts have suggested possible diagnosis of what ails Britney. The temptation is strong, I know, to say something about Britney's parents or her environment or the effects of fame or what money can do to the young -and, sometimes, to the old as well. Some of what's been said makes sense, but I prefer to know the patient and his or her background before opening my DSM and coming to any conclusions.

So let me just deal with Dr. Phil McGraw's role in all this. He uses the title "Dr." for his television program and since he deals with behavioral issues, it's logical to assume he's a psychologist and not, for instance, a veterinarian. Dr. Phil indeed has a B.A. from Midwestern State University and an M.A. and Ph.D. in clinical psychology from North Texas State University with a dual area of emphasis in clinical and behavioral medicine. So says his web site. But while he was once licensed in Texas, he is not licensed in California. The state licensing board there made the sound decision that what he does on television is not psychology, but entertainment. That does not mean that he does help people or that what he calls his "get real approach" to psychological problems does not have value. This is not a bad technique. In fact, it is one I use quite often myself.

So, if Dr. Phil can help people what does it matter what he calls himself or what the public thinks he's doing? Well, it matters to me and others because for millions of people, Dr. Phil is psychology. They see what he does and they think it's representative of what psychologist in general do. It's not. There are three critical differences: PROCESS, CELEBRITY, and CONFIDENTIALITY!

PROCESS -- Dr. Phil is known as being very confrontational and direct. Good for him. Allowing a patient to slump into victimization doesn't do the patient any good. It retards the acceptance of reality. It delays the ability to take charge of one's own life. But with Dr. Phil, reality is not slowly revealed to the patient by coming to terms with it. Dr. Phil often just states it: this is what's happening. Now, this is what needs to be done.

But how? What's the process? We can't see it because none has been revealed. No initial period of trust was built. No unique language of communication was established between each member of the dyad: the patient and the therapist. One could argue that the people who go on the Dr. Phil show are predisposed to trusting him and to understanding a shared language. They know who he is and what he does. He's famous for it. We believe in him and we've unconsciously communicated and interacted with him already in our fantasies. But it's all superficial. Patience and time has not worked its wonders. The patient has not arrived at a course, chosen a path, come to terms with a problem and learn how to grapple with it, but has been told what to do. This is show biz, not therapy. This is an episode, not a relationship.

CELEBRITY -- We have identified how celebrity can be potentially helpful. It moves along the process to resolution faster than normal paths. Patients often grade a therapist by their celebrity -famous for treating the famous. Sometimes our worth is measured by how much we charge -the more we ask, the better we must be. But neither hourly rates nor the fame of our patients say much about the real value of the therapy. In fact, it can all lead to unrealistic expectations or fantasy, and disappointment can follow.

What may be more important that the effect celebrity has on Dr. Phil's patients is the effect it has had on him. Does he forget sometimes that the power of celebrity is quite different than the ability, the willingness, to establish a profound, trusting, and meaningful relationship? Celebrity that attaches to the psychologist side has to interfere with that.

CONFIDENTIALITY -- Everyone knows about this. Even people who have not had therapy know about confidentiality. It is the essence of some interactions and what makes them work. We trust our significant others to listen to us and to be on our side and to not tell others. We trust our lawyers to keep their mouths shut about what's in our will or what crimes we may have committed or that we're planning, just as soon as the stock options are exercised, to get a divorce.

We need to trust our therapist to listen unconditionally when we reveal our most intimate and embarrassing thoughts. If that confidentiality is broken, trust goes out the window -and with it any chance of good and successful therapy. But Dr. Phil, whatever his role, made a public statement shortly after seeing Britney. Never mind what he said. He should have said nothing. He acted as if he had two clients, to obligations to satisfy -Britney and the press. Since he was not functioning as a therapist -remember, he is not licensed in California - he cannot be accused of acting unethically. But to the general public, he's the most famous shrink since Freud - and he seemed to break confidentiality!

Even when I see children -- when they are brought to me by a parent, when the parent pays the bills, when the parent, obviously, is a loving and caring party - I am clear to the child and to the parent that (barring some grave threat to the child) I will say nothing to no one about what transpires in my office. Parents are often shocked and angered by this policy. But it's essential. Otherwise, I could never gain the trust of the child.

Confidentiality is an important, essential, component of the psychologist's ethic. It can be hard sometimes to get your only applause or appreciation when you look at yourself alone in the mirror after a session. But confidentiality is integral to trust and alliance. It is the omerta of the mental health mob.

Dr. Phil has his uses, but he has made his choice. He's an entertainer, not a licensed therapist. But that's a distinction the public may not understand. Whatever his intention for visiting Britney Spears, as long has he had the moniker "Dr." before his name, he should have kept his mouth shut.