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However, the writers of In Treatment have done a pretty good job considering these challenges. For the most part the interactions are consistent with what might actually occur in psychotherapy. There are a few obvious mistakes, one of which has to do with the psychologist's relationship with his patient, Laura. Paul, the psychologist, blunders grossly in his handling of Laura's feelings for him (transference) and his feelings for her (countertransference.) His failure to deal with the transference issues properly ultimately leads to his flagrantly unethical, and potentially disastrous pursuit of a romantic relationship with Laura. He has essentially abandoned his proper role as the treating therapist, and has capitalized on his position of trust as a therapist for his own personal gratification. Such an action on the part of a psychologist could and should result in the loss of his/her license to practice psychology. Paul's rationalization that they can pursue a romantic relationship because she is "no longer" his patient does not in any way mitigate this act of malpractice, because her perception of him has been shaped by the psychotherapeutic relationship. This cannot be changed by terminating therapy and does not relieve him of his ethical constraints as a psychologist. In Laura's assertion to Paul that her feelings for him are no different than the romantic feelings in any other relationship, she (not surprisingly) fails to understand the transference issues involved. A patient's feelings of sexual attraction, or love or hate, toward a treating therapist are qualitatively different from such feelings in any other relationship. Such feelings are defined as "transference" because the relationship is so uniquely lopsided in terms of the knowledge the therapist and patient have of each other and the nature of their interaction. Paul's startling inability even to touch Laura when he attempts to move from the role of therapist to that of "lover" is not surprising. The basic building blocks of a social or romantic relationship are never had been established in psychotherapy. The potential damage of their interaction is obvious. Laura perceives Paul as "testing" her regarding a romantic relationship. Because of the power projected onto the therapist, any outcome that does not fulfill the hopes and fantasies of the patient can be devastating to the self worth of the patient. Psychotherapy necessarily involves a complete focus on the patient's life, feelings, personal thoughts and well being, with minimum information being revealed about the therapist. Furthermore, by definition, the psychotherapeutic relationship is structured as a one sided relationship in the sense that the psychologist functions as the expert, as the knowledgeable, authoritative person who is there to help the patient emotionally and psychologically, an effect that is not expected to be reciprocated. The patient is there to benefit from the psychologist's help, not to help the psychologist, nor to find out about the personal life of the psychologist. Taking into consideration these differences, it is not hard to understand that Laura's "love" for Paul can only be based on the image of the attentive, helpful, supportive, concerned therapeutic role that Paul plays in her life. It cannot be based on her knowledge of Paul as a person, because he is properly constrained to the role of therapist in her presence, which precludes his revealing his personal life to her, a boundary that Paul actually violates as soon as he expresses to Laura his "love" for her. This discussion only touches upon the complexity of these transference issues. Dealing with transference and countertransference issues presents difficult personal "boundary" problems, which, if mishandled, can result in professional malpractice and in harm to the patient. The recent Dr. Phil and Britney Spears controversy touches upon important questions about psychology, psychotherapy and issues of privacy and confidentiality in a relationship between patient and psychologist. Many people who watch the Dr. Phil show incorrectly assume that he is a psychologist. However, Dr. Phil does not claim to have a license to practice psychology, nor does he call himself a psychologist. Since Dr. Phil's show is considered a form of entertainment, not the practice of psychology, no license is required for what he does on his show. On the other hand, he could not treat Britney Spears or any other patient in a hospital or in a private setting in California because state law requires a psychology license to practice psychology in the state of California. For information on how you can determine whether Dr. Phil or anyone else is a psychologist, click on Check Qualifications. For a more detailed discussion by a psychologist of the Dr. Phil - Britney Spears controversy, you may copy the following address into your browser. (This will take you out of my website.) From Clinical Psychiatry News,
March 2008 A study reported by Leslie S. Kinder, Ph.D. of the Veterans Affairs Puget Sound Healthy Care Systems in Seattle suggests that depression may be a better predictor of health outcomes and mortality among veterans than PTSD. TABLE OF CONTENTS of Additional Recent Psychology Publications Unlike the other pages in this
website, the following material was not written by (1)
What
to know about discontinuation of psychotropic medications. (2) Psychologists are taking a more comprehensive approach to wellness at work. (3) Diagnosis of Multiple Childhood Trauma (4) Love is not Sex: Why Romantic Love is not limited by Gender (6) Does Love Last? (7) Phantom Pain and the Brain (8) Hostility and Coronary Heart Disease: Don't Get Mad (10) Helping Others, Helping Ourselves (11) Is Altruism Real? (12) Tourette's Syndrome (13) Coping with PTSD through Cognition
What
to know about discontinuation of psychotropic medications. By
Laurie Meyers Monitor
on Psychology What
is the practitioner’s role when a patient comes off medication? What should a
psychologist do for a client who is experiencing significant side effects? And
what about clients on multiple medications? As
the health professional who often has the most contact with a client, a
psychologist may be in the best position to spot or even help prevent seriously
adverse reactions to medication withdrawal—if he or she knows what to look
for. “Psychologists
need to be on top of what patients are taking,” says John Sexton, PhD, one of
10 participants in the U.S. Department of Defense (DoD) 1991–1997 pilot
program to grant psychologists prescriptive authority. “It’s important for
us to know what is going into a person’s body.” Discontinuation
dilemmas A
particular red flag to watch for: It’s all too common for patients to abruptly
stop taking medication on their own, which can have unpleasant or dangerous
consequences, says Sexton, who is now working in psychological and counseling
services at the Patients
may not discuss discontinuing medication with the physician who prescribed the
medication, or they may not pay attention to the tapering directions they are
given, points out psychologist Michael Enright, PhD, APRN, who works in a
primary-care clinic in •
Antidepressants—Due
to the short time they stay in the body, some selective serotonin reuptake
inhibitors (SSRIs)—a class that includes drugs such as Zoloft, Prozac, Paxil
and Lexapro—can cause a discontinuation syndrome with symptoms including
nausea, headache, problems sleeping, tingling or shock-like sensations, and, in
some cases, flu-like symptoms. Paxil and Effexor—which is actually a
serotonin-norepinephrine reuptake inhibitor—are the most likely to cause the
syndrome and Prozac is the least likely, Enright notes. These reactions can be
uncomfortable, but are not generally life threatening, he says. Psychologists
can help ease the patient’s discomfort by explaining that the symptoms are
temporary. They can also teach patients to self-monitor and to contact their
physician or visit the emergency room for serious symptoms such as irregular
heartbeat, difficulty breathing, depersonalization and suicidal thoughts or
urges, say Enright and Sexton. It’s also important for practitioners to watch
for rebound anxiety or depression, emphasizes Enright. In some cases of severe
withdrawal, the physician may prescribe a short course of Prozac, which is so
long-acting that it requires little or no tapering. Another option is to
increase the dosage of the current medication and taper more slowly, he notes.
Other antidepressants can also cause similar withdrawal side-effects such as
nausea and flu-like symptoms. •
Benzodiazepines—Because
they are potentially addictive substances, benzodiazepines—which are usually
prescribed for panic and anxiety—can be harder to taper and should never be
stopped abruptly, says Sexton. Short- acting benzodiazepines like Xanax can
cause seizures, coma and even death if the patient does not come off them slowly
enough, he explains. Valium or Librium are longer acting and require less
tapering, but withdrawal can still cause shakiness, Sexton notes. •
Mood stabilizers and antipsychotics—Lithium
and other mood stabilizers such as anticonvulsants can cause seizures and
rebound mania, characterized by symptoms such as agitation, rapid speech, racing
thoughts and mood instability, if a patient stops taking them suddenly, says
Sexton. “Mood stabilizers are a very difficult medication to discontinue in
patients with a history of mania because you risk taking away the one thing that
may be keeping that person stable,” says Elaine Orbana Mantell, PhD, another
graduate of the DoD pilot program who still prescribes for the Air Force at
Eglin Air Force Base in Florida. If a client shows signs of rebound mania, ask
for a release to contact the prescribing physician, urges Mantell. Patients who
are discontinuing mood stabilizers and are also taking an antidepressant should
also consider the risk of triggering a rebound manic episode with unopposed
antidepressant use, she adds. Antipsychotic withdrawal can cause a significant
rebound in psychotic symptoms, notes Enright. Psychologists should proceed with
caution, track a client’s symptoms closely and work with the prescribing
physician, he adds. A serious psychotic or manic episode—one in which a
patient loses touch with reality or exhibits behavior that is dangerously
erratic—is an emergency and requires immediate action, say experts. •
Stimulants—Medications
such as Ritalin and Strattera—prescribed for attention-deficit disorder and
attention-deficit hyperactivity disorder—can cause discontinuation symptoms
such as lethargy, lack of motivation, and, in some cases, depression, says
Mantell. Patients should also taper Dexedrine, because it is an addictive
substance that can cause jitteriness, shakiness and other symptoms of substance
abuse withdrawal. The
power to unprescribe?
If
a psychologist has the power to prescribe, he or she also has the authority to
unprescribe, says Enright. However, non-prescribing psychologists are in a
trickier situation when they see a client they think is overmedicated or ready
to taper, he says. Practitioners who spot side effects that may indicate
overmedication or a bad drug reaction should consult with the prescribing
physician if possible, and should also let the patient know about their concern.
Let clients know that side effects that seriously affect health and quality of
life are not normal and that they should talk to a physician about changing or
stopping their drug regimen, Enright explains. What about clients who are on
multiple medications? Proceed with care, Enright stresses. In cases of severe
bipolar disorder, schizophrenia or other psychosis, the prescribing physician
may have been struggling to end a spiral of suicidal depression or repeated
psychotic breaks, he notes. Even as a prescribing psychologist, Enright
hesitates to immediately start tinkering with medication in these cases. It’s
best for any psychologist faced with a patient on multiple medications that
include mood stabilizers and antipsychotics to monitor and work closely with the
prescribing physician, he says. In some cases, the client will still require
multiple medications, but a psychologist may be able to help reduce the number. Ultimately,
psychologists can help by advocating for their clients, say experts. They can
use their diagnostic skills to determine what symptoms a patient has and whether
the medication actually alleviates them, says Enright. In some cases,
medications such as benzodiazepines may be useful in the short term for panic or
acute anxiety, but the goal should be to work on cognitive and therapeutic
solutions, he adds. Enright advises monitoring all patients on
medication—particularly those on several—for drug interactions and side
effects that are markedly decreasing the patient’s cognitive ability or
quality of life. Talk to the prescribing physician about any concerns, he
suggests. Psychologists who aren’t in practice with physicians may find it
useful to establish collaborative relationships with local psychiatrists or
other physicians, Enright says. Patients
with depression and anxiety disorders may be on multiple medications as well.
Enright himself sometimes prescribes a small amount of Wellbutrin to counteract
the sexual side effects of SSRIs. Because people metabolize medications
differently, sometimes two drugs might be prescribed because they enhance each
other, making the combination more effective for that particular patient,
Enright adds. Ultimately, however, the client should be on as few medications as
possible. Whole workplace health Psychologists are taking a more comprehensive approach to wellness at work. By
Amy Cynkar And psychologists are
helping these organizations figure out how to cost-effectively keep employees
healthy and performing at their best—not just by reducing work stress, but by
guiding companies to think more holistically about the ways their workplace
practices affect physical and mental health, says Matthew J. Grawitch, PhD,
primary research consultant for APA’s Psychologically Healthy Workplace Award
program and lead author of a recent workplace study review—published last
summer in the Consulting Psychology Journal: Practice and Research (Vol.
58, No. 3, pages 129–147)—indicating that Americans relate nearly a quarter
of their life satisfaction to their job happiness. “The whole concept of a
psychologically healthy workplace emphasizes the interplay between the
organization and the employees, and recognizes that there are going to be some
benefits and some costs associated with every kind of program that is put in
place,” notes Grawitch, chair of the organizational studies program at St.
Louis University. These days, organizations
are abandoning the “keeping up with the Joneses” philosophy on employee
benefits in favor of a more comprehensive approach to employee well-being. The
payoff, say psychologists, comes in the form of healthier and more productive
workers, and a boost to an organization’s bottom line. The trend, they say,
also brings a larger appreciation for the skills psychologists bring to the
workplace. A multi-tiered approach While the notion of a
healthy workplace has evolved over the past 60 years, research from as far back
as 1990 suggests a strong link between healthy workplace practices and
organizational improvement. In fact, says Grawitch, in designing the awards
program, APA reviewed research by psychologists and others and identified five
categories of employer practices that foster both employee well-being and
organizational performance: • Employee
involvement:
Empowering employees by involving them in decision-making and giving them more
job autonomy. • Work-life balance: Offering
employees flexible work scheduling and other benefits that help them manage the
demands they face both inside and outside of work. • Employee growth and
development: Providing
opportunities for continuing education, tuition reimbursement and leadership
development. • Health and safety:
Providing benefits that help employees optimize their physical and mental health
and develop healthy lifestyles, such as stress-management, weight-loss and
smoking-cessation programs. • Employee
recognition: Rewarding
employees both monetarily and non-monetarily through performance-based bonuses
and pay increases, profit-sharing, employee awards programs and simple but
genuine expressions of thanks. Research has shown that
these practices, especially when combined, relate to positive trends in employee
job satisfaction, organizational commitment and morale. “Organizations are
starting to understand that simple interventions when a problem arises don’t
work, and that truly improving the health of a workplace is more complex and
long term, and must be built into the culture,” says David Munz, PhD, an
organizational psychologist and professor of psychology at St. Louis University. Leveraging expertise A number of progressive
companies, for example, provide employees with free gym memberships or build
onsite fitness centers, at an employee’s suggestion. Some even provide
employees’ families with gym discounts. Programs such as these, Grawitch
notes, encompass employee involvement, health and safety and work-life balance.
Psychologists are even showing some companies how to expand this type of benefit
into an employee recognition tool by rewarding employees who lose the most
weight each quarter, or featuring employees who recently quit smoking in the
company newsletter. Employers haven’t always
viewed such programs as necessary. But as research repeatedly demonstrates their
value, organizations increasingly turn to psychologists for help in everything
from teaching employees good communication skills to researching the effects of
on-site yoga classes on employee absenteeism, says Lou Perrott, PhD, chair of
APA’s Business of Practice Network Steering Committee. “It’s a new enough
area that psychologists are just evolving ways to adapt their skills to the
workplace—there’s not a ready-made opening,” he says. “We need to make
psychologists more aware of the potential that exists for them in helping
organizations improve worker health.” El Nuevo Dia Interested in attending
lunchtime talks on improving family health? How about subsidized onsite
after-school day care? For offering such benefits, El Nuevo Dia, a
newspaper company in “When you walk into an
organization that has a psychologically healthy workplace, you can feel it,”
says Moreno-Velazquez. “El Nuevo Dia is a great example of an
organization that is really looking out for its employees, and will hopefully
inspire other companies in In 2004, to encourage the
spread of holistically healthy workplaces in her territory, Moreno-Velazquez, a
psychology professor at the HOW serves students
looking to gain real-life experience in healthy workplace development, and is
working to revamp the commonwealth’s perspective on the value of employee
health. To get a handle on the region’s workplace problems, students are
collecting statistics on, for example, work-related accidents and illnesses in
Latin America and Moreno-Velazquez also
leads local workshops on how to evaluate the impact of employee wellness
programs. She teaches employers how to measure a program’s effectiveness in
terms of impact on worker health, productivity and retention. “Some organizations
cannot see the economic impact of these practices...because they don’t measure
it,” she says. “We have to show organizations that building psychologically
healthy workplaces is the smart thing to do, and is a matter of productivity and
social responsibility.” A new diagnosis for childhood trauma? Some push for a new DSM category for children who undergo multiple, complex traumas. By
Tori DeAngelis Yet no one diagnosis
adequately captures the plight of these youngsters, and that’s why a new
diagnosis is needed for them, asserts a working group of child psychiatrists and
psychologists developing such a diagnosis for possible inclusion in the 2011
iteration of the Diagnostic and Statistical Manual of Mental Disorders,
the DSM-5, published by the American Psychiatric Association. As it stands now,
these children are often misdiagnosed and incorrectly treated, working group
members argue. The team is an interest group of the National Child Traumatic
Stress Network, a consortium of 70 child mental health centers founded and
funded by the Substance Abuse and Mental Health Services Administration that
brings together clinicians who work with children who have complex trauma
histories. To fill the gap, the group
is proposing a diagnosis called “developmental trauma disorder” or DTD, to
capture what members see as central realities of life for these children:
exposure to multiple, chronic traumas, usually of an interpersonal nature; a
unique set of symptoms that differs from those of post-traumatic stress disorder
(PTSD) and a variety of other labels often applied to such children (see "Current
trauma diagnoses"); and the fact that these traumas affect children
differently depending on their stage of development. “While PTSD is a good
definition for acute trauma in adults, it doesn’t apply well to children, who
are often traumatized in the context of relationships,” says The 10-member group has
been meeting since 2005, gathering relevant research, hashing out possible
criteria and devising a strategy for getting the diagnosis to a rigorous enough
place to be considered. They admit they have much work ahead before that
happens, given the labor involved in gathering case materials, developing
instruments and testing those instruments in the field for validation. But they are committed to
the task because they believe state mental health systems currently flounder on
treatment plans for these children because they lack an accurate framework for
understanding their problems. “We think DTD has a
strong scientific basis to it,” says Building a case
To make its case that
science supports the DTD diagnosis, the group is examining large databases of
children who can help inform the potential diagnosis. For example, members of
the child trauma network, which sees up to 50,000 children per year, are
building a core data set where they’re finding out not only what kind of
traumas children have experienced, but when they occurred and for how long. The
group also is tracking a 20-year longitudinal study of 4,000 Australian child
survivors of natural disasters that includes life-history questions. The team
will look at differences between children who report interpersonal traumas and
those who don’t, van der Kolk notes. In addition, the team is
drawing from the attachment, developmental and interpersonal trauma literature,
says University of Connecticut psychologist Julian Ford, PhD, a group member and
an affiliate of APA Divs. 12 (Clinical) and 56 (Trauma). Ford outlines some of
this research in a paper in the May 2005 Psychiatric Annals (Vol. 35, No.
5, pages 410–419). The team is considering
two research streams, Ford says. One finds that children who experience
interpersonal trauma show a disrupted ability to regulate their emotions,
behavior and attention. For instance, studies show that when caregiving in
animals is disrupted or withdrawn, they become anxious and highly reactive to
stressors, and when they are older, are less likely to explore their
environments, Ford notes. The other research area
shows that much of children’s later ability to think clearly and solve
problems in a calm, non-impulsive way stems from their experiences in the first
five to seven years of life. A case in point is an ongoing retrospective study
of 17,337 adult managed-care users funded by Kaiser Permanente and the Centers
for Disease Control and Prevention, cited by van der Kolk in the May 2005 Psychiatric
Annals (pages 401–408). It found a highly significant relationship between
reported traumatic childhood experiences such as sexual and physical abuse, and
later episodes of depression, suicide attempts, alcoholism, drug abuse, sexual
promiscuity and domestic violence. It also discovered that the more adverse
childhood experiences a person reports, the more likely he or she is to develop
life-threatening illnesses such as heart disease, cancer and stroke. In addition, the team is
including the latest findings on the neurobiological consequences of traumatic
interpersonal stress. For instance, studies show that women abused as children
who recall memories of abuse or are confronted with stressful cognitive
challenges have strong reactions in brain areas that signal threat, but reduced
mobilization of brain areas related to focusing attention and categorizing
information, Ford’s paper notes. Finally, the group is
piecing together information on how complex interpersonal trauma can
differentially impact each stage of development, says Pynoos. It also is
incorporating the fact that effects of early trauma can spill over into other
stages, even if those traumas have stopped occurring, he notes. Finding the right
treatment Group members are
investigating existing child trauma treatments. They’re also gathering
information on new interventions geared specifically to working with these
youngsters. One type of promising
treatment teaches children self-regulation skills—in essence, helping them see
how they have adapted in the face of trauma. The treatment helps them modify
those adaptations in creative ways so they can shift out of survival mode and
into one more appropriate to their developmental stage, according to Ford.
Similar therapies focusing on self-regulation help children to achieve
developmental competencies that they were unable to acquire initially, says
Pynoos. Involving parents or
caregivers is critical too, emphasizes In the
intervention—Parent-Child Psychotherapy, which she created and which is
supported by research—“we help the mother or father become attuned to their
own dysregulation,” she says, “and that helps them become more responsive to
the child’s dysregulation.” As one example, Lieberman’s team recently saw
an abused mother and her toddler in treatment. At one point the child fell and
hit his head, and lifted his arms to the woman for help. She responded,
‘“Don’t you hit me!”’ Lieberman recalls. The team’s job was to help
the woman understand where her reaction was coming from, and to learn more
appropriate ways of responding to and caring for her child, Lieberman explains. Experts’ view of DTD The group is tackling an
important and overlooked phenomenon, other child experts concur. “The idea of isolating
reliable and valid diagnostic criteria to identify this group of children is one
whose time has come,” says APA Div. 56 (Trauma)
President Judie Alpert, PhD, a psychologist at The proposed diagnosis
highlights the importance of bringing relationship factors more fully into the
DSM, adds Emory University psychologist Nadine Kaslow, PhD, who discusses this
need in an article in the September 2006 Journal of Family Psychology (Vol. 20,
No. 3, pages 359–368) along with lead author Steven Beach, PhD, and
colleagues. “Often we develop
psychological difficulties in the face of interpersonal challenges,” says
Kaslow, chief psychologist at But the experts also
caution that it’s vital the group be sure its research is airtight so they are
sure they are identifying the right youngsters, and so such a potential
diagnosis is not mis- or overused. “People vary
dramatically in their resilience to adversity,” says Saywitz, “so it is
important the group is vigilant in its efforts to prevent misuse of a new
diagnostic category and the untested treatments that may well arise.” The group’s accurate
fingering of a widespread problem likewise underscores the need for better
trauma training in graduate school, Alpert says. “When trauma is discussed in
courses that focus on diagnosis and the DSM,” she says, “trauma often
receives short shrift.” Despite these
caveats—and no matter what happens with the diagnosis in the short term—the
group does a major service by bringing these youngsters and their needs to the
attention of the public, funders and policy makers, Saywitz believes. “If the debate over DTD
is a catalyst for such a discussion,” she notes, “it will benefit not only
these children and families, but our society as a whole.”
Why
romantic love isn't limited by a person's sexual orientation. Christopher Munsey But
a psychologist who argues that it's not that simple, bases her findings on
follow-up interviews with a group of women she's followed for more than a
decade. Developmental psychologist Lisa Diamond, PhD, started noticing something
interesting about her study group's love lives. Most
of the women identified themselves as non-heterosexual, but several reported
falling in love with, and developing sexual desire for, individual men in their
lives, says Diamond, a Talking
to them, Diamond at first thought the women were mistaken about what they were
feeling or were confused about their own sexual orientation. “The
more I started listening to their voices, the more I started to think I was
wrong,” Diamond says. Diamond
started studying the women's experiences for her master's thesis. She's kept in
touch with the participants for more than 10 years, interviewing them
individually about their sexual identities, sexual desires and romantic
relationships every two years. After
reviewing work by other love researchers and delving into accounts of love and
friendship across cultures, Diamond developed what she describes as a
biobehavioral model distinguishing love and sexual desire. In
her model, she proposes that sexual desire and romantic love are functionally
independent; that romantic love is not intrinsically oriented to same-gender or
other-gender partners; and that the links between love and desire are
bidirectional. Based
on her model, Diamond thinks it's possible for someone who is heterosexual to
fall in love with someone of the same gender, and for someone who is homosexual
to fall in love with someone of a different gender. Diamond's
model offers a new interpretation of the implications of the ideas developed by
psychologists Phillip Shaver, PhD, and Cynthia Hazan, PhD, who see adult
romantic love as similar in certain respects to the infant/caregiver attachment
bond, but with attachment and caregiving running in both directions between
partners and with sexuality added to the mixture. While
Diamond argues that a person can fall in love with someone to whom they wouldn't
usually be sexually attracted to, Shaver sees sexual attraction as one of the
three behavioral systems contributing to the blossoming of adult romantic love,
making it different from childhood attachments. Other
psychologists such as Pamela Regan, PhD, who studies how adults think about love
and sex, say that most people view sexual attraction as an essential ingredient
in the development of romantic love, the spark needed to set passion burning. The
links between love and desire Diamond
bases her model on the notion of romantic love evolving from the attachment bond
formed between infant and caregiver. As
described in her 2003 article in Psychological Review (Vol. 110, No.1,
pages 173–192), her model argues that while the goal of sexual desire is
sexual union for the purpose of reproduction, romantic love is governed by the
attachment or pair-bonding system, with its goal of maintaining an enduring bond
between two individuals. Sexual
desire is driven by the gonadal hormones of estrogens and androgens. Animal
research indicates that attachment is mediated by the neuropeptide oxytocin,
with a more robust oxytocin-receptor network present in the female brain. And
since romantic love, she hypothesizes, is an outgrowth of infant/caregiver
attachment, there's no way to “code” romantic love for gender. That's
because highly dependent infants become attached to the most responsive
caregiver present, whether it's a woman or a man, she says. Diamond
also argues that the links between love and desire are bidirectional, because
sexual desire can facilitate affectional bonding, and affectional bonding can
facilitate sexual desire. Most
people perceive connections between the two experiences. Owing to cultural
factors, people are expected to form romantic bonds with people they desire. But
they are not expected to experience novel sexual desires for people they love
who are not “appropriate” partners, as judged by society. An
example of the type of relationships that fit in with Diamond's model are the
intense friendships developed between girls at boarding schools in the 1800s,
called “smashes,” and between same-sex individuals in other
gender-restricted environments, such as combat units in the military, and
college sororities and fraternities. And
because the links between love and desire are bidirectional, developing sexual
desires running counter to a person's sexual orientation is possible too. “It
appears to be something everybody is capable of,” says Diamond. Now
a psychology professor at While
teaching at the Describing
himself as familiar with Diamond's work, Shaver says it's possible to see the
elements of romantic love in things like the crushes that young children,
particularly girls, develop for each other in elementary school. In
such relationships, children become possessive of another person, and can feel
some of the anxiety, jealousy and distress at separation experienced by adults
in romantic relationships, Shaver says. “I
think you could have one or two of these motivational systems active, and then
you'd see a partial form of the full-blown romantic reaction,” he says. But
once a person goes through puberty, all three systems come together for many
people's experience of passionate love, he says. “And
then a lot of the driving force, even if the person doesn't know it, is
sexual,” he says. Romantic
love's essential ingredient Regan's
work supports a more familiar understanding of love and desire. Now
a social psychologist at California State University Los Angeles, Regan started
out as an English major in college. Her study of sublimated sexual desire was
confined to novels such as “ She
switched to studying psychology when she found she could study passion and
desire full time. From
the years of research she and her students have done studying how people think
about passionate love and sexual desire, Regan has concluded that sexual desire
is an integral part of heterosexual adults' passionate love. “Those
are definitely connected experiences,” she says. As
described in a 1998 article in the Journal of Social and Personal
Relationships (Vol. 15, No. 3, pages 411–420), people asked to list the
features of passionate love overwhelmingly list sexual attraction as one of its
key aspects. In
another study, when presented with information packets supposedly filled out by
couples who either said they were “in love” with each other, “loved”
each other or “liked” each other, participants rated the couples who said
they were “in love” as experiencing the highest levels of sexual attraction,
Regan says. In
studies cataloging the experiences of dating couples, Regan found men and women
who described themselves as “in love” scored very high on measures of sexual
attraction, as presented in an article in Social Behavior and Personality
(Vol. 28, No. 1, pages 51–60). While
she thinks sexual desire is a key ingredient to passionate love, Regan says
there's a difference between what people find sexually attractive and what they
find romantically attractive. “What
turns you on physically is not necessarily what turns you on romantically,”
she says. In
a curious twist, while both men and women find the attribute of physical
appearance as sexually attractive, men misunderstand what women seek, and women
misunderstand what men seek, Regan says. Men
think women find a man with resources highly sexually attractive—while women
think men find a woman who's stereotypically feminine attractive. The truth is
men and women both list physical appearance as the quality that's most sexually
attractive. But
the list is more comprehensive for romantic attraction. Both men and women list
qualities of kindness, warmth, a sense of humor, sociability, trustworthiness
and a stable personality as attributes sought in a romantic partner. Some
attributes make the list for both sexual attractiveness and romantic interest,
such as a sense of humor, she says. Judging
from her review of what men and women self-report on their daily levels of
sexual desire, Regan says men have a stronger sex drive than women. She
notes that social pressures that approve of an openly expressed sex drive in
men, and disapprove of it in women, may influence those results.
New
research suggests love may be a drive as primal as thirst or hunger. Sadie
F. Dingfelder Conducting
research with lovesick college students poses some special challenges. At least
that's what Arthur Aron, PhD, and his colleagues found while running a brain
imaging study a few years ago. His participants—students who had recently
fallen madly in love—had no trouble with the first part of an experiment:
lying in a brain-imaging machine, gazing at their partners' pictures and
thinking about the person they loved. But when Aron asked students to shift
their attention to a picture of an acquaintance, he ran into trouble. “They
couldn't stop thinking about their partners,” says Aron, a social psychology
professor at After
months of pilot testing, Aron, Lucy Brown, PhD, and Helen Fisher, PhD, and their
colleagues discovered that they could distract participants by showing them a
randomly generated number and making them count backwards by sevens for several
minutes. Only afterward could they think about their acquaintances. “One
subject told us that having done that in the study helped her go to sleep at
night,” Aron says. The
great lengths the student had to go through to stop pondering her partner
illustrates what a powerful force romantic love is, says Aron. But, contrary to
popular opinion, that force is not an emotion, he contends. Rather, it is a
motivational state, perhaps one as fundamental as hunger and thirst. Recent
research by Aron and others supports this theory. For instance, functional
magnetic resonance imaging (fMRI) studies show that dopamine-rich areas of the
brain light up when we think about a romantic partner. Those regions, such as
the ventral tegmental area (VTA), are known as the motivation and reward system,
and appear to activate whenever people get something they deeply desire—food,
water, cocaine or perhaps a girlfriend's phone call. Some behavioral research,
as well as people's description of romantic love, lends further support to the
theory, Aron says. “For
many people, the experience of falling in love is like being in a desert and
suddenly seeing water out there,” notes Aron. Exquisite
suffering A
parched man in the desert may feel elated upon spotting an oasis. But if the
water turns out to be a mirage, he'll experience an entirely different set of
strong emotions, notes Lucy Brown, PhD, a neurology professor at the Albert
Einstein College of Medicine in “People
tend to think when you are in love you are happy, but love can also mean feeling
anxious, angry, sad,” says Brown. An
as-yet-unpublished study by psychology graduate student Bianca Acevedo confirms
Brown's hunch. Acevedo, in her fourth year at She
found that people checked off about seven more list items when given the target
term “love” than they did with the other targets. What's more, the students
linked both positive and negative words to “love,” whereas words like
“joy” garnered only positive associations. “We
believe this shows that love, in general, operates differently than emotions,”
Acevedo says. Those who think of love as an emotion may be misdirected by the
fact that love can cause such strong emotions, she notes. Some
emotion researchers take issue with that stance. Gian Gonzaga, PhD, a
psychologist and the senior research scientist at eHarmony Labs, says that the
flash of love, the warmth and affection that you feel for just a few moments
when you think about a lover, is an emotion. And like other emotions, love has a
distinct nonverbal display, according to a 2006 study by Gonzaga and his
colleagues in Emotion (Vol. 6, No. 2, pages 163–179). The researchers
videotaped 63 couples while they reminisced about their first date. During these
exchanges, participants tended to lean toward each other, smile and gesture with
open hands, the researchers found. In
contrast to Acevedo's findings, the participants in Gonzaga's study reported
feeling a consistent set of positive emotions, including high levels of
happiness and arousal and low levels of discomfort and fear. The
conflicting results may come from the varying definitions of love used by
different schools of researchers, Gonzaga notes. “There
are a lot of theories of love and love across time,” Gonzaga notes. “In some
conceptions love isn't always a good thing. It isn't always a happy thing.” Drug-like
effects While
there may be moments of placidity, the larger experience of love is a mixed bag,
Aron agrees. In fact, participants in Aron's fMRI study, published in the Journal
of Neurophysiology (Vol. 94, No. 1, pages 327–337), reported a variety of
different emotions as they gazed at their partners—and their brains, too,
showed a diverse array of activation patterns. Some participants who reported
being happily in love even reacted to the photos with increased amygdala
activity—a response associated with fear and anxiety. Those
fretful participants might have been worried about the possibility of losing
their partners, notes Brown, a study co-author. “With
love, emotion is certainly involved, and emotion areas of the brain are
involved, but it is going to be much more dependent on the individual's
personality and attachment style,” she says. While
the participants in Aron's study felt many different emotions when thinking of
the person they loved, they did have one thing in common—they all showed
activation in the VTA, the right posterodorsal body and the medial caudate
nucleus. These dopamine-rich regions of the brain signal satiation of deep
needs, notes Helen Fisher, PhD, an anthropology professor at “All
of the basic drives are associated with the dopamine system, and so is romantic
love,” Fisher notes. The
increase in energy that people newly in love experience—their ability to stay
up all night talking—may be due to a flush of dopamine, Fisher says.
Dopamine-system activation is also related to focused attention, underpinning
the feeling that one person is the new center of your world, she says. Some
of the same systems activated in people who are happily in love are also similar
to those activated among people who have been recently rejected, according to an
as-yet-unpublished study by Fisher and her colleagues. They had 15 lovelorn
students lie in an fMRI machine and look at pictures of their former partner or
a familiar acquaintance. As
with the happily in love students, the lovelorn showed increased activation in
the motivation and reward systems when they thought about the person they loved.
Unlike the happily in love students, the lovelorn also showed activation in
their right nucleus accumbens, an area of the brain associated with taking big
risks. Taken
together, the studies paint a picture of love acting in a manner not unlike
cocaine, which also works through the dopamine system and causes intense
craving, says Fisher. “Addictions
are very powerful, and all of the addictions are associated with dopamine in one
way or another,” she notes. Seeing
love as an intense drive to be close to someone, rather than an emotion, may
help clinicians understand the yearning people have for their loved-ones, says
Fisher. It could also help us predict how people will react when they can't get
what they want, she says. “Many
instances of homicide and suicide and stalking are associated with romantic
love, and the more we can understand the basic processes in the brain, the more
we can understand why people commit these crimes,” says Fisher. THE
LOVE DRUG One
school of thought holds love is destined to ebb. Another finds it all depends on
the lovers. Laurie
Meyers Some
psychologists say romantic love endures, while others disagree. Here's a look at
both sides. Every
flame dies down Romantic,
passionate love is fleeting, says Elaine Hatfield, PhD, a psychology professor
at the In
1981, Hatfield and fellow social psychologist Jane Traupmann, PhD, performed a
series of interviews that assessed the level of passionate and companionate love
in a random sample of 953 dating couples, newlyweds and older women who had been
married for an average of 33 years. In findings presented in a chapter of the
book “Aging: Stability and change in the family” (1981. “The
prevailing wisdom was that passionate love would last for a few years and then
companionate love would grow, but it also declines,” notes Hatfield, who has
continued to write and give presentations about passionate and companionate
love. She adds that it tends to decline at the same rate as romantic love, and
generally never stops declining. Hatfield's findings are backed by other, more
recent research. In a 1999 study published in the Journal of Personality and
Social Psychology (Vol. 76, No. 1, pages 46–53), social psychologist Susan
Sprecher, PhD, found that couples in relationships may subjectively feel like
their love and commitment is increasing with time, but it is actually declining.
In a study of dating couples, Sprecher administered two questionnaires to each
member five times over a four-year period. The questionnaires included a survey
asking about feelings of love, satisfaction and commitment and another one that
contained scales to measure actual levels. She found that in the second round,
love decreased for men and satisfaction decreased for both sexes. However, for
the couples who stayed together, measures of commitment increased.
Interestingly, she also found that among couples who broke up, both men and
women were likely to report a decrease in satisfaction and commitment before the
break-up, but no change in feelings of love. So
what keeps marriages and other long-term relationships together? Passionate love
must come back intermittently, like small sparks that keep the relationship
smoldering, Hatfield theorizes. She
does allow that there “are some couples with really good marriages who have
come to love, like and understand each other, and so the companionate love is
maintained or even grows.” Both
fan the flame Psychologist
Robert J. Sternberg, PhD, thinks that love doesn't have to decline, but in order
for it to flourish, both partners must share the same love “story.” For
Sternberg, a former APA president who is dean of the “I
was interested in the fact that people seem to relate strongly to love
stories,” he says, noting that people seek them out in books, magazines, on
television and in the movies. “Is
there any way to capture the story essence?” he wondered. In
a series of interviews in the 1990s with college and graduate students who
ranged in age from 17 to 26 years old, Sternberg identified about 25 stories
that people use to describe love. As Sternberg detailed in his book, “Love is
a story” (1998. New York: Oxford University Press), the stories range from the
“travel” story (“I believe that beginning a relationship is like starting
a new journey that promises to be both exciting and challenging”) to the
“humor” story (“I think taking a relationship too seriously can spoil
it”) to the “autocratic government” story (“I think it is more efficient
if one person takes control of the important decisions in a relationship”). In
the 2001 study published in the European Journal of Personality (Vol. 15,
No. 3, pages 199–218), Sternberg and his co-authors found that the type of
story wasn't the deciding factor in forming a lasting relationship, but having
matching stories was. It's
not the only thing that makes a relationship work, but it's important, says
Sternberg. “If
the stories don't match, sooner or later people become unhappy or
unfulfilled,” he found, adding that the more people's stories matched, the
happier they were. An actual touch, or an imaginary one? It’s all the same to (some parts of) your brain. By
Sadie F. Dingfelder Scientists
have long conceptualized the part of the brain known as the primary
somatosensory cortex (S1) as where it first registers touch sensations. Prick
your finger and S1 springs into action, sending raw information about the
injury’s location to higher brain areas for further interpretation, according
to most neuroscience textbooks. Those
textbooks may need new editions. S1 doesn’t simply catalogue physical
sensations: It also registers sensory illusions that are generated elsewhere in
the brain, according to a recent study in PLOS Biology (Vol. 4, No. 3, pages 459–466). In fact, as far as S1 is
concerned, there’s no difference between a real or imaginary touch, says lead
author Felix Blankenburg, PhD, a neuroscience researcher at University College
London (UCL). Other researchers, including David Ress, PhD, a neuroscience
professor at Together,
the research paints a picture of a deeply integrated brain, one that begins
making sense of information at the earliest stages of perception, says Ress. “You
use a lot of your brain to make a visual decision,” he says. “The whole
system is probably used as an integrated whole in order to create visual
consciousness.” Tactile
illusions Tap
people’s arms rapidly at the wrist and then at the elbow, and they will feel a
phantom tap right in the middle, as if a rabbit were hopping the arm’s length.
Blankenburg and his colleagues, including Jon Driver, PhD, director of the
Cognitive Neuroscience Institute at UCL, harnessed this phenomenon, known as the
cutaneous rabbit illusion, to see how tactile illusions play out in the brain. The
researchers strapped electrodes to the arm of 10 adult participants, placing the
electrodes at three points between each participant’s elbow and wrist. While
the participants lay in a functional magnetic resonance imaging (fMRI) machine,
the researchers delivered pulses to the electrodes. In one condition,
participants experienced real sensations hopping up their arms, as experimenters
activated the three electrodes in succession. In another condition, participants
only thought they felt the sensation hopping up their arms, as researchers
delivered pulses first to the electrode near their wrist and then to one by
their elbow. Participants
reported feeling the illusory touch and the real one equally strongly, and their
brains agreed—the S1 area registered both sensations at the same location in
the brain and with a similar amount of neural activity. “This
is quite remarkable because traditionally we thought S1 formed a map of the body
that faithfully represents the actual touch on the skin, but our results suggest
this is not always the case,” says study author Christian Ruff, PhD, a
psychology and neuroscience researcher at UCL. Instead, S1 seems to be
representing what we feel—not what is actually there, he adds. Where
is S1 getting its false information? One possibility is that higher areas of the
somatosensory cortex, the ones that would integrate information about the time
and location of a tap on the skin, also register raw sensory information and
then force their interpretation on S1, says Ress, who also studies perception. In
fact, while S1 showed no differences in activation during real and imagined
touch, the right premotor cortex showed increased activation during the illusory
touch, and that area may be at least part of the illusion’s source, Ruff
observes. “It
could be that signals from higher-level brain structures can influence the
primary sensory cortex via neural feedback connections,” Ruff notes. Visual
mistakes Researchers
who study an entirely different sense—vision—are coming to similar
conclusions. Scientists traditionally claim that the primary visual cortex, or
V1, registers sensory information and then kicks it tohigher-level areas for
processing. A study published in a 2003 issue of Nature Neuroscience
(Vol. 6, No. 4, pages 414–420) suggests otherwise. The
study’s four adult participants lay in an fMRI machine while watching a screen
that showed a faint vertical grating on a similarly patterned background, or
just the background alone. Participants had one second to view the screen and
then one second to press a button indicating whether they had seen the vertical
grating —a process repeated several hundred times for each participant. Analysis
of their brain activity showed high levels of activity in V1 both when the
participants saw the grating and when they just thought they saw it. What’s
more, the V1 area was similarly quiet when participants did not see the grating
as when they just missed it. These
results, like those of the Blankenburg study, help explain why false perceptions
sometimes feel quite real, says Ress. “If
you think you perceive a sensation, then the lower-level primary sensory area
that is associated with that false perception actually becomes involved,” he
notes. However,
he cautions that fMRI data doesn’t always match up with the electrical
activity of the brain. “It’s
a very indirect measure of neural activity, and we are still not exactly sure
what it means,” he notes. That
said, this line of research could eventually help amputees who suffer from
phantom limb pain, Blankenburg says. If phantom pain comes from the lowest level
of the sensory system, effective drugs or therapy could target that area. In
the distant future, research on the translation of sensation to perception may
lead to machines that transmit visual signals directly into the brains of blind
people, allowing them to see. But if higher level areas of the brain feed
information to the lower areas, as is suggested by this line of research, such
applications wouldn’t just be able to transmit raw data straight into
people’s primary cortices, Ress posits. “The
design of something that emulates cortical processing becomes more complicated
when the brain is a recursive network,” he says.
More research links hostility to coronary risk. By Nadja Geipert Yet ensuing large
epidemiological studies failed to confirm the connection, and most health
psychologists abandoned the concept in the late 1980s in favor of a component
often found in Type A people: hostility. A meta-analysis presented
by German researcher Michael Myrtek, PhD, in his chapter on heart disease, Type
A and hostility in the recently published APA book “Contributions Toward
Evidence-based Psychocardiology: A Systematic Review of the Literature” (see “One
heart—many threats”) confirms that there is no significant association
between Type A personalities and heart disease, but that there is a connection
between hostility and coronary heart disease. “The consensus is really
that it is not all aspects of Type A behavior, but just the hostility
component,” says Redford Williams, MD, director of the behavioral medicine
research center at Duke University School of Medicine. David Krantz, PhD,
chairman of the department of medical and clinical psychology at Today, the heart
disease-hostility link has gained significant credence among investigators, even
though the exact nature of the connection remains up for debate. One hot-button
issue is that several studies have linked hostility with other well-established
risk factors like smoking, obesity, depression and socioeconomic status. But,
with the help of technological advances, researchers have also discovered
evidence that hostility contributes independently to the pathogenesis of heart
disease through lipid accumulation, increased blood pressure and heart rate and
platelet physiology. New findings Psychologists
conceptualize hostility as consisting of three components: the emotion, the
expression and the cognition—so-called cynical mistrust. Most research has
focused on the cognitive hostility aspects of distrust, antagonism and general
manipulativeness and how these traits relate to medical measures like blood
pressure and heart rate or traditional cardiac risk factors like smoking. A study co-authored by
Krantz in the July issue of Psychosomatic
Medicine (Vol. 67, No. 4, pages 546–52) found that in 506 women
with suspected artery disease, those with higher hostility scores were more
likely to have subsequent coronary events like hospitalizations for angina,
nonfatal myocardial infarction, stroke and congestive heart failure in the next
three to six years. This remained true even after the investigators adjusted for
other risk factors, suggesting that hostility indeed constitutes an independent
risk factor. Another study published in
the February issue of Neuropsychobiology
(Vol.53, No.1, pages 26–32) found a positive association between increased
hostility and increased plasma homocysteine levels, which is also considered an
independent risk factor for coronary heart disease. In another example of
high-tech experimentation, University of Pittsburgh School of Medicine (UPSM)
researchers used carotid-artery imaging to evaluate a connection between intimal-medial
thickening—a measure of subclinical atherosclerosis—and hostility in white
and African-American middle-aged women. They found that each one-point increase
in hostility scores predicted a significantly higher intimal-medial thickening.
The results were published in the November issue of the American
Heart Journal (Vol.152, No. 5, pages 982.e7–13). “These new technologies
allow one to measure atherosclerosis in healthy people way before there are any
symptoms of the disease and offer opportunities to examine the associations
between hostility with sub-clinical disease,” says study co-author Karen
Matthews, PhD, professor of psychiatry, epidemiology and psychology and director
of the cardiovascular behavioral medicine research training program at UPSM. Hostility’s
complex role Other research points to
hostility’s overlap with other well-established psychological and physical
risk factors. For example, a recent
study published online in Psychosomatic
Medicine examined hostility, depression, anxiety and trait anger as
it related to coronary heart disease in U.S. Air Force Veterans. The study
concluded that while each individual psychological attribute was a significant
predictor of coronary disease, it was really the co-variation of the four traits
that posed the biggest risk. Meanwhile, a meta-analysis
published in the July issue of Health
Psychology (Vol.25, No.4, pages 493–498) found a relationship
between hostility and the following measures: triglycerides, body mass index,
waist-to-hip ratio, glucose levels, socioeconomic status, alcohol consumption
and smoking. The results suggest hostility plays a complex role in the etiology
of heart disease. Such findings lead the
study’s lead author Jerry Suls, PhD—a health psychologist at the
By Laurie Meyers Psychology helps heal
metaphorical broken hearts, but what can it do for real ones? It can help keep
them from breaking in the first place through behavioral interventions for major
heart disease risk factors such as smoking, physical inactivity and diabetes. Two major preventive
ingredients are proving important: Focus on the constructive—what people can
do to help themselves—and follow up, says psychologist Elyse Park, PhD, an
assistant psychiatry professor at “It’s about building
up efficacy and motivating them to see things positively,” she says. Park also believes that
health professionals shouldn’t wait for people at risk for heart disease to
come find them. “The patients who come forward are more successful, but
sometimes being reached out to can really help patients,” she notes. Up in smoke Cigarette smoking
increases the risk of cardiovascular disease by itself and can also interact
with other factors to further increase risk, according to the American Heart
Association. Smoking increases blood pressure, decreases exercise tolerance,
increases the tendency for blood to clot and decreases “good” cholesterol.
Taking into consideration all of these effects, smoking accounts for almost
440,000 deaths annually. So how do you get people
to quit? A combination of behavioral change counseling and pharmaceutical
assistance works best, says Park, who has worked with cancer patients and
survivors, expectant and new parents and other groups who are trying to quit
smoking. Interventions should be targeted to an individual’s barriers, she
says. “Try to figure out what motivates them to smoke, what is their quit
history and their support system, and help them set goals,” Park says. For instance, in a 2006
study published in Obstetrics &
Gynecology (Vol. 108, No. 1, pages 83–92), Park and her team found
that a telephone intervention targeted specifically at pregnant women was more
effective than an untargeted method in light smokers or those who had previously
tried to quit. However, the intervention was not more effective in heavy
smokers, who likely need additional strategies such as pharmaceutical therapy or
more intensive counseling. Events like a heart
attack, cancer diagnosis or pregnancy can also be what Park calls “teachable
moments” which can give extra motivation. The counseling in the cessation
therapy would target condition-specific issues such as the negative effects that
smoking has on a fetus or how quitting smoking can reduce the risk of a repeat
heart attack. On the move Physical activity helps
reduce the risk of heart disease by improving blood circulation throughout the
body, reducing cholesterol levels, controlling blood pressure and reducing
weight gain, according to the American Heart Association. However, only about 30
percent of Americans 18 or older engage in 30 minutes or more of leisure-time
physical activity five or more times a week, recent Centers for Disease Control
and Prevention estimates suggest. Health professionals are working to increase
that number through a variety of means. One approach is to teach a
successful exercise regimen involving planning and self-regulation, says Martina
Kanning, a sports psychology researcher at the “You have to plan your
[exercise] actions—when you will do it, and what you will do,” notes Kanning,
who was one of the contributors tothe recent APA book release “Contributions
Toward Evidence-Based Psychocardiology: A Systematic Review of the Literature”
(see “One heart—many
threats”). Behavioral techniques can
be useful in addressing this, but future research should determine what works
consistently, she says. One approach is to give people specific small steps that
they can take to start improving their fitness and well-being, says John Jakicic,
PhD, a professor of exercise physiology at the It’s based on a national
initiative pioneered by the The goal of “Our goal is to take
more simple steps to make people more healthy, because The coalition has used the
media to get out the message about The coalition also worked
with the city’s largest grocery chain to develop a “healthy foods” section
in all of its stores. The chain is also developing plans for stores that will be
like the organic market chain Whole Foods. Defeating diabetes In the |
Recently in the news:
Is the HBO series In Treatment a good representation of how
psychotherapy really works? What about the issue of attraction between
psychologist and patient and
how it is handled in this series? I usually cringe when I see how painfully
unrealistically, unethically and hokey psychotherapy is portrayed in a movie or
television drama. Part of the problem is the understandable lack of
psychological expertise and knowledge on the part of the writers. Another
problem is the need to present a coherent picture of the complex
psychotherapeutic process in a limited television time slot while keeping it
moving fast enough to keep the interest of the viewing audience.