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What Films Can Teach Us About Therapeutic Ethics

Clinical Update
By Zur Institute

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Our 6 CE credit online course Therapeutic Ethics & the Movies , fulfills the Law/Ethics Requirement:

 

Movies have long exhibited fascination with sexual and other therapeutic boundaries. We have just completed an exciting and challenging course on ethics by using scenes from movies as a jumping off board for discussing therapeutic ethics. It turned out to be a rather comprehensive six (6) CE credit course on ethics that also fulfills the Ethics & Law Requirement in California and other states.

Following are a few examples that are discussed further in the course.

 

    What About Bob: When clients rather than therapists violate therapeutic boundaries.

  • In this comedy a client follows his rather neurotic analyst to the analyst's family's vacation.
  • Most discussions about boundaries focus on the role of therapists in boundary crossings and boundary violations. However, in reality, as in this movie, clients are often the ones that violate therapeutic boundaries when they delay leaving the office at the end of the session, do not pay their bills on time or avoid paying them altogether, dress in sexually suggestive ways, use foul or vulgar language or threaten and even stalk their therapists.
  • It is important for therapists to recognize the clinical and ethical meaning of such clients' boundary crossings or violations and respond appropriately.
  • The exasperated psychiatrist in this comedy tries to manufacture an unethical, involuntary hospitalization in order to get the client off his tail. We must watch how we respond to clients violating our space and/or privacy.
  • We use this movie to teach therapists how to deal with situations when clients, rather than therapists, violate therapeutic boundaries.
  • Consultation with experts is highly advisable in complex and potentially violent or volatile situations.

 

    Good Will Hunting: Leaving the office, aggressive touch and extensive self disclosure.

  • This movie stimulates a discussion on the ethical complexities of going for a walk with a client, making extensive self-disclosure and using rather aggressive touch towards a client. This movie created an uproar among many therapists who viewed the film as depicting therapists in a bad light. The movie depicts the following three ethical or boundary considerations:
  • Leaving the office for a walk has been reported to be effective with restless adolescents, depressed clients and those who prefer side-by-side rather than face-to-face conversation, such as the young client in this move. Clients who feel too confined, restricted or fearful in the office may also benefit from a walk by the river as depicted in this movie. Other reasons to leave the office are making a home visit; attending a graduation, confirmation or Bar Mitzvah; conducting in-vivo desensitization for fear of open spaces; adventure therapy; or attending a performance by a client who is extremely shy.
  • Self-disclosure is probably the most common and therapeutically effective boundary crossing. Behavioral, Cognitive-Behavioral, Feminists, Group and Humanistic psychotherapists use it therapeutically, albeit for different reasons.
  • Touching clients is the most controversial of all therapeutic boundaries. The impulsive and aggressive shaking of the client in this movie is clearly below the standard of care, even though the movie presents it as a highly effective intervention.

 

    Antwone Fisher: Inviting a client to the therapist's home.

  • This movie invites us to explore the complexities of dual relationships when the client is also the lover of the therapist's son. This issue is close to my heart as I encountered a similar situation in my life and practice.
  • Unavoidable Dual Relationships are very common in many small and rural communities, university campuses and small ethnic, spiritual and disabled communities. They are normal parts of training institutions and, apparently, as depicted in this movie, also occur in large cities. The movie portrays an appropriate use of consultation and flexible ways of handling unexpected, unusual and personally difficult situations with clinical and personal integrity.
  • Unavoidable Self-Disclosure is another theme that is explored in this movie in regard to a home office. The home office setting always involves significant amounts of self-disclosure on the part of the therapist about the therapist's professional, personal and familial life. Therapists must be careful in screening clients and pay attention to the impact of the self-disclosure on different clients.

 

    Basic Instinct, Bliss and Mr. Jones: These movies depict the ultimate boundary issue -- sexual relationships between therapist and client.

  • The popular theme of sex is also depicted in movies, such as 12 Monkeys, Tin Cup, The First Wives' Club, Deconstructing Harry, Beyond Therapy and The Butcher's Wife.
  • Sexual relationships between therapists and current or recently terminated clients are always unethical and often illegal. What is interesting about some of these movies is that they depict the sexual relationships as effective in promoting health and healing.

 

    Prince of Tides: A social and sexual relationship between a therapist and the client's brother.

  • Sexual relationships with a client's close relative are always unethical.
  • Social dual relationships with a client's close relative are not necessary unethical. It all depends on if it impairs the therapist's objectivity and how it affects the clinical work.

 

    House of Games: Therapist acting also as an investigator.

  • This movie depicts a therapist who is both intrigued by the client's world and also takes on the unusual roles of investigator and savior to satisfy her need or impulse to help her client.
  • Dual relationships, in which a therapist takes on additional roles to help a client, can be unethical if the therapist abandons his/her clinical role in the process or acts in a way that negatively affects the therapeutic relationship.

 

    K-Pax: Questions about confidentiality.

  • In order to learn more about his unusual patient, who pretends that he is an alien from another planet, the therapist takes his client to meet a group of astronomers.
  • The psychiatrist shares his fascination about his client with a friend and with his wife.
  • Confidentiality in psychotherapy is considered one of the cornerstones of the therapeutic relationship. If the clients do not sign an authorization to release information, talking about them with anybody without disguising their identity is unethical, illegal and potentially harmful for these clients.

 

This course uses movie vignettes to explore and discuss the following five areas:
Confidentiality, Self-Disclosure, Touch, Dual Relationships and Out-Of-Office Experiences (i.e., home visits, in-vivo exposures, attending a wedding, incidental encounters, etc).

 

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