Monday, June 04, 2007

Boundaries! Boundaries! Boundaries!

So the psychiatrist is talking to her own psychiatrist and he tells her he saw another psychiatrist in the hallway and this third psychiatrist, in the hallway, gave him a quick review of the literature on psychotherapy of sociopaths, and wouldn't you know it, it seems that psychotherapy validates, rather than cures, sociopaths, and it increases, rather than decreases their criminal recidivism rate. The first psychiatrist, who in this particular setting is the patient, becomes upset. It seems that her own psychiatrist believes that her years of work with a criminal patient have been a waste-- she hasn't helped the patient, rather she's harmed him and also society as a whole by increasing his comfort with his unconscionable violent behavior. And I'm thinking: Well that's not a very therapeutic thing for the psychiatrist to say to his patient!

Soon after, the psychiatrist and her psychiatrist are at a dinner party, with lots of other psychiatrists. What are they doing sitting together at a dinner party? If it's a professional thing, shouldn't they at least sit at separate ends of the long table? Another psychiatrist begins to discuss the negative findings of psychotherapy with criminals, and the first psychiatrist (now a dinner party guest and not a patient in this setting) gets angry with her own psychiatrist-- he set this up, he wants to convince her that she's wrong to continue her work with the sociopathic patient! And then to add to the mayhem, her psychiatrist tells the entire table the identity of his patient's famous criminal patient.

So the poor psychiatrist/patient has transference issues with her own psychiatrist: she wants his approval. Even though after years of sympathetic therapy, he declared himself a HIPAA-violating jerk by telling their colleagues the identity of her nefarious patient.

So the sociopath comes for his regular psychotherapy session. Life has been hard: his son has been psychiatrically hospitalized after a serious suicide attempt and the Lexapro just isn't working for the kid, and come to think of it, only weeks ago his favorite nephew died after he killed him.

The sociopath is warm and gentle with his psychiatrist today, commenting on how meaningful her work is because she spends her days helping people the way she's helped him. The psychiatrist, now a complete transference-to-her-own-shrink/countertransference-to-her-gangster-patient mess, is visibly angry and fires the sociopathic patient after 7 years of psychotherapy. The angry sociopath leaves declaring the psychiatrist to be immoral, and I believe he's right.

I've watched this therapy evolve, and yes, it started with ducks. The series started when mob boss Tony Soprano presented to Dr. Melfi in the throes of panic attacks. Something to do with migrating ducks in his pool. Really. They've been through a lot together-- he's stolen her car to have it repaired, offered to off her rapist, driven her to drink, declared his love and survived the rejection. One more episode, and this is how they end?

ClinkShrink asked that I tell you that she wasn't any of the three psychiatrists mentioned above. And the weird thing is that I never knew Clink was in The Sopranos.

The Boston Globe had a nice write up about Tony's prospects for redemption that appeared before this episode aired: Tony Is A Monster


Anonymous said...

You shrink, you write, you blog, you have a couple of teenagers and you still have time to watch the Sopranos?

Rach said...

I think I may just need to start watching the Sopranos. I tend to watch one series at a time - I'm halfway through Huff right now (which actually features a psychiatrist with his own HIPPA/boundary problems)...

You make the sopranos sound very, very cool!

Gerbil said...

Rach, I'm with you. I've had so many people recommend The Sopranos and yet have never seen it. (It's not even an excuse anymore that we don't have cable--for we do have DVD!)

Mrs. Gerbil and I are fixated on SVU. We are still wondering why Mary Stuart Masterson's character conducts impromptu therapy sessions with Det. Stabler in her house... no appointment necessary, just ring the bell.

Midwife with a Knife said...

I've never seen the Sopranos. I'm such a looser, I can't do violence on t.v. very well at all.

Catherine said...

Like Gerbil I'm more of an SVU fan, but your write up of the last episode was, well, interesting. Not sure if it would qualify as intriguing, but definitely interesting.

(And I am glad ClinkShrink had you clarify; I was starting to wonder! Just kidding, of course)

Zoe Brain said...

I've not seen the series in question, but my initial reaction is : Have you no sympathy for Dr Melfi?

Look, she's been trying to do her best for a really SCARY guy. By abiding by her professional non-disclosure ethics, how many people's deaths has she caused?

Now, when the one thing that was keeping her going, the thought that she might be doing some good for her patient, has been undermined so she no longer believes it - for goodness's sake, she's Human! Fallible!

Immoral, no. She may be wrong, but on the other hand, how ethical is it to keep on taking money from a patient that you believe is getting worse, not better, from your treatment?

Please be a bit easier on members of your profession, even fictional ones. I stopped believing medics were Gods a long time ago. They're just humans who, in general are extremely bright and doing their best to help.

DrivingMissMolly said...

Wow, Zoe, you're a brilliant chick, but I must disagree.

The doc let *her issues* drive the firing of the patient. The psychiatrist has to know when the issue is his or her countertransference and deal with it. It is not the PTs fault.

I also thought that it was illegal to fire a PT without giving them a thirty day notice. You can't just dump a PT without warning.

If she is that insecure about her work then her PT definitely deserves better than her anyway.

It's funny how she never had a problem treating a murdering philanderer until someone she looked up to told her it was fruitless.

She was wrong, but she should have the sociopath kill her shrink...just kidding.


Anonymous said...

I have watched every episode of the Sopranos. It seems that I am in a very small, albeit wonderful group! For those of you that do not know the background, Dr. Melfi showed Tony the door after 7 years of therapy.......7 years! Her character is very flawed as if should be. Her mentor is nothing better than a NERD....without any boundaries.....and a jealous one at that.

Sarebear said...

I've never seen it either! Although I've seen it referenced enough all over the place to get the gist.

I would think a shrink treating someone like that would have thicker skin; they'd haveta (Clink, I think I remember you talking about inmates whistling at you or unprintable here on the blog comments at you or other females as you go about your duties in there?).

But, if she thought she was making him worse w/therapy, I can see that. If it was just unexpressed anger transference crap, then I agree w/Dinah again.


Sara (who is experiencing a huge big life-changing experience (I think) because of just starting a new med.

Sarebear said...

And yes, I realize the irony of the (I think) as it modifies that sentence. Lol. Don't mind me, I'm in uncharted territory.

Unknown said...

I'd ask "how can personal issues NOT overlap professional?"

I cannot see a psychiatrist who would not have overlapping issues. At least that is my feelings on the matter.

I was in a rather large argument a couple weeks ago on this issue. I had stated that for male survivors of the more violent female offender sex crimes there is no possibility of psychiatric/psychological help; the sexism within the professions forbid it. That is both my opinion and experience.

WELL! A PhD psychologist and an MD who does counselling both flipped at my statement! (really mad at me!)

Yet, according to all that has been collected from speaking with male survivors of the more violent female offender rapes, I am right!

So, we see personal feelings "I am not sexist" overlapping professional (the guys are complaining a LOT, collecting data at a rapid pace and have some good science to back them up).

How can that not extend to deeper issues such as presented within the Sopranos?

Anonymous said...

Huge fan of the Sopranos here!

I think that if Melfi really believed she was harming her client she had an obligation to finish the therapy. The reasons she believed that was the case are a separate issue (one piece of new research, peer pressure, transference/ countertransference). What was really outrageous for me was the way she dealt with him. It was really personal and abrupt. Like a bad brake-up. Not to mention the behaviour of her shrink... I wanted to slap him across the face.

Funny, when I was watching it I thought of Shrinkrappers, especially of Clink. I thought: that's going to make their blog. It did, too :).

I can't believe there is so many people who never watched Sopranos! I have them as a wallpaper on my computer screen.

jw: could you please give us some titles/authors of articles on those male survivors of the more violent female offender sex crimes. sounds interesting.

Rach said...

Just out of curiosity, when are you going to post the next pod-cast. I spent the morning listening to most of the old ones (from when you first started). I'm starting to worry that you've maxed out at 21 podcasts!

My Own Woman said...

Soprano's? I didn't watch a single episode since I don't have HBO ........ until my daughter bought them on DVD and I watched until I couldn't stop. I even blogged about what kind of person would actually wish (and I did wish) that a psychiatrist would tell her mob boss patient that she was raped and WISH he'd whack the SOB. Now, I'm doomed to wait until the last episode comes out on DVD. Oh, the cruelty of it. Wait, I know there was a question posed, but I just can't remember what it is.

pemdas said...

The Sopranos = my personal crack.
I have watched every episode TWICE, courtesy of DVD and Comcast Cable's OnDemand Service. I'm not addicted. I can stop anytime I want. Any time after this Sunday at 9PM.

Anonymous said...

look guys!! wake all comes down to SEX!! SHRINKS ARE PEOPLE TOO! Their patients fancy them, they want some of their patients...etc, so if they just had sex they would get all the embarrasing stuff/feelings etc out of the way at the beginning.

My advice, have sex together , say in session 3, then you will know each other well enough to work together...etc and the THERAPY RESULTS will probably be MUCH BETTER !! Just agree, it's a one off + won't happen again= no problem!