Does the representation of counsellors in TV and film shape our relationship with therapy? A look at the history of media’s portrayal of fictional therapists and current shifts towards more realistic therapist characters.

I often ask new clients is if they have any expectations of what counselling will be like. For clients who have had therapy before, their answer is often shaped by their personal experiences. For first timers, the image they have formed about therapy is based on what others have told them and their own research. It’s also often at least partly shaped by what they have seen on TV. I thought it would be fun to write some reflections on this!

Throughout my training, I often pondered the impact of so many films and TV shows having characters usually fit one description of a therapist. 10-15 years ago, I still came across many clients who were surprised that all therapy wasn’t conducted with the “patient laying on a couch”. TV therapists were almost always written as the “expert”. Fictional therapists were often an older male and usually vaguely working from a classically psychoanalytic approach. Every time I saw a new therapist in a TV show, I was left wondering the scripts writers experience and understanding of modern therapy. It felt like most therapists were lazily written and from the same blueprint. Often therapist characters were smaller parts of the narrative as a tool to illustrate something of a main character’s relationship with self and/or others, or they are written as a joke character.

Worse than this, from a clinical viewpoint, these fictional therapists often have poor boundaries, and their ethics are sketchy at best.

In recent years there has been a shift in how fictional therapists are presented in TV and film.

They are often more prominent characters, more relational and they aren’t all bad…

Below we will explore some examples of fictional TV and film therapists, the good, the bad and the uncomfortable….

Most of these examples covered here are white middle class women, this seems to be the new “older, intellectual, white male therapist” in TV and Film. However, I have noticed that there’s been a very recent influx of Netflix shows with main therapist characters who are women of colour. I will add more diverse examples when I watch more shows!

Dr. Jean Milburn – Sex Education

For the first season or so, we see Jean as a person outside of her job. She’s human – a woman, a mother, a friend. Jean is written as a whole person from the start. She’s a well-known sex therapist and instead of being written as a cliché therapist, she is a divorced single parent who regularly has one-night stands. We see her as authentic, someone capable of making mistakes and someone who deeply cares for those around her. Jean is always true to her core beliefs and values, even if it makes her son cringe at times.
We have a small view into her approach as a therapist in season one. In later seasons we see more of this, when Jean takes on the role of school counsellor. Jean helps a lot of students work through their insecurities, she quickly builds relational safety with these teenagers and genuinely connects. She is able to work within organisation policy without compromising her approach. In particular she is able to help an asexual student realise that she is ok just the way she is, and that she doesn’t need sex to feel whole.

Dr Jean Milburn isn’t the perfect therapist by any means, she doesn’t keep notes secure and there’s some dual relationships which are complex at best. But, if we chalk that up to necessary plot points – I still think its a positive example of therapy.

Dr Linda – Lucifer

Dr Linda was the first fictional TV therapist I could relate to. She behaves like a therapist in the sessions. She she’s warm and kind whilst also challenging her clients. Dr Linda is the epitome of authenticity, she jokes with Lucifer in sessions whilst maintaining the boundaries of the therapeutic relationship (minus the obvious issue with payment). She is congruent and she holds the core condition of unconditional positive regard.

Dr Linda meets Lucifer where he is in his journey and accepts him for who he is. She works well with metaphor and is clearly knowledgeable about psychoeducation and mental health. When she realises that Lucifer is the *actual* devil, she understandably gets a bit ‘star struck’ around his family members and cautious about her relationship with him. She is able to be honest with this, without having to be seen as the ‘perfect’ therapist. Dr Linda also quickly works on her own ‘stuff’ and makes sure she can be there appropriately for her client.

It’s also refreshing to see a portrayal of American therapy that isn’t centred around medication.

Again, there are some issues with this representation of therapy and ethics. I’m excusing as they feel essential to the story line and more obviously not the ‘norm’ in therapy. She is friends with her client’s friends and meets Lucifer outside of sessions. Although Dr Linda does do a good job with holding confidentiality within these dual relationships. Spoiler alert… she also helps him to escape an inpatient facility in the second season and accepts sex as payments for sessions in season one. Both of these are flagged as unethical and we see that there’s accountability to ethics and registration boards within the therapy professions.

Julia Sasaki – Atypical

Julia Sasaski is a an autism expert. We see her as a thoughtful practitioner and someone who can build a safe relationship with Sam.

Julia helps Sam to navigate the difficulties he experiences as a teenager, she understands his point of view and helps him to forge meaningful connections with his peers and navigate his dating life.

Julia does take out her frustration on Sam when Sam oversteps the boundaries of their relationship (and the law). There would therapeutically be better ways to approach Sam developing feelings for Julia, but her reaction is both understandable and needed for the story line.

We also see some glimpses into Julia’s background and why she ended up with her area of specialism. It feels positive to see counsellors who are specialists within TV.

Dr Anne Carlson – Working Moms

I found Anne as a character really interesting. We meet her having just had her second child and navigating life a new baby, a tween daughter and her relationship with Lionel. Anne is trying to raise her daughter to be independent and empowered, whilst feeling overloaded herself at times. There’s a commentary about feminism within this.

Anne is a Psychiatrist and practices from home in season 1. She increases her hours for financial reasons and we see the struggle of her managing this. There’s a lot of problems in her work in this season, e.g. it’s often interrupted by her family. It doesn’t seem like Anne has much space for her patients, mentally or physically. In later seasons we see Anne’s practice move to private premises, an employed job in a university, and a break to write her parenting book.

There are a lot of subtle suggestions of Anne’s skills as a therapist throughout the seasons. She has a lot of committed patients, she successfully builds a practice multiple times and she is given a book deal. In later seasons when an unwell patient becomes attached to her daughter, Anne responds with the priority of protecting Alice, not helping her patient in the moment. This suggests that Anne has been able to work with complex presentations well up until this point.

One of the reasons I find Anne’s character so interesting is that we see her own journey with Anger. No therapist is perfectly neutral all the time, therapists are human and we all have our own emotions to navigate. Anne’s anger seems to get more problematic the more she try’s to keep going and juggling everything even though she is probably quite burnt out. Her anger also gets less ‘contained’ after she is reminded of a past trauma, which is very representative of common responses to traumatic situations.

Observations of other TV/Film therapists

Dr Jennifer Melfi – The Sopranos

I haven’t watched The Soprano’s, so I can’t comment on this in too much detail. From what I’ve heard, there’s a lot of issues with Dr Jennifer Melfi. But, she was the first ‘younger’ female therapist that I’d heard of in TV shows at the time.

Dr Paul Weston – In treatment

In treatment was such a long show that it feels impossible to summarise Paul’s journey here. There’s a lot of good we see in his practice, but a lot of worrying things too. It’s also the first representation of clinical supervision I saw on TV. I also really liked the portrayal of his supervisor Gina Toll and his later therapist Adele Brouse.

Dr Fraiser Crane – Cheers & Fraiser

I am of the generation that grew up watching Fraiser re-runs. I always found his character funny, but unlikable. The show follows his family and personal life more than his work. He is a practicing psychiatrist but we mostly see his work as a grumpy radio host. For me he’s another representation of old school male ‘experts’ in therapist roles.

Sharon Washington – Joker (2019)

Sharon appears to be a burnt out social worker, working in an underfunded system. She tells Joker on their last meeting “they don’t give a shit about people like you, Arthur. And they really don’t give a shit about people like me either”. She seems to care about her clients, but is broken by the world she is working in. It’s also a clever commentary on the need for adequate funding of mental health services and what can happen when society doesn’t look after those who need help.

Who is your favourite TV/Film therapist and why?

I’d love to know your thoughts on media representations of therapists in fictional TV and film. Have they impacted how you think about counselling?
What do you think of the therapists I’ve covered? are there any other therapist’s you’d like to know my views on? and who’s your favourite TV therapist?

I’ll be writing about ‘real life’ therapists who are on reality TV in a separate article.