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TV psychology

Whether they're documentary-style or fictional, there have never before been so many shows on television featuring psychologists and psychopathology. Gene Ondrusek, PhD, who did casting and consulting on the original "Survivor," says this trend has found a greater platform in the sprawling world of modern cable television.

"That voyeuristic bent has always been there," Ondrusek says.

Of course, some shows may be better at satisfying our baser instincts than giving an accurate portrayal of psychological issues. Here's a look at five hot psychology shows, what they get right and where they go awry.

"In Treatment"

Premise

In this HBO drama, Gabriel Byrne plays Paul Weston, a driven, neurotic psychologist who has a therapist of his own. Each episode delves into the struggles of Weston's clients and his own disastrous personal life.

Professional Take

Byrne's character isn't the finest ambassador for therapy, says media psychologist Frank Farley, PhD. Of course, there's nothing wrong with a therapist seeking treatment – there's nothing novel about it TV-wise, either, since Lorraine Bracco's character did it in the "The Sopranos." But Weston is unrealistically "loaded up with problems and issues," Farley says. "For the broad field, it's not a helpful depiction." Farley says he worries that the self-loathing psychologist could steer people away from treatment.

As for how realistically the show depicts therapy, Farley looks no further than the sofa featured so prominently in Weston's office. "I think it would be very interesting to do a survey of APA-licensed psychologists and see how many still use a sofa," he says. "It probably wouldn't be many."

Professional concerns aside, plenty of psychologists would agree that Weston's drama makes for good drama. "A lot of my colleagues have pointed out that it's been a very good show," says Ondrusek. "Personally, I've liked what I've seen."

"Lie to Me"

Premise

In this prime-time Fox show, Tim Roth plays crime-solving psychologist Cal Lightman, whose expertise in reading suspects' body language and microexpressions never fails law enforcement. The show is based very, very loosely on the life and work of psychologist Paul Ekman, PhD, who did groundbreaking research on the relationship between facial expressions and their underlying emotions.

Professional Take

Ekman, who's a paid consultant to the show, warns that "Lie to Me" frequently strays from science for the sake of drama — and an unforgiving 52-minute clock. He pens a weekly critique evaluating the most recent episode's adherence to reality at , and he often finds he has a lot to write about. Ekman estimates that about 70 percent of the methods used in the first season were portrayed accurately, but that number started slipping during the second season, then bottomed out during the third. "They've reduced the amount of science," Ekman says.

What's more, the Lightman character has become, well, kind of a jerk. "They've decided that he would be edgy and nasty with people, to lie to them in order to uncover lies," Ekman says. "I told them repeatedly no one would deal with me if I treated people the way he does." Ekman sometimes worries that the show could lead to false convictions in the real world by overstating an expert's lie-detecting abilities, and he's told the producers he'd love to see an episode in which Lightman bungles a case. "They like the idea, but I've never seen it air," he says.

"Obsessed"

Premise

With the help of mental health professionals, each episode of this A&E reality show peers into the mind of a patient with obsessive-compulsive disorder (OCD). Objects of fixation include odd numbers, electrical outlets and incessant tapping.

Professional Take

It may feel overly dramatic at times, but this show gets much closer to reality than most "reality" fare, says Ondrusek, who once worked with the show's executive producer, Rob LaPlante. By chronicling therapy in an episodic manner — showing the problems, the intake, the treatment and post-treatment — Ondrusek says, "Obsessed" generally captures how legitimate therapy "requires time, work and adequate therapeutic intervention." Part of the show's credibility, he adds, comes from the fact that therapy doesn't always work or the client relapses, illustrating a fundamental truth of treatment: "There's not a magic cure."

Unfortunately, plenty of fans watch "Obsessed" not to learn about therapy but to revel in other people's problems — and that can make psychologists squirm. "It's a big piece of the attraction," notes Farley.

"Hoarders"

Premise

This other OCD-themed offering from A&E takes viewers into the lives of compulsive hoarders who are buried beneath the things they collect, be they clothing, newspapers, trash or cats. Each episode tends to be set in motion by a crisis, such as a threat of eviction or an investigation by child and family services.

Professional Take

Hoarding expert Randy Frost, PhD, says he believes "Hoarders" should be credited for making people aware of a serious and oft-misunderstood problem. "It's clear that they aren't just lazy and messy but have no control over behavior," says Frost, the author of the 2011 book "Stuff: Compulsive Hoarding and the Meaning of Things." But Frost also says the program oversimplifies treatment for hoarding, often portraying a big one-weekend cleanup as some kind of major breakthrough. "We know that is not the case," says Frost, "because that doesn't change [long-term] behavior."

Frost is also a little uncomfortable with what he describes as the show's "exploitative" undercurrent — something Farley recognizes, too. Given the visual redundancy of this one — scene after scene of houses stuffed to the rafters — Farley believes this show says more about our own voyeurism than anything else. Although professional psychologists are brought in to help, most of the show seems to fixate on jaw-dropping clutter and filth. "You have this interesting show," says Farley, "but you don't see what works with these people over the long term."

"Intervention"

Premise

Each episode in this A&E reality series chronicles the life of someone struggling with addiction who's about to face an intervention staged by friends and family. The addict is given a choice: either get treatment or risk estrangement from loved ones.

Professional take

The show's value, says Dennis Marikis, PhD, is in shining a light on the challenges people face in overcoming addiction. But the praise stops there for Marikis, a therapist who consulted on one of the program's as-yet-unaired "celebrity" editions. As with many reality shows, the nuance and complexity of the patient's problems disappear in the editing process, he says. "That's the part that's always misportrayed — the messiness and the hard work of it all, on the therapeutic side and the side of the people being treated."

Even though treatment may carry on for months, the show is boiled down to a few tidy, powerful moments of self-realization. Marikis worries that some viewers may walk away from the show thinking treatment is a short and easy process.

Unfortunately, he says, "real life isn't like that."


Dave Jamieson is a writer in Washington, D.C.