Recently a psychologist on a professional forum was wrestling with the sticky wicket of psychotherapists and their patients and their varied psychological problems and circumstances in the expanding genre of so-called reality television on shows, ranging, e.g., from Survivor to Hoarding; in other words, shows where people buy into the aphrodisiac, the psycho-seductive prospect of the adventure and celebrity of self-discovery in front of millions of voyeurs. They are playing the game of how to be neurotic for fun, profit and celebrity. It's an idea whose time has come and shows no sign of going very soon.
The therapist noted that they would soon be presenting a media ethics workshop for a state psychological association. They disclosed that they were struggling with ethics concerning bringing one’s current patients on a show like that, even demonstrating the therapeutic process on camera with a current patient or doing brief therapy/counseling those with "patients who volunteer to be on such a show to participate in treatment on camera.
“In the past," the therapist noted, " I have taken a hard line approach when presenting this topic-- no use of patients! However, apparently, there is a new TV reality show, Hoarding and Obsessed, where a well-published, respected psychologist in the area of obsessive compulsive disorder (OCD) and hoarding discusses patient problems and treatment. It takes place in a residential treatment program for those suffering from OCD … Even the acclaimed "This Emotional Life" on PBS, narrated and written by Dr. Dan Gilbert, showed scenes of a psychologist conducting marital therapy. So, it's going on; reputable people are using real folks [she should have said, as well, that real folks are using reputable people], but I'm not sure what the guidelines are… I would love to hear of additional media ethics resources/ideas.”
I replied to the writer in the following fashion:
Why not just follow your own standards, things that make sense and feel right for you and protective of the patients right and need or advisability of privacy, whether they realize it or not. This may lead you to do thing others might feel uneasy over and refrain from things others do without compunction. But you can always recalibrate when necessary.
In APA, media and ethics issues have been wrestled with for decades, with varying degrees of success and consensus. Legal issues concerning restraint of trade have always complicated things and muddied the waters in our theo-capitalist culture. It's vexing and problematic, finding our ethical comfort zone. Do we go with guides that are either outer- or inner-directed, radar or gyroscopic, as David Reisman might have put it?
Moreover, the line of ethical behavior and confidentiality keeps moving, especially as, in the world of so-called reality shows and social networking sites like Facebook, people are giving away privacy rights hand over fist to become "someone,” have a following, gain attention if for no other reason than that you’re one of the camera-willing, walking wounded and people will tune in to be informed or amused by you, or merely to feel superior to SOMEBODY, maybe just ANYBODY. A classic win-win situation in today’s media-saturated society.
Culturally, this is a very fluid time, no less for ethics than for values, manners and etiquette of any sort. Today, maybe as never before, in this era of so-called reality television, the beast called " media" seems to call the shots: propriety is in the eye of the audience. If it appears on TV and no one complains too much; if it gets ratings, makes money and sires copycats, it is, then, ipso facto, the public and the market forces that ultimately dictate ethics, taste and standards -- for good and for ill.
So, construct and follow your own ethics, don't break any established laws, care for your patients' privacy, turn down opportunities which make you feel uncomfortable, and don't be dazzled out of your common sense just because someone tells you or you think you could be the next clean, ethical Dr. Phil -- because you convince yourself that you will certainly exercise control where needed and stick to your ethical guns.
Trust me, that's not how the call and game of media celebrity works. Rationalization, ego, and producers' eloquent seductions is how it works. Compromise is usually a gradual, piecemeal affair. It hurts less that way.
Should I or should I not? That's always the Faustian question media psychologists must continuously ponder.
But I want to amplify these thoughts a bit. Perhaps my advice was too Libertarian.
Media spokespersons and apologists are fond of telling us that the marketplace dictates programming. If people don’t tune in, sponsors tune out. If people don’t tune in, offending shows with their offending values or failed aesthetics and artistry, die off like so many Darwinian specimens languishing in a Galapagos media pond. In effect, goes the mantra, adapt programming principles to audience tastes -- or die.
But that’s not entirely true, is it? Not hardly. Media users and media producers are, in fact, in a two-way feedback system, along the line of the Uses and Gratifications model of media effects: Audiences affect what the media offer but the media affect what the audiences become socialized to want to see. They affect what the audience has available to choose from in terms of the venues in which these offerings can be found, on screens large or small, stationary or mobile i.e. media platform presence.
Media can push agendas, in terms of, say, politics e.g., Fox News or MSNBC, or social values and standards. If programs show enough violence or sexualization of… well everything, from beer drinking, to fashion to sports, then people who first objected to this eroticized or violent programmatic landscape may eventually adapt to it, numb out, overlook it or, as the evidence continues to show, comes to see these omnipresent images and perspectives as the world as taken for granted, i.e., “I can live with it, maybe even come to like it.” If you don’t think so, just catch some European commercials on the CLIO awards the next time it airs. Very funny, very sexy, very accepted, stuff (but oddly not prurient-- a subject for another blog).
In other words, media shape tastes as much as taste shapes media.
And so it is with the concept of privacy in mediated world; especially with the youth but also with young adults who have grown up in a wireless, Twitter-crazed, Facebook-tethered, digital world. With social media and reality television, nowadays people can pull back the curtain on their lives and see if what they’re willing to expose of or about themselves flies with the public both on TV and on line. Hell. Lady Gaga has 10,000,000 friends. That must be some sort of character validation. Right?
If patients want to go on TV or want their therapists to get them on a TV show so they can strut their neurotic stuff or weep their anthology of woe for that 15 minutes of fame—even though they might regret it later, or for the rest of their lives, what’s the correct decision? In these value-fluid, privacy-deprioritized times, what should the therapist do?
Years ago, as a clinical-media psychologist, I made the rounds of many afternoon and evening tabloid talk shows. After doing Oprah, I received a call from a young women, a young women with vengeance on her mind.. She wanted me to help her get on Oprah. Why? Because she wanted to reveal, to publicize to the world how her parents had mistreated her. She wanted to ruin their lives as they ruined hers. And she indeed had a story to tell.
I recommended that instead of going on a TV talk show, why not get into therapy and see if she can work through some of her anger, pain and issues with them. “Absolutely not,” she stated firmly. Why, I asked? “Because one therapist in one office isn’t enough. I want an audience as big as Oprah’s.” I saw the future and the times they were a changin’
So, reader, do you have a take on this professional-ethical dilemma? Has Has it perhaps reached the time in the evolution of our entertainment-obsessed, celebrity-scavenging culture where networks, advertisers and audiences do what they can to pass the time or make a buck, a time where the new truth is a sick mind is a terrible thing to waste? Will the sweeping tide of narcissistic neurotic exhibitionism, on TV, Facebook, other twittering Internet forums become the therapeutic media of first resort and if your not spilling your psychic guts somewhere in the universe of social media, you haven't lived and you don't count.
Should therapists stand firm on their principles of patient exhibitionistic sobriety or stand aside and let the media-thirsty patient go for the gold?
Finally, should the therapist "take the call" and become an on-camera shrink and, like Dr. Phil or Dr. Drew, gain celebrity, dispense wisdom, entertain the audience, briefly therapize the celebrity-seeking "guest," and be part of the media-enabled movement called neurosis on parade?