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Article 38

DSM at the Movies

Use of Media in Clinical or Educational Settings

Janice J. Caron

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Feeling anxious about the future? Struggling with growing pains? On the verge of yet another major life change? Or just hungry to make a difference? Utilizing films is a new counseling intervention based on the principals of bibliotherapy and the capacity to use technology-supported videos or DVDs. Bibliotherapy uses literature to bring about a therapeutic interaction between client and therapist (Hynes & Hynes-Berry, 1986). As therapists and educators, the use of media as a therapeutic approach for facilitating therapeutic or educational processes is an additional strategy in attaining therapeutic objectives.

Films describe political beliefs and struggles, hopes and fears for the human race and they have an impact on human behavior. Films can also provide us with alternatives for dealing with our life experiences; be they positive or negative. Through the use of films, individuals can identify with the key characters in the film, and gain an increased understanding of how these individuals resolve their problems. In watching films, individuals can identify characters and themes similar to their own. In addition, films enable individuals to watch for successes and failures and also learn new approaches to solving problems – a process called modeling (Hesley & Hesley, 1998).

Film is both an accessible art form and cultural experience, so viewing and discussing films “becomes a way of pulling clients in, engaging them in a relevant subject in a gripping way. And if the therapist watches with the clients, it becomes a shared experience that’s more immediate than if, for example, they read the same book” (Walker, 2003).

Benefits of Using Films

There are numerous benefits to viewing films in clinical and educational settings. It validates a client’s experience when they view specific films that portray dilemmas similar to his or her own. Knowing that someone else has been through the same experiences and emotions may have a profound effect on the client’s journey of change. Furthermore, a difference in interpretation between therapist and client may enable them to generate a variety of productive insights. Humor in films helps to decrease the impact of irrational thought or behaviors (Hesley & Hesley, 1998).

The emotional impact of film generally encourages lively interaction and provokes honest and thoughtful discussions. Viewing films related to cultural and ethnic diversity issues provides students with a feel for the difficult challenges and struggles that immigrants encounter during the acculturation process. Watching the various characters’ roles in films enables students to relate to and understand the lives and beliefs of characters with whom they have little in common (Anderson 1992; Fleming, Piedmont, & Hiam 1990).

Furthermore, minority students may find that they can relate to the narratives found in feature films. Plots may center on their daily challenges and concerns (e.g., AIDS and/or community violence) and are more likely to include characters from diverse ethnic and sociocultural backgrounds (e.g, Boyz in the Hood; Philadelphia). For students who have lived sheltered lives or who have not been exposed to different cultures, the films may provide an opportunity to begin desensitization in a safe environment. Instructors need to inform the audience about any violence and profanity prior viewing films. When integrated into a curriculum, appropriate films may offer opportunities to encourage critical thinking skills. More important, by engaging a wide range of students, films can stimulate critical thinking in those who feel alienated from traditional teaching.

Use of Films in Clinical and Educational Contexts

Due to the anxiety associated with certain therapeutic issues such as suicide, divorce, domestic violence, or sexual abuse, Guerin (1976) discussed the use of movies as a displacement technique. Displacement is a technique that allows one to become emotionally involved in a situation but yet allows one to maintain distance and remain objective. Educators can use movies in the same way with counseling students. Although movies do not permit mutual interaction between counselor and clients, they do afford beginning counselors the opportunity to experience complex therapeutic situations. This method provides the opportunity to reflect inner struggles, dilemmas, and problem resolutions through the use of visual media.

To effectively use film in the psychotherapeutic process, Berg-Cross (Berg-Cross, Jennings, & Baruch, 1990) created a four-step technique. First, the client should have a specific issue that he or she is working on. Second, the therapist must work in a systematic manner in order to promote the best therapeutic technique possible to advocate change. Third, the therapist must prepare the client and set the stage for the film. Fourth, it is critical to process and discuss the film with the client soon after it has been viewed. These steps provide optimum benefit in a therapeutic setting.

In utilizing cognitive behavioral perspective, films can serve as an intervention method to help clients understand maladaptive core beliefs. In addition, clinicians can utilize cognitive restructuring and appropriate behavior modification to implement changes. Clients can become motivated to copy the behavior of film characters who demonstrate courage in the face of a challenge. Recent theories of learning and creativity suggest that there are seven intelligences: the logical (plot), the linguistic (dialogue), the visual- spatial (pictures, colors, symbols), the musical (music and sounds), the interpersonal (storytelling), the kinesthetic (movement), and the intrapsychic (inner guidance). The more of these intelligences clients access, the faster they learn—and film allows us to access all seven of them (Wolz, 2003).

A client’s readiness to view a film is assessed by the therapist using the same criteria used when assigning intense homework. When clinicians are in doubt about the emotional strength of the client to deal with the film, it is best to choose a less threatening film or just not use one at all (Hesley & Hesley, 1998). Keep in mind that not all clients enjoy viewing films, and not all clients will benefit from viewing films. Clients who have been diagnosed with major psychiatric disorders would not be candidates for viewing films. This is due to the fact that it can be difficult to deal with issues that arise while viewing the film in their own homes. Films are also not recommended for clients who might have recently experienced a trauma or loss similar to the protagonist in the film. These clients may be able to view a film later as they attempt to put the event behind them.

Two examples of how films were implemented in clinical settings are as follows. One of the author’s personal film favorites is The Great Santini. This film portrays the tragic story of a super-tough marine dad who bullies his family into compliance. Watching the film enabled a client to face up to his bullying behavior. Film viewing is a non-confrontive approach that enabled the client to watch from a distance and also allowed the client to see his behavior clearly. It is as though his behavior was mirrored in the film’s story. It appears that it is easier for clients to focus on a close- to-home story in which the same things viewed on film are happening in the client’s life.

Because it is often assumed that film watching is a passive form of entertainment, it is necessary to psychologically prepare client(s) before introducing movies into therapy. Preparation includes letting individual or group clients know the rationale for choosing a particular film and providing stimulus questions prior to viewing. Holding a discussion about the benefits of watching the movie and how this activity can be helpful follows. Further preparation includes asking the client, couple, or group a key previewing question: “What can this film teach me?” It is with this cognitive set that the film is then viewed. At the same time, this preparation also moves the film viewing activity out of the realm of entertainment and into the therapeutic process.

How Films Work in the Classroom

The use of films as a counselor education tool creates a rich opportunity for promoting insight into the dynamics of human behavior, for studying psychopathology, and for identifying particular counseling interventions that might have been useful in the situations portrayed in film. A number of applications of films are as follows.

In using The Great Santini film as a teaching tool, students can be asked to identify each family member’s role in the family system and to address both strengths and weaknesses of each family member as well as strengths of the family as a unit. Viewing highly intense films can elicit reactions in students who may project their personal reactions to clients and hence interfere with their ability to sustain an objective systems perspective (Higgins & Dermer, 2001).

Other techniques that facilitate class discussion and debate about counseling ethics include use of film clips that are viewed during or before class. These film clips then provide a common ground or context for analysis of key issues portrayed. Films could be selected by students for class presentations related to specific ethical concerns or could be used for topics for academic papers. Film plots could be rewritten, following an ethical decision model to illustrate the appropriate and ethical approach to the situation presented in a film. For example, films such as the Prince of Tides and Good Will Hunting could be assigned to help teach difficult concepts like transference and power and control issues. Movies can also be used in the classroom to analyze personality change. In addressing personality issues, one can use Groundhog Day to show how a nasty, self-centered weather forecaster bored with the same old assignment and same old coworkers wakes one day to find he is condemned to live the same exact day over and over, seemingly forever. As Phil (Bill Murray) discovers his plight, he allows his selfish nature to take advantage of the situation, using his foreknowledge of what others will do to get the upper hand. But in the end, life on a perpetual unchanging merry-go-round shows him how to convert himself into a much more pleasant human being. Suggestions offered to students before viewing include noticing the transformation Phil goes through after he moves beyond denial and resentment over the conditions of his life. When he becomes authentic and compassionate, his life circumstances change as well. Questions to ask include the following: (a) Are you feeling stuck in your life right now? (b) What would you do first, if you woke up one morning and noticed that—miraculously— you have the capacity to change your situation? (c) Does Phil’s behavior demonstrate something that you want to avoid and other behavior that you might want to adopt when you feel stuck? (d) Do you have the inner resources that Phil didn’t initially have?

Again, instructors can use Groundhog Day or Switch as a final project for a course. Students can use theories of personality to observe, explain, and predict human behavior. Students can address five areas of personality assessment. These include (l) structure— the basic units or building blocks of personality; (2) process—the dynamic aspects of personality, including motives; (3) growth and development—how we develop into the unique person each of us is; (4) psychopathology—the nature and causes of disordered personality functioning; and (5) change—how people change and why they sometimes resist change or are unable to change.

For educators teaching a group counseling course, students are requested to select a film they would eventually use in a group context. Students watch each other’s selected clips. Through watching the film, the group members can either identify with major characters and situations or disavow them, depending on their own life experiences. After viewing the video clip, they discuss the characters, their problems, and the resolution of those problems based on theoretical frameworks. Finally, they draw parallels to the difficulties they have in their own lives.

Film critique can be used as an alternate final exam as suggested by Tyler and Reynolds (1998). Students could be asked to view a film clip and then answer specific questions regarding the clip. They might be asked to identify particular constructs (transference), comment on emerging themes and patterns, develop a treatment plan, identify character roles, or develop hypotheses (Fleming et al., 1990). Students can also be asked to compare and contrast models (e.g., how hypotheses about this family or couple would be different from a transgenerational or strategic perspective). This method of assessment provides an innovative method for assessing student’s clinical knowledge.

Conclusion

For many clinicians and educators, films in counseling and psychology are becoming an essential tool in the therapeutic toolbox for working with both clients and students. The use of film as a teaching tool can bring a personable and intimate study of human issues directly into the classroom, thus providing dialogue in the context of film characters’ life circumstances. Additionally, future therapists can be trained in the language of films, teaching students how to recognize clinical syndromes and personality disorders.