Psychiatrists With Television Shows

[Moki]

What is the general consensus about psychiatrists working with patients on camera for broadcast on their own television shows?

The reason for my question is that a psychiatrist by the name of Keith Ablow is set to begin a television show this Fall. (I have heard him speak on a few occasions and he appears to have tremendous ability.) In any event, how are these actions viewed by the psychiatric community? If done tastefully and in a non-exploitive manner, will it help the field by dissolving misconceptions and bringing more people into treatment who might otherwise have foregone out of fear? Is it conceptually possible for the interaction between a doctor and patient contained in this setting to be conducted in a non-exploitive manner?

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[whopper]

From what I understand, unless the patient signs an affidavit that allows for the doctor to broadcast confidential patient info on TV--its illegal.

Further, even if the patient did sign the affidavit, to some degree this is unethical. E.g. if a psychiatrist had a show--and was profitting off of the show, the "bottom line" is not so much treatment now as it is profit via ratings.

However if the show was done by a 3rd party, who was neutral to the therapist, this would be more objective.

I really cant' just more until I see the show. There could be things about this show we don't know about and therefore really can't judge until we see it for ourselves.

 

[Psyclops]

What if the Pt would receive free tx if they opted to be filmed during tx? It wouldn't just be the doctor who profited.

Other medical specialties have doen this, or do this on a routine basis with no presumable ill effects (e.g., DR. 90210; Discovery Health [many specialites]).

 

[Psyclops]

It can also be that they don't consent to braodcasting until the filming is over. So they know what will be aired. I don't have an immediate "no"reaction to this. If done well I do think it has the potential to erase many of the sterotypes the MH field is associated with.

 

[psm1776]

I think it's a bad idea in general - (I also think in today's culture anything and everything takes on a voyeuristic nature - something things are not meant to broacast!) - But more specifically, part of what makes psychiatry work is the therapuetic alliance which takes place within the "frame" of the consulting room. Inherent within the relationship (and IMO, what makes it work partly) is the therapuetic space between 2 people where that emotional intimacy and transference/counterference takes place. A camera or any other broadcasting device, makes it much like a Schroedingers' cat scenario. Therapy/psychiatry/psych medications is no longer mystifing/taboo subject, and I'd really have to ask myself, why is this necessary or even beneficial except for less than noble reasons. Reality tv (& I may be wrong) in its various forms are merely exploitative, not educational.

 

[LM02]

What if the Pt would receive free tx if they opted to be filmed during tx? It wouldn't just be the doctor who profited.

At least in psychology (our ethical principles are slightly different than those in psychiatry), this would be considered coercion.

 

[Psyclops]

That may be, but not necessarily. As I understand it, this would only be coercion if it made it difficult to refuse, or even too difficult to refuse. The price of tx might not be so high that it would qualify. For example, if a wealthy patient, who was fully able to pay for Tx out of pocket, or with insurance money were to b given that option it could hardly be considered coercion. This would be a more interesting question for those who were too poor to obtain MH Tx, or only able to afford it just barely.

On another note, I'm not sure if this whole thing is a good idea or not, but I don't immediately think it is a bad idea.

And for the above poster discussing the therapeutic relationship, I'm not sure this would violate it. Many training programs and research studies videotape therapy sessions to insure consistent admonistration of tx accross therapists and participants. And, there is always group therapy which is certainy not private but works well nevertheless.

 

[PublicHealth]

Tell Dr. Phil about coercion and therapeutic relationships.....while he deposits his check for several million.

 

[LM02]

Tell Dr. Phil about coercion and therapeutic relationships.....while he deposits his check for several million.

I loathe Dr. Phil.

He presents himself as a "life coach" or something like that to get around state ethics boards that govern the practice of psychologists. Even using his "Dr." title, if he doesn't call himself a "psychologist," there's little they can do. 😡

But I recently spoke with a member of our state ethics board, and he said that there has been lots of discussion amongst his colleagues about how to deal with this growing problem. Not that they have a solution...

 

[fiatslug]

was shocked to learn recently from one of my attendings that in the state of California, anyone can call him/herself a psychotherapist regardless of level of education, training, etc... terrible!

 

[PublicHealth]

was shocked to learn recently from one of my attendings that in the state of California, anyone can call him/herself a psychotherapist regardless of level of education, training, etc... terrible!

You would be surprised by who is a "psychotherapist" nowadays. The degrees are an alphabet soup of LPCs, MAs, MSWs, PhDs, PsyDs, etc.

 

[Psyclops]

You would be surprised by who is a "psychotherapist" nowadays. The degrees are an alphabet soup of LPCs, MAs, MSWs, PhDs, PsyDs, etc....

...and MDs. Admittedly psychotherapist is no longer an informative title. I guess I don't have to preach to you guys about the dangers of loosely defined practice definitions, or ambiguous and loosely defined titles.

As those of you on this board may, or may not know, the BIG APA is having its anual conference this weekend, and guess who is the invited presidential speaker....no really, guess....

 

[Moki]

Bill Clinton? No, that's the ABA. Sorry. . . .

(Please don't go off on a political thing! The comment is purely for the sake of humor - remember "It depends on what your definition of 'is' is?")

 

[Moki]

It is reassuring to see that the disquiet within me that prompted this question is reflected in others. My primary area of concern is not with the legality of the consent form or any overt coercion that might occur. Ablow does not strike me as someone who would fail to obtain adequate legal counsel or who would knowingly manipulate people and their pain for profit. (Granted I base that merely on having heard him speak on two occasions, having read the majority of his non-fiction, and a gut feeling.) I am more concerned with the chain that begins with his show, the others who might be less skilled and less ethical in their choices and actions. I worry about the possibility of the bastardization of the heart and soul of psychiatry – that this realm will fall into the current trends of our society, namely one obsessed with, and controlled by, voyeurism and exhibitionism.

I wonder why the Dr. Phil show concept doesn't raise the same level of concern for me. . . . Perhaps, because that line has already been crossed? Anyone else feel the same on that topic? Are there different ethical standards by which psychiatrists and psychologists should be held – be they codified by state or association or based on what Robert M. Pirsig spent hundreds of pages and a good portion of his life attempting to define – "Quality?"

In any event, I agree that it is hard to pass judgment until this particular show airs and we are able to see how Ablow dances the line. What gives me hope is that Ablow successfully did something similar while in residency training that ruffled a few feathers. Specifically, he wrote a number of rather revealing and deeply personal articles regarding his experience that pushed aside a portion of the veil of silence surrounding the medical training process. In my opinion, I think he did a fine job and generated a lot of good with that work. The following passage from his book entitled "To Wrestle with Demons," which contains all of those articles, provides me with a hope that he will do the same with this endeavor:

"Treating psychiatric patients is hard to talk about, in the way that the soul is hard to talk about. There is something immeasurable in the work, a coalescence of mind and spirit, that resists words. I think the resistance to discuss the psychiatrist's trade is due not so much to its complexity as it is to the practitioner's fear - my fear - that the beauty in it will evaporate if we examine it too closely; as if, by explaining the workings of empathy, we will explain it away. Maybe that's the reason for all of the infighting between those who understand mental illnesses in terms of disordered life stories and others who understand them as abnormal brain chemistry."

Then I contrast that passage with the fact that he has promoted himself and his new show on the Tyra Banks show and the disquiet comes back. I am worried about the fluff factor and I can't seem to reconcile the two. Anyone?

 

[Anasazi23]

The psychological APA and the psychiatric APA are entirely different animals. Trust me.

Psychiatric drug trials commonly 'coerce' patients into free treatment for a variety of reasons, including free pharmacotherapy, chances to obtain the latest treatment options, and so on.

Dr. Phil is a very typical psychologist, who uses an amorphous 'eclectic' approach to patient treatment...which amounts to nothing more than good advice.

The term "life coach" is not new, and is used by many a pseudo-practitioner to charge a lot of money and become wealthy at the perceived expense of non-patients - particulary in California.

 

[Psyclops]

Psychiatric drug trials commonly 'coerce' patients into free treatment for a variety of reasons, including free pharmacotherapy, chances to obtain the latest treatment options, and so on.

Very good point.

Dr. Phil is a very typical psychologist, who uses an amorphous 'eclectic' approach to patient treatment...which amounts to nothing more than good advice.

(Lets see if I can do this without losing my composure.)

Not in my experience. But the "typical" for each respective field has pushed me towards psychology and not psychiatry. I loath the stereotypical "therapist" shown on tv, I hate that that image often gets applied to psychologists, I hate that therapy is seen as such a joke, and by extension my entire chosen profession. But, I'll take that over the psychopharmachologist aproach that is the typical of field of psychiatry.

 

[fiatslug]

The term "life coach" is not new, and is used by many a pseudo-practitioner to charge a lot of money and become wealthy at the perceived expense of non-patients - particulary in California.

Here in CA, "life coaches" are almost entirely employed by and paid for by the wealthy parents (usually divorced) of young brittle borderlines... it's almost diagnostic!

 

[Anasazi23]

Very good point.



(Lets see if I can do this without losing my composure.)

Not in my experience. But the "typical" for each respective field has pushed me towards psychology and not psychiatry. I loath the stereotypical "therapist" shown on tv, I hate that that image often gets applied to psychologists, I hate that therapy is seen as such a joke, and by extension my entire chosen profession. But, I'll take that over the psychopharmachologist aproach that is the typical of field of psychiatry.

Aw, Psyclops, you didn't see the humor and sarcasm in that post?

It didn't come across in text, I suppose. You know I'm kidding...(mostly)
😉

 

[Psyclops]

Aw, Psyclops, you didn't see the humor and sarcasm in that post?

It didn't come across in text, I suppose. You know I'm kidding...(mostly)
😉

Sore subject I guess 😳

 

[psm1776]

I think someone mentioned this already, but "Dr." Phil is not a doctor at all - & right, virtually anyone can hang a shingle in front and claim to be a psychotherapist, it's loosely regulated.

Second, I understand patients are taped and recorded for educational purposes - having something broadcast on nationwide tv constitutes entertainment, not education. I think that's the difference. (Aside from the frame mentioned)....

 

[LM02]

Psychiatric drug trials commonly 'coerce' patients into free treatment for a variety of reasons, including free pharmacotherapy, chances to obtain the latest treatment options, and so on.

As a treatment researcher who has worked with many university IRBs, this is not entirely true. There are many guidelines and standards under which clinical trials are conducted to minimize "coercion." Of course, it does not entirely eliminate this dynamic of treatment in a clinical trial, but the research procedures (e.g., informed consent, alternative treatments, etc.) are designed to directly address it. The television situation is different in two important ways:

1. The risks associated with exposing oneself on national television (the supposed trade-off for free treatment) are most likely going to be greater than the risks associated with volunteering for a typical pharmacotherapy/psychotherapy clinical trial to get free treatment. After all, clinical trials involve continuous monitoring over the course of several months (and in some cases, over several years) using scientifically-validated instruments. The television scenario seems to be wham-bam-thank-you-ma'am.

2. Clinical trials have oversight boards - both within the IRB and the independent Data Safety Monitoring Board (required for all NIH-sponsored clinical trials). What does a television psychiatrist have? The producers?

Dr. Phil is a very typical psychologist, who uses an amorphous 'eclectic' approach to patient treatment...which amounts to nothing more than good advice.

I know you were being provocative, but this is just false. 😛

The term "life coach" is not new, and is used by many a pseudo-practitioner to charge a lot of money and become wealthy at the perceived expense of non-patients - particulary in California.

I wasn't suggesting that this was new - but I was suggesting that Dr. Phil, a trained psychologist, uses the title of "life coach" in an underhanded way to avoid being held accountable for his behavior as a psychologist. Sadly, the man does have a PhD.

 

[Psyclops]

I think someone mentioned this already, but "Dr." Phil is not a doctor at all - & right, virtually anyone can hang a shingle in front and claim to be a psychotherapist, it's loosely regulated.

Second, I understand patients are taped and recorded for educational purposes - having something broadcast on nationwide tv constitutes entertainment, not education. I think that's the difference. (Aside from the frame mentioned)....

So, if something is on tv it is only for entertainment puposes. What aobut the discovery channel, CNN, Fox News ( ), PBS, etc. I don't think htat is the difference.

 

[Moki]

What about the point LM02 brought up regarding the wham-bam-thank-you-ma'am feel of the "therapy session?" Can that ever be beneficial to a patient? I suppose some people could benefit from one shot, but to what extent and with what longevity?

The spotlight turns again to the overall intent of the show and a question of do the ends justify the means?

 

[Anasazi23]

I certainly didn't mean to imply that coercion and recruitment for clinical trials are the same. This point is harder to argue when they offer cash for your participation.

The term "life coach" is a way to get around the legal requirement of having a degree that confers the ability to practice therapy or medicine.

Anyone at all can offer services as a "life coach." Many high-powered business people and even celebrities go to these folks, who are often psychologists or MDs, so that they do not have to report to insurance or have in the papers that they're seeing a psychiatrist.

 

[psm1776]

Psyclops,

Yeah, I tune in to Fox for all my info needs(hmm) - seriously, I'm not saying you can't *learn* anything from tv, but when television shows begin to fill one's (anyone's) educational needs - I'd say that might be a problem. That's a fundamental glitch, someone sees it on tv and considers their own bad self to be some sort of an expert.

A patient sees a creepy ad for Lunesta and demands that drug (a crass example) -

The stuff people see on tv in general is believed to be *true* -another worrisome trend. It's qualitatively different if Joe Blow picks up the green journal and tries to read about trials of olanzapine (good luck!) versus watching episodes of ER. & why, because of the rigor of the academics involved.

I'm not sure of what the possible positive outcomes might be to someone watching a psychiatrist work on tv. (& would this be *the* example of a psychiatrist?)

 

[Psyclops]

WEll it may offer another clipse of what "ture" treatment might be like. There are alot of things that I want to "know about" but won't consider myself an expert on. Like I'll watch a documentary and be able to have a better understanding of how something works or what goes inot it. SUre there will always be people who consider themselves experts without the appropriate knowledge. BUt I think if done well the benefits might be appreciable. I say this from a clinical psychology standpoint. I would like more people to know what treatmetn or assessment would truly entail.

 

[psm1776]

OK, from a clinical psychology POV, tell me what are the benefits to seeing how a mental health professional "works" - oh and what about the whole nitty gritty too - like countertransference? Why would a Patient/client/audience member need to know what treatment entails from our point of view? I don't understand why they *need* to see that, much less try and grasp the fine nuances of it. Dr. Phil, because he is on tv is hailed as an expert. Many people don't know he's not a dr. per se. But because he's on *teevee*, his word is taken as gospel by many people, too many IMO.


Do people watch "COPS" because of the educational value of it, like hmmm, what should I do when I get caught with crack next time let me tune in and find out (I'm kidding). Nope, people watch "COPS" for some voyeuristic thrill.

I may want to watch something because its interesting and may offer something I've never seen before - but I'd like to hear of a case where someone says, gee let me turn on the tv and educate myself tonight.

I think it is exploiting a patient, especially given the fact that the therapuetic relationship occurs in a frame, in a given time/space that is occupied by the participants (I'm including group therapy). It's not for everyone to "intrude" upon, even if the patient consents. (Just because a patient consents doesn't give the green light. ie a patient may agree to sex, but its unethical)

Shucks, I think the dang horse died.

 

[Moki]

Brief clips were made available on the link below. Impressions?

http://drkeith.warnerbros.com/galleries/video/

Still have not come across a statement of purpose for the show. After viewing these clips, I would really like to see one.

 

[Anasazi23]

Brief clips were made available on the link below. Impressions?

http://drkeith.warnerbros.com/galleries/video/

Still have not come across a statement of purpose for the show. After viewing these clips, I would really like to see one.

Flippant, overly casual, and not, in my experience, typical of real psychiatry.

More of a pop-psychology feel.

 

[Psyclops]

Flippant, overly casual, and not, in my experience, typical of real psychiatry.

More of a pop-psychology feel.

In response to the OP: I do believe that one could produce a show that would demonstrate MH treatment in a non-exploitattive and interesting way, this guys isn't going to do it. I don't know what his plan is but it sure doesn't have much to do with psychiatry as I know it.

But then again, if he were to show typical psychiatry as it is practiced today how would he do it? Four 15min med checks per 1hr episode? A little wrap up explaning why he upped the celexa?

No one would want to watch that. It's amazing people want to do it as a profession. 😴 😕 😴 😕

Lots o' love to MD brothers and sisters 😍

 

[Anasazi23]

In response to the OP: I do believe that one could produce a show that would demonstrate MH treatment in a non-exploitattive and interesting way, this guys isn't going to do it. I don't know what his plan is but it sure doesn't have much to do with psychiatry as I know it.

But then again, if he were to show typical psychiatry as it is practiced today how would he do it? Four 15min med checks per 1hr episode? A little wrap up explaning why he upped the celexa?

No one would want to watch that. It's amazing people want to do it as a profession. 😴 😕 😴 😕

Lots o' love to MD brothers and sisters 😍

I think I can get more useful descriptive psychopathological information out of a 20 minute session with a patient than most from any other profession can in an hour. Doctors are busy....we see and treat a lot of patients.
🙂

 

[Anasazi23]

Coincidentally, I saw the guy today on the street on Broadway near Houston. He had the camera on him with a production crew and a small crowd watching. He was talking to some girl about her relationship, and got down on one knee at some point to play up for the camera. I wasn't interested enough to stick around to hear exactly what was happening.

Again, it didn't look anything like typical psychiatry.

 

[Moki]

I find that disturbing and repulsive. I expect someone trained as a psychiatrist and/or one who has worked in the mental health field to have more respect for pain and suffering. Perhaps, I am being naive. . . .

 

[Anasazi23]

I find that disturbing and repulsive. I expect someone trained as a psychiatrist and/or one who has worked in the mental health field to have more respect for pain and suffering. Perhaps, I am being naive. . . .

To be honest, the girl didn't look like she was suffering much. She was thrilled to be on camera and was giggling, all of which made the entire escapade look even more nonsensical.

 

[LM02]

Coincidentally, I saw the guy today on the street on Broadway near Houston. He had the camera on him with a production crew and a small crowd watching. He was talking to some girl about her relationship, and got down on one knee at some point to play up for the camera. I wasn't interested enough to stick around to hear exactly what was happening.

Again, it didn't look anything like typical psychiatry.

What? You mean you *don't* practice street-corner therapy with a camera crew? 😉

 

[Moki]

To be honest, the girl didn't look like she was suffering much. She was thrilled to be on camera and was giggling, all of which made the entire escapade look even more nonsensical.

Who knows? Appearances can be deceiving . . . . 😎

 

[Anasazi23]

Who knows? Appearances can be deceiving . . . . 😎

True, she might have committed suicide shortly thereafter.

 

[Moki]

Funny!

 

[Doc Samson]

Never met the guy, but he trained up here in Boston back in the halcyon days of Tufts/New England Medical Center. Word on the grapevine is that he was well known as a raging Narcissist... which is totally surprising for a psychiatrist who'd treat patients on camera.

 

[Anasazi23]

Never met the guy, but he trained up here in Boston back in the halcyon days of Tufts/New England Medical Center. Word on the grapevine is that he was well known as a raging Narcissist... which is totally surprising for a psychiatrist who'd treat patients on camera.

Or, he feels that he has finally had his just attention so that the world can take notice of his genius and pending success.

Either way, it's off.

I think we should have the SDN psychiatrists start our own psychiatry TV show. Who's up?

 

[PublicHealth]

I think we should have the SDN psychiatrists start our own psychiatry TV show. Who's up?

I'm down, though I'm just a student. I do have an idea for the first topic, though...j/k 😛

P.S. Was the "Who's up" a Freudian slip?