Book Excerpt: Sopranos Psychology

Television psychotherapists have not fared much better. They appear to be far more disturbed than their patients and seldom helpful to those who seek them out. I am aware that Frasier has been lavished with Emmy Awards and that Sidney Freedman helped Hawkeye work through a devastating trauma on M*A*S*H, but for the most part therapists on TV would not lead the average viewer to check the yellow pages for the nearest mental health clinic.

After a disconcerting history of more than four hundred American films featuring outrageous portrayals of mental health professionals at work, we psychotherapists have finally found a therapy process we can take seriously. Not only is the therapy an arguably accurate version of what actually happens in our consulting rooms, but the writers are blessed with an extraordinary psychological sophistication. The themes in Tony's life represented in the therapy are so complicated and compelling that they inspire collegial debate in the hallways of office buildings and at cocktail parties. Lorraine Bracco, who plays Dr. Melfi, and four of the show's five writers have been in psychotherapy themselves, and their experiences give the treatment an "inside" perspective that provides a ring of truth to the sessions between Tony and Dr. Melfi.

Not all mental health professionals are thrilled with the series or with the psychotherapy portrayed. The disagreements have prompted heated exchanges. In Psychiatric News, the official newspaper of the American Psychiatric Association, a reader asserted that he would flunk Dr. Melfi if he were examining her for the board certification exam because she colludes with her patient's antisocial behavior instead of confronting him about it. Another psychiatrist responded with an impassioned defense of Dr. Melfi: "I would dare say that The Sopranos has done more to destigmatize mental illness (through educating the public about such clinical diagnoses as panic disorder and antisocial and borderline personality disorders), reveal to the American public what goes on behind the closed doors of the therapist's office, and help define what a psychiatrist is than any public relations initiative ever promulgated by our own professional guild organization." He goes on to suggest that the American Psychiatric Association should honor the producers and writers. In fact, in December 2001, the American Psychoanalytic Association did present the producers and writers with an award for "the artistic depiction of psychoanalysis and psychoanalytic psychotherapy." Lorraine Bracco received an award at the same event for creating "the most credible psychoanalyst ever to appear in the cinema or on television."

Other colleagues criticize Dr. Melfi for telling Tony that if he reveals an intent to harm others, she will have to report him to the authorities. In their view, she has thus encouraged him to violate the fundamental rule of psychoanalytic therapy, which is to say whatever comes to mind without censoring. Still others have felt that Dr. Melfi is stiff and stilted in her style, heavy-handed, prone to speak in jargon and inclined toward lengthy psychoeducational monologues.

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