A 28-year-old young woman sits curled under a blanket, confessing to a small group the details of her father's drug usage and how it led to her own decade-long struggle with marijuana and alcohol. Private moment for an in-patient rehab group and its shrink? You'd think. But the girl happens to be a former child actress from the 1980s sitcom Family Matters, and she's confessing her addiction in front of millions of television viewers.
The moment is part of VH1's addiction reality series Celebrity Rehab, one of a variety of new shows that chronicle the struggles of the psychologically ill. TV's “treatment” genre spans syndicated programs, scripted dramas and reality shows, and follows fictional characters and real subjects—famous folk and ordinary people alike.
TV audiences have long been curious to peer behind the closed door of a therapist's office and learn about the sacred doctor-patient relationship. But never before have there been as many shows, and never before have they been as popular with critics and viewers. HBO's current scripted drama In Treatment has fascinated reviewers—not to mention shrinks. And A&E's reality show Intervention is earning its best ratings ever this season, its fourth, regularly attracting more than 2 million viewers and up more than 60% in key demos.
The recent crop of shows is decidedly darker than earlier entrants like The Bob Newhart Show and, more recently, Frasier, which parodied the role of the shrink. Those shows gave way to more serious dramatizations, such as The Sopranos' Dr. Melfi, and also a new breed of reality shows about the psychologically ill, not to mention TV shrinks such as Oprah protégé Dr. Phil.
And never before has therapy on TV offered such graphic, and sometimes pathetic, portraits of people in need. Celebrity Rehab premiered with the image of Jeff Conaway, best known for his acrobatic dancing as Kenickie in Grease, hunched over his steering wheel in a drunken and drugged-out stupor, barely able to speak.
“There have been portrayals of therapy within media for a good 70 to 80 years, but what is new is that people nowadays think it has sufficient commercial interest so you can bring in an audience with it,” says Dr. Charles Goodstein, a psychiatrist at NYU Medical Center, professor at the NYU School of Medicine and former president of the Psychoanalytic Association of New York.
TV executives and therapists offer an array of reasons why these shows are gaining traction. Some say viewers are looking for a quieter alternative to the violence and noise in current events, blockbuster movies and hit TV dramas. Others cite the rise of social networking Websites like MySpace that offer voyeuristic satisfaction with the promise of a peek inside the lives of strangers. Still others say that talk therapy shows' popularity reflects a rebellion against quick-fix solutions to mental problems.
Therapists disagree on how accurately and responsibly the shows portray their practice. Some say the programs are commendable for exposing the oftentimes taboo subject of psychological strife, at times with hideous graphic glory, to viewers who might otherwise fear seeking help. Others say fictionalizing or sensationalizing therapy risks giving viewers the wrong idea about the practice and threatens the safety of the shows' subjects.
“I think it's unfortunate that people are watching these shows to see what therapy's like,” says Jody Davies, Ph.D., a psychiatrist whose well-known writings on erotic transference, the subject of an In Treatment storyline, earned her a mention by name in the show. “I think there's a danger that people will think this is what therapy is.”
The new shows come when the topic has never been hotter in U.S. media. Tabloid magazines and syndicated TV shows, like Extra and Access Hollywood, mine the celebrity-addiction storyline with new reports daily on the latest starlet to check into rehab.
And the programs' popularity coincides with what seems to be a growing acceptance of therapy among Americans. Ninety-one percent of Americans are likely to consult or recommend that a family member consult with a mental health professional, and 50% of Americans think the stigma of seeking mental health services has decreased, says the American Psychological Association.
Interest from viewers, some who have struggled with their own addiction problems, has fueled ratings for many shows, and fans have flocked to online message boards to discuss them. A MySpace page on Intervention cites 777 friends of the show and subgroups with names like “Clean and Sober krew” and “Do Not Give Up Hope USA.”
The show building the most buzz at the moment, at least from critics and members of the psychoanalytic community, is HBO's In Treatment, a stark, dialog-heavy, half-hour drama starring Gabriel Byrne as a therapist every bit as complicated and troubled as his patients. The series was adapted from a 2005 Israeli show that so captivated that nation that traffic levels plunged during new episodes.
There's not much action in the sessions, but there's plenty of drama. Shot like a series of one-act plays, episodes feature uncut scenes of Byrne's Paul Weston character and his counselees, in an office whose silence may be just what is keeping viewers transfixed. Some say the therapy shows are a reaction to violent events in the news and the sense of pervasive violence in many hit TV and film dramas.
“First of all, television everywhere is a very horrific place,” says Hagai Levi, the creator of In Treatment's Israeli predecessor, who co-executive-produced the show for the U.S. “There are a lot of very noisy, violent shows, and I think there is some willingness for this quiet and good place where people help each other.”
The show requires almost as much commitment as seeing a real analyst; the U.S. version of In Treatment premieres new episodes each weeknight at 9:30 p.m. Because HBO only reaches about 28 million subscribers who aren't conditioned to watch it with that much regularity, the show hasn't met with the same sort of ratings success as the original. But with added plays on video-on-demand, iTunes and the pay cable network's Website, it's picking up steam, averaging about 1.5 million weekly views per episode, according to the network.
“These shows are a way of people getting back in touch with the soul, and the audience wants that,” says Dr. Glen Gabbard, professor of psychiatry at Baylor College, who has written 22 books including Psychiatry and the Cinema and The Psychology of The Sopranos : Love, Death, Desire and Betrayal in America's Favorite Gangster Family.
Gabbard calls In Treatment the most realistic portrayal of therapy ever on TV, and speculates that the rise in shows with psychiatric treatment at their heart reflects a desire to slow down the pace of a constantly connected world where it seems everything is a click away. Such immediacy has fostered a desire to focus on getting to know others as individuals, and a subsequent interest in shows that do so for the viewer, he says.
What we're seeing is a backlash against the kind of quick-fix, high-tech mentality where things are reduced to neuroimaging without taking into account the unique subjectivity of the human being,” he says.
“There's something about humanity that's foregrounded [in these shows],” adds Irwin Z. Hoffman, Ph.D, an NYU faculty member whose work informed the Israeli In Treatment. “It's about their emotional life and their experiences as individuals, as opposed to a whole fundamentalist world out there.”
Some say that today's constant connectedness, especially through social networking sites where users can reveal the most intimate details of their lives to complete strangers, has fed a natural human predilection for voyeurism, and in turn an interest in these shows.
We're in a sort of apex moment where people enjoy watching other people, and seeing them exposed for who they really are and getting insights into humanity that way,” says Rob Sharenow, A&E's senior VP of non-fiction and alternative programming, who oversees Intervention for the network. “With social networking on the Web, people are letting it all hang out in an unprecedented way in world history and getting more comfortable with broadcasting who they are.”
Intervention has spawned a breed of similar cable reality shows that document real-life victims of addiction and other psychoses. In the A&E show, addicts agree to have their struggles documented on film, not knowing their family members have planned to stage—and film—an intervention at the end. The show is posting its highest-ever ratings this season—an average 2.2 million viewers, with 1.4 million of them 18-49, up 57% and 62% over season three, respectively.
In the same vein is VH1's Celebrity Rehab, in which a group of D-listers, including an alcoholic porn star and a coke-addict ex-American Idol contestant, bunk together in an in-patient facility in Pasadena under the watch of doctor-cum-TV-persona Dr. Drew Pinsky. The show premiered in January as cable's top show of the night with 1.5 million viewers and has held strong every week since, with scenes of curse-laden group therapy fights and rewards for its comely cast in the form of parties by the pool.
Such scenes raise the issue of whether these shows exploit their subjects and are irresponsible to their viewers. But executives say they make the shows to reflect the reality of the nation and take care to protect their subjects.
“We didn't go in with giant expectations of ratings,” says Jeff Olde, VH1's executive VP of original programming and production, who greenlighted the show after a pitch meeting with Pinsky. “You do a show like this because it's a new story to tell that's resonating in pop culture. The thing that was intriguing to us was taking something that was water-cooler conversation but not presented in a way that was real or honest.”
For Rehab, VH1 scrapped its usual preproduction process of fashioning its own storylines, and instead let Pinsky's rehab plan provide a natural structure for the show. The network created an anti-drug PSA with Partnership for a Drug-Free America, and has provided after-care support for its stars. Producers for A&E's Intervention, which stops chronicling its subjects before they get therapy, also keep in touch with the addicts they portray.
“We wouldn't have done the show if we thought it was exploitative,” says Olde. “We felt the reality was incredibly gripping and the human stakes involved were gigantic. I go to sleep every night knowing this is something we did that helped people and continues to help people spread the message about sober living and addiction.”
Still, many therapists agree that true analysis, like that portrayed in HBO's In Treatment, can span years of daily sessions and is inherently counter to the rhythm of TV shows, which try to pack in as much drama as possible in a half-hour.
“This is not life, it's HBO,” says Dr. Arnold Richards, former editor of the Journal of the American Psychoanalytic Association and chair of the Committee of Psychoanalytic and Psychotherapeutic Publications & Organizations (C3PO). On March 8 at New York's Mount Sinai Medical Center, the group will lead its annual conference with a screening of both versions of In Treatment and a panel discussion with creators.
“In TV, you need a script and a narrative and a soap-opera feeling,” says Richards. “The usual psychotherapy doesn't have a plot. If you put a camera in the room of a therapist and patient for nine sessions and brought that show to an audience, it would be very, very boring.”