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May 10, 2011

A Shrink's Take on Speed Shrinking

I recently read the novel Speed Shrinking by Susan Shapiro. The title derives from heroine Julia's quest to find a new shrink after her longtime psychologist, Dr. Ness, moves away.  Determined to find one she clicks with, Julia interviews eight shrinks in eight days.

In short, I liked the book.  Ms. Shapiro is a stylish writer.  She delves into modern woman issues with sophistication and informed wit.  Her self-deprecating and self-analytical insights are sometimes hilarious, sometimes sincere and always poignant.

From a therapy standpoint, Shapiro lets the reader into the sacred territory of the complex interactions between doctor and patient. And I don't mind admitting that as a practicing psychologist I like to see what goes on in the offices of my contemporaries, even if these revelations derive merely from the mind's eye of a fiction writer.

What I loved about Shapiro's novel (and her earlier book) was her smart play on words.  Speaking of Julia's early cat-and-mouse games with her husband, for example, she writes, "I was ambivalent about him - until he abandoned me for the West Coast where I followed, chasing him until he caught me."

What I didn't like about Speed Shrinking?  And what provoked me to write this post?  Reading a series of highly questionable if not most certain ethical violations on the part of the treating psychologists depicted in the novel.  Most of the violations fell under the heading multiple relationships (better known as dual relationships) and lack of professional boundaries.

Some examples of what I believe to be violations found in Speed Shrinking are given below (hoping I am remembering them correctly as I don't have the book in front of me) where one or more of Julia's treating  psychologists do the following:

- Provide therapy while simultaneously serving as editor and professional consultant for a manuscript the patient is writing.

- Discuss details of their own therapy, supervision and psychological issues with the patient during and give detailed answers to the patient's personal questions.

- Continue the therapeutic relationship via telephone, digi-cam (such as Skyping) and in-person meetings despite Julia's transition to and regular participation with a new psychologist, i.e., the former psychologist fails to adequately terminate treatment.

- Go to the patient's home to help her make remodeling decisions.

Multiple relationships as defined by the American Psychological Association (APA):

   A multiple relationship occurs when a psychologist is in a professional role with a person and (1) at the same time is in another role with the same person, (2) at the same time is in a relationship with a person closely associated with or related to the person with whom the psychologist has the professional relationship, or (3) promises to enter into another relationship in the future with the person or a person closely associated with or related to the person.

In addition to multiple role violations, there are a few examples of broken confidentiality.  In one example, Julia's new psychologist readily acknowledges that he is treating a friend of hers.  He then discloses details gleaned from their sessions.

As I came toward the end of the book, I predicted that Shapiro's character would grow from the realization that her beloved Dr. Ness may have been doing more harm than good.  That part of the reason Julia was obsessed with him had to do with his failure to adhere to professional boundaries.  That her persistent feelings of betrayal stemmed from his having created a false sense of specialness.  Indeed, the frequency and rapidity with which he responded to her between session contacts suggested she was his only patient.  I hoped Julie would gain these insights as a result of the new shrink applying strict, ethically appropriate boundaries within and outside of their sessions.

Do my predictions come true?  Stay tuned for my next post where I discuss this and other ethical implications.