Reel Therapy

Unraveling the mind through film.

Jeremy Clyman is pursuing his doctorate in clinical psychology at Yeshiva University. See full bio

April 11, 2009, Media

In Treatment: The Debate Behind the Show

What is therapy at its best?

This past weekend marked the kickoff of In Treatment's second season and with it a televised image of therapy that doesn't involve wooden caricatures (think Ordinary People) or goofy misrepresentations (think Analyze this). At last the field of clinical psychology has a show free of melodrama and full of the detail and depth necessary to realistically represent the therapeutic process. Predictably enough, patients all across the country are discussing the show in therapy and therapists are discussing it with each other. Just last summer I attended a research conference hosted by the American Psychological Association in which a seminar was offered on the show In Treatment. The seminar had overflowed with practitioners eager to offer their praise

Now that the image of realistic therapy is being delivered to the masses, an important and long-standing question is following on its heels, what does the best therapy look like? Unfortunately not even therapists can agree on the answer. You see, there is something called theoretical orientation. This is the theoretical framework from which a therapist operates, the route he/she takes toward inducing growth and positive change in the patient. This means, oddly enough, that you can have a handful of equally qualified and competent clinicians conducting therapy that differs dramatically in content, process and outcome. By far the top two competing camps are Psychodynamic Theory and Cognitive Behavioral Theory. The star of In Treatment, Dr. Paul Weston, seems to practice from a psychodynamic viewpoint even though this is never explicitly stated. His tools are distinctly dynamic tools - an awareness of transference (i.e. Alex's in-session anger with Paul was really misdirected anger with Alex's father), a use of interpretation (working hypothesis that Alex was gay), an appreciation of unconscious forces (Alex could be gay and honestly not realize it) and even a little blank slate (i.e. Paul refused to answer any questions about his personal life). The trajectories of the Psychodynamic camp and the Cognitive Behavioral camp are kind of like the acting trajectories of Mickey Rourke and Matt Damon.

Psychodynamic theory is like Mickey.

There's the promising beginning: Mickey was a top dog in the action genre for much of the 80's and psychodynamic theory played king of the theoretical mountain for the first half of the 20th century. Next came the slow but steady decline: Mickey produced too many duds while psychodynamic theory contained too few checks and balances on dysfunctional practitioners. Then came the precipitous bottoming-out: Mickey suffered drug problems and a forced hiatus from Hollywood while psychodynamic theory proved too elusive for systematic scientific study. And, finally, there is the late-inning comeback: Mickey receives an Oscar nomination for The Wrestler and emerging research in neuroscience is beginning to support many dynamic tenants.

Cognitive-Behavioral Theory (CBT) is like Matt.

You start off with a bang: Matt's first major role brings critical acclaim with Good Will Hunting while CBT presents an intuitive and grounded model of the mind as computer. Next, steady ascension through the ranks: Matt has yet to produce consecutive box-office bombs or even formulaic role choices while CBT has churned out an unparalleled amount of supportive research studies. And, most recently, there is the beginning of a suspiciously low ceiling: Matt cannot seem to earn an Oscar nomination for acting or, for that matter, cry on command and CBT is failing to respond with authority to many questions about personality development and emotion.

Last season, it seemed that Dr. Weston experienced a mixture of success and failure with his patients with some debate about how much of his failure derived from an imperfect theory versus an imperfect practice of that theory. As fans, clinicians, patients and future patients tune in to the second season, expectations and perceptions of the therapeutic process will undoubtedly be molded. As the debate over the best type of therapy rages onward, there is one thing I'm sure all clinicians can agree upon - whatever theory Dr. Weston uses, he'd better use it well!