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© Birgit Wolz
Occidental, CA, USA



Therapeutic Movie Review Column

By Birgit Wolz, Ph.D., MFT


Director: Jonathan Levine
Producers: Seth Rogen, Ben Karlin, Evan Goldberg
Screenplay: Will Reiser
Cast: Joseph Gordon-Levitt, Seth Rogen, Anna Kendrick, Bryce Dallas Howard, Anjelica Huston, Philip Baker Hall, Serge Houde, Andrew Airlie, Matt Frewer, Donna Yamamoto, Sugar Lyn Beard, Yee Jee Tso
MPAA Rating: R
Year of Release: 2011


50/50 straddles the line between comedy and drama. Will Reiser, a close friend of co-lead and co-producer Seth Rogen, wrote the screenplay after his own cancer diagnosis, which lends the film a sense of realism.

As the movie opens, 27-year-old Adam appears to have everything: a great job, a pretty girlfriend, and a carefree, lovable best friend. He plans to settle into domesticity with his girlfriend, Rachael, by clearing out a drawer for her in his apartment. The protagonist works as a writer and producer for public radio in Seattle. He is also a risk-averse young man who does not drink, smoke, or drive a car because he has seen the fatality statistics for drivers. He also tries to exert control over his physical wellbeing by focusing on a healthy diet and daily exercise. 

Adam's life is turns upside down when he starts experiencing persistent, nagging back pain and breathlessness. His aloof oncologist delivers the diagnosis in frightening-sounding medical terms: neurofibroma sarcoma schwannoma , a rare and possibly deadly form of malignant tumor along his spine due to a rare genetic mutation. Adam will have to undergo chemotherapy. When the physician notices that his patient is horrified and confused, he hands him the phone number of a hospital psychotherapist.

Adam learns from searching the web that his form of cancer gives him a 50/50 chance of survival. In a state of shock, his most frequently uttered words are "I'm fine." He starts seeing the recommended psychologist, Katherine McCay. She awkwardly tries to offer comfort but appears very inexperienced and spacey. All the therapeutic techniques she tries fail. After one of his chemotherapy sessions, she gives Adam a ride home. An attraction starts to develop between the two. Throughout the movie, her professional boundaries follow Hollywood's story line rather than ethical or legal criteria.

After telling Rachael about his cancer, Adam lets her know that he would understand if she decides to leave him. The girl vows to stand by his side, because she believes that this is expected of her. To demonstrate her support, she rescues Skeletor , an old, ex-racing Greyhound dog, for her boyfriend from the pound.

Adam was raised by his smothering and hysterical mom, Diane. Now she wants to support him in her familiar clingy, possessive, and loving fashion. Initially, she insists forcefully that she must move in with him. But Diane already has to take care of a husband with Alzheimer's disease. When Adam reassures her that his girlfriend Rachael will be there for him, she backs off.

It becomes obvious that Rachael is not up to the task when Adam goes through the challenges of cancer treatment. Although she drives him to the hospital, she does not want to accompany him during his chemotherapy sessions, citing the hospital's "bad energy" as an excuse.

Adam turns to his best buddy and colleague Kyle for support and encouragement, and his friend tries to rise to the occasion. But when Kyle starts using his caretaker role on women to get dates, Adam gets annoyed. On one of his dates, Kyle sees Rachael kissing another man. He takes a picture of them on his cell phone, which he immediately shows to Adam. When Kyle witnesses his friend's inability to confront Rachael and stand up for himself, he kicks Rachael out of Adam's house and helps him destroy a painting that she had given him.

Although Adam initially does not cooperate, Kyle keeps trying to get his best friend laid. The two young men pick up two women at a bar, but Adam is unable to enjoy sex because of his back pain. All these experiences make Adam's despair more potent. Like the volcanoes he was researching for his radio show, his suppressed emotions eventually erupt. Although he is an inexperienced driver, he hijacks Kyle's car and breaks down by the side of the road, crying: "Why me?"

Adam starts feeling a little better when he befriends Alan and Mitch, two older chemo patients receiving treatment alongside him. When he and Kyle hang out with Alan and Mitch at home, Adam becomes impressed with Mitch's loving relationship with his wife. But during a subsequent chemotherapy session, Adam hears from Alan that Mitch died the previous night. Now he believes that he has no chance of survival.

After Mitch's funeral, Katherine tells Adam in one of their sessions that his mom already has a hard time taking care of his father besides worrying about her son not returning her calls. Therefore he decides to reconnect with his parents. They accompany him to a doctor's appointment in which they are informed that his tumor has grown despite the chemotherapy. His only choice is to have a high-risk operation that might well kill him, but could also conceivably cure him. 

Increasingly nervous about the procedure, Adam decides to go drinking with Kyle. While drunk, he lashes out at his friend for being more interested in having sex with random women than being there for him. In his despair, Adam calls Katherine late at night for support. She tells him that she might go out with him after his surgery. Back at home, he discovers that Kyle has been following the instructions of a book on how to comfort cancer patients. Deeply touched he realizes that Kyle was doing his best to support his friend.

Adam undergoes surgery as Kyle, Katherine, and Diane are nervously waiting. The doctor informs them that, although the journey will be long, Adam will survive. Six months later, Katherine and the now happy and healthy Adam are dating.

Cinema Alchemy

30-year old Michael had come to see me, because his fiancé suggested that he see a therapist before they get married. She believed that his angry outbursts that erupted out of the blue were damaging for their relationship. Michael had no experience with therapy and was not convinced that he needed it, because he had always been such a calm guy.

After a series of questions about the timing and potential triggers for his anger, it became obvious that it might have been connected to a car accident that happened recently. He and his best friend, Jonathan, were hit by a truck while driving in Jonathan's car. Michael had almost no injuries while his friend was seriously hurt. Jonathan had to undergo an operation and faces more surgeries to prevent chronic back pain. My client felt helpless when he saw his buddy hurting. He was not sure whether he helped or made things worse when he visited him. He was not able to tell me more details of their interactions or identify any other emotions than anger.

Michael's difficulties to articulate his inner-active or inter-active processes indicated that Cinema Alchemy might be useful. I told him to watch 50/50 and focus on the dialogs between Adam and Kyle. I also encouraged him to find out which scenes about their interactions made him feel good and which did not.

I was impressed with how well Michael was able to talk about his observations of the characters. He understood how Kyle was trying hard to comfort Adam, but failed often. My client was appalled by Kyle's awkward Patrick Swayze cancer joke and his attempt to share his medical marijuana prescription. "I understand that Kyle wants to distract Adam from his condition by cracking terrible jokes, but it really doesn't work", my client said. "I have also urged Jonathan to use the pity card to get dates. Now I feel kind of bad about it". We discussed the concept of the Inner Critic that sometimes arises when we acknowledge mistakes and try to learn from them.

This allowed Michael to feel better about his discoveries. Now he was able to recognize that he had many better interactions with his buddy than the characters. "Some of Kyle's comments in regards to dating are pretty bad. I would have not said such a thing", he told me proudly. I encouraged him to continue practicing his healthy communication style. My client looked relieved when he concluded this discussion with the comment, "overall Kyle really cares about Adam, like I care about Jonathan."

Shortly after this conversation, Michael was able to recognize that helplessness and survivor's guilt had triggered his irritability, which led to sudden outbursts of anger. This increased consciousness helped him reduce and eventually let go of his reactivity. His communication with his girlfriend as well as with Jonathan improved significantly when he was able to admit feelings of helplessness.

Toward the end of our work, Michael said: "Therapy is new to me. But somehow it seemed strange that the therapist in the movie ended up in a relationship with Adam." I handed my client the BBS brochure Professional psychotherapy never includes sex. I also explained that screenwriters tend to pay more attention to the dramatic effects of a therapeutic relationship than to the fact that (in California) any kind of sexual contact or behavior between a therapist and a patient, as well as sexual contact within two years after termination of therapy are illegal and unethical.

Theoretical Contemplations

With Adam, I used the The Prescriptive Way of Cinema Alchemy. Films can be prescribed to model specific behavior. Clients can also learn "by proxy" how not to do something or not to behave because they see the negative consequences of a character's action.

With clients who are inexperienced with the therapeutic process or have difficulties identifying thought processes and emotions, movies can be a very useful aid in this teaching process. The film demonstrates feelings and ideas that a client had trouble putting into words. I noticed that most clients are able to evaluate communication patterns on the screen. If a character demonstrates healthy and/or unhealthy communication, I ask clients whether they recognize this in their own relationships. They usually come up with an answer, even if it was originally hard for them recognize these patterns in their own life.

Guidelines and Questions for Work with Clients

•  Focus on the dialogs between the characters A and B.

•  Find out which scenes about their interactions made you feel good and which not.

•  Talk about your observations of the film's characters. Why did you like certain interactions and not others?

•  What did you learn from the characters' communication?

•  Be aware that your Inner Critic might sometimes surface when you acknowledge your own mistakes through this process and try to learn from them.


Birgit Wolz wrote and co- 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