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Therapists on the Big and Small Screens versus Real Life

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This blog was inspired by a recent conversation over lunch at Greenblatt's Deli with fellow therapist and friend Lisa Jonsson here in Los Angeles.

We shared our frustration that much of what is known about therapists is derived from unflattering cinematic depictions. One might surmise we are a group of mostly unworthy professionals who routinely act out in ways illegal and unethical. A few exceptions in which therapists are represented in a more positive light are noteworthy.

Perhaps the most accurate portrayal of a good therapist in a film is Judd Hirsch in "Ordinary People" (1980). More recently, honorable mention goes out to "Hope Springs" (2012). Steve Carell does an excellent job validating what we want to see in a therapist. Clients Meryl Streep and Tommy Lee Jones are treated just as they should have been in a therapeutic setting -- with warmth, nurturance, respect, kindness, and empathy.

"Silver Linings Playbook," (2012) renders a realistic therapist-client relationship initially, until it goes awry as unfortunately he winds up socializing in client, Bradley Cooper's, home. Medical doctors can do this, though it may be ill-advised. Except in cases of harm to self or others, therapists are not supposed to disclose their relationship or even greet clients in public. This is the client's right under confidentiality.

Another runner-up for life-like and realistic portrayals of therapist is the television show, "In Treatment" (2008-2011), though the decision for Dianne Wiest to move from clinical supervisor of Gabriel Byrne to personal therapist is not advised. Edie Falco, who is plausible as James Gandolfini's therapist in "The Sopranos" (1997-2007), ended seven years of treatment too abruptly.

For the most part, therapists have been depicted as bordering on the criminal, in need of immediate intervention and dangerous to themselves and others. It is well known that the helping professions do attract those who have first hand knowledge of the territory, having been wounded and hopefully healed themselves.

The idea is that in becoming repaired through scholarship, training and experience, we have surrendered to the process and now are able to help others with their journey to wholeness. The best among us continue with clinical treatment and supervision ourselves, in addition to maintaining mental health practices, continuing education and diligent self-care.

It's disturbing to note that therapists are frequently rendered breaching a serious, even sacred trust, engaging in inappropriate and/or dual relationships with our clients. To say this is potentially very damaging in the short and long terms, is an enormous understatement. Understandably, therapy can be such a transforming experience and yet it's hard to sell. The truth is lasting and positive personal change is also hard to come by, even when you want it. There are no short cuts.

Effective and lasting change is best likened to watching paint dry, or more aptly watching blood dry. It's assumed the mainstream or majority public would prefer not to engage with moving material without pumping up the conflict and tension to heighten the drama. Hence we have scandalous reality and self-help talk shows that may have desirable -or dubious - effects in terms of educating the public about sensitive subject matter.

For the most part though, therapy and therapeutic experiences -- the lightening bolt 'ah-ha' moments -- are over-dramatized for the entertainment factor in film and television representations. What follows are brief snapshots, or a heads-up on some of the most shocking, egregious boundary-violating bad-news therapists we're referring to:

Though no doubt entertaining, Lisa Kudrow in "Web Therapy" (2011-) plays a strongly opinionated, self-disclosing therapist. We aren't meant to provide advice to clients, rather to help maximize your potential.

"Running with Scissors" (2006) psychiatrist Brian Cox takes a patient's son to live with him in his home and then provides him with alcohol and drugs so that he can fake his own suicide. Often times, even psychiatrists are portrayed as "therapists" when in actuality most psychiatrists are medical doctors who do not engage in talk-therapy just psychotropic medical management.

"Prime" (2005), Meryl Streep continues to see a client Uma Thurman, even after she finds out she is actually her son's girlfriend.

"The Departed," (2006) therapist Vera Fermiga sleeps with patient Leo Decaprio.

"The Prince of Tides," (1991) Barbara Streisand plays a therapist engaging in a love triangle with her client's brother. In at least one scene she sits on her desk wearing high heels, a power-suit jacket and short skirt, her legs crossed at her knees, thighs showing tapping her long painted finger nails on her desk while patient Nick Nolte slouches on the couch.

"Antwon Fisher," (2002) Denzel Washington plays a psychiatrist treating a rage filled soldier returning from war who invites the patient to his home and it's not his home-office.

Not naive, Lisa and I do not expect anything to change soon. Film and television will continue to portray us as boundary challenged, engaging in dual relationships, unstable as individuals or even apathetic. Disrespecting therapists provides a more interesting, risky story arc. Despite the pervasive pejorative representations of therapists, we hope this blog post begins to raise awareness to the public about what a therapeutic relationship should really look like.