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In recent years, as the stigma surrounding mental health has started to fade, therapy and mental health themes have become more prominent in TV shows. But how do these portrayals measure up to real life? And do they explore sensitive content responsibly?
We asked a forensic psychologist to give his opinions on some of the most popular psychology TV shows.
Featured Expert: John Delatorre, Psy.D.
John Delatorre, Psy.D., holds a psychology license in Arizona, Texas, and New York, with advanced training in forensic psychology. He received his doctorate from Midwestern University-Glendale and completed his postdoc at a crisis stabilization unit. Delatorre treats patients with severe mental illness, significant trauma histories, and personality disorders.
He is experienced in risk/threat assessments, courtroom testimony for criminal cases, and child custody evaluations. He regularly provides commentary for Court TV and Law & Crime Trial Network.
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"Criminal Minds" hailed during the height of the crime drama era of the 2000s. It was released after other procedurals, such as "Law & Order" and "CSI," but became one of the most popular crime shows of all time.
"Criminal Minds" sets itself apart from similar shows by diving deeper into the psychological aspects of detective work, rather than focusing on the judicial system or physical evidence. The plot revolves around agents in the Behavioral Analysis Unit (BAU) of the FBI, who use criminology to solve high-profile cases.
"Criminology is essentially the profile of a killer: the psychological aspects [that indicate] why someone would do what they do," Delatorre explains.
Detectives have been using psychology to understand and identify criminals since the 1800s. But the practice developed dramatically during the upsurge of serial killings that started in the 1970s. In the latter half of the 20th century, psychology programs began offering forensic psychology as a specialty. Part of the curriculum includes teaching students how to analyze the minds of criminals.
In real life, forensic psychologists sometimes use these skills to help law enforcement develop criminal profiles. It wasn't until 2001 that the American Psychological Association recognized forensic psychology as an official specialty.
"The show does its best, but it's clearly fiction … It seems to imply that everybody [in the BAU] is some kind of profiler — that they can see into the hearts and minds of these serial killers," Delatorre says.
While the FBI does use psychology to identify offenders, it's not always as central to their strategy as the show portrays.
"Are there people who really do those kinds of things? Yes, there are FBI agents who have a long history of investigative work, and training, but they're not necessarily psychologists," Delatorre states.
"In terms of comparison, if you want to watch how profilers really work, I think 'Mindhunter' on Netflix is a much more accurate depiction of what profilers in the FBI actually do."
This early 2000s drama is more than another crime fiction. It weaves in themes about morality, redemption, and death as it follows the daily life of New Jersey mafia boss Tony Soprano. At the beginning of the show, Tony is forced to start seeing a psychiatrist due to recurring panic attacks.
Throughout its six seasons, viewers sit in on sessions between Tony and his therapist, Dr. Melfi, who is continuously plagued with the ethical dilemma of helping Tony.
Delatorre states, "Treating someone with antisocial personality disorder, which is certainly possible for Tony Soprano, is a double-edged sword because what we want to do is get someone to kind of break free from some of these maladaptive behaviors they're exhibiting."
Some traits of people with antisocial personality disorder (sometimes called sociopathy) include manipulative behavior, deceit, lack of remorse, and repeatedly breaking the law. Tony exhibits all of these characteristics.
"If someone has a personality disorder, there are very few treatments that are actually successful," Delatorre explains. "In some ways, what we might be doing [in therapy] is teaching them how to recognize fear in others."
Personality disorders are difficult to diagnose, let alone treat. This is because patients may not provide accurate accounts of events or are reluctant to participate in therapy, according to the Mayo Clinic.
Additionally, there are no medications approved by the Food and Drug Administration for personality disorders.
The show succeeds in showing this real issue in therapy. However, it's difficult to look past an obvious plot hole: Dr. Melfi's failure to report Tony's crimes. While Tony doesn't make any outright admissions, it's an open secret between the two characters that Tony is a mob boss.
"If you're a danger to someone else, I'm a mandated reporter … So I don't think that Tony Soprano himself would continue treatment if I'm constantly having to remind him of my ethical obligation, that not everything gets to be kept a secret," Delatorre says. "So, I don't think someone like Tony Soprano realistically makes it very long in therapy."
"13 Reasons Why"
The teen drama based on the novel of the same name was adapted for Netflix and ran for four seasons between 2017 and 2020. The series follows high school student Clay Jensen as he reels from the loss of his friend and love interest Hannah Baker, who died by suicide. Before her death, she records herself explaining why she ended her life and leaves the audio tapes to Clay.
The show caused major controversy for its depiction of suicide. Some critics believe that it romanticizes self-harm by depicting an aftermath in which Hannah is turned into a martyr.
A study published in 2020 even suggested that the release of the first season could be linked to an uptick in teen suicides. However, researchers and therapists are divided on this issue.
"Oftentimes, I think some mental health professionals don't want to ask a client if they're having thoughts of harming themselves because they believe that it's going to put the thought in a person's head. But there's no such thing as inception," Delatorre says.
"The thought is either there or it's not there – and if it is there and it goes unaddressed, then that's putting that person at risk for actually doing that behavior."
In Delatorre's view, stories like "13 Reasons Why" can provide an opportunity for dialogue.
"Parents can watch that show with their older teenagers and the two can have a conversation," Delatorre says.
"Children often think that they are absolutely alone and that the problems that they face are unique to them. Parents have an opportunity to say, 'Everything you're going through right now, I went through 20, 30 years ago. There's nothing new other than the time and place in which this happened.'"
"In Treatment" gives viewers the feeling of being a fly on the wall inside therapy sessions. Each 30-minute episode features a different patient from Dr. Weston's revolving roster, each with their own unique situations and issues.
The American version, based on an Israeli TV show, came out in 2008 and ran for three seasons. Fans were excited when it was revived after a decade-long hiatus — this time with a new female lead.
The show not only depicts the struggles of patients, but also of mental health professionals. As the series progresses, Weston struggles in his personal life and starts to question his own competency as a therapist.
Similarly, Dr. Taylor, the new protagonist in season four, becomes overly invested in patients and has trouble setting boundaries. She also confronts her own resurfacing demons when a patient's history of drug use comes up during their sessions. These are real issues that therapists face throughout their careers.
One pet peeve many mental health professionals share about the way therapy is shown on TV is the idea that therapists are always calm, cool, and collected.
Delatorre says that "In Treatment" is one of the only shows that portrays the stress that sometimes occurs when interacting with patients.
"What it's like to sit in the room can be very awkward and difficult," Delatorre states. "There's this idea that you can turn it off and turn it on whenever you want … it is not something that is just easily moved to the side."
He continues, "I think 'In Treatment' really does the best overall, although there are a lot of things that, as psychologists, we kind of need to look past, but I do think that's probably the better of all of them — the most accurate."