GIRLS #2: Dr. Rice’s Failure. 4 Ways Not To Talk To Hannah About OCD

Have you ever wondered what’s on a psychologist’s “don’t do” list for a session with a patient? Go to Season 2, episode 8, “It’s Back”, and re-watch Hannah’s (Lena Dunham) consultation with Dr. Rice (Bob Balaban). I know this is a comedy. But, there’s absolutely nothing funny about Hannah’s recurrence of OCD symptoms, her counting 8’s, and the torment she’s trying to fight off. As a psychologist who takes very seriously the close listening and sensitive responses my work requires, I found Dr. Rice’s behavior cringe-worthy. Here’s what went wrong:

1.  Don’t Be Detached And Cold

An anxious Hannah sits across from Dr. Rice. She’s suffering, so there’s a good chance to reach her with a compassionate approach. But, Dr. Rice is detached, ready to take notes, and appears disinterested in what’s going on inside Hannah.

Detached and cold isn’t what anyone needs in a first session (or any session) with a therapist. It’s scary enough to be talking to a stranger. It’s up to the therapist to create a welcoming, open, and empathic place to talk. It helps too, when a therapist eases the way by seeing and speaking to a patient’s understandable discomforts.

Dr. Rice doesn’t see Hannah’s uneasiness (or Hannah) at all. Because of this, he makes a number of unhelpful blunders.

2.  Don’t Say Things That Aren’t Helpful

Dr. Rice makes his first blunder after Hannah gives him a history of her OCD symptoms. Particularly that she forced herself in High School to see things, like sexual and murderous thoughts, in loops of 8.

Instead of trying to further understand these worrisome feelings and thoughts, all Dr. Rice says is:  “So it really was a classical presentation.” It’s not helpful to Hannah to be talked to in that academic way. She doesn’t live in a textbook. She needs the particular and personal reasons for her symptoms to be understood.

In the absence of understanding, Hannah’s mad. And, she’s forced to impress upon him exactly how bad her symptoms were and are. She gives him a list, including her compulsive masturbation as a teenager. Compulsive masturbation, like counting 8’s, is unconsciously intended to make disturbing feelings go away.

What choice has she ever had and what choice does she have now? Hannah tries to be heard. What Dr. Rice does, though, is to push her feelings farther and farther away.

3. Don’t Ignore Obvious Feelings

Dr. Rice asks Hannah, “Do you have reason to be anxious?” Although I think this is Dr. Rice’s job to understand the roots of Hannah’s anxiety, the even more important thing is his response to her display of feelings. None.

Hannah’s clearly fighting tears as she replies: “Just went through a break-up a month ago.” Instead of noting the tears and trying to sensitively help her with her sadness, Dr. Rice asks a rather mindless question: “Was that stressful?”

A break-up would be stressful to anyone who’s human. There’s loss. But, Dr. Rice virtually ignores Hannah’s obvious feelings. And, Hannah knows it: “I don’t think you’d understand any of my problems because you seem to have a tremendous amount of will power and general togetherness.”

She mistakes detached and tightly controlled for “together,” something she too is trying to achieve. Control is what the counting 8’s is meant to give her. Not having that kind of will power causes her shame.

In the absence of any attention and confirmation for her feelings, Hannah idealizes Dr. Rice’s apparent control. Wanting to look stronger and more capable, she says: “I have a book deal.  I don’t know if my mom told you that.”

Any good therapist would see her shame and sympathetically comment on how hard it must be to feel she isn’t together and needs help. Not Dr. Rice.

4.  Don’t Be Competitive

Dr. Rice does something no therapist should do – he one-ups her:  “I wrote a book about a bionic dog. In every book, he’d save the world from disaster. It sold 2 ½ million copies.”

He has to show her how bionic he is. This is decidedly not therapeutic. By not understanding Hannah’s insecurities and, instead, perpetuating them, he’s inflicting more disaster on her. Not helping her with feelings she misconstrues (since she’s alone with them) as unbearable.

What does Hannah have left to do at the end of this disastrous consultation?  “I’ll do anything you say if you just tell my parent’s I’m OK.”  She has to be.  There really is no one to turn to. To her Dad, she retorts: “I hate it when people are so concerned about me.”

There’s clearly no place anywhere for Hannah’s fears, anxiety, or vulnerable feelings – all of which she hates in herself. Feelings to Hannah are weak. Concern means she’s failed. She hates concern because she’s ashamed of not being the bionic girl without feelings.

Since Hannah’s attempt to get help pitifully failed thanks to Dr. Rice’s errors, she now, once again, is alone to struggle with her anxieties. And, s0on, there’s the Q-tip.  Stay tuned for my next post.

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