The social intelligence of TV shrinks

Just got around to watching part of the first season of “In Treatment,” the popular HBO series about a psychotherapist and his patients.  My initial impression is: there is no way I would ever try to get help from that guy.

It is very hard to write compelling psychotherapy fiction.  On the one hand, you would like the dialogue to be true to both the real complexity of patients and their problems, and to what real therapists might try to do to help.  On the other, you generally need the therapy scenes to advance some kind of bigger plot — find the killer, show how a woman struggles against an oppressive society, see if a Mafia don will ever give up his evil ways.  It’s not always easy to balance that out, particularly in film and TV, where producers and directors have a phobia against the “talking heads” thing.  (They assume that two people just sitting and talking will bore the audience, so they always have shrinks or patients jumping up and staring out the window, or taking bathroom breaks in the middle of sessions, or patients fondling the knickknacks on the shrink’s bookcase — or the shrink.  I can tell you that in over 20 years of doing therapy, I’ve never gotten up to stare out the window during a session, and neither did any of my clients.  I recall only a couple of “bathroom emergencies” and nobody messed with my knickknacks, in any sense of the term.)

But aside from all the inaccurate writing about what happens in the room, the biggest difficulty writers generally have with TV or movie shrinkage is the really, really low levels of responsive listening the shrinks do.  Therapists butt in before patients get a chance to say very much at all about their difficulties.  TV shrink “writers” have learned that therapists are somehow never supposed to “give advice” and to always, always, always “answer a question with a question.”  And so watching TV shrinks is generally all about people popping up and down, patients trying to be understood while the “wiser than thou” shrink asks clever questions to prove that the patient is actually wrong about, well, everything.  Finally, of course, the therapist is often such a newbie that any hint of, say, the patient having an actual feeling about them triggers a major crisis that forces the shrink back into therapy of their own.  (Where, if we’re lucky, as in “In Treatment,” we learn where they probably learned all those awful habits.)

And yes, every single one of these common therapeutic offenses happens in the very first week of the “In Treatment” show.  The therapist sort of tries to look like a really good listener, but clearly his heart isn’t in it.  By the end of an hour, he talks as much or more as the patients, who are generally realistically frustrated at his being such a pain in the head.  People bop up and down and fondle his knickknacks, and the shrink answers questions only with exasperating questions of his own.

The real problem with all that stuff is that it shows therapists as being remarkably poor in basic social intelligence.  Because a core part of SI is being able to tune in to both the words and the feelings of another person.  That takes patient listening to patients, not interrupting. (Maybe that’s why the poor people who have to put up with the shrinks are called “patients”?  It sure takes a lot of it sometimes.)

Whether you are someone’s shrink, their friend, their boss or their mother or dad, most of all, people want to finish telling you their story.  The whole story.  (Or as they say in court, “the whole truth” [though in fact, lawyers are generally pretty good at making sure you only tell the part of the "whole truth" that helps their case.  But that's a topic for a different blog.])

If you really want to “help” someone, just be quiet.  Make eye contact.  Do whatever it takes to really understand the entire story, situation, feeling, as seen through their eyes.  Don’t be super worried about what you are supposed to say.  Believe me — you will do much more for them and for your connection with them than you ever imagined, if you just give them the rare experience of listening.

In real life, a really good therapist may say three sentences, tops, in many sessions.  Sometimes even those three sentences aren’t all that necessary.  But the listening, the eye contact, the feeling it the way the other person does — priceless.

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[A related post on my other blog: Doctor Mustard, In the Consulting Room, With Words]