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Rx: visit your 'mother' once a week.

The new film "Prime"--set in New York City--is billed as a romantic comedy, but the love story is a clunker. The encounters between the two paramours left me somnolent. So why bother with this movie? Because the fun takes place between the romantically involved woman and her psychotherapist, especially when a juicy ethical dilemma threatens to torpedo the treatment.

The Dilemma

The therapist, Lisa Metzger (Meryl Streep), is a masters-prepared clinical social worker, judging from the titles (MS, CSW) we glimpse on her office door near the beginning of the film. She has a client, Rafi Gardet (Uma Thurman), a commercial photography producer, who, having just divorced, begins an affair with a younger unemployed painter David Bloomberg (Bryan Greenberg).

David turns out to be none other than therapist Lisa Metzger's son (she uses her maiden surname professionally). Neither Lisa nor Rafi knows this at first, nor does David realize that Rafi is his mother's client, but Lisa is the first to figure it out. She would have done so sooner but for Rafi's initial fibbing about David's age--telling Lisa he's 27 when he's really 23--because she's 37 and embarrassed by the age spread.

So, what's a mother--or in this case a mother/therapist--to do? In fact, Lisa does exactly the right thing: She seeks consultation, booking a session with her former therapist, Rita (Madhur Jaffrey). Rita speculates that the relationship between David and Rafi could be just a brief fling. She warns Lisa that disclosing the facts now and terminating Rafi might, in the long run, not be in her client's best interests. So temporize for now, keep your connection to David to yourself, and see what happens, Rita advises.

Easier said than done, as Rafi becomes more, not less, enamored of David; begins to speak resentfully about David's "difficult" mother; and shares details of the couple's sexual ardor. "We've had sex on every surface of my apartment," Rafi announces proudly in one therapy session. "David's penis is so cute I want to knit a little hat for it," she gushes. In Lisa's conversations with David, meanwhile, she keeps countering her son's blissfulness with her concerns about the couple's religious incompatibility (The Metzger-Bloombergs are observant Jews, while Rafi is not Jewish.)

When David moves in with Rafi, it's the last straw for Lisa, and she spills the beans. Understandably, Rafi feels betrayed. Was Lisa right to soldier on as Rita advised, until it became clear that this was more than a fling? Or should she have withdrawn immediately, as soon as David's identity as Rafi's lover became known to her? Good conundrum, I would say, and one without an immediately obvious, one-size-fits-all answer.

The Rest of the Story

After Rafi's treatment ceases, everyone tries to be good sports. David's parents--Lisa and Jack--host a dinner for Rafi and David, attended also by David's grandparents (with whom he had been living before moving to Rafi's tony Upper East Side apartment). In speaking with David about the affair, Lisa strays occasionally across the parent boundary into therapy-babble, and David perceptively calls her on it. In time Rafi and Lisa reconcile, although, quite correctly, their treatment relationship is not resumed.

Predictably, the first fires of infatuation wane, and Rafi and David's affair descends an increasingly bumpy path. This romance is not even slightly nuanced: Their thing together is decidedly physical and little more. Greenberg is a hunk of a kid here but otherwise unformed. Thurman shimmies around, her flaxen hair always in a fetching mad tangle, the fabulous Uma eyes--embryolike, nearly--casting impossibly soulful glances at her man. The nadir of their affair is signaled one evening when David chooses to keep playing Nintendo instead of responding to Rafi's sexual overtures. Details of the romantic resolution need not concern us, except to say that Lisa has no direct hand in it.

"Mothering" in Therapy

The American Psychological Association's Media Watch Committee recently came out swinging, castigating the therapy motif in this film, saying it distorts real therapy (Weekend America, Oct. 29, 2005). Gosh, just when I was about to say the opposite, that Streep's psychotherapist does represent a legion of therapists of a certain stripe out there in clinical practice. This group may not include a lot of doctoral-level psychologists or psychiatrists, but there are many masters-prepared therapists (mostly women) who conduct practices significantly devoted to mothering dependent clients (again, mostly women).

Like Lisa Metzger in this movie, such therapists are typically informal in manner, offer unconditional positive regard (to use Carl Rogers' term), hug their "kids" often--sometimes at the end of every session--and act the cheerleader whenever the client does something positive. Their offices are often appointed like Lisa's: the busy atmosphere of a traditional homey parlor, full of comfy, overstuffed furniture covered in expensive fabrics, flowers, quaint prints in gilt frames. I found myself looking around for a plate of fruit or cookies.

Clients who have somehow not gotten enough mothering--maybe mother died when the client was young or never was loving or available--seek out such therapists and often flourish as objects of the warm attention paid them. Indeed, we learn that Rafi apparently had little if any proper mothering as a child, or so her story goes. Small wonder that she might bask in the glow of Lisa's "good enough" mothering.

Is This Therapy or What?

The potential long-term benefits of such supportive experiences in therapy are tirelessly (and tiresomely) debated. Do clients in such treatment ever change--get their fill of parenting and move on--or do they remain dependent? Psychodynamic psychotherapists take the latter view, that this casual, parenting-style therapy gratifies and reinforces immature, neurotic propensities and a constricted sense of self, and preempts the client's opportunities for change.

Henry Pinsker, M.D., a leading proponent of supportive psychotherapy within our profession (see his text, "A Primer of Supportive Psychotherapy," Hillsdale, N.J.: The Analytic Press, 1997), wrote in Psychiatric Times (November 1998) that "a supportive relationship is characterized by acceptance, respect, and interest. Most people rely upon supportive relationships with family, friends, and coworkers to help prevent emotional problems, and to help them cope with problems, when, and if, they emerge. A supportive relationship must exist if any psychotherapy is to proceed, but a supportive relationship alone does not constitute psychotherapy."

Dr. Pinsker gets to the nub of the matter: When does informal, uncritical support cross the line from psychotherapy to simple friendship, to rent-a-mom? Professional therapists may be stretching things to justify dispensing such support on a regular basis, but what is one to do when reasonably functional people who are not faring as well in life as they desire ("the worried well" we used to call them) want a supportive relationship with their therapist and nothing more, claiming there is no one they can turn to in their social circle to meet this need?

Do Patient Preferences Matter?

Legendary psychotherapist Jay Haley asserted, decades ago, that many people seeking therapy really don't want to change, no matter what they may say to the contrary. For that matter, we all know that people often tend to prefer the familiar even when the road more traveled is fraught with repeated frustration and heartache. Better the enemy you know than the enemy you don't know. Haley felt that many of his clients had to be "tricked" into change.

We shouldn't be surprised to find that the mothering style of supportive therapy is common, and perhaps we shouldn't be so quick to condemn such practices if indeed they fill a perceived need for substantial numbers of patients. What is surprising is that this inelegant form of therapy has not been represented much in feature films. (Offhand, the only other good example I can think of is Claude Rains, playing a kindly psychiatrist in the 1942 film, "Now, Voyager," acting the benevolent parent to aid Bette Davis' neurotic victim of heartless mothering.)

Meryl Streep gives a good portrayal here, not that she's all that cuddly: She shows more reserve and is less effusive than some therapist-mamas I've met, but then we would expect Lisa's ethical predicament to constrain her. Uma Thurman is also convincing in the reciprocal role of the client needy for mother love. She's far better in the scenes with Streep than when writhing around with Greenberg. Thurman's actual mother is a psychotherapist, and one wonders to what degree this background enhanced her effectiveness in the therapy scenes.

Besides the provocative psychotherapy subtext, there are a couple of amusing cameos to add some life to "Prime": There's David's other grandmother, now deceased, Bubi (Lotte Mandel), whom we see in flashbacks hitting her head with an iron skillet whenever David would frustrate her, and Damien (Ato Essandoh), the disdainful doorman at Rafi's apartment house. If only there had been more humorous contributors. David's misogynistic sidekick Morris (Jon Abrahams) definitely does not qualify, though not for want of effort. Writer-director Ben Younger is capable of better work. (His first film, in 2000, "Boiler Room," was a brash, whip-smart story about junk investment scammers.)

Overall, "Prime" may be so-so, but as an example of therapy served like apple pie, Ms. Streep's performance deserves to be listed among my "best therapists on film," until this approach to psychotherapy is debunked, which hasn't happened yet by a long shot.

DR. ATKINSON is a professor of psychiatry at Oregon Health and Science University, Portland. For more reviews, visit his Web sites at www.AtkinsonOnFilm.com and www.Psychflix.com. Share your thoughts with Dr. Atkinson by writing him at cpnews@elsevier.com.

BY ROLAND ATKINSON, M. D.
COPYRIGHT 2005 International Medical News Group
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Author:Atkinson, Roland
Publication:Clinical Psychiatry News
Geographic Code:1USA
Date:Dec 1, 2005
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