December 14: THE THERAPIST AS PSYCHOPATH

Like may others, I presume, I have been gripped, horrified and intrigued by ‘The Fall’ BBC 2’s violent and disturbing thriller now well into it’s second series. This is a misnomer really as it is a straightforward continuation of where it left off. BBC this year have stolen the mantle from ITV in producing brilliantly written and acted thrillers that owe much to the success of the Scandinoir thrillers that have had audiences gripped for the last couple of years. The series is dominated by the the central performances of Gillian Anderson (Stella Gibson) and Jamie Dornan (Paul Spector). The premise of serial killer/psychopath does not break new ground and the controversy it has caused has been about its graphic portrayal of violence against women. Little has been made about the fact that the killer is a bereavement counsellor.

I suppose that anything that shows a member of one’s profession as a killer is somewhat upsetting but fair game in the name of art. It did get me to try and think if there are any precedents for this and so far I haven’t been able to find any that are really about therapists. There are heaps of psychiatrists and we need go no further than Hannibal Lector. Psychiatrists, psychologists and nurses abound as murderous sadistic villains. To give the psychologists their due they are mainly portrayed as behaviour modifying agents of state control rather than downright killers. The traditional role of the psychotherapist/psychoanalyst has been that of enlightening the plot and indeed, as in ‘Spellbound’, actually solving the crime. What is also common is an ’acting out’ of the sexual transference as in Spellbound’ (again) and “Prince of Tides’. In ‘Prince of Tides’ more criticism was heaped on Barbra Streisand for the length of her nails than for sleeping with her (sort of) patient. I never quite understood why it was considered so preposterous for a therapist to have long nails!

So ‘The Fall’ does bring us into uncharted territory. Perhaps it is merely personal, but I find Dornan’s character very disturbing because the essence of therapy lies in trust. We no longer implicitly trust the medical profession and in this I include nurses. This is most likely to do with enough awful cases in the news to shatter any previously held automatic trust. After all the well known phrase, ‘Trust me I’m a Doctor’ generally means the absolute opposite. Jokes about therapists tend to be about their refusal to be categorical about anything. You could say that we can be ‘trusted’ not to give a straightforward answer. I am not saying that therapists are above criticism or do not behave unethically and we know there are rogues out there. An area where therapists do get into trouble is when they confuse ethics with morals. This is easily done and most obviously in the area of sexual orientation. I am glad to say that in this country, at least, all the registering bodies have outlawed any therapy that purports to change sexual orientation. It is indeed an offence that leads to having registration withdrawn. Another reason for making sure your therapist has been trained appropriately.

However, I’m now slipping in to defending my profession which is not what I’m really interested in. Perhaps because the nature of our work is that our patients do need to be able to trust us, which isn’t to say they believe we are always right and a good thing too! It is perhaps unthinkable that we could be dangerous as we are mainly non-directive. Nevertheless it does bring up the question could a psychopath train as a therapist and not be spotted? One would like to be able to say categorically no but I’m not entirely sure. We are an eclectic bunch prone to infighting, splitting and acting out. Things that we try to ‘fix’ in our patients but fail miserably at doing in our professional organisations. However, training psychopaths is another matter or is it? When I began training several psychoanalytic trainings were either covertly or overtly refusing to train Lesbians and Gay Men, who identified themselves as such. The grounds were that they couldn’t be ‘successfully’ analysed. Of course Lesbians and Gay men did train with these organisations and what I find astonishing is that they went through their training analysis concealing their sexuality. I have no figures for this but several US analysts have latterly ‘come out’ as gay. So is it stretching the bounds of possibility that a ‘charming’ psychopath could get through unnoticed?

Perhaps a more reasonable explanation is that psychopaths lack empathy and our profession does require at least a modicum of it. This isn’t necessarily the case in either psychiatry, clinical psychology or CBT. The belief in this branch of the field is that they are putting a disorder right and they are the experts. In my work in the NHS, I worked with all these other disciplines and the most empathic practitioners in those disciplines were those who were also trained or wanted to train in a more psychotherapeutic approach. Often because they had had or were having their own personal therapy. In other words they were trained to be much more self reflective.

Back to ‘The Fall’. Forgive me if I now talk about it as if it was real. Paul Spector (Jamie Dornan) is a Bereavement Counsellor, not a psychotherapist so we can assume that he would not have undergone a full training analysis. I know that some counselling trainings only stipulate a minimum number of personal therapy sessions and partly to do with the cost of training trainees will only do that minimum and then grudgingly. However, having worked in Bereavement, I know that often patients are in extremis and the work is difficult because bereavement is something that no one can escape from. We are in essence probably more identified with our patients than in any other situation. Yet the majority of Bereavement work is carried out by trainees or newly qualified practitioners. So, the really awful situation in ‘The Fall’ where Paul Spector is called in to offer counselling to his only surviving victim is truly awful. Yet it makes sense that they would request him as a qualified and experienced practitioner. We know already that he has been sexually aroused by this woman as in Series 1 he doodled pictures of her breasts as he was talking to her and her husband. The husband becomes his first male victim. Of course, his continued ability to get away with his killings will increase his sense of omnipotence which will lead to greater risk taking and he will be caught.

As with all good modern thrillers Stella Gibson (Gillian Anderson) has her own demons and Spector has broken into her hotel room and taken photos of her personal journal. Spector is a great name for this character as spectre like he creeps through Belfast. The series is also littered with references to this still somewhat divided city.

I think this is a great thriller and I particularly like the fact that it has never been a whodunnit. This has opened up the possibility of making the psychopath a much more chilling figure. The series is due to finish just before Xmas and again is Spector like a satanic Santa Claus creeping into houses in the dead of night. I still don’t know whether there are any genuine psychopathic therapists out there. I have heard colleagues in rage saying about other therapists sh/he is a f*****g psychopath, but I don’t think it was a clinical diagnosis!

Happy Christmas and a Good New Year!

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