Film Critique: Fatal Attraction

PSY/480 Clinical Psychology

April 28, 2014

     The movie opens with what appears to be a family enjoying their normal everyday life but rapidly the scene turns to the husband (Dan; played by Michael Douglas) falling into what was to be a one night affair with a client. However, his one night fling quickly spirals out of control when the woman, Alex (played by Glenn Close), begins to display symptoms of a darker more disturbed personality disorder. Shifting from the secure, professional, understanding, fun filled, flirty woman whose sexual promiscuity and impulsivity was so intoxicating only moments before into an insecure, needy, fearful, childlike, and often angry person the next; she becomes so distraught that Dan is leaving to return to his “normal” life she slits her wrists, all the while trying to seduce him to stay with her. 

     As movies go, he saves her and the secret of their affair, returning to his family and leaving Alex behind only to have her show up at his work days later with an apology and an offer to go with her to see Madam Butterfly. His rejection, although initially appears to be accepted is internalized with intense emptiness and is soon followed by stalking behaviors that escalates to vandalism. Alex tells Dan she loves him and that she is pregnant but does not need him to be involved. His continued rejection of her escalates her diminished cognitive symptoms and eventually she winds up killing the family rabbit putting it to boil in the kitchen cook pot. 

     Alex’s behavior spirals out of control as she becomes so erratic and unpredictable that she takes Dan’s daughter in an attempt to gain his attentions. After Alex is assured Dan’s anxiety is in full height she drops the child off at the house as though they were friends after their trip to the amusement park. Frustrated and freighted, Dan storms into Alex’s house as though he would try to kill her, only to stop when he realizes what he was doing, leaves, and goes to the police. At this point it appears that Alex has a psychotic break and begins to hallucinate that Dan’s wife, Beth (played by Ann Archer), is the cause of her problems and needs to be removed from the equation. During Alex’s efforts to kill Beth Dan gets involved, Beth runs out, returns with a gun, shoots and kills Alex; thus ending her rain of terror.      

• How is the movie related to a topic(s) covered in class?

     Fatal Attraction is about making observations in human behavior which directly relates to contemporary psychological assessments. As an integral part of psychologists’ duties, observing behaviors is paramount. There are often specific cues that a person gives, both verbal and nonverbal, that provide insight into the nature of his or her specific difficulties (Plante, 2011). Thus reiterating just how important the interviewing and observation process are to any assessment process. For example diagnosing borderline personality disorder can be difficult; however, specific issues with affectivity, interpersonal functioning, impulse control, and cognitive instability are apparent upon observation, as demonstrated in the movie Fatal Attraction (Baskin & Paris, 2012). Affective instability and mood reactivity are often accompanied by impulsivity (e.g., gambling, binge eating, sexual promiscuity, etc.), interpersonal difficulties (e.g., frequently changing goals, beliefs, vocation), and brief periods of paranoia or psychosis (Biskin & Paris, 2012). In addition, it is highly unlikely that a woman with such emotional fluctuations and suicidal tendencies has not been seen by a therapist at least once in her lifetime; thus, “even a single psychoeducational session could help to reduce [the severity of her] symptoms…” keeping her from harming herself or others (Biskin & Paris, 2012, p. 1793; Plante, 2011).  

• How is the psychological issue(s) portrayed in the movie? Is the portrayal realistic?

     Glen Closes’ portrayal of a woman who suffers from borderline personality disorder was excellent. The initial bedroom scene when Dan was attempting to leave Alex to return home after their affair reflects the extremity of rapidly changing emotions and the reality of the “…suicide attempts among patients with borderline personality disorder…” (Biskin & Paris, 2012, p. 1789). Although the majority of Alex’s symptoms were dramatically over the top, I believe the portrayal of moody reactivity to external events and the expression of sensitivity and perceived rejection were brilliantly executed. I also feel that Douglas gave Dan’s character just enough of a narcissistic personality that most people would consider it “normal” behavior.     

• Provide two discussion questions that can be developed from viewing the movie.

1.      What would have been an appropriate method for Dan to have safely removed himself from the “relationship” with Alex after he realized she was suffering from a mental illness?

2.      While ethical violations are clearly made by Dan (attorney-at-law) having a sexual relationship with a client (Alex), how does one maintain a professional distance with a client who has no sense of interpersonal functioning?

• Conclusions and personal reactions

     As a psychological thriller Fatal Attraction did a great job of introducing (and freighting) moviegoers to the psychological disorder known as borderline personality disorder. The awareness that people gained by watching how shifting moods and volatility affect the lives of people with mental illness was immeasurable. However, the movie relates to contemporary psychological assessments through observation in an attempt to “better understand, predict, and alleviate the intellectual, emotional, biological, psychological, social, and behavioral aspects of [the negative] human functioning” of BPD, which is the psychological goal (Plante, 2011, p. 5). I feel it is a great movie with excellent educational results, when viewed in that setting.

References

Biskin, R. S., & Paris, J. (2012). Diagnosing borderline personality disorder. Canadian Medical Association Journal, 184(16), 1789-94. Retrieved from http://search.proquest.com/docview/13144755012?accountid=458

Plante, T. G. (2011). Contemporary clinical psychology (3rd ed.). Hoboken, NJ: John Wiley & Sons.

 

Major Approaches to Clinical Psychology: Generalized Anxiety Disorder

PSY/480 Elements of Clinical Psychology

April 14, 2014

Compare and Contrast the Major Approaches of Clinical Psychology – Psychodynamic, Cognitive-Behavioral, Humanistic, and Family Systems in Relation to Generalized Anxiety Disorder (GAD).

Philosophical Origins

            The Psychodynamic perspective of GAD can be founded in the unconscious realms of the mind and influence the way people experience the world around him or her. Thus, “…Freud’s psychoanalytic approach, the revisionist approaches, and object relations theorists” suggest past experiences have a profound influence on the present (Plante, 2011, p. 132).

Cognitive-Behavioral Therapy (CBT) focuses on maladaptive thought patterns of GAD and the “…behaviors acquired through learning and conditioning in one’s social environment” (Plante, 2011, p. 117). Thus, anxiety behaviors are perpetuated through learning processes.

The Humanistic perspective of GAD suggests that something in the present is blocking a person’s upward growth that may extend beyond existential anxiety. Philosophically, the humanistic perspective has a phenomenological emphasis to one’s perceptions and experiences (Plante, 2011).

The Family Systems approach of GAD involves the interaction of the entire family dynamic. Although this approach has only been around since the 1950s, its main focus is on communication within the family structure.

Goals of Each Approach

The psychoanalysts’ goal is to promote growth and change, by bringing the unconscious to the conscious, helping to uncover the anxiety issue which is ultimately a defense mechanism (American Psychoanalytic Association, 2014).

The cognitive-behaviorists’ goal is to teach a patient to control his or her thoughts and actions, thus reducing or avoiding anxiety episodes.  

The humanists’ perspective is ultimately designed to promote growth toward self-actualization. In addition the humanist perspective attempts to help a person establish a harmony between his or her feelings and actions.

The goals of the family support systems approach to therapy include improved communication and a de-emphasis on the problems of a single individual over the family unit as a whole (Plante, 2011).

Techniques and Strategies Used by Each Approach

Psychoanalysis uses such techniques as lying on a couch looking away from the analyst, which enables patients to freely associate with his or her unconscious thoughts, feelings, and experiences that are, in essence, affecting his or her present thoughts and actions.

With CBT a patient may undergo “…psychoeduction, symptom management techniques, cognitive restructuring, worry exposure, and self-monitoring” (Katzman & Tsirgielis, 2011, p. 50).

Humanistic counseling is designed to help people make better choices, thus it is important for a clinician to have effective listening skills so he or she can paraphrase, reflect, summarize, and clarify what is said to him or her; helping to establish understanding of what is being said and what is not (Plante, 2011). Another helpful technique is called the empty chair, which is a common Gestalt technique, allowing a client to deal with issues in the moment.

Family support techniques involve changing the communication and relational dynamics of the family unit.

How Each Approach Affects the Treatment Strategies of GAD

Although psychoanalysis is a lengthy process, taking many months or even years to work through the “…unconscious factors that affect patterns of thought, emotion and behavior,” it can be quite liberating to a patient to understand where his or her excessive levels of anxieties began (American Psychoanalytic Association, 2014, para. 6).

CBT focuses on altering behavior (e.g., reducing tension) and cognition (e.g., redirecting negative thoughts) that produces distress (Katzman & Tsirgielis, 2011).

Humanists’ use active listening skills and then carefully reword what he or she heard so that the patient or client feels like he or she is accepted and understood, which enables growth. The empty chair method provides one with the opportunity to become aware of his or her current thoughts and feelings (Plante, 2011).   

By altering communication patterns, the family support approach encourages each person to express his or her true feelings; thus, encouraging congruent communication. Changes in relational patterns focus on appropriate levels of dependence and involvement within the family to allow autonomy and positive self-regard breaking patterns of GAD.

Evaluating the Effectiveness of Each Approach, in Relation to GAD, Based on Treatment Outcome

Generalized anxiety disorder is described as chronic, uncontrollable anxiousness over an extended period of time that affects daily functioning and sleep. Although, clearly, most treating clinicians prefer the essential components of CBT (e.g., psychoeduction, relaxation, stimulus control, desensitization, etc.) for treating GAD for its effective results, the other methods of treatment have substantial benefit too (Hoyer, van der Heiden, Portman,  & Phil, 2011). For example, family support systems are very important for treating GAD, family members who learn to support his or her loved one without perpetuating his or her symptoms by trivializing the disorder can be very helpful and important to treatment. From the humanistic perspective, mitigating negative self-talk and finding trusted outlets (e.g., friends, clergy, etc.) who are supportive can be helpful in keeping anxieties in check. As for the effectiveness of the psychodynamic style of treatment, allowing one to explore his or her interpersonal experiences and how he or she learned such patterns of avoidance and defense are insightful to the treatment process, breaking down the barriers to regression (Crits-Christoph, 2002).

References

American Psychoanalytic Association. (2014). About Psychoanalysis. Retrieved from http://www.apsa.org/ABOUT_PSYCHOANALYSIS.aspx

Crits-Christoph, P. (2002). Psychodynamic-interpersonal treatment of generalized anxiety disorder. Clinical Psychology: Science and Practice, 9(1), 81-84. Retrieved from http://www.personal.kent.edu/~dfresco/mindfulness/CPSP_crits-cristoph.pdf

Hoyer, J., van der Heiden, C., Portman, M. E., & Phil, D. (2011). Psychotherapy for generalized anxiety disorder. Psychiatric annals, 41(2), 87-94. doi:http://dx.doi.org/10.3928/00485713-20110203-07

Katzman, M. A., & Tsirgielis, D. (2011). Treatment approaches to generalized anxiety disorder. Current Medical Literature, 22(2), 37-56. Retrieved from http://search.proquest.com/docview/902876639?accountid=458

Plante, T. G. (2011). Contemporary clinical psychology (3rd ed.). Hoboken, NJ: John Wiley & Sons.

 

Examination of Clinical Psychology

PSY/480 Elements of Clinical Psychology

April 07, 2014

     Author and clinical psychologist David Richo (n.d.) states “[o]ur wounds are often the openings into the best and most beautiful part of us” (para. 1). However, “…to better understand, predict, and alleviate ‘intellectual, emotional, biological, psychological, social, and behavioral aspects of human functioning’ clinical psychology focuses on the health and dysfunction of a person’s being” (Plante, 2011, p. 5). Thus, clinical psychology attempts to use the scientific method to identify and treat emotional and behavioral problems. In an examination of clinical psychology it is necessary to review its history and evolving nature, the role research and statistics plays, and the differences between clinical psychology to other mental health professions.

The History and Evolving Nature of Clinical Psychology

     Long before psychology was established as a scientific field, dedicated to alleviating human suffering in the emotional, behavioral, and physical realms, such influences were thought to be of a supernatural influence (Plante, 2011). Not unlike some modern approaches, the ancient Greeks believed holistic rituals (e.g., prayer, foods, bathing, etc.) could stimulate healing and bring the body back into balance (Plante, 2011). Hippocrates believed that a person’s environmental conditions affect the etiology of his or her illness, thus one’s biological, psychological, and social factors all contribute to physiological well-being (Plante, 2011). Furthermore, Hippocrates and his followers, Plato, Socrates, Aristotle, and Galen helped to establish the holistic perspective that is essentially in use today.

     As disease and war spread during the Middle Ages, fear gripped the world turning treatment of medical and mental illness toward the spiritual and supernatural realm of exorcism and persecution, where some “…150,000 were executed in the name of religion…” (Kemp, 1990 as restated by Plante, 2011, p. 35). However, there are some (e.g., Aquinas, Paracelsus, and Vives) who thought otherwise, helping to shift belief away from the supernatural back toward the physical and the astrological but sadly this did not improve the inhumane treatment of the mentally ill of that time (Plante, 2011). After the dark ages, the Renaissance ushered in a time of “revival or rebirth” for empirical efforts giving momentum to new philosophies about psychology (Renaissance, n.d., para. 1). What Goodwin (2008) called an “era of revolutionary developments in science” (p. 32). A few of the great minds from this era are Galileo, Newton, and most notably, Rene’ Descartes, mathematician, anatomist, and philosopher. He was the first to suggest a Cognitive Perspective of psychology; “arguing for a clear separation between mind (or ‘soul’) and body” (Goodwin, 2008, p. 34). Unlike Descartes, John Locke, philosopher, physician, and medical researcher brought about a more Humanistic Perspective. He suggests that each person is born as a tabula rasa, or blank slate, thus developing through experience; including thought and reflection (Goodwin, 2008).

     The Nineteenth Century saw a profound movement toward more humane and moral treatment of the mentally ill (Plante, 2011). French physician Phillippe Pinel began the “moral therapy” movement, encouraging improved living conditions and treatment through nurturing and interpersonal relationships (Plante, 2011). Dorothea Dix, school teacher and head nurse during the Civil War, petitioned for improved treatment and conditions for the mentally ill within the United States; after 40 years “New Jersey became the first state to build a hospital for the mentally ill in 1848” (Plante, 2011, p. 37). As the formal science of psychology was forming, William Wundt, founder of the Structuralism Perspective, established its first laboratory in 1879. At this same time William James was establishing the first “psychology laboratory at Harvard University” in the U.S. (Plante, 2011, p. 38). However, James is credited with founding the Functionalist Perspective; emphasizing the adaptiveness of both mental and behavioral processes.

     Perhaps one of the most controversial theorists’ of the Nineteenth Century is Sigmund Freud. However, as “the ancient Greeks believed, Freud reawakened… a more holistic view… of health, illness, and abnormal behavior” (Plante, 2011, p. 46). Freud’s Psychoanalytic Perspective opened the door for future theorists’ and perspectives. Although, the term “Psychology” was first coined by Lightner Witmer, he was also the first to “develop [and use] a specific [psychological] treatment program” (Plante, 2011, pp. 38-39). Witmer is further credited for opening the first psychology clinic, which is still in operation today.

     Intelligence testing is a major development in the psychological realm; used in almost all perspectives. Initially developed by Alfred Binet and colleague Theodore Simon, the Binet-Simon scale was issued in 1908; although it was believed to  lack the necessary “comprehensive and objective index of intellectual functioning… for use beyond the classroom” (Plante, 2011, p. 40). The revised Stanford-Binet intelligence test was profoundly popular and during both World Wars the military turned to psychology and these tests to evaluate its troops (Plante, 2011). Shortly thereafter, Government programs (VA & NIMH) were designed to help train thousands of students in the mental health field to accommodate the influx of mental health patients created by both wars. In addition APA standards and guidelines for graduate and internship training are continually changing to include new comprehensive research, treatment, and assessment updates (Plante, 2011). With new models of clinical training disseminated to licensed, practicing clinicians periodically at “conference events” (e.g., Boulder, 1949; Miami, 1958; Chicago, 1965; etc…).  

     As stated by Plante (2011), “Just as this mind-body integration has developed, the practice and training of clinical psychologists have mirrored landmark scientific changes in this evolving field of study” (p. 31). Thus, it is just as important for the evolution of clinical psychology that the Diagnostic and Statistical Manual (DSM) and the Ethical Standards of care, that were developed in the 1950s to provide mental health practitioners guidelines for enabling better care, continue to evolve as the fields of study evolve. 

The Role of Research and Statistics in Clinical Psychology

     Founded on the backbone of research, clinical psychology uses questionnaires, laboratory experiments, and archival data studies

“…to better understand human behavior… develop psychological assessment techniques and treatment strategies that are reliable, valid and effective. [Therefore,]… The general goal of research in clinical psychology is to acquire knowledge about human behavior and to use this knowledge to help improve the lives of individuals, families, and groups” (Plante, 2011, p. 74).

     Thus, when a person realizes that he or she is in distress and seeks the service of a clinical psychologist the research then relies largely on the validity of personal interviews, individual studies, and in a clinicians research he or she should be allowing the user to direct the flow of questions as to not bias the perspective (McCourt, 2011). After all, basic and applied research provides the basis and direction that allows practitioners to use his or her techniques with confidence in a practical setting.

The Differences Between Clinical Psychology and Other Mental Health Professions

     When practitioners use his or her psychological techniques it is always with the consideration of the profession for which he or she is working. For example the differences between clinical psychology and other mental health professions, such as social work, psychiatry, and school psychology include training, focus, and location.

     Clinical Psychology requires either a Doctorate of Philosophy (PhD) or a Doctorate of Psychology (PsyD). However, unlike the medical doctorate training, the clinical psychologist spends his or her time focusing on mental health research, assessment, and treatment related issues. Clinical Psychologists are also found in a variety of vocations; teaching, consulting, administration, private practice, education, hospitals, and more.

     Social workers can become licensed clinical case workers or obtain a bachelor degree in social science and then a master’s in social work. However, training focuses less on research and more on administration. “Historically, social workers focus on patient case management, patient advocacy, and a liaison to optimal social service agencies and benefits” (Plante, 2011, p. 25). Social workers are employed by schools, hospitals, social service agencies, private practice, and more.

     Psychiatry is a field that requires an extensive medical degree (MD) and a complete residency spending many years in school, with 40% working private practice, according to the APA (2010) as restated by Plante (2011). Although, Psychiatrists have the ability to diagnose, treat, and prescribe medications for a variety of medical and mental health issues.

     A school psychologist will typically have a master’s degree and work in elementary, secondary, or some type of special education program. However, some do choose to persue his or her PhD for research opportunities (Plante, 2011).

Conclusion

     From the profound beginnings to the multifaceted approaches that are available today, clinical psychologies history has evolved considerably. Understand that research designed around mental well-being is the most important aspect of clinical psychology; it allows psychologists to remain abreast of the current theories, assessments, and treatments. However, when a potential student understands the different disciplines, he or she is able to make appropriate decisions on a career, thus making both future patients and practitioner happy and fulfilled.

References

Goodwin, C. J. (2008). A history of modern psychology (6th ed.). Hoboken, NJ: Wiley.

McCourt, J. (2001). User-friendly research in clinical psychology. Psychologist, 14(6), 296. Retrieved from http://search.proquest.com/docview/211824599?accountid=458

Plante, T. G. (2011). Contemporary clinical psychology (3rd ed.). Hoboken, NJ: John Wiley & Sons.

Renaissance. (n.d.). Collins English Dictionary - Complete & Unabridged 10th Edition. Retrieved April 04, 2014, from Dictionary.com website: http://dictionary.reference.com/browse/Renaissance

Richo, D. (n.d.). David Richo quotes. Retrieved from http://www.searchquotes.com/quotation/Our_wounds_are_often_the_openings_into_the_best_and_most_beautiful_part_of_us./322929/