Psychotherapy in Popular Media: Concept of Stigmatization and Active Listening

Please reply to the discussion post below. All reference 5 years or less.
Initial Post
The depiction of psychotherapy in pop culture is varied; movies, television, and other media often portray specific stereotypes of clients, counselors, therapy settings, and content. In your initial post:
Locate a representation of psychotherapy in popular media. Suggestions include but are not limited to movies such as Good Will Hunting, Analyze This, A Beautiful Mind, or Antwon Fisher, and TV series including the Sopranos, Monk, Big Little Lies, or Mad Men. Your selection may include a positive or negative depiction of therapy and may or may not be realistic. Describe the psychotherapy setting portrayed in the selected movie or series.
The movie that I want to discuss for this assignment is the 2019 movie “The Joker” with Joaquin Phoenix. This movie portrays the life of Arthur Fleck and shows his painful downward spiral into madness and his transformation into the Joker. Arthur is bullied and disregarded by society and the system fails him due to medical state funding.
Describe the stereotypes that are portrayed in the therapeutic relationship, setting, or content of the therapy sessions.
Arthur Fleck suffers from multiple non-specified mental illnesses that are poorly controlled in this movie and what he desires most is to be accepted by society. Due to the negative stigma of mental illness in this this movie, Arthur is looked down upon and he is rejected by society. He demonstrates a condition known as pseudobulbar affect which involves emotional lability and episodes of uncontrollable laughter which results from a brain disorder and individuals may be prone to anger (Nierenburg, 2019). In an attempt to demonstrate to society that he means no harm, Arthur carries a card letting people know that his behavior is related to a medical condition. In one painful scene, Arthur is brutally beaten by a group of men for his uncontrollable laughter and tries to pull out his card to show them.
Describe the relationship depicted between the psychotherapist and the client. Does the provider demonstrate professionalism, ethical comportment, and/or therapeutic communication in client interactions? Explain your rationale.
There are several scenes in this movie where Arthur is in psychotherapy and the therapist demonstrates that she has a lack of concern and poor memory of what Arthur is telling her due to disinterest or maybe even a demonstration of burnout. The therapists’ responses are non-therapeutic and the therapist does a poor job in developing a therapeutic alliance with Arthur. In another scene, Arthur is telling his therapist that the medications aren’t working, and he is asking that the therapist requests an increase in his medications and the therapist states “Arthur, you are on seven medications. Surely, they must be doing something.” In another scene, the therapist asks Arthur if he is having any bad thoughts and his response is “all I have are bad thoughts.” This statement should be questioned in a real-life setting and the safety of the patient would need to be assessed. The therapist did a poor job in establishing a therapeutic alliance in this movie. A therapeutic alliance involves the ability to establish a good, trusting rapport with your patient over the course of the diagnostic interview (Carlat, 2017, pp. 17). The PMHNP can establish this concept by projecting warmth, being emotionally sensitive, showing competence, and being courteous while interviewing their patient (Carlat, 2017, pp. 17).
The therapist also did a poor job demonstrating non-verbal communication. One component of therapeutic communication that I feel is extremely important to convey to the patient is active listening. Active listening can be conveyed to the patient by using kinesics which involves head nods, facial expressions, movements of the eyes, and eye contact (Keutchafo, Kerr, & Jarvis, 2020, pp. 8). According to Keutchafo et al. (2020), eye gaze showed the patient that the provider had a willingness to be engaged in conversation and was effective in improving communication skills and keeping the patient engaged in the conversation (pp. 8). It is also important to note that the PMHNP should avoid negative nonverbal communication such as crossing arms, looking at their watch, and looking away from patient while asking questions. Effective therapeutic communication leads to improved care outcomes and increased patient satisfaction (Xue & Heffernan, 2021).
Discuss the ways, if any, that any element related to ethnicity, religion, race, class, or cultural identity appeared to impact the client-therapist relationship.
Arthur Fleck lives with his mother in a deteriorating part of town and he is unable to keep a job due to his mental illness. The movie discusses Arthur’s childhood trauma and extreme abuse and neglect at the hands of his mother who also suffered from a delusional romantic relationship with Bruce Wayne. Arthur also suffers from a delusional romantic relationship with a woman who lives in his apartment complex. This is a demonstration of the nature versus nurture theory. In one scene, the therapist tells Arthur that the government has cut funding for social services and psychotherapy and that he will no longer be able to receive his medications from the state and she also tells him with some expletives that the government does not care for people like him or for her role as his therapist. In a real-life setting, there are issues that arise with state funding, but the comment would never be mentioned to the patient.
Explain how popular culture depictions mental health treatment, specifically psychotherapy, depictions in popular culture might impact client and psychiatric mental health nurse practitioner (PMHNP) perceptions of psychotherapy as an effective treatment modality.
The joker has negative depictions of the mental health system and may make many think that their feelings aren’t valid and there is no concern for them by mental health providers and counselors. Neirenberg (2019), agrees that this movie increases stigma for individuals with psychiatric disorders and will “make people afraid….it will take great efforts to combat this setback in the battle against stigma.”
References
Carlat, D. J. (2017). The psychiatric interview (4th ed.). Wolters Kluwer.
Keutchafo, E. L., Kerr, J., & Jarvis, M. A. (2020). Evidence of nonverbal communication between nurses and older adults: A scoping review. BMC Nursing, 19 (53), 1-15. Retrieved from https://doi(dot)org/10.1186/s12912-020-00443-9Links to an external site.
Nierenberg, A. A. (2019). The joker movie and the stigma of psychiatric disorders. Psychiatric Annals, 49(12), 510-510. DOI::10.3928/00485713-20191106-01
Xue, W. & Heffernan, C. (2020). Therapeutic communication within the nurse-patient relationship: A concept analysis. International Journal of Nursing Practice, 2021 (27), Retrieved from https://doi(dot)org/10.1111/ijn.12938Links to an external site.
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