Informed Consent In The Movies – Movie Vignettes and Analysis

 

 

Antwone Fisher

Antwone Fisher, an African-American in the U.S. Navy, has trouble with his anger. An African-American psychiatrist, Dr. Jerome Davenport, helps him work through his extensive childhood trauma.

Davenport usually schedules one to three sessions to evaluate a patient and to make recommendations. In order to give Antwone the time necessary to open up, and to let him carry the responsibility for treatment success, the psychiatrist states that their three sessions do not start until Fisher begins talking. According to the boundaries that were set in their first meeting, Davenport terminates after three therapy sessions.

The psychiatrist informs his client during their first session that they will have three sessions for the purpose of assessment and possible referral. Davenport clearly states that he starts counting these sessions when Antwone starts talking. This information also serves as an intervention. The movie doesn’t indicate whether this informed consent was legally documented.

Since many issues remain unsettled, Antwone acts out by attacking a peer. He also explodes in the clinic’s waiting room and behaves toward Davenport in a highly inappropriate way. When Antwone apologizes and says “I don’t know what to do,” the psychiatrist admits his mistake in insisting on only three sessions and agrees to see him for ongoing weekly sessions.

It appears that Davenport decides to start Antwone’s ongoing treatment at this point. The client needs to be informed about the now modified nature of the therapeutic relationship and provided sufficient opportunity to ask questions and receive answers. The movie doesn’t indicate whether this took place.

Later in their work, the psychiatrist attempts to terminate again. This triggers his patient’s abandonment issues. When Antwone consequently describes another traumatic incident, Davenport tells his client to contact him again after he finds his family.

Therapists might repeatedly have to reevaluate the necessity for termination during the course of therapy. Antwone’s example demonstrates that the therapist’s need for flexibility regarding treatment decisions such as termination should to be mentioned if this topic is included in the initial informed consent or in subsequent ones.

 
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Girl, Interrupted

After a half-hearted suicide attempt and being evaluated by psychiatrist Dr. Crumble, Susanna Kaysen spends one year at Claymoore. In this psychiatric hospital, she receives treatment from Dr. Melvin Protts and Dr. Sonia Wick, while nurse Valerie looks after her. Susanna befriends the other patients, Lisa, Daisy, Janet, and Georgina.

After she gets busted for comforting another patient, Polly, Susanna is called into Dr. Sonia Wick’s office. Susanna expresses that she wants to leave the hospital. She assumes that she can leave at any time since she signed herself in. But Dr. Wick responds, “You signed yourself in, but we decide when you leave.”

The movie indicates that Susanna was not informed about her limited rights to leave the hospital when she signed in. If she had signed a document about the conditions of her discharge during her intake at the hospital, she might remember them when she wants to leave Claymoore in the mentioned scene. Knowing about these discharge conditions might have changed her mind about signing herself into the hospital. Her rights to freedom, autonomy, and human dignity would have been better preserved. In these kinds of situations it is important to determine whether the consent is valid, as many patients sign voluminous documents upon admission to hospitals or psychiatric wards.

 
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Good Will Hunting

Will Hunting, a working-class young math genius, is wasting his talent. Mathematics professor Lambeau takes him under his wing and finds a therapist for his protégé. In his therapy with Sean McGuire he begins the healing process of his childhood trauma. Lambeau introduces Will to various therapists. One of them tries to hypnotize the young man while Lambeau and his colleague watch the therapeutic process.

The movie is not explicit about this, but it can be assumed that Will was not informed prior to the session that Lambeau would be present during the hypnotherapy. If the client did not waive his confidentiality rights with the hypnotherapist, this is a case of a boundary violation.

When Will’s therapy progresses, Lambeau checks in with McGuire about his client’s progress several times. He even suggests that the therapy take a different direction. They should focus more on Will’s future than his past. The therapist expresses his reluctance, because he thinks that “he is not ready for that” and argues with Lambeau about his therapeutic approach. In one scene Will overhears an intense, loud, and angry discussion between McGuire and Lambeau about the goal of the young man’s therapy.

Will Hunting needed to consent to McGuire and Lambeau discussing his case at the beginning of his first session. Otherwise his therapist breaks the confidentiality of the therapy session and therefore commits a boundary violation. Consent to discuss clinical issues between therapists and faculty members is often signed in a routine manner in mental health clinics, colleges, and universities. Nevertheless, it is important that clinicians reiterate them to make sure that a true and valid consent has been received.

 
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Grosse Pointe Blank

A psychiatrist, Dr. Oatman, is alarmed to learn that his patient, Martin, is a hit man. He is concerned about confidentially and wants to terminate the relationship against his client’s wishes.

Dr. Oatman says that he would have to tell the authorities if Martin committed a crime or thought about committing a crime.

Dr. Oatman needs to inform his client as early as is feasible in the therapeutic relationship about limits of confidentiality, such as a serious threat to the life of another (Tarasoff). In most states the Tarasoff ruling is applied when a client communicates to the psychotherapist a serious threat of physical violence against a reasonably identifiable victim or victims. The question in the case is whether the hit man is still in this line of work and whether he reveals to the therapist the identity of his victims. It is important to realize that the Tarasoff ruling does not apply to past crimes, only to future ones. Another issue raised in the movie is when a therapist wishes to terminate in the middle of therapy. It is advisable that therapists include a statement regarding termination in the Informed Consent that clients sign prior to the start of therapy. Following is an example of such statement:

Termination: As set forth above, after the first couple of meetings, Dr. xx will assess if he can be of benefit to you. Dr. xx does not accept clients who, in his opinion, he cannot help. In such a case, he will give you a number of referrals whom you can contact. If at any point during psychotherapy Dr. xx assesses that he is not effective in helping you reach the therapeutic goals, he is obligated to discuss it with you and, if appropriate, to terminate treatment. In such a case, he would give you a number of referrals that may be of help to you. If you request it and authorize it in writing, Dr. xx will talk to the psychotherapist of your choice in order to help with the transition. If at any time you want another professional’s opinion or wish to consult with another therapist, Dr. xx will assist you in finding someone qualified, and if he has your written consent, he will provide her or him with the essential information needed. You have the right to terminate therapy at any time. If you choose to do so, Dr. xx will offer to provide you with names of other qualified professionals whose services you might prefer.

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