Big Little Lies: Therapist Edition

Svasti Dutta

While HBO’s Big Little Lies has received literal awards for its cinematography and acting, its portrayal of therapy has also earned metaphorical laurels from real-life therapists (Dahl, 2017). The character of Dr. Amanda Reisman is one of its kind in popular culture, and realistically approaches the ways in which a therapist can support a victim of domestic abuse. This blog post will analyse Dr. Reisman’s as a therapist, and will sometimes draw away from what she got right in order to point out where she went woefully wrong.

Dr. Reisman’s therapeutic approach seems eclectic; she does provide a non-judgemental space, but her questions are often directive and probing. In the first season, she is a lot more gentle with Celeste, and her approach does have aspects of client-centred therapy. However, her guidance in the second season doesn’t fit any particular approach, and borders on being unethical, in my opinion.

Her role begins as that of a couples’ therapist for Celeste and Perry; however, Celeste eventually becomes her primary client. While it is technically unethical for a couples’ therapist to counsel either member individually, she addresses this issue and says, “I throw off the ethical chains when I sense a patient in danger” (Kelley, 2017). This is, in fact, perfectly ethical behaviour on her part. It was important for the violence to be addressed in the abuser’s absence, so that the victim’s safety could be ensured. (Johnson, 2017)

In spite of a lack of clear acceptance from Celeste that Perry was violent with her, Dr. Reisman was able to figure out and address the abuse by reading subtler cues in their body language. Celeste remained defensive of Perry, and took a great deal of the blame for the violence. It was only with Dr. Reisman’s help that she began to understand that her abuse was not her fault.

With victims of domestic abuse, confidentiality is tricky territory. One may ask if a therapist is obligated to break confidentiality in order to report domestic abuse; however, according to guidelines, therapists should “respect client autonomy and do no harm, while also facilitating client safety and welfare” (Kress, Protivnak & Sadlak, 2008). I think Dr. Reisman does this to the best of her abilities. She shows great concern for Celeste’s safety, while refraining from imposing any judgement on her choice to stay with Perry. Reporting is only mandated if there is knowledge of harm to children. Once it has been established that Perry is violent, Dr. Reisman asks Celeste very clearly, “Does he ever hurt the children?” (Kelley, 2017). Since the client vehemently denied the possibility, the therapist focused on ensuring helping Celeste come up with a safety plan. Another important thing that Dr. Reisman did correctly was that she didn’t push Celeste to leave Perry. Studies show that women who leave their husbands without putting proper safety plans in place end up returning to their abusive partners, and also cut off from their therapists (Kress, Protivnak & Sadlak, 2008). It was essential for Celeste’s safety that she remain in contact with her therapist, especially since she hadn’t confided in anybody else. The only error I feel Dr. Reisman made is that she did not help Celeste create a safety plan during the same session, since they had run out of time. The violent, volatile nature of the relationship implied that Celeste’s life was at risk, and it was important for a safety plan to be put into place as soon as possible, preferably during that session itself.

In the second season, post Perry’s death, Dr. Reisman’s credibility as a therapist begins to dwindle. In the aftermath of her husband’s demise, Celeste found herself struggling with missing him whilst knowing that he was abusive as well as an accused rapist. Instead of helping her process her emotions in a healthy manner, Dr. Reisman seems to shame her for her thoughts, and says things like, “Are you an addict, Celeste? Is Perry your drug?”(Kelley, 2017). There is also a scene in which she asks Celeste to shut her eyes and relive her trauma, and to re-imagine it by putting her best friend in her place. This method of prolonged exposure is a possible route of treatment for post-traumatic stress disorder, but was executed in a shoddy manner by Dr. Reisman. She also takes a session with Celeste’s friends Madeline and Ed; this is another example of unethical behaviour, since she should ideally have referred them to another therapist (Smith, 2003). Her session with them comprises a lot of judgemental statements on her part. She moves away from directive questioning and simply imposes her views upon her clients.

Finding realistic portrayals of mental illness and therapy in popular culture is a Herculean task. For Big Little Lies to have achieved this on any level is no small feat. It is, however, important to recognize the ways in which Dr. Reisman behaved unethically and failed to help her clients; these are mistakes that, hopefully, no therapist would make in real life.


References:

1. Kelley, D. (2017). Big Little Lies [Television Series].
2. Johnson, R. (2017). "Big Little Lies": Domestic Violence Therapy - Minding Therapy. Retrieved 25 September 2019, from https://www.mindingtherapy.com/big-little-lies-therapy/
3. Smith, D. (2003). 10 ways practitioners can avoid frequent ethical pitfalls. Retrieved 25 September 2019, from https://www.apa.org/monitor/jan03/10ways
4. Dahl, M. (2017). Real-Life Therapists Love the Big Little Lies Therapist. Retrieved 25 September 2019, from https://www.thecut.com/2017/03/real-life-therapists-love-the-big-little-lies-therapist.html
5. Kress, V., Protivnak, J., & Sadlak, L. (2008). Counseling Clients Involved with Violent Intimate Partners: The Mental Health Counselor's Role in Promoting Client Safety. Journal Of Mental Health Counseling, 30(3), 200-210. doi: 10.17744/mehc.30.3.e0r87734721l6016