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)
Introduction
From all the psychotherapeutic themes that are presented in the movies, the sexual theme has been given the most attention and focus to draw the viewers’ attention. Both male and female therapists are portrayed in these films. In Mr. Jones, a psychiatrist who has problems in her personal relationships falls in love with a manic-depressive patient. In Basic Instinct, the therapist sleeps with her client/colleague during and after treatment. In The Prince of Tides, the therapist’s initial professionalism is undermined when she falls in love with a patient’s brother.
Needless to say, sexual relationships with current clients are always unethical and counter-clinical and are illegal in many states. The codes of ethics of most professional organizations also mandate that therapists neither terminate therapy in order to pursue sexual relationships with their clients nor promise them such relationships nor be involved in such relationships for at least two years after termination.
Basic Instinct
Detective Nick Curran and his colleague, Gus Moran, investigate a murder. Nick gets sexually involved with one of the suspects, Catherine Tramell. He is in psychotherapy with police psychologist, Dr. Beth Garner, who had also become his lover. In order to protect Curran, Garner gives Lt. Marty Nilsen access to the therapy notes about Nick.
At the beginning of the movie, we learn that, a while ago, Internal Affairs had ordered detective Nick Curran to see police psychologist Beth Garner for psychotherapy, because he killed four people on duty in the last five years and struggled with an addiction to alcohol and cocaine. During their last therapy session, it becomes obvious to the viewer that they had a romance during the course of his treatment. As he leaves her office, Beth says to him, “I still miss you, Nick.” Referring to Curran and Garner, one of his colleagues tells another one in a later scene, “Sometimes I think that he started banging her just to get off the hook with Internal Affairs.”
By starting an affair with Beth, Nick gains power over his therapist. As a result of her attraction to him, she decides to and acts in his favor several times. This movie implies that the therapist is a victim of her client lover and that she doesn’t have a professional, ethical, and legal responsibility to refrain from sexual relations with her client. In the real world, this could potentially be very damaging to the therapist-client relationship. All professional codes of ethics and most states’ laws (definitely in California) prohibit any sexual contact between therapists and clients.
What is rarely discussed in the literature is the fact that some clients in some situations gain significant power over their therapists with whom they have sexual relationships. Most of the literature confuses therapists’ responsibility to avoid sexual relationships with current clients with the power issue. Looking deeper into power and therapy issues, here is an excerpt that discusses this issue:
In the power differential argument against boundary crossing, clients are often portrayed as passive and malleable, even defenseless, perceiving their therapists as strong and superior (Lazarus, 1994; Tomm, 1993; Williams, 2002; Zur, 2000). In reality, many therapists work with clients who are much more powerful than they. Some clients are CEOs of large corporations, judges, powerhouse attorneys, master mediators, or successful entrepreneurs. Often, these clients do not regard their therapists as particularly powerful or persuasive but as professional listeners or facilitators (Lazarus & Zur, 2002; Zur, 2005a), and, indeed, they may, simply by virtue of their roles in life, exert a power and influence of their own over the therapist (Zur, 2007, p. 47).
In this case, starting an affair with Beth, Nick gains power over her. As a result of her attraction to him, she decides to and acts in his favor and even lies on his behalf.
Nick feels sexually teased and provoked by the murder suspect, Catherine Tramell. Shortly after this encounter with Catherine, he visits his ex-therapist, Beth Garner, to have passionate sex with her. She reveals that she knew Catherine when they were both psychology students at the University of California at Berkeley. Beth gets jealous of Catherine when she understands that Nick has fallen for her and throws the detective out of her apartment.
Garner’s roles as Nick’s therapist, lover, colleague, and possible witness in a murder case become intermingled. The above-mentioned Codes of Ethics mention specific rules about sexual intimacies with former clients. As was noted above most of the codes of ethics of professional organizations also mandate that therapists neither terminate therapy in order to pursue sexual relationships with their clients nor promise them such relationships nor be involved in such relationships for at least two years after termination. Garner’s unethical roles as Nick’s therapist, lover, colleague, and possible witness in a murder case become increasingly intermingled, complex, and unmanageable.
Because they are colleagues at the police department, Beth Garner knows that Curran sometimes discusses his cases with other officers in a bar. When she gets angry in one scene, Beth finds Nick at the bar and gets into an argument with him in front of the other officers.
Because both the therapist and the client are employees at the police department, a social encounter in a bar might be more common than in other therapeutic relationships. Her inappropriate public display of anger in front of the other officers results from their sexual relationship.
During a subsequent team meeting at the police department, his supervisor threatens Nick Curran with suspension because he acts unprofessionally in the murder investigation. Because she still loves Nick, his ex-therapist, Beth Garner, lies for him in order to bail him out. The psychologist convinces the other officers to make his suspension dependent on a psychiatric evaluation. To thank her for the favor, he kisses Beth in front of the office building.
Garner’s roles as Nick’s ex-therapist, ex-lover, colleague, and evaluator are intermingled again. While the therapeutic as well as the romantic relationship has ended the subsequent relationships should be handled with caution and care.
For his psychiatric evaluation, Nick has to meet several police psychologists, including Beth Garner. When they ask him about his childhood, he gets angry and storms out of the room. Garner bails him out again by manipulating the other psychologists into a favorable evaluation.
Because Garner’s roles as Nick’s ex-therapist, ex-lover, colleague, and evaluator are intermingled, she may be biased in her evaluation. Forensic dual relationships have generally been frown upon even though they may not be unethical per se.
Bliss
Maria and Joseph see Alfred for couples therapy, while Maria secretly consults sex therapist Dr. Baltazar Vincenza. The latter therapeutic relationship ends when Baltazar starts teaching Joseph “the ways of love.”
The movie indicates that Baltazar engages with Maria sexually to help her achieve orgasms and to heal her psychological problems. Later, Joseph is taught what he needs to do: not just to bring Maria to orgasm, but to break through the emotional wall to discover her hidden secret that is preventing her from enjoying sex with her husband. Baltazar explains to Joseph that he doesn’t use sex with his clients to satisfy his own needs, but as a therapeutic act. For example, the therapist states, “The only way that the mind can heal itself is through the body. …There is no psychoanalytic cure for Borderline Personality Disorder. … The mind cannot heal the mind. … Conscious sex achieves bliss that heals. Ecstasy heals the unconscious.”
This is a case in whicha therapist employs sexual acts as part of clinical intervention with a client. According to the therapist this is not a dual relationship, which is defined as “the existence of a role or roles between therapist and client in addition to the clinical relationship”. Dr. Baltazar, according to the movie, does not take on an additional role besides the role of a therapist or teacher. In the 1960s and 1970s therapists used sex surrogates to provide patients with actual sexual experiences. All professional codes of ethics and most states’ laws (including California) prohibit any sexual contact between therapists and clients regardless of the clinical rationale or the expressed intention of the therapist. In short, these intervention are clearly unethical, most likely to be illegal, and always below the standard of care.
Maria visits Baltazar briefly after he had promised Joseph that he would not continue therapy with her any more. They dance for a short while in a non-sexual way before the therapist sets a clear boundary and withdraws.
For a male therapist to dance with a female client could be easily misinterpreted by the client and others. In this case Baltazar had much more intimate contact with Maria during prior sessions (see discussion above). If she had gotten attached to him, dancing might be a gentle way to help her let go.
Dressed To Kill
After Kate Miller is brutally murdered, Dr. Elliot, her psychiatrist, and Detective Marino try to find her killer. Kate’s teenage son teams up with a prostitute, Liz Blake, who witnessed the murder, to do an investigation of their own.
In an early scene, Kate reveals to the therapist that she doubts her own sexual attractiveness; she asks him whether he finds her attractive and whether he would want to sleep with her. Elliot answers with “Yes.” His patient asks in response, “Then why don’t you?” And he says, “Because I love my wife, and sleeping with you is not worth jeopardizing my marriage. Is it worth it to you to jeopardize yours?”
Dr. Elliot doesn’t mention anything about the codes of ethics or state laws regarding sexual dual relationships between a therapist and a client.
Elliott reaches his arms out to greet Kate, initiating a level of intimacy that would be appropriate for a friend or romantic partner.
The therapist is attracted to the client. Instead of seeking consultation or dealing with his attraction in a professional way, he seems to be on the edge of acting it out. He admitted his attraction and greeted Kate inappropriately.
The psychiatrist’s voice is slightly seductive and playful when he guides his patient into the office saying, “The doctor will be with you shortly.” Later the psychiatrist stares at Kate in a leering manner, leans forward toward her in a seductive way, and tells her that there is nothing wrong with her wanting a satisfying sex life.
Elliot’s flirtatious behavior and tone of voice seem unprofessional and potentially unethical.
Girl, Interrupted
After a half-hearted suicide attempt and being evaluated by psychiatrist Dr. Crumble, Susanna Kaysen spends one year at Claymoore. Susanna befriends the other patients, Lisa, Daisy, Janet, Polly, and Georgina.
One night Susanna and Lisa play music to cheer up Polly. In order to distract a male nurse from his attempt to stop Susanna’s guitar playing, she seduces him to kiss her.
The fact that Susanna seduces the psychiatric nurse doesn’t change anything about the fact that he engages in behavior that is considered unethical. There are many reports of how clients attempt to cross sexual and other boundaries. It is the therapists’ responsibility to do their best to respond appropriately and maintain appropriate therapeutic boundaries regardless of patients’ actions.
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.
Dr. Symington smiles at Frances in an adoring way and moves an ashtray in a manner that is overly solicitous.
Symington’s flirtatious behavior appears to be professionally inappropriate unless he has a subtle clinical rationale for his actions.
Mr. Jones
Mr. Jones gets treated for Bipolar Disorder in a mental hospital by Dr. Libbie Bowen. They fall in love with each other and start a romantic relationship.
Dr. Bowen has serious problems in her marriage. Early in the movie we see her husband moving his things out of their house as he embarks on an affair with another woman. The rejection by her husband and her attraction to Jones makes Libbie vulnerable to disregarding professional boundaries. She puts her hand on her patient’s shoulder when she first talks to him. Later she gives Jones a ride home and takes him out for something to eat. They keep getting closer, fall in love, and end up in a romantic relationship.
This is a “classic” unethical sexual relationships tale. The psychiatrist finds herself falling for Jones, a bipolar hospitalized patient, with her eyes wide open. She knows it is wrong for a psychiatrist to get romantically involved with a patient and confesses to a superior. “But he’s so charming” is Libbie’s justification. An outraged male colleague threatens to report her if she doesn’t end the relationship immediately. But Libbie claims that she has already gone too far and cannot stop it.
The unethical behavior of therapists having sex with current clients is clear as the APA Code of Ethics of 2016, section 10.05, clearly states: “Psychologists do not engage in sexual intimacies with current therapy clients/patients.” The NASW Code of Ethics of 2017 similarly states in section 1.09, “Social workers should under no circumstances engage in sexual activities or sexual contact with current clients, whether such contact is consensual or forced.” Similarly, the CAMFT Code of Ethics of 2011 states in section 1.2.1, “Sexual intercourse, sexual contact or sexual intimacy with a patient, or a patient’s spouse or partner, during the therapeutic relationship, or during the two years following the termination of the therapeutic relationship, is unethical.”
By threatening to report her, Libbie Bowen’s colleague expresses concerns about the ethical and legal ramification of the therapist’s behavior. But like many movies this film ends up suggesting to the viewer that a sexual love relationship between a therapist and his or her client is acceptable or even clinically helpful. Regardless of whether the sexual touch seems to help the client, it is clearly unethical, always below the standard of care, and illegal in most states.
The focus of the story changes as the patient’s suicide, by jumping from a steep rooftop, is narrowly avoided. As often depicted in movies, boundary violations, such as this sexual behavior, are viewed positively. It is not his psychotherapy and lithium, according to the movie, but the therapist’s love that transforms the patient. As a result of the sexual dual relationship, the wildly manic Jones transforms the rigid psychiatrist by loosening her up. In many movies psychotherapy operates on different principles than real-life treatment. This is especially true around the subject of sexual dual relationships in therapy.
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.
Although he first doesn’t want to talk about his problems, Tom is in need of healing. Dr. Lowenstein takes on the task. As Tom meets her with the intention to help his sister, he enters into an unacknowledged therapeutic relationship with the psychiatrist. Soon their conversations turn from the therapeutic to the personal. They fall in love with each other during Tom’s cathartic recall of traumatic memories. Tom and Susan have a brief love affair that seems to rescue the psychiatrist from her marital misery and help her regain her self-respect. Both consider a more permanent arrangement, but part when Tom’s wife asks him to come home to his family.
Obviously, sexual touch and sexual relationships with current clients or their immediate family members are always unethical. From an ethical point of view the therapist’s sexual relationship with a current client’s brother is clearly unethical. The APA code of ethics of 2016 states in section 10.06, “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.” Similarly, the NASW Code of Ethics in section 1.09 states, “Social workers should not engage in sexual activities or sexual contact with clients’ relatives or other individuals with whom clients maintain a close personal relationship when there is a risk of exploitation or potential harm to the client. Sexual activity or sexual contact with clients’ relatives or other individuals with whom clients maintain a personal relationship has the potential to be harmful to the client and may make it difficult for the social worker and client to maintain appropriate professional boundaries. Social workers not their clients, their clients’ relatives, or other individuals with whom the client maintains a personal relationship assume the full burden for setting clear, appropriate, and culturally sensitive boundaries.” Similarly, the CAMFT Code of Ethics of 2011 states in section 1.2.1, “Sexual intercourse, sexual contact or sexual intimacy with a patient, or a patient’s spouse or partner, during the therapeutic relationship, or during the two years following the termination of the therapeutic relationship, is unethical.” As often depicted in movies the sexual relationship between the therapist and the client’s brother does not compromise the primary clinical relationship, a fact that neither justifies it nor makes it ethical, legal or within the standard of care.
Stay
A psychiatrist, Sam Foster, treats art student and painter, Henry Letham. Foster tries to do everything to figure out why and where his patient wants to kill himself in order to prevent the suicide.
Sam Foster lives with his girlfriend, Lila, who is an ex-patient. There is no indication how long after the therapeutic relationship ended that their romance started.
The above-mentioned Codes of Ethics mention specifics about sexual intimacies with former clients. Because the movie does not indicate how long after the therapeutic relationship ended the romance started it is hard to determine the ethics of the psychiatrist’s behavior. At face value, the movie seems to depict the couple as having an egalitarian and cooperative relationship.