Table Of Contents
(For detailed descriptions of the movies, click here)
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By Birgit Wolz, Ph.D., and Ofer Zur, Ph.D.
Table Of Contents
(For detailed descriptions of the movies, click here)
Frances
The actress Frances Farmer was a rebel since her teenage years. To gain control over her life, Frances’s mother, Lilian Farmer, orchestrates a series of hospitalizations. After an evaluation by a psychiatrist, Dr. Symington, Frances undergoes shock treatment and a lobotomy.
When Frances resists her involuntary hospitalization and her treatment in the hospital, she is restrained.
Restraining a client physically in order to stop them from hurting themselves can be ethically and legally justified if done appropriately with minimal necessary force. Therapists who work in psychiatric inpatient units or psychiatric wards should have specific training in restraining clients physically and should follow clear protocols. Similarly, when involuntary hospitalization is ordered by the appropriate authorities, restraints may be legally used to hospitalize or restrain patients. However, one must also consider the moral implication of taking one’s freedom owing to a diagnosis that may or may not be relevant or justly applied. The fact that the mother orchestrated the hospitalization calls on all of us to be very cautious and extremely careful when we initiate an action that will restrict someone’s freedom.
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.
Susanna stays in bed because she is depressed when her friend, Lisa, is taken to another ward. Nurse Valerie picks her up and throws her into a bathtub with cold water. She even pushes the patient’s head under the water when Susanna yells, “fuck!” Valerie says, ”Sorry, too cold?” After an angry exchange, Valerie says, ”You are a lazy, self-indulgent little girl who is driving herself crazy.”
Because Valerie is angry, she behaves inappropriately even though she seems to have Susanna’s best interest at heart. This behavior cannot be interpreted as a therapeutic intervention and is therefore inappropriate.
Lisa is handcuffed when she is brought to the hospital because she had run away two weeks earlier. Lisa gets restrained again after she attacks the newcomer because Susanna was given Lisa’s best friend’s bed. Lisa’s friend hanged herself because Lisa had run away. After another escape, Lisa is caught again, restrained, and held in solitary confinement.
If Lisa is a threat to herself or others, these interventions are ethical and clinically appropriate.
Susanna is upset because nurse Valerie watches her as she shaves her legs in a bathtub with a razor. They have the following dialog:
Susanna: “Has anyone ever watched you shave your legs?”
Valerie: “I got two kids and one bathroom, what do you think?”
Susanna: “I think you should lock the door.”
Since Valerie assumes that Susanna is a threat to herself, this intervention is appropriate.
Good Will Hunting
Will Hunting, a working-class young math genius, is wasting his talent. Mathematics professor Lambeau takes him under his wings and finds a therapist for his protégé. In his therapy with Sean McGuire he begins the healing process of his childhood trauma.
Toward the end of their first session, McGuire fends off a series of verbal attacks during which Will insults the therapist’s painting. The dark image of an empty boat that floats on the waves of a stormy ocean represents McGuire’s loss of and grief for his deceased wife. For quite a while, Will doesn’t seem to be successful in his attempts to hurt his therapist. Eventually Will says, “Maybe you married the wrong woman,” and McGuire stops responding. Now his client knows that he hit a vulnerable spot in the therapist, repeats this statement, and asks, “What happened? Did she leave you? Was she banging another guy?” At this point McGuire grabs him by the throat angrily, pushes him against the wall, and threatens him, “If you ever disrespect my wife again, I will end you, I will fucking end you! Got that chief?” With this physical attack, the therapist gains control for the first time. But Will still tries to regain the upper hand as he responds with “Time’s up” and leaves the office.
Using his client’s “language” and by responding on a physical level, McGuire demonstrates that he is the “alpha animal” in this relationship. Even though this involuntary, reactive physical attack might have been one of the very few ways to gain control over the session in order to eventually achieve a positive treatment outcome with this extremely resistant client it is a questionable action ethically. If one considers the unique context of the therapy, which includes the resistive client of a certain class and culture one can construct an ethical and clinical rationale for the highly unusual physical intervention. Obviously, this is a unique situation, as the use of physical force must be handled with a high degree of care and thoughtfulness.
In a pivotal intervention, when they work with his abuse-induced attachment problems, McGuire says, “Look at me son, it’s not your fault,” and then continues saying repeatedly, “It’s not your fault,’, moving closer to his patient and increasing his voice with each utterance. Will experiences a cathartic transformation, sobs, and recognizes that he doesn’t need to carry the responsibility for his abusive childhood as an orphan. They hug as he cries.
Moving closer to his client and eventually hugging him appears to support the therapist’s treatment goal. The therapist displays a supportive gesture and authentic connection with his client when he gives him a hug at the end of a highly emotional session. Such physical expression of support seems to be highly important and equally effective in complementing the verbal message and helping the client work through a life-long block. It is therefore an ethical and clinically appropriate intervention.
Therapist and client hug each other again at the end of their last session, when Will thanks his therapist for their work. When Will asks him whether this is ethical, McGuire responds jokingly, “As long as you don’t grab my ass.”
Hugging a client at the end of the last session seems to be very common. As always it is important that the client feels comfortable and open to such a goodbye gesture. Given that a major focus of their work was Will’s attachment problem, this gesture appears to be an important expression of affection between Will and McGuire.
K-Pax
Dr. Mark Powell is intrigued by his new patient, Prot, who claims to be an alien from the planet K-PAX. In order to evaluate his knowledge in astronomy, the psychiatrist takes his patient to his astronomer friend, Steve Becker, and a group of astrophysicists. Later he brings Prot to a garden party with his wife Rachel, his children, and friends. Powell’s superior, Claudia Villars, does not agree with his approach.
At the beginning of the movie, the police restrain Prot, who is taken to a mental hospital. When he tries to protect Powell’s daughter at a garden party, the hospital personnel misinterpret his behavior and restrain him again.
Restraining a client physically is justified when is done in order to protect the client from himself or herself or others. Minimum force should be used, and it is hoped that the therapist or staff has undergone training in the ethical and legal application of physical restrains.
Ordinary People
Conrad is the second son of a mild-mannered, successful attorney, Calvin, and a selfish, controlling mother, Beth. He sees a psychologist, Dr. Berger, after a suicide attempt. Conrad blames himself for his older brother’s drowning death, which resulted from a boating accident.
The psychologist demonstrates well how varying distance during therapy can be clinically effective. Dr. Berger wheels his chair far away from the client when he wants to give the adolescent client space. A few seconds later, he wheels it up close and confronts the teenager by being “in his face.”
Dr. Berger’s choice of proximity to his client supports his treatment goal. It is therefore an ethical and clinically appropriate intervention.
Prince Of Tides
Tom, an unemployed, aimless ex-high school football coach from the South, meets his sister’s psychiatrist, Dr. Susan Lowenstein, who wants him to shed light on their family life.
In one of their first meetings, the psychiatrist demonstrates her lack of emotional stability and professionalism by throwing an ashtray at Tom, her original patient’s brother.
Needless to say throwing an ashtray is inappropriate in almost all situations.
What About Bob?
After one therapy session, Bob Wiley follows his psychiatrist, Dr. Leo Marvin, to his lakeside summer home in order to further discuss his problems. There, Bob befriends Marvin’s son Sigmund, daughter Anna, and wife Fay.
Marvin is angry with his patient when he befriends the psychiatrist’s family at their summer place. After many unsuccessful attempts by Marvin, Bob succeeds in getting Marvin’s son to dive from a pier. Unaware of his aggressive impulses, Marvin pushes Wiley so hard that his water-phobic patient falls into the lake.
Although the comedy shows a pretty unlikely scenario in this part of the movie, this scene demonstrates that therapists can act out their anger unconsciously when they are not able to set boundaries with an overbearing client.
In order to get rid of his patient, Leo Marvin admits Bob into a mental hospital. He gives the admitting physician, Dr. Catherine Tomsky, misleading information about Wiley. The hospital staff temporarily restrains him until Tomsky discovers the mistake.
Restraining a patient who resists a psychiatrist’s involuntary hospitalization may be ethical and legal. This particular example supports Thomas Szasz’s and others’ assertion that involuntary hospitalizations are immoral coercion and abuse of power. This movie presents a parody of psychotherapy, psychotherapists, and clients. Within this comedy a lot of boundaries are crossed and violated by the client himself, which leads to several unusual behaviors on the part of the therapists.