PsychologicalReports, 1990, 67, 399-402.
O Psychological Reports 1990
COUNTERTRANSFERENCE IN T H E MOVIES: EFFECTS O N BELIEFS ABOUT PSYCHIATRIC TREATMENT ' THOMAS SCHILL, JEFF HARSCH, AND KATIE RITTER Southern Illinois University at Carbondale Summary.-This study examined the effect of viewing the movie Lovesick on college students' beliefs about countertransference and psychiatric practice. Consistent w ~ t hh e concerns of Gebbard and Gebbard (1985) that the public may develop erroneous beliefs about psychiatry from watching such movies, after seeing the film subjects were more accepting of sexual behavior between analyst and patient and were cynical about the motivation of the mental health professions in prohibiting such behavior.
A number of people (Gebbard & Gebbard, 1985; Schneider, 1987) have recently written articles critical of the picture of the psychiatric profession presented in the movies. Gebbard and Gebbard, for example, have written about recent movies which portray a psychiatrist overwhelmed by countertransference of feelings. They voice concern over such portrayals because watching a movie is how many people come to know what a psychiatrist does and the nature of psychiatric treatment. For instance, one of the movies they review is Marshall Brickman's Lovesick which stars Dudley Moore as a psychoanalyst who acts out his countertransference feelings with a young woman patient played by Elizabeth McGovern. The Gebbards claim that after seeing this movie a patient of theirs in analytic treatment had the disturbing thought that perhaps the boundaries of psychotherapy were not as clear as she had thought and stated that if she developed erotic feelings in the transference, she might not be so willing to talk about them. The Gebbards remark one can only speculate as to the effects these movies may have on prospective patients who have never seen a psychiatrist. The present study explored what effect viewing this movie had on the beliefs of a group of college students. The number of symptoms checked on Langner's Psychiatric Impairment Scale was also included as an individual difference variable which might affect subjects' reactions to the film. -
~
METHOD Subjects were 57 men and 57 women volunteers from an introduction to psychology class who were given course credit for their participation. Their mean age was 19 y t and the majority were sophomores in college. Only individuds who had not seen the movie were included. Three groups, each
'Requests for reprints should be sent to Thomas Schill, Department of Psychology, Southern Illinois University, Carbondale, IL 62901.
400
T.SCHILL, ETAL.
including approximately 40 men and women, completed the following procedure during a single session. A premovie survey was completed by all of the subjects. The survey consisted of the six "assumptions" which the Gebbards conclude the public might make about the psychiatric profession after seeing the movie Lovesick. Subjects responded to the following statements using a six-point scale where one was strongly agree and six was strongly disagree. (1) The sexual feelings an analyst develops for one of hisher patients can be real love. (2) Sexual relations between the analyst and hisher patients are not damaging. (3) Consulting with another professional is standard procedure for analysts when they become emotionally and/or sexually involved with their patients. This procedure, however, is Uely to be totally ineffective in helping himher deal with these feelings. (4) It is more cruel for an analyst who is in love with hisher patient to abandon the patient (terminate treatment and stop seeing the person) than to continue a sexual affair with the patient. (5) The mental health professions prohibit sexual affairs between therapists and patients mainly because it looks bad to outsiders and therefore tarnishes the reputation of the professions. (6) Psychoanalytic principles of ethics which forbid sex between analyst and patient are outmoded and repressive restrictions which prohibit the analyst from being emotionally spontaneous with his/her patient. Four additional statements not specifically addressed by the Gebbards were: (7) actual sexual relations between the analyst and patient seldom occur. (8) Because they are human, psychiatrists can't help acting on strong feelings (sexual feelings) which develop in their relationships with patients regardless of their training. (9) I would be reluctant to discuss sexual feelings I had for my therapist if I were in treatment for fear the therapist might respond to them unethically. (10) If I had a personal problem that I didn't feel I could handle myself, I'd have little reservation about seeing an analyst or psychotherapist. Subjects also completed the Langner Psychiatric Impairment Scale (Shader, Ebert, & Harmatz, 1971), a 22-item symptom checklist which screens for symptoms of emotional disorder. It correlates .72 with Eysenck's Neuroticism Scale and .77 with Taylor's Manifest Anxiety Scale. It was used in this study to assess whether greater psychological distress (where treatment should have more salience) differentially affected beliefs as a function of watching the movie. Subjects then viewed the movie Lovesick and again filled out the survey. Filling out the survey before and after the movie and seeing the movie took about two hours.
RESULTS AND DISCUSSION To assess whether viewing the film changed subjects' beliefs about countertransference and the mental health profession a 2 (sex) x 2 (distress) x 2 (repeated measure on belief; before and after the film) analysis of variance
40 1
MOVIES AND BELIEFS ABOUT PSYCHIATRIC TREATMENT
was performed for each of the 10 items of the survey. Langner scores (which ranged from 0 to 13) were split at the median, 3.5, to form groups of high and low psychological distress. Table 1 presents the significances of effects as well as means and standard deviations. TABLE 1
MEANS,STANDARD DEVIATIONS, AND F TESTS FORSLIRVEY ITEMS Question 1 2 3 4
Effect Retest
Retest
5 6
x
Sex
F 17.68' 9.38' 15.96' 6.30' 5.87'
Retest Sex
13.04' 8.67'
Sex
M F M F
M F
Distress
Pretest Mt SD 2.77 4.45 3.69 3.25 3.94 3.28 4.22 3.94
1.30 1.48 1.58 1.70 1.58 1.74 1.93 1.59
Posttest M SD 2.19 4.04 2.94 3.09 2.82 2.79 2.80 3.30
Total M
SD
3.28 4.00
1.57 1.58
1 28 1 48 1.58 1.58 1.67 1.60 1.61 1.63
3.30 1.47 3.34 1.52 3.30 1.69 2.56 1.65 3.02 1.54 2.99 1.55 High 3.95 1.72 2.89 1.84 Low 3.12 1.52 3.48 1.62 tMeans indicate scale points where 1: strongly agree, 2 moderately agree, 3: slightly agree, 4: slightly disagree, 5: moderately disagree, 6: strongly aissgree * p < .05.
7 8 9 10
.06 24.31' .06 Retest x Distress 10.82'
Retest
There was significant change on the first six items, indicating subjects held more erroneous beliefs about psychiatry after seeing the film. Subjects were more likely to believe an analyst's sexual feelings can be real love (Item I), that sexual relations between the analyst and patient aren't so damaging (Item 2), that consulting with another professional is an ineffective procedure for analysts when sexually involved with a patient (Item 3), that the mental health professions prohibit sexual affairs mainly because it looks bad for the professions (Item 5 ) , and that psychoanalytic principles of ethics which forbid sex are outmoded and repressive restrictions (Item 6). After seeing the film women also believed that it is more cruel for an analyst to terminate treatment than continue a sexual affair (Item 4). The additional survey items also produced some interesting results. Even before seeing the film subjects' agreement with Item 7, actual sexual relations between the analyst and patient seldom occur, was only slight. In addition, subjects initially slightly agreed with Item 8, because they are human psychiatrists can't help acting on sexual feelings, and more strongly agreed after seeing the movie. I t is clear many subjects had reservations
402
T. SCHILL, ETAL.
about whether therapists can act in a moral and ethical manner even before seeing the film. The film had no effect on Item 9, I would be reluctant to discuss sexual feelings for fear the therapist might respond unethically. Subjects slightly agreed with this statement before and after seeing the film. Thus, one of the Gebbards' main concerns about viewing the filrn was not an issue for this group of students. Finally, the film affected response to Item 10, if I had a personal problem I'd have little reservation about seeing an analyst or psychotherapist, depending on a person's level of psychological distress. The less distressed group agreed with this statement before seeing the movie but was more ambivalent after seeing it. The more distressed group, however, was ambivalent before seeing the movie but in agreement with the statement after seeing the filrn. Perhaps, the prospect of a more personal relationship with a therapist as seen in the film reduced whatever prior reservations they had about treatment. An expectation of an affectional relationship with the therapist could, of course, increase the probability of a sexualized transference if the person entered treatment. I n general, the results indicate subjects' belieis about psychiatry can be affected by seeing movies like Lovesick. However, the changes noted in this study were often slight and one wonders how long lasting they were. Also, these changes occurred with college students and these results may or may not generalize to other samples. Finally, an improvement in studies of this type would be to control for the effects of having subjects rate the questions twice. GEBBMD,G., & GEBBMD,K.
REFERENCES Countertransference in the movies. Psychoanalytic Review,
1985, 72, 171-184.
SCHNEIDER,I. The theory and practice of movie psychiatry. American Journal of Psychiatry, 1987, 144, 996-1002.
SHADER,R., EBERT,M., & HARMATZ, J. Langner's Psychiatric Impairment Scale: a short screening device. American Journal of Psychiatry, 1971, 128, 596-601. Accepted August 15, 1990
O Psychological Reports 1990
COUNTERTRANSFERENCE IN T H E MOVIES: EFFECTS O N BELIEFS ABOUT PSYCHIATRIC TREATMENT ' THOMAS SCHILL, JEFF HARSCH, AND KATIE RITTER Southern Illinois University at Carbondale Summary.-This study examined the effect of viewing the movie Lovesick on college students' beliefs about countertransference and psychiatric practice. Consistent w ~ t hh e concerns of Gebbard and Gebbard (1985) that the public may develop erroneous beliefs about psychiatry from watching such movies, after seeing the film subjects were more accepting of sexual behavior between analyst and patient and were cynical about the motivation of the mental health professions in prohibiting such behavior.
A number of people (Gebbard & Gebbard, 1985; Schneider, 1987) have recently written articles critical of the picture of the psychiatric profession presented in the movies. Gebbard and Gebbard, for example, have written about recent movies which portray a psychiatrist overwhelmed by countertransference of feelings. They voice concern over such portrayals because watching a movie is how many people come to know what a psychiatrist does and the nature of psychiatric treatment. For instance, one of the movies they review is Marshall Brickman's Lovesick which stars Dudley Moore as a psychoanalyst who acts out his countertransference feelings with a young woman patient played by Elizabeth McGovern. The Gebbards claim that after seeing this movie a patient of theirs in analytic treatment had the disturbing thought that perhaps the boundaries of psychotherapy were not as clear as she had thought and stated that if she developed erotic feelings in the transference, she might not be so willing to talk about them. The Gebbards remark one can only speculate as to the effects these movies may have on prospective patients who have never seen a psychiatrist. The present study explored what effect viewing this movie had on the beliefs of a group of college students. The number of symptoms checked on Langner's Psychiatric Impairment Scale was also included as an individual difference variable which might affect subjects' reactions to the film. -
~
METHOD Subjects were 57 men and 57 women volunteers from an introduction to psychology class who were given course credit for their participation. Their mean age was 19 y t and the majority were sophomores in college. Only individuds who had not seen the movie were included. Three groups, each
'Requests for reprints should be sent to Thomas Schill, Department of Psychology, Southern Illinois University, Carbondale, IL 62901.
400
T.SCHILL, ETAL.
including approximately 40 men and women, completed the following procedure during a single session. A premovie survey was completed by all of the subjects. The survey consisted of the six "assumptions" which the Gebbards conclude the public might make about the psychiatric profession after seeing the movie Lovesick. Subjects responded to the following statements using a six-point scale where one was strongly agree and six was strongly disagree. (1) The sexual feelings an analyst develops for one of hisher patients can be real love. (2) Sexual relations between the analyst and hisher patients are not damaging. (3) Consulting with another professional is standard procedure for analysts when they become emotionally and/or sexually involved with their patients. This procedure, however, is Uely to be totally ineffective in helping himher deal with these feelings. (4) It is more cruel for an analyst who is in love with hisher patient to abandon the patient (terminate treatment and stop seeing the person) than to continue a sexual affair with the patient. (5) The mental health professions prohibit sexual affairs between therapists and patients mainly because it looks bad to outsiders and therefore tarnishes the reputation of the professions. (6) Psychoanalytic principles of ethics which forbid sex between analyst and patient are outmoded and repressive restrictions which prohibit the analyst from being emotionally spontaneous with his/her patient. Four additional statements not specifically addressed by the Gebbards were: (7) actual sexual relations between the analyst and patient seldom occur. (8) Because they are human, psychiatrists can't help acting on strong feelings (sexual feelings) which develop in their relationships with patients regardless of their training. (9) I would be reluctant to discuss sexual feelings I had for my therapist if I were in treatment for fear the therapist might respond to them unethically. (10) If I had a personal problem that I didn't feel I could handle myself, I'd have little reservation about seeing an analyst or psychotherapist. Subjects also completed the Langner Psychiatric Impairment Scale (Shader, Ebert, & Harmatz, 1971), a 22-item symptom checklist which screens for symptoms of emotional disorder. It correlates .72 with Eysenck's Neuroticism Scale and .77 with Taylor's Manifest Anxiety Scale. It was used in this study to assess whether greater psychological distress (where treatment should have more salience) differentially affected beliefs as a function of watching the movie. Subjects then viewed the movie Lovesick and again filled out the survey. Filling out the survey before and after the movie and seeing the movie took about two hours.
RESULTS AND DISCUSSION To assess whether viewing the film changed subjects' beliefs about countertransference and the mental health profession a 2 (sex) x 2 (distress) x 2 (repeated measure on belief; before and after the film) analysis of variance
40 1
MOVIES AND BELIEFS ABOUT PSYCHIATRIC TREATMENT
was performed for each of the 10 items of the survey. Langner scores (which ranged from 0 to 13) were split at the median, 3.5, to form groups of high and low psychological distress. Table 1 presents the significances of effects as well as means and standard deviations. TABLE 1
MEANS,STANDARD DEVIATIONS, AND F TESTS FORSLIRVEY ITEMS Question 1 2 3 4
Effect Retest
Retest
5 6
x
Sex
F 17.68' 9.38' 15.96' 6.30' 5.87'
Retest Sex
13.04' 8.67'
Sex
M F M F
M F
Distress
Pretest Mt SD 2.77 4.45 3.69 3.25 3.94 3.28 4.22 3.94
1.30 1.48 1.58 1.70 1.58 1.74 1.93 1.59
Posttest M SD 2.19 4.04 2.94 3.09 2.82 2.79 2.80 3.30
Total M
SD
3.28 4.00
1.57 1.58
1 28 1 48 1.58 1.58 1.67 1.60 1.61 1.63
3.30 1.47 3.34 1.52 3.30 1.69 2.56 1.65 3.02 1.54 2.99 1.55 High 3.95 1.72 2.89 1.84 Low 3.12 1.52 3.48 1.62 tMeans indicate scale points where 1: strongly agree, 2 moderately agree, 3: slightly agree, 4: slightly disagree, 5: moderately disagree, 6: strongly aissgree * p < .05.
7 8 9 10
.06 24.31' .06 Retest x Distress 10.82'
Retest
There was significant change on the first six items, indicating subjects held more erroneous beliefs about psychiatry after seeing the film. Subjects were more likely to believe an analyst's sexual feelings can be real love (Item I), that sexual relations between the analyst and patient aren't so damaging (Item 2), that consulting with another professional is an ineffective procedure for analysts when sexually involved with a patient (Item 3), that the mental health professions prohibit sexual affairs mainly because it looks bad for the professions (Item 5 ) , and that psychoanalytic principles of ethics which forbid sex are outmoded and repressive restrictions (Item 6). After seeing the film women also believed that it is more cruel for an analyst to terminate treatment than continue a sexual affair (Item 4). The additional survey items also produced some interesting results. Even before seeing the film subjects' agreement with Item 7, actual sexual relations between the analyst and patient seldom occur, was only slight. In addition, subjects initially slightly agreed with Item 8, because they are human psychiatrists can't help acting on sexual feelings, and more strongly agreed after seeing the movie. I t is clear many subjects had reservations
402
T. SCHILL, ETAL.
about whether therapists can act in a moral and ethical manner even before seeing the film. The film had no effect on Item 9, I would be reluctant to discuss sexual feelings for fear the therapist might respond unethically. Subjects slightly agreed with this statement before and after seeing the film. Thus, one of the Gebbards' main concerns about viewing the filrn was not an issue for this group of students. Finally, the film affected response to Item 10, if I had a personal problem I'd have little reservation about seeing an analyst or psychotherapist, depending on a person's level of psychological distress. The less distressed group agreed with this statement before seeing the movie but was more ambivalent after seeing it. The more distressed group, however, was ambivalent before seeing the movie but in agreement with the statement after seeing the filrn. Perhaps, the prospect of a more personal relationship with a therapist as seen in the film reduced whatever prior reservations they had about treatment. An expectation of an affectional relationship with the therapist could, of course, increase the probability of a sexualized transference if the person entered treatment. I n general, the results indicate subjects' belieis about psychiatry can be affected by seeing movies like Lovesick. However, the changes noted in this study were often slight and one wonders how long lasting they were. Also, these changes occurred with college students and these results may or may not generalize to other samples. Finally, an improvement in studies of this type would be to control for the effects of having subjects rate the questions twice. GEBBMD,G., & GEBBMD,K.
REFERENCES Countertransference in the movies. Psychoanalytic Review,
1985, 72, 171-184.
SCHNEIDER,I. The theory and practice of movie psychiatry. American Journal of Psychiatry, 1987, 144, 996-1002.
SHADER,R., EBERT,M., & HARMATZ, J. Langner's Psychiatric Impairment Scale: a short screening device. American Journal of Psychiatry, 1971, 128, 596-601. Accepted August 15, 1990
