香港六合彩精准资料

A young American couple, both committed Christians, have come to therapy to address聽their mutual lack of sexual desire. As the session progresses, the woman聽confesses that she only enjoys sex when her husband pretends to be a roguish, sexually confident Frenchman called Jean-Claude. It is a brave admission from a deeply private couple. But聽this couple aren鈥檛 my clients 鈥� I was listening in on their therapy, along with thousands of others who tune in regularly to US psychotherapist Esther Perel鈥檚 podcast series Where Should We Begin?¹

Each episode is an edit of a two-hour, real therapy session with the couples and relationship therapist at her private practice in New York. In another episode, we hear a mixed-race couple facing the unspoken challenges that their cultural differences bring to their relationship. In another, a lesbian聽couple deal with the negative impact on their relationship of finally having their longed-for children.

As a therapist, the chance to be a fly on the wall while a fellow practitioner works, especially one as respected and successful as Perel, is hard to resist.聽But as I listen, entranced, I also feel聽unsettled. Confidentiality is at the heart of what we do, so can it ever be ethical to use real-life sessions as a basis for what is, after all, entertainment? And聽is the argument valid that it benefit our profession and our clients by demystifying what happens in the therapy room? Is it simply a distorted representation of what we do, edited down for entertainment?

Client confidentiality

Addiction counsellor Mandy Saligari, Director of the Charter Harley Street private rehabilitation centre in London, wrestled with this dilemma before agreeing to be involved in the Channel 5 series, Celebrities in Therapy. Each programme is an edit of several therapy sessions conducted by Saligari with celebrities known for their 鈥榯roubled鈥� pasts, such as Kerry Katona, Daniella Westbrook and Bobby Davro. The sessions are filmed in single takes with聽a fixed camera at Saligari鈥檚 therapy room in central London, then condensed into a 45-minute programme. It often makes for compelling viewing 鈥� we see Davro deny and then admit his dependence聽on alcohol, and Katona talk about encouraging her drug-addicted mother to kill herself.

Saligari admits to having qualms even聽as she is being filmed. 鈥楢 couple of times,聽I felt protective of the clients, of how聽much they would give themselves over,聽not just to the camera but in general, to聽the media,鈥� she says. 鈥楰erry Katona was a聽perfect example of that. I became aware聽that there was literally a tiny bit of her聽left that was Kerry, and having spotted聽that, there was an internal conflict 鈥� do I聽move in to work with it on TV, therefore聽making it public, or do I shield it? I chose聽to point it out, but said, 鈥淚 am not going聽to go there because you need that.鈥� I聽made her conscious of how much of聽herself she gave away, which was part of聽her primary issue: not enough of Kerry聽belonged to Kerry.鈥�

The production company chose which聽celebrity clients were interviewed, but聽Saligari says she had the right to veto聽their choices, on clinical grounds. 鈥楳y聽criterion was, are they robust enough to聽do the type of therapy I do on TV?鈥� She聽also ensured clients had some power聽over what was included in the final聽edit: 鈥楢t times they would say, 鈥淚 don鈥檛聽want this filmed,鈥� and I would say, 鈥淭he聽camera will keep rolling, but you can聽mark it by saying, 鈥楧on鈥檛 use this鈥� a few聽times, as you say it,鈥� then it can鈥檛 be used聽as they can鈥檛 edit it out,鈥� she explains.

The ethics of consent

There are ethical concerns even with聽consent, says Professor Brett Kahr,聽psychoanalyst, author and former BBC聽Radio 2 Psychotherapist in Residence.聽鈥業 have been approached by a number聽of television companies over the years聽for exactly that sort of project and I have聽always turned them down. I just did聽not feel sufficiently comfortable with聽the notion, and sometimes I felt that聽the researchers and producers from聽television companies had really not聽thought through the ethical implications聽carefully enough and the potential long-term聽impact, both on the clients and聽the therapist.

鈥極ne has to ask how much聽preparation, how much informed聽consent is being provided before people聽expose those parts of themselves聽through their own authorisation in a聽public forum,鈥� he says. As there is an聽element of unknown potential with聽every broadcast 鈥� how many people聽will view it, will it trigger media interest,聽will the press coverage be positive or聽negative, how will that influence public聽opinion? 鈥� it could be argued that clients聽are unable to give full consent, as they聽are unaware of what they are consenting聽to. Perhaps the most famous example聽of this is 鈥楪loria鈥�, the client who featured聽in the famous Three Approaches to聽Psychotherapy films made by California聽psychologist and psychotherapist聽Everett L Shostrom in 1965. Gloria was聽filmed in session with three leading聽proponents of three different models聽of therapy 鈥� Franz Perls (Gestalt), Carl聽Rogers (person-centred) and Albert Ellis聽(rational emotive therapy). Shostrom聽originally cast an actress in the role聽of the client in his first attempt, called聽Introduction to Psychotherapy, which he聽made in 1963, but he wasn鈥檛 happy with聽the result, so found a 鈥榬eal鈥� client for the聽1965 project.

Gloria was told it would be an聽educational series on how therapy聽works, but the film was shown聽nationwide throughout the US on聽mainstream cinema screens, and she聽found herself the subject of widespread聽and prurient public interest in her聽 sex聽life. According to an account written after聽her death at age 45 by her daughter,聽Pamela J Burry, taking part in the聽sessions negatively impacted on Gloria聽for the rest of her life.²

鈥極ne has to think very carefully about聽the meaning of informed consent,鈥櫬爏ays Kahr. 鈥榃hen one invites Ms X from聽Scunthorpe or Mr Y from Basingstoke聽to appear on a television programme,聽one must ask whether anybody has聽had a thorough conversation with these聽people beforehand to help them think聽with consideration about the meaning of聽such a decision, particularly the meaning聽of one鈥檚 mind and body becoming聽public property. One must be very聽vigilant as to whether exposing oneself聽on camera might become a聽re-enactment of an early sexual trauma.鈥�

Saligari agrees that consent is a聽complex issue, but says the production聽company she works with takes the聽issue seriously. 鈥楶rior to filming and聽through the agents, should there be聽any concerns regarding mental health聽issues, the production company offers聽to pay for an independent mental聽health assessment with an accredited聽professional. These individuals are聽already in the public eye and are talking聽here about issues that they have mainly聽discussed in the media before. They are聽well versed in the pitfalls of those issues聽being public knowledge.鈥�

Fact versus fiction

Without broadcasts of real therapy聽sessions, prospective clients only聽have fictionalised accounts on which聽to base their knowledge of therapy,聽and these are notoriously unreliable聽and misleading, argues Dr Otto Wahl,聽Professor of Clinical Psychology at the聽University of Hartford. He conducted聽a systematic review of the portrayal of聽therapists and therapy in films released聽between 2000 and 2013,³ and, while he聽found some changes for the better in聽terms of accuracy of portrayal, there was,聽he says, still 鈥榓 lot of unethical behaviour鈥�.

鈥業t wasn鈥檛 the same as in films of the聽past, when the therapists were usually聽shown as evil and manipulative, or聽sleeping with their patients, but in a聽more insidious way. Therapists would聽share personal information about聽their clients without their permission.聽If I鈥檓 a client considering going to聽psychotherapy, I might think, if I am聽going to tell someone something聽really personal, I want to know that it聽is between me and the therapist,鈥� he聽says. Such fictional portrayals can easily聽normalise this kind of practice. 鈥業n the聽films we looked at, therapy was also聽seldom helpful. You rarely saw people聽get better, and for those that did, it聽tended to be because of a dramatic聽breakthrough that occurred.鈥�

His biggest concern was over physical聽touch. 鈥楽eventy per cent of therapists聽in the films we studied touched their聽clients in some way, other than shaking聽hands. It wasn鈥檛 always overtly sexual,聽but one of the problems with boundary聽violations is that they begin gradually.聽If a client is uncertain about what the聽boundaries are 鈥� what kind of touching is聽OK and what is not OK 鈥� those who tend聽to trust their therapists can be led into聽relationships in a gradual fashion. If you聽are communicating that touching is a聽common and acceptable part of therapy,聽you are opening the door to expanded聽physical contact.鈥�

Kahr agrees that fictionalised聽accounts of our profession largely do聽us a disservice. 鈥業 do not recognise the聽psychotherapists and counsellors I see in聽films and TV programmes. In Treatment聽[HBO鈥檚 drama series that showed 鈥榬ealtime鈥櫬燾lient sessions with the fictional聽psychotherapist Dr Paul Weston] was聽beyond diabolical in giving so much air聽time to a mental health practitioner who聽had an affair with a patient,鈥� he says.

It is for this reason that, while we聽should take the issue of consent聽seriously, says Wahl, we cannot let it聽stop us from finding ways to bring real聽therapy sessions into the public domain.聽鈥榃e have to show real psychotherapy.聽To contradict and challenge stereotypes,聽we need to stimulate discussion about聽them. We have to say, 鈥淲hat you see in聽films, it鈥檚 not what you see in real life.鈥澛燱e have to help people become more聽critical viewers, to make them ask if this聽is accurate. But confidentiality belongs to聽the client. If the client says it鈥檚 OK, then聽it鈥檚 OK for you to show their treatment,聽as long as there is no coercion or聽persuasion involved.鈥�

Kahr agrees: 鈥榃e have a huge聽responsibility to disseminate useful,聽admirable, responsible knowledge聽about our profession to members聽of the general public. We may think聽of ourselves as kind, compassionate聽people, but we are an intimidating聽profession in that people have all kinds聽of fantasies about what we are going to聽say to them, what we are going to say聽about them, what aspects of their secret聽lives will be unearthed, and whether聽we can be trusted to keep their secrets.聽So, I think we do have a responsibility聽to portray ourselves so that people can聽learn about our work.鈥�

Therapy as entertainment

There is also the issue that good聽therapy doesn鈥檛 necessarily make good聽entertainment. Therapy rarely achieves聽its results in a cinematically dramatic聽breakthrough; its 鈥榩lot鈥� is rarely linear 鈥撀爂enerally, changes unfurl very gradually聽over time.聽 How accurate can 鈥榬eal-life鈥櫬爌ortrayals of therapy be, given the聽impossibility of sustaining dramatic聽interest in real time? Did Saligari feel a聽pressure to change the way she worked,聽to make it more dramatic, I wondered?聽鈥業 took responsibility for therapy and the聽producer took responsibility for TV, so聽we had our clear roles, and when we聽disagreed with one another, we would聽argue it out and hold our corners,鈥� she聽says. 鈥業f it wasn鈥檛 interesting TV, it wasn鈥檛聽my problem: they gave me the clients, I聽worked with them in the same way I work聽with all clients. That鈥檚 how we did it, and聽it worked.鈥�

Her guide was that fundamental聽principle of therapy: 鈥業 would say, we聽have to trust the process. With [reality聽TV star] Nikki Grahame, for instance,聽for 25 minutes she didn鈥檛 speak, and聽in terms of television, that is a long,聽long time. I pushed her and she went聽into a shame-based withdrawal, and聽I knew I had to sit it out. If I went to聽retrieve her from it, I was rescuing her聽and reinforcing the victim space. But,聽in my mind, I wondered how easily the聽production team were waiting. They聽were downstairs, and I could almost聽hear their thoughts through the floor:聽鈥淭his is 25 minutes of television time!鈥澛燗nd I鈥檓 thinking, 鈥淒on鈥檛 come in the聽room.鈥� Afterwards I said, 鈥淚 am so grateful聽that you trusted me to roll with that.鈥澛燭hey said they had discussed what聽they should do, but the mutual respect聽between us meant they held off from聽coming in.鈥�

This potential for 鈥榞ood entertainment聽versus good therapy鈥� conflict was an聽issue for psychotherapist Susie Orbach聽in the making of her Radio 4 series,聽In Therapy. 鈥楾herapy is not a good聽spectator sport, and there can be聽longueurs where nothing happens,鈥� she聽says. 鈥楾he fact is, you are sitting with聽somebody and helping them not to聽feel alone. There isn鈥檛 very long; each聽[broadcast session] is 12 and a half聽minutes, so the BBC had to struggle with聽allowing silences in that time.聽 More time,聽two 20-minute sessions for instance,聽would have been much better but it聽wouldn鈥檛 have fit the schedules.鈥�

The series didn鈥檛 feature live clients.聽The sessions took place in Orbach鈥檚 own聽therapy rooms and were unscripted; the聽clients were actors, who were given a聽detailed brief about their character and聽then freed to improvise. 鈥業 knew I didn鈥檛聽want to script something; that would not聽show how therapy actually goes,鈥� she聽says. 鈥業 suggested very little beyond the聽barest outlines. I said, give me a young聽couple whose life dilemma may be聽reflecting their personal histories; give聽me a 60-year-old trade union person聽who is facing a difficulty, but I didn鈥檛聽know what that difficulty was. I would聽be told a paragraph of background,聽similar to what you would know about聽any new client before they walked聽through the door. But then we had to聽make it sound like I had been seeing聽them for six months.鈥�

She had no idea what would emerge聽鈥� that John, the trade union steward,聽for instance, would confess that he had聽fallen in love with her. 鈥楾he director聽would put a few 鈥渂ombs鈥� into each聽session. Although I did say, you can鈥檛 put聽too many聽 bombs in each situation as聽then I am being thrown about too much,聽and it鈥檚 implausible.鈥�

Orbach鈥檚 motivation was to show how聽therapy is done. 鈥楾here has always been聽a strong aesthetic for me in therapy 鈥� it鈥檚聽a craft,鈥� she says. 鈥業 wanted to show many聽different things 鈥� how deeply interesting聽it is, how therapy is a different form of聽talking, a different form of listening, and聽a different form of engagement. I also聽wanted to show how people can think聽differently when exposed to different聽ways of talking and feeling.鈥�

Demystifying therapy

Orbach also wanted to 鈥榖ring people聽closer to the experience of the聽consulting room鈥�: 鈥楢ttitudes to therapy聽have changed dramatically since I鈥檝e聽started working, when it really was a聽taboo; now, it鈥檚 not a taboo in the same聽way, but it鈥檚 still a mystery, and I had聽the opportunity, through vignettes with聽imagined people, to show what I do and聽what my day is like.鈥�

Saligari similarly says her motivation聽for being involved in the programme聽was to 鈥榙estigmatise therapy and聽addiction鈥�: 鈥業 saw it as an opportunity to聽make therapy seem accessible, to teach聽people to interview their therapists聽rather than just turn up to be fixed,聽and to push through an unconscious聽glass ceiling that therapy doesn鈥檛 have聽to come at the end of a long line of聽changes, like moving house, changing聽relationships, changing your hair; it聽could be an earlier option,鈥� she says.

Orbach has always been in the public聽eye, so the clients she sees in her聽private practice three days a week were聽unaffected by the programme, she says,聽although it did trigger a rise in enquiries聽from potential clients. Saligari also聽carried on seeing regular clients during聽filming of her TV show. 鈥業 preserve two聽days for client work. My pattern is that聽I do the intake session, then refer the聽client to my team or onward for inpatient聽treatment. I also have 12 regular clients聽a week, and I refused to let the filming聽schedule intrude on those days, so they聽had their time with me as normal.鈥�

She believes the show has had a聽positive effect 鈥� she sees a spike in聽enquiries when the series airs; most want聽to know how to find a therapist near聽them, and she refers them to the 香港六合彩精准资料,聽UKCP and BABCP websites. 鈥楲oads of聽people have written and said, 鈥淚鈥檇 never聽thought I鈥檇 have therapy but since聽watching the programme I am going聽to give it a shot.鈥� One man got in touch聽and told us he had booked into a hotel聽to take his own life. He turned the TV on,聽watched the Bobby Davro programme聽and was transfixed, and decided to go to聽AA instead.鈥�

Certainly Channel 5 thinks there is聽a growing public appetite for real-life聽therapy. A fourth season of Celebrities聽in Therapy is planned for this year, and聽Saligari is currently looking for couples聽to appear in a new programme on聽couples counselling. Esther Perel鈥檚聽podcast frequently appears in the top 10聽of iTunes鈥� 鈥榤ost-listened to鈥� podcasts,^4听and Orbach is working with director聽Ian Rickson at the National Theatre to聽develop a stage version of In Therapy.

These pioneers of the genre are聽carefully walking the line between聽education and entertainment.聽Broadcasts of 鈥榣ive鈥� or simulated therapy聽are a way to showcase ethically and聽responsibly to the general public what聽therapists and therapy do. So long as聽principled and accountable practitioners聽are working with responsible and聽principled broadcasters, we can be聽hopeful that they are making it easier,聽safer and more acceptable for people聽to seek help, without creating another聽generation of Glorias.

Sally Brown is a聽counsellor and coach聽in private practice聽(),聽a freelance journalist,聽and Executive Specialist聽for Communication聽for 香港六合彩精准资料 Coaching.

References

1. Where Should We Begin? is available on聽iTunes or at audible.co.uk
2. Burry PJ. Living with the Gloria films: a聽daughter鈥檚 memory. Ross-on-Wye: PCCS Books;聽2008.
3. Wahl O, Reiss M, Thompson CA. Film聽psychotherapy in the 21st century. [Online.]聽Health Communication 2016; 29 December.聽doi: 10.1080/10410236.2016.1255842
4. bit.ly/2lFjUkB

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