Hope Springs: A New Spring in Depicting Therapists and Treatment by Hollywood?

Since the mid-1960s, the end of the era that the Gabbard brothers called The Golden Age of Hollywood's depiction of psychiatrists and psychiatric treatment, major motion pictures have tended to portray psychiatrists and treatments negatively. Whether evil or foolish, psychiatrists have galloped across boundaries with their patients in all manner of self-serving or clumsy ways. Most mental health professionals, when asked to think of the last film that showed a psychiatrist or other mental health professional (Hollywood isn't particularly careful in distinguishing the different types) behaving ethically and effectively, end up reaching all the way back to 1980 and Ordinary People.

In 2012, we now have a film that transcends the stereotypes of the depraved Hannibal Lecter (Silence of the Lambs) or the bumbling psychiatrist (What About Bob?) and presents a psychiatrist as an earnest, skillful, ethical professional. Hope Springs, directed by David Frankel, depicts an ordinary, older midwestern couple, Kay (Meryl Streep) and Arnold (Tommy Lee Jones), whose marriage is dying on the vine. Kay learns about a five-day marital therapy intensive treatment program offered by Dr. Feld (Steve Carell). Crusty and skeptical Arnold, who is in denial about Kay's withering happiness in their sexually inert relationship, has no intention of honoring Kay's request to try this treatment. Through clever and relentless approaches, which are a model of how one might convince a reluctant person to get treatment, Kay eventually recruits Arnold to fly with her to Maine and they spend the week working with Dr. Feld, as a couple. The quaint Maine resort town seems to come out of a historical era that could easily have been when Kay and Arnold were first romantic together.

Unlike many films with psychiatrists in which the doctor is a featured character, Dr. Feld is more of a means to an end than a focus of the film. Though instrumental in facilitating the essential arc of this couple's journey, he is not depicted with typical Hollywood stereotypes, such as the wounded healer, whose own mending comes through his work with the leads (e.g., Good Will Hunting). Hence, the plot needs only to focus on Dr. Feld's giving therapy and not on his back or side story. Steve Carell was a challenging casting choice as the therapist, since it's hard to overcome so many associations with him as a comic actor. Yet, he plays this role not just straight, but with a level of professionalism and expertise that could be used to instruct students in the nuances of marital therapy. Watching his technique with the couple, whom he sees both individually and together during the intensive treatment week, I found myself thinking what I would do or say, just before Dr. Feld speaks. To my amazement, we were almost always in agreement. This was really solid, mainstream therapy, in the hands of a clearly seasoned, responsible professional; no weird exercises, no exploitation for the doctor's gain or narcissistic fulfillment, none of the ethically questionable devices that are habitually mobilized by directors trying to get some dramatic twist out of the psychiatrist character. Yet, there was nothing boring about Dr. Feld. I wasn't simply relieved to see a treater and his techniques portrayed so faithfully, but I actually admired Dr. Feld for his efforts, earnestness, devotion to the process, and skills. Dr. Feld's professional credentials are not given, but some think he might be a psychiatrist, since he might be writing a prescription on a pad at one point (though it turns out to not be for a medication). As I said, the film industry doesn't take many pains with such distinctions. Whatever he is, he made me proud to be a psychiatrist; a rare experience for me when watching movies these days.

The trajectory of the couple's change week is also refreshingly realistic, even if it is compressed into a week for the sake of the plot device. False starts, blind alleys, awkwardness, and even embarrassment befall Kay and Arnold as Dr. Feld helps open up their ossified communication. Though at times they seem on the verge, there are no great breakthroughs, cures through intense catharsis, or dramatic reversals here. Without revealing the outcome, let me just note that, like most of the progress in real therapy, important movement takes place outside the office and even after the week is finished. The movie follows them for months after this treatment week. Though painful, sometimes humorous, and occasionally, frankly silly, all change with this mature couple of brilliant actors comes in understated whispers, not shouts. The shoehorning of therapy into a single week was unrealistic, but it did add up to at least 15 hours (five half days), which would be more hours of marriage counseling than most couples achieve who try therapy. Such an intensive private therapy is certainly not typical; however, the approach, language, and skillfulness of the therapist are typical.

I have written and lectured on how most of the public's knowledge about mental health professionals and treatment comes, not from personal experience, but, as we learn about so many things, from movies. Unfortunately, movies tend to teach more about what is unethical, inappropriate, and untrue, than otherwise. Indeed, I have taught residents how not to behave, using examples from Hollywood films and TV shows. When a quietly competent and ethically principled psychiatrist finally comes back to the silver screen, whose language, behavior, and methods are conventional and sound, my own hope once again springs eternal for the public's learning more accurately who we are and how we work.

• © 2013 American Academy of Psychiatry and the Law