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© 2002-2013 Birgit Wolz
Loch Lomond, CA, USA

 

 

Boundaries Crossings in Psychotherapy - Portrayed in a Movie

By Birgit Wolz

 

Antwone Fisher

Director: Denzel Washington
Producerss:Randa Haines, Todd Black, Denzel Washington
Screenwriter: : Antwone Fisher
Cast: Derek Luke, Denzel Washington, Joy Bryant, Salli Richardson, Stephen Snedden
MPAA Rating: PG-13
Year of Release: 2002


Review

This movie is based on a true story of the man who wrote the screenplay - Antwone Fisher, an African-American in the U.S. Navy stationed in San Diego, California. In one of the first scenes he gets into a fistfight with a fellow officer. Fisher's angry outburst is sudden, swift, and virtually unprovoked.

Antwone has to be evaluated and treated by the African American psychiatrist, Dr. Jerome Davenport. Their first sessions are largely characterized by the patient's squirming in silence after stating, "you may be able to make me come here but you can't make me talk", and Davenport's tough love.

Toward the end of the fifth session, Antwone finally says, "what do you want me to say?", and Davenport responds, "It's not what I want you to say, it's what you want to tell me." And their conversation continues: "I understand you like to fight." "That's the only way some people learn." "But you pay the price for teaching them." At this point Antwone begins sharing his story, and the emotional floodgates open. During the subsequent weekly therapy the psychiatrist asks gentle but probing questions, listens compassionately, and helps his patient understand patterns of instilled self-loathing that were established in the days of slavery, and have been passed down from generation to generation. Davenport uses an integrative approach that blends psychodynamic, behavioral, interpersonal, humanistic orientations, and bibliotherapy.

During their weekly sessions, Antwone tells the therapist about his birth father, who died at the hands of a former girlfriend before Antwone was born, and about his widowed mother, who gave birth to him while she was in prison. Because she did not claim him, he lived in an orphanage for two years, and eventually landed in the home of the Tates, a storefront preacher and his wife. His foster family experiences were marked by serious physical and emotional abuse, molestation, and abandonment. Thrown out of the Tate house after standing up to his foster mother, he stayed briefly in a men's shelter. Then Antwone joined the Navy after a criminal escapade that cost his closest childhood friend's life and nearly his own. He experienced his friend's death as another abandonment.

As Antwone's sessions continue, he falls in love with another young sailor, Cheryl Smolley. He is shy around her, asks Davenport for tips on dating, and struggles with the fact that he is still a virgin.

The psychiatrist urges his patient to return to Cleveland, Ohio, to search for his biological family and find closure. At first Antwone resists, but finally, with Cheryl's help, he flies back.   There he has a confrontation with his abusers, a conversation with the mother who abandoned him, and a reunion with his father's family. This journey proves fruitful in ways that are both agonizing and liberating.

As Antwone's wounds start healing, he begins to own the inner strength that had enabled him to weather the storms of the past. He breaks through his defensive shell and emerges as a smart and sensitive young man who writes poetry, draws, and loves his girlfriend.

 

Boundary considerations

Jerome Davenport crosses several boundaries while treating Antwone. Are these boundary crossings beneficial because they support a certain treatment method or goal, are they unavoidable, or are they unethical and possibly harmful for the patient?

1. Flexibility of boundaries in the service of chosen treatment modalities and goal

Therapeutic time frame:
Davenport usually schedules one to three sessions to evaluate a patient and to make recommendations. In order to give Antwone the time necessary to open up and to let him carry the responsibility for treatment success, the psychiatrist states that the three sessions do not start until Fisher begins talking.
To avoid putting pressure on Antwone, the psychiatrist does paperwork or eats a sandwich while waiting for his resistant patient to start speaking.
According to the boundaries that were set earlier, Davenport terminates after three productive therapy sessions. Since many issues remain unsettled, Antwone acts out again by attacking a peer. He also explodes in the clinic's waiting room and behaves toward Davenport in a highly inappropriate way. When Antwone apologizes and says "I don't know what to do", the psychiatrist admits his mistake in insisting on early termination and agrees to see him for ongoing weekly sessions.
Later in their work, the psychiatrist attempts to terminate again. This triggers his patient's abandonment issues. When Antwone consequently describes another traumatic incident, Davenport sticks to his plan, and tells his patient to contact him again only after he finds his family.

Therapist-patient interactions outside the therapeutic hour:
When Antwone makes a surprise visit to the psychiatrist's home, Davenport sets boundaries clearly and quickly.
As he takes on the role of a surrogate father, the psychiatrist invites his patient to a family dinner at Thanksgiving. It appears as if Davenport designed this invitation as a treatment intervention: because Antwone gets the opportunity to experience a supportive family for the first time in his life, he has a corrective emotional experience. In other cases such an invitation might be inappropriate, because it could lead to an interference with therapeutic objectivity.
In a subsequent scene they meet in a jail cell. This intervention seems supportive and therapeutically necessary.
Dr. Davenport says during one session, "I'm gonna give you my phone number. If you have any problems, any questions at all, you call me ... any time of day or night. ... Give me a call, ok?" Assuming the therapist planned it as a re-parenting intervention, this boundary crossing has a therapeutic purpose.

Use of language:
Several times the psychiatrist addresses Antwone as "son". Davenport evolves temporarily into a father figure for a man robbed of guidance and in need of re-parenting. This use of language might be questionable in a different therapeutic context, especially if dependency develops.

Self-Disclosure:
When asked, the psychiatrist speaks openly about his wife and their relationship. Antwone needs this modeling because he doesn't have any relationship experience.
To normalize his patient's anxiety about dating, Davenport also speaks about his own nervousness.
After termination of their sessions, Davenport tells Antwone that working with him made him a better therapist and husband. The psychiatrist's stiff upper lip and grin-and-bear-it attitude had begun to undermine his marriage before his work with Antwone had a transformational effect on him. Disclosing this seems to support the therapeutic outcome.

2. Unavoidable boundary crossing

Antwone is ordered to see psychiatrist and superior officer Davenport at an outpatient clinic of a U.S. naval base, to be evaluated and screened for psychological issues that might impair service and to provide brief therapy. When Antwone skips his second session, the psychiatrist has officers escort him to his appointment the following week. In a military environment, these boundary crossings appear to be common and apparently sometimes necessary.

3. Unethical boundary violations

Confidentiality:
Dr. Davenport tells his wife details that Antwone had told him during their sessions.
Confidentiality and the therapeutic container are compromised when sessions are held in the psychiatrist's living room with the door open and his wife in the house, and later, in a men's room.

Self-Disclosure:
When he encourages Antwone to locate his family, Davenport says "I love you, son". If stated outside the context of a therapeutic intervention, this might reflect the therapist's counter-transference: Antwone becomes a surrogate son to the psychiatrist, who is himself in denial about the pain of his childless marriage. If Davenport's professional judgment is impaired, an emotionally exploitive dual relationship might develop that can be detrimental for Antwone's treatment.

Boundary crossings in other movies

Dating from the first psychiatric film, Dr. Dippy's Sanitarium (1906), over 500 movies dealing with psychotherapy have been made. Some of these films show only short episodes of a therapist-client relationship. However, most of them portray some form of boundary crossing. Discussing the associated ethical questions after watching movies like Prime (2005), Stay (2005), Good Will Hunting (1997), or Ordinary People (1980) can create a productive, enjoyable learning experience.


Birgit Wolz wrote the following continuing education online courses;

Cinema Therapy - Using the Power of Movies In the Therapeutic Process, which guides the reader through the basic principles of Cinema Therapy.

Cinema Therapy with Children and Adolescents - This course teaches Cinema Therapy with young clients. It includes numerous movie suggestions, which are categorized according to age and issues. It serves therapists, teachers, and parents.

Positive Psychology and the Movies: Transformational Effects of Movies through Positive Cinema Therapy - This course teaches how to develop clinical interventions by using films effectively in combination with positive psychotherapy. It serves for mental health practitioners and anybody who is interested in personal growth and emotional healing.

Therapeutic Ethics in the Movies - What Films Can Teach Psychotherapists About Ethics and Boundaries in Therapy, which covers: confidentiality, self-disclosure, touch, dual relationships and out-of-office experiences (i.e., home visits, in-vivo exposures, attending a wedding, incidental encounters, etc.)

Boundaries and the Movies - Learning about Therapeutic Boundaries through the Movies, which covers informed consent, gifts, home office, clothing, language, humor and silence, proximity and distance between therapist and client, and, finally, sexual relations between therapist and client.

DSM: Diagnoses Seen in Movies - Using Movies to Understand Common DSM Diagnoses.


Psychodynamic Diagnostic Manual (PDM) - A New Approach to Diagnosis in Psychotherapy