Reel Therapy

Using fiction as a clinical tool. Film and movies can be a form of therapy.

By John W. Hesley, published January 1, 2000 - last reviewed on June 9, 2016

After 12 sessions, Jan Hesley, ACSW, had made little progress with her patient Beth. It had been years since Beth, who was raped by her father when she was a little girl, was able to feel pain or cry about her childhood experiences. She began therapy with her husband's full support because she had begun to worry, based on her own trauma, that he might sexually abuse their children.

Hesley asked Beth to think about watching Bastard Out of Carolina, a movie about a girl who had a similarly traumatic childhood, and she told her the story line in great detail. Hesley shared her own emotional responses to the character's pain, and made sure Beth knew she could call her if she wanted as she viewed the film.

Beth chose to watch the movie in small clips and invited her husband to watch it with her since she was scared to relive the agony she knew lay ahead in the plot. Beth later shared that she tried not to feel or cry but finally let go.

The 13th session saw more progress than all 12 sessions in the previous three months, with Beth finally discussing her abuse in emotional detail.

An increasing number of therapists are relying on movies to move people toward breakthroughs faster. In this age of managed care, time has become precious: using movies allows patients to grow in their own "free" time.

In fact, it was standing-room-only at the movie therapy workshop one marriage and family therapy's annual meeting. In a survey of the attendees, an overwhelming majority said they routinely discuss movies in psychotherapy. An increasing number of professors are also using films to teach graduate students about personality types and emotional disorders, and are encouraging them to assign movies to clients. The growing number of therapist-authored film critiques on the Web and the onslaught of related academic and journalistic articles illustrate the impact film therapy is rapidly making on the field.

Although people might be surprised when a therapist recommends a movie, using fiction as a clinical tool is not actually new. Since the 1930s, when a doctor named William C. Menninger first assigned fiction to psychiatric patients, therapists have introduced literature—novels, short stories and poetry—into the therapeutic process. Movies are simply the latest, most accessible and time-saving addition to what has become known as bibliotherapy.

Movies connect a client's world to the characters and plots—furnishing role models, providing inspiration and hope, and offering new solutions to old problems. They assure clients that they are not alone, that others have experienced hardship and triumphed.

Clinicians have found movies particularly effective in couples therapy.

Richard, a 51-year-old father, was worried about his sexual performance and his relationship with his wife of 23 years. He believed that she avoided him by watching TV each night while doing paperwork. He said he went to bed early and expected her to notice that he was staying awake, waiting for her to join him. When she didn't, he became grumpy and demanding, and told her he resented her evening habit.

Hesley, co-author of Rent Two Films and Let's Talk in the Morning, recommended that they watch Bridges of Madison County together, and that he observe how the protagonist, played by Clint Eastwood, treats his on-screen lover, played by Meryl Streep. According to Hesley, this film helps men learn what women value in a romantic and sexual relationship. Eastwood helps peel carrots, brings Streep a beer, reflects on his day and expresses interest in her life and dreams. He values her experiences, though they are quite workaday compared to his. He lights candles and makes love by the fireplace.

On the way home from work that day John rented the movie, and his wife was pleased that he asked her to watch it with him. After both enjoyed the film, she commented that he had been nicer to her than usual that evening. She asked him to join her another night in watching an old romantic movie that she particularly enjoyed.

At his next visit, John happily reported that he and his wife were spending more time together, that he had helped her with her paperwork and that their intimate time together had improved. John asked for other movie suggestions.

Therapists also use films to help clients develop the courage to surprise themselves, to fundamentally change their lives.

For some time, Karen, a client of therapist David Cambronne, had been struggling against a "way of living" that she found unfulfilling, saying she was bound by a form of "golden handcuffs." She wanted to leave her husband because he was financially irresponsible, emotionally cold and distant and, at times, verbally abusive. But her husband was sociable and popular at his small business in town, and Karen was afraid no one in her community or family would support her if she divorced him. Cambronne encouraged Karen to watch Titanic, to look specifically at how the character Rose learned to break free of her social constraints. Karen identified several characters who unexpectedly stood by Rose during her arduous transformation, and began to identify people in her own life who would offer unconditional love. Karen soon gained the confidence to make the changes she needed, and, to her surprise, many people remained supportive of her.

Shirley Hanson, of the School of Nursing at Oregon Health Sciences University, also uses film to encourage clients to muster up the courage for self-improvement. Hanson tells of counseling a terminally ill man who had been estranged from his family for many years. She asked him to view the film My Life, about a young man who is dying and making a videotape for his soon-to-be firstborn child. "The movie warmed him up and inspired him," Hanson says. "Our conversation about the film resulted in my patient persuading his aging parents to come to therapy with him so he could apologize for his arrogance and pride during his younger years. The reconciliation that followed was a beautiful sight to behold."

Many doctors have found that films can also help families rebuild after tragedy.

New Orleans-based marriage and family therapist John Dawson, treats a multiethnic population that is highly dependent on family for emotional support. Recently, five grieving adult children and their parents came to him for counseling following the death of the eldest child. But the session soon focused on sibling rivalry and parent and child relationships. Dawson recommended they watch Soul Food because of its parallel story line. Most of the family watched it, comparing themselves and each other to the characters, reflecting and learning about themselves.

One of my own patients, a verbally abusive father, was able to learn about himself and change his behavior after watching a film and discussing it with his wife in a therapy session. Since direct confrontation seemed ill-advised, I had asked him to watch the film The Great Santini, about an alcoholic Marine who was unaware of how his behavior troubled his family. In the following therapy session the man asked his wife, "Am I really as bad as that guy?" "Not quite as bad," she answered. "But close."

He stared out the window for a while, and then spoke quietly: "That was my old man in that movie. I said I'd never be like him; I don't want to be." Prior to the viewing he had always referred to his father as "stern but fair." Afterward he spoke more candidly not only about his father, but also about himself. Following this experience, he finally began to change for the better.

Another patient, John Bard, had lost his father when he was a baby. He told psychologist Mary Gregerson, Ph.D., of Alexandria, Virginia, that he was worried about becoming a new father himself because an example was never set for him. "We are using films to explore the roles and relationships between father and child. We are working at developing what I call `pre-verbal' guidance for him."

The use of films in therapy is likely to become even more commonplace as many next-generation therapists are being trained with the aid of films. Kit Johnson, at Florida's Barry University, uses movies to illustrate hard-to-grasp concepts to her students. She relies on Angel Baby—a film in which a schizophrenic young couple are expecting a baby—to underscore how discontinuing medication is often detrimental to a client's mental health. She believes that a movie's emotional power makes clinical material come alive in the classroom. She also encourages students to incorporate films into their own practice to motivate change in clients.

But film therapy does have limitations. Therapists should treat films as icebreakers; too much time discussing a movie leaves less time for the issues that brought a client into therapy. When choosing a film, therapists should be sensitive to the client's intensity threshold and his or her compatibility with particular characters.

Most important, not all movies feature healthy role models or realistic scenarios. A poetic film such as American Beauty shows a man liberate himself from a mundane, repressive life by dropping out of society—to the point of neglecting his teen-age daughter and ogling her friend—and then serendipitously happening upon enlightenment before his sudden demise. So don't take movies too literally. Take them carefully and thoughtfully. And call your therapist in the morning.