Johnny Carson once said: “In Hollywood if you don't have a shrink, people think you're crazy.” His observation says less about the stars than it does about the rest of us, who are typically reluctant to enter psychotherapy. By the time a client walks into my office, she knows something needs to change, has exhausted her own efforts, and is at a loss about how to spark transformation.
Fifteen years of private psychotherapy practice has taught me that transformations can have unexpected catalysts. Therapists are trained to help clients dig deep into their psyches, family histories, and daily struggles. But to achieve real change, it can be just as important to help people step back—to gain space from their own problems or to see them in a new light.
It turns out that one of the most effective ways to achieve that space—and to ignite a dramatic psychological shift—is to kick back and watch a film.
Insight versus ACTION
There are many brands of therapy out there, but they all share a common goal: to help a client develop insight into his problem. Insight is therapy’s universal guiding principle. Insight is to therapy what creativity is to the arts, or what unique visitors are to a website: the central, essential driving force. And for most people, therapy does help them to generate insights, to become more aware of themselves and their relationships.
Too often, however, therapy hits a roadblock when clients try to turn insight into action. Many times I have heard a client say “I see things more clearly now, and I know what I need to do. I just wish I could take these insights and act on them.”
Insight is necessary to make change, and it’s hard work to generate meaningful self-awareness, but insight alone is not sufficient. The real challenge in therapy is to help transform awareness into action. Only when a person begins to act on their newfound observations have they fundamentally changed. And it is at precisely this juncture, the elusive trick of converting insights into action, that many therapists hit a brick wall.
The Movie Cure
In therapy as in life, however, sometimes less is more. One of the most effective techniques to help people convert their insights into action is to simply have them watch the right film, and then engage with that film through the therapy process.
Years ago, I worked with an intensely shy client whom I’ll call Angie. Angie grew up in an isolated, rural area with few friends and little exposure to life outside her family’s farm. She had become a gifted computer programmer, but had felt displaced ever since she started her adult life as an urban professional. Angie displayed no interest in her physical appearance. She was an attractive woman, but her hair and clothing often looked unwashed; she wore the same denim jacket, week after week. Angie had never had a boyfriend, though she longed for a romantic connection.
Discussing her past, Angie eventually revealed that her father had a drinking problem, and would routinely call her a “worthless, ugly waste.” She came to realize that her disinterest in her appearance was a way to remain loyal to her father’s message that she was unsightly and unlovable. She was most comfortable in this unlovable role, though it caused her paralyzing emotional pain. It took time and hard work, but Angie began taking better care of herself. She eventually met a down-to-earth, wonderful guy who lived in her building, and they hit it off. When she ended therapy, I asked her to evaluate our work and to tell me what, if anything, was most helpful.
“It made a big difference to realize that growing up with such a critical father lead me to devalue myself and seek unavailable guys. But honestly, what helped the most was when you suggested that I watch Punch Drunk Love.” This quirky love story starring Adam Sandler and Emily Watson refuses gratuitous formulas and portrays what falling in love can look like when one or both people struggle with intimacy. Angie explained:
Seeing these two awkward characters trying so hard to connect, and watching their imperfect but beautiful union, helped me feel less alone. The kissing scene was so much like my own experiences. And believe me, my personal kissing scenes are way different than the easy breezy fireworks that others describe. That movie showed me that I’m not as much of a freak as I thought, and I promised myself that if Emily Watson’s eccentric character could find love, so could I.
I was surprised that a movie could have such a dramatic impact on a client. But I also noticed that Angie was far from unique. I continued to rely on films as a supplemental tool in my therapy. I assigned movies as homework in between sessions. And they continued to generate results, across a wide range of clients with a wide spectrum of problems.
Recently, for example, I worked with a client in his late twenties who came to therapy humiliated by his live-in girlfriend’s discovery of his habitual interest in online porn. Jeff was raised Catholic and expressed tremendous guilt about his desire to view pornography. He wore colorful argyle socks that looked out of place in his otherwise rugged style. His freckled face flushed with pride describing his glamorous, sophisticated girlfriend, Jen. Unfortunately, Jen moved out the morning after she searched Jeff’s computer.
We had honest discussions about sex, porn, and the primary messages Jeff received through his upbringing on the topic of sexuality. Sex did not exist as a topic for discussion during his childhood. The implied parental message that Jeff absorbed was: “Don’t talk about it, and by all means don’t do it out of wedlock. Or you will go to hell.” Jeff spoke honestly about the appeal of porn: “I’m not actually doing it, so technically the sin isn’t as great. My parents are pissed that Jen and I were living together and not married, so porn feels oddly more acceptable. Also, it’s a fantasy, it’s easy and it’s fun.”
Interestingly, the more Jeff explored his wish to be less drawn to porn, the more he opened up about the aspects in his relationship with Jen that felt imbalanced. Jen had chosen every meal, every joint activity, and even Jeff’s new job. (It turns out the incongruent argyle socks were also Jen’s doing.) He had been prohibited from hanging out with his high school and college buddies. Although they were loyal, wonderful guys, they did not make as much money as those in Jen’s social circle.
Through our work together, Jeff began to realize that his pull toward Jen had been as much the problem as his pull toward porn. He began dating women with whom he felt more permission to be himself. Jeff’s therapy was ultimately a success:
I am so much happier and had no idea what a difference it could make to date someone who accepts me, and my friends, and my career. It’s a relief to not always hear a list of ways I need to change. Maybe since I am more real with Tracy, I am less drawn to the fantasy world of porn. I don’t even want to watch anymore.
When we ended, Jeff also pointed to a film as the true catalyst for his transformation:
This may sound strange, but what made the biggest single difference was when you suggested that I watch the movie Don Jon. The film made me realize I’m not such a bad guy just because I watched some porn. I know we discussed this in our sessions. But watching that character felt more believable than anything you could say or do. The movie also pointed out that women like Jen obsess on other forms of fantasy that are just as messed up as too much porn. I don’t need it anymore, and that movie changed my views about it anyway.
My initial inclination to question my clients’ evaluations with stodgy skepticism has gradually given way to an honest admission that I, too, have repeatedly noticed a substantive shift in my clients following prescribed film viewing. They seem lighter, more confident, and more self-possessed.
Recent academic research bears out my anecdotal experience. A 2013 University of Rochester study determined that when couples viewed a series of films and discussed them afterwards, they were more likely to remain married than a control group. This pioneering study revealed an even more remarkable finding: the movie viewing approach was just as effective in keeping couples together as two well-established forms of couples psychotherapy: Preparation and Relationship Enhancement Program (PREP), which emphasizes communication skills and problem solving strategies, and Compassionate and Accepting Relationships through Empathy (CARE), which focuses on acceptance, joining, and developing a shared perspective on differences.
Researchers assumed that these two therapeutic approaches would have a positive impact on marital health. They were also curious if the use of movies to supplement or replace these techniques might also make a difference. 174 engaged or newly married couples enrolled in the study. Of the participating couples, one quarter received PREP therapy, one quarter received CARE therapy, one quarter received no intervention, and the remaining quarter engaged in a structured film viewing approach titled “Relationship Awareness.”
These couples watched the 1967 film Two For the Road about a husband and wife looking back on various high and low points in their marriage. Following this film, study participants engaged in an hour-long, clinically guided conversation touching on marital themes such as conflict, stress and forgiveness. They were then sent home with a list of 47 films and instructed to watch one film together each week and discuss the same questions on their own that were covered with a clinician during the introductory session.
Three years later, those who had PREP or CARE couples counseling had an 11 percent divorce rate. The couples with no intervention had more than double that divorce rate at 24 percent. The shocking result was that the couples that watched the films also had an 11 percent divorce rate. The movies were just as effective as the therapy.
By using films as the focal point, and then providing participants with a set of open-ended questions to discuss once in a clinical setting and then 47 times at home, this intervention gave the couples significant autonomy. The study concluded: “Rather than teach couples new skills, Relationship Awareness drew partners’ attention to current behavior in their relationship and encouraged them to decide for themselves if their behavior was constructive or destructive.” The stated goal of the Relationship Awareness design was to provide “low-dose, low cost interventions, particularly interventions that couples can incorporate easily into their daily lives.” During an interview with the New York Times, Ronald D. Rogge, the lead researcher, explained the clinical value of the films: “A movie is a nonthreatening way to get the conversation started. It’s really exciting because it makes it so much easier to reach out to couples and help them strengthen their relationships on a wide scale.”
How does it work? Each film functions as a vehicle allowing clients to see dimensions of themselves and their relationships, but the distance between the client and the screen lowers defenses and facilitates a safe pathway for genuine change. Allowing the primary content to come from a film, rather than from the clients or the therapist, sets up a scenario in which each participant has tremendous psychological space to pick and choose what aspects resonate, and to apply them to their relationship. When a character in a film reflects a viewer’s own flaws, it can help a viewer absorb his own role in marital conflicts. He may therefore be more able to act to improve the marital dynamic, since the information is not being rammed down his throat by a frustrated spouse or a patronizing professional.
In this mode, the clinician becomes less central to the therapy, but not completely irrelevant. Part of what makes the film viewing so effective is the selection of quality, relevant, client-focused films. Furthermore, the film viewing is followed by clinician-structured, thoughtful discussions of the material, so that the viewer must engage with and process the viewing experience.
In April 2014, the International Journal of Group Psychotherapy published a study titled “Use of Movies for Group Therapy of Psychiatric Patients: Theory and Practice,” which reported equally promising results in the treatment of psychiatrically ill patients. As with the couples-focused study, researchers took great care to select clinically relevant films appropriate to the hospitalized patients. For example, patients with schizophrenia viewed the film A Beautiful Mind. The findings confirmed the value of film viewing as a catalyst for change. The study reported the importance of helping patients take a step back from their situations to see if the films related to their own experience: “Movies can be an important, positive, and productive means of treatment…The movies served as extended metaphors in the therapy sessions. They thus helped to create a better understanding and to promote different ways of expressing thoughts. It seemed that the movies represented a mirror reflecting the inner world of the patients.”
Although this particular study focused on the alienation felt by severely mentally ill patients, the same “reflecting mirror” effect appears to work with high-functioning individuals seeking therapy. Most of my clients who find film viewing helpful also mention that the experience of watching characters on film experience parallel adversity helps them feel less isolated. But it does so from enough emotional distance that the viewer can process the material without feeling threatened or targeted.
If a friend, family member, romantic partner -- or even a therapist -- intervenes with advice about the need to become more patient, this can come across as condescending. When an intervention feels patronizing or forced, in turn, the recipient of the advice may become even less patient. But watching a film with a highly impatient character takes the condescension out of the equation and allows the viewer to reflect on his behavior in a much less intimidating format. Cinematherapy gives permission for a client to organically pick and choose what pieces of the puzzle he feels ready to integrate in order to change.
The impact of cinematherapy can be further magnified in a group therapy setting. And indeed, both cinematherapy and group therapy work in similar ways. Incorporating a film into a group therapy setting is a little bit like holding a looking glass up to a mirror. Like films, psychotherapy groups create a room of mirrors that can work as non-threatening agents for transformation.
Many people think that group therapy died out somewhere around the time that The Bob Newhart Show left the airwaves. But anyone who has attended conferences held by the American Group Psychotherapy Association can tell you that group therapy is alive and well. Almost every client who eventually agrees to participate in a group does so reluctantly, with doubt and trepidation. Nevertheless, those who do often describe the group as a change catalyst, for reasons very similar to those who benefit from cinematherapy.
A corporate executive whom I’ll call Joseph initiated therapy expressing intense anxiety about the process. He was in the throws of a consuming extra-marital affair and asked to pay for extra time before our session began and after it ended so that he could be certain that he would run into no one he knew in my waiting area. I assured him that I scheduled my appointments carefully to avoid such chance encounters, but Joseph was adamant: “My wife cannot know that I am here; I know a lot of people and if it gets back to her, she will get curious. If she finds out what’s going on, I’m ruined.”
Needless to say, it was not easy to convince Joseph to join a group. But after a few months of therapy in which he gained some significant insights but little had actually changed, he agreed. One week before the group, I suggested the film The Wrestler. After the group ended, we met to discuss Joseph’s perspective:
I’ll never forget the first day I joined the group. If I had known in advance that you would have me in a group with a woman whose husband was unfaithful AND with a woman who was in a long-term relationship with a married man I NEVER would have entered the room. Who in their right mind would sign up for that? But without hearing from the women in the group I never would have been able to put things with Sherry [his mistress] on hold to figure out my marriage. Without the group and also that movie where Mickey Rourke is basically playing my father, I doubt I would have realized my own role in what’s not working. When my father walked out on us, I lost my sense of worth or belonging. I’ve approached every relationship with the assumption it will eventually crumble.
I asked him whether his difficulty feeling worthy in relationships was something he could discuss with his wife. I knew this question was a stretch, but Joseph’s affair had been going on for months. At this point, any genuine interaction with his wife could be useful:
I’m pretty sure my marriage is too broken to fix. And I get it now that Sherry makes the marriage bearable so it maintains a messed up status quo. Our individual sessions have helped me parse out the intellectual reasons that continuing with Sherry is like putting a skimpy band-aid on a gushing wound. I am just delaying the inevitable. But knowing is easy. Listening to those women, how they feel, what they think - I could see pieces of myself in their descriptions of their significant others and it changed me forever. I don’t know that I can ever be vulnerable in my marriage. I’m not a bad person for cheating. But I’m a wimp for not telling my wife that I’m unhappy and that things have to change.
Like good films, a good therapy group comprises an extraordinary cast of characters who teach and inspire. By sharing their own stories, each character helps the others see aspects of herself and her loved ones through a clearer, more compassionate lens. For example, it is easy for a group member stuck in a physically abusive marriage to realize and feel passionately that a different group member is in an unhealthy relationship and must get out. The true change, however, takes place when she suddenly realizes that, just as she has no doubt about the other member’s ability to end an abusive relationship, she should apply the same rule to herself. The startling nature of this revelation in the heat of the moment often acts as a channel for a genuine, long-awaited transformation. And when a therapist combines the power of the group with the power of film, the potential for positive clinical outcomes multiplies.
The clever trick as a therapist is to help people create authentic, meaningful change. Therapy usually requires a significant amount of work both for the therapist and the client. But it may take less effort than we think, if we take full advantage of these simple and inexpensive tools. Hollywood movie stars are immersed in a culture of wealth and excess that accepts and even expects the indulgence of exceptional self-reflection. It is no wonder that they have the luxury of viewing long-term psychotherapy as a part of a normal life. Ironically, the fruits of their labor have the potential to make therapy more accessible and more productive for the rest of us.
Some details were altered to protect client privacy.
This article was originally published at The Washington Post. Reprinted with permission from the author.