As a therapist in training, I'm appalled by this movie

I am going to preface this post with the information that I am in my third year in a clinical psychology doctoral program. This translates to I am one year above where the therapist in this film is in her training. I cannot express how appalled I was watching this movie with any scene that displayed the horrific and entirely unethical psychotherapy delivered to this suffering patient. I believe it would have been a much stronger film had the therapist actually been portrayed appropriately. Without saying it, I think it’s obvious that her level of unethical practice is ten times worse than what actually happens in real-life therapeutic situations. First off, WE DO NOT DATE/SLEEP WITH OUR PATIENTS!!! I cannot reiterate this fact enough times and just to prove it without going on a massive tangent here is the exact ethical code that states this obvious fact:

10.05 Sexual Intimacies with Current Therapy Clients/Patients
Psychologists do not engage in sexual intimacies with current therapy clients/patients.

10.06 Sexual Intimacies with Relatives or Significant Others of Current Therapy Clients/Patients
Psychologists do not engage in sexual intimacies with individuals they know to be close relatives, guardians, or significant others of current clients/patients. Psychologists do not terminate therapy to circumvent this standard.

In addition, WE DO NOT TOUCH OUR PATIENTS WITHOUT EXPRESS PERMISSION!!! He even noted how uncomfortable it was for her to be touching him throughout treatment and got legitimately irritated at her for it. Furthermore, as part of realistic psychotherapy practices we do not provide our patients with any additional services (i.e., we don’t give them rides home).

As part of our training to be psychologists we are taught to uphold the highest standard of practice and that includes informed consent. For example, during their first meeting she just goes straight into the appointment and does not even provide the patient with the limits of confidentiality (e.g., intent to harm self or others, suspected child or elderly abuse). She, once again, violates an ethical standard. Furthermore, her statement that what does on in the therapy room will be used in dissertation violates the informed consent to research code which is similar to the one presented below:

10.01 Informed Consent to Therapy
(a) When obtaining informed consent to therapy as required in Standard 3.10, Informed Consent, psychologists inform clients/patients as early as is feasible in the therapeutic relationship about the nature and anticipated course of therapy, fees, involvement of third parties and limits of confidentiality and provide sufficient opportunity for the client/patient to ask questions and receive answers. (See also Standards 4.02, Discussing the Limits of Confidentiality, and 6.04, Fees and Financial Arrangements.)

(b) When obtaining informed consent for treatment for which generally recognized techniques and procedures have not been established, psychologists inform their clients/patients of the developing nature of the treatment, the potential risks involved, alternative treatments that may be available and the voluntary nature of their participation. (See also Standards 2.01e, Boundaries of Competence, and 3.10, Informed Consent.)

(c) When the therapist is a trainee and the legal responsibility for the treatment provided resides with the supervisor, the client/patient, as part of the informed consent procedure, is informed that the therapist is in training and is being supervised and is given the name of the supervisor.

I will give her one point that in the beginning of their appointment when he asks how the other patients she has seen are doing she refuses to answer (good for her!). Also, when he is guessing how many patients she has seen she does agree to tell him, which is part of our transparency of training obligation we have to our patients. It is their right to know the level of care they are receiving. However, despite her momentary reflections of reality, the list of violations continues.

During their first appointment, he calls her doctor even though she still is in her training and goes on to explain that the hospital is a training facility. Given her level of inexperience, it is likely that this placement is her first practicum or clinicals as other professions call it. Part of training in the mental health field is learning how to be transparent with our patients, particularly when it comes to our level of training and where we are in the program. She is still under training and it is required that she tell him this and what it means about his treatment (i.e., she is receiving supervision on her cases). Despite the fact that he continues to call her doctor, which he as the patient has every right to do, she does not attempt to deter him from doing this. If she is portraying herself as a doctor, which is the vibe I received when watching the film, she is again violating an ethical code:

5.01 Avoidance of False or Deceptive Statements
(a) Public statements include but are not limited to paid or unpaid advertising, product endorsements, grant applications, licensing applications, other credentialing applications, brochures, printed matter, directory listings, personal resumes or curricula vitae or comments for use in media such as print or electronic transmission, statements in legal proceedings, lectures and public oral presentations and published materials. Psychologists do not knowingly make public statements that are false, deceptive or fraudulent concerning their research, practice or other work activities or those of persons or organizations with which they are affiliated.

(b) Psychologists do not make false, deceptive or fraudulent statements concerning (1) their training, experience or competence; (2) their academic degrees; (3) their credentials; (4) their institutional or association affiliations; (5) their services; (6) the scientific or clinical basis for or results or degree of success of, their services; (7) their fees; or (8) their publications or research findings.

(c) Psychologists claim degrees as credentials for their health services only if those degrees (1) were earned from a regionally accredited educational institution or (2) were the basis for psychology licensure by the state in which they practice.

One of my biggest complaints, aside from the obvious ethical violations, is how the therapist portrayed herself in the therapy room. She presents herself as fearful, nervous, excessively talkative, inexperienced, and unprepared. Part of clinical training prior to practicum place is all about engaging in behaviors that are best for the patient. This particular individual was not interested in being lectured to or having words put into his mouth (e.g., you must be angry right now). Her incessant need to dominate the therapy room and tell him how he is supposed to be feeling portrays therapists and know-it-alls who lack the appropriate social skills to work with individuals who are going through some of life’s biggest challenges. She presents herself as awkward and unknowing in a lot of the situations. Just as a side note, who seriously doesn’t know who Doogie Howser is? I am 23, younger than this portrayed therapist, and I know who he is and not just as Barney Stinson. At that point in my training, which was just one year ago, I was nervous to finally be seeing patients because it is a stressful situation, but we are also under constant supervision and do not have the opportunity to make such egregious ethical errors.

Another technicality that I cannot get over is her lack of theoretical orientation. During the first appointment she has him engage in relaxation training, but I cannot see any orientation motivated choice for doing this. Not to mention, during ALL first appointments therapists are trying to establish a relationship with the patient and just learn their history. This therapist, and I use the term so loosely, just goes into the role that she has something to give him and makes him do something that SHE thinks will make him feel better. Nowhere in any of their appointments did I observe any rapport building or any actual listening to Adam’s complaints. THIS ISN’T HOW WE DO IT!!!

Even though she does make some obvious ethical errors, there are areas within the field that still have some gray area. When she gives him her personal phone number and stresses that it should be used for emergencies and he uses it as such, this is more reflective of how certain patient/therapist relationships are, especially for someone in his situation. Additionally, her presence in the waiting room with his family is not entirely unheard of in surgical-type settings. However, she should have kept her mouth shut when they said they were Adam’s family because that automatically crosses the clinical boundaries without proper disclosure forms.

Overall, this individual is a poor and unethical portrayal of therapists and as a therapist in training I am personally and professionally insulted. We try above all other things, including above our own care, to ensure that our patients are receiving the highest standard of care and to ensure ethical practices. I hope no one takes this portrayal seriously because it would be a shame for someone to not seek out mental health treatment just based upon this horrible depiction of care.

For additional information into ethical standards and mental health care please visit the APA’s website: http://www.apa.org/index.aspx