Sunday, November 10, 2002
By Steven Berglas
Dr. Phil is hot. The new TV show got the highest ratings for a talk show debut since Dr. Phil McGraw's mentor, Oprah Winfrey, went national in 1986. Between his TV show, lectures and books, no living man in the business of dispensing psychological wisdom is making more people feel good than Dr. Phil.
Dr. Phil's success, however, may be the bane of traditional psychotherapy.
Dr. Phil the man is not my problem. Nor is my concern born of sour grapes (although I envy his power to command lecture fees in excess of what most college professors earn in a year). What I fear is that the format of his TV program -- along with all media psychologists who write self-help books offering ''quick fix'' techniques -- blind the public to the fact that it is incredibly difficult to achieve psychological change. The more efficacious Dr. Phil is seen as being, the more difficult it will be to convince people suffering from psychological disorders that psychotherapy is worthwhile.
To be fair, many media psychologists, Dr. Phil included, do not claim to be providing psychotherapy, and many (such as Dr. Ruth and Dr. Laura) acknowledge that their training is not in clinical psychology. Although Dr. Phil does have a Ph.D. in clinical psychology, he was discovered by Oprah because, as a consultant specializing in jury selection and related courtroom matters, he helped her prevail in a lawsuit brought by Texas cattlemen who claimed her remarks about beef hurt their business. Dr. Joyce Brothers' career was jump-started when she won a TV game show.
Unfortunately, few audiences ask what a media shrink's area of specialization is. Instead, the audience hears the honorific ''doctor'' and concludes that the person dispensing wisdom can heal.
The light dawns -- then fades
Should it matter that a media shrink lacks training in clinical psychology or psychiatry? Absolutely. What happens to guests after they call Dr. Laura or appear on Dr. Phil will be greatly affected by the disorder underlying the problem discussed on air. Most often, for example, media shrinks deal with self-defeating behaviors: Marriage to an abusive spouse, tolerance of second-class citizenship in a family or at work, or an inability to control personal dependencies or addictions. When confronted -- and confrontation does seem to be what sells -- by a doctor who tells them to ''get real'' or ''get a life,'' sufferers appear to experience an epiphany that will lead to change.
Would that it were so easy. Virtually all those I have treated for self-defeating disorders know the damage they inflict upon themselves is ''wrong'' and are motivated, at some level, to change. Many do, for a while, but most regress owing to issues that cannot be addressed through confrontation. Moreover, because all self-defeating disorders have some rewarding aspects to them, such as blocking a person from assuming adult responsibilities, people resist ''getting a life.''
Sufferers need longer-term attention
Dr. Phil is as charismatic as can be but he cannot will a cure with one heartfelt admonition. Protracted follow-up after insight is the key to psychological change, and this is rarely the stuff of good TV or radio.
Consumers can and should be warned about the dangers of what looks like a godsend for those trapped in patterns of defeat. Licensed psychotherapists' professional groups, for instance, could promote awareness of the therapeutic struggles that ''patients'' such as Tony Soprano endure. That relationship between The Sopranos' main character and his psychiatrist, Dr. Melfi, although prettied up for TV, is far more representative of the ebb and flow of what leads to a resolution of a psychological disorder than the gratefulness of those ministered to by media shrinks.
It's fine to love Dr. Phil, but let's just add a small warning label: ''Do not try this on your own.''
Steven Berglas spent 25 years in the Harvard Medical School department of psychiatry. He is the author of Reclaiming the Fire: How Successful People Overcome Burnout.