NEWSMental Health News Mind in the Media: What "The Shrink Next Door" Reveals About Toxic Therapy Dynamics ByCynthia VinneyCynthia VinneyCynthia Vinney, PhD is an expert in media psychology and a published scholar whose work has been published in peer-reviewed psychology journals.Learn about our editorial processUpdated on January 19, 2022Fact checked Verywell Mind content is rigorously reviewed by a team of qualified and experienced fact checkers. Fact checkers review articles for factual accuracy, relevance, and timeliness. We rely on the most current and reputable sources, which are cited in the text and listed at the bottom of each article. Content is fact checked after it has been edited and before publication. Learn more. by Elaine HinzeyFact checked byElaine HinzeyLinkedInElaine Hinzey is a registered dietitian, writer, and fact-checker with nearly two decades of experience in educating clients and other healthcare professionals.Learn about our editorial process Share Tweet Email The Shrink Next Door / Ellen LindnerSpoiler alert! This article contains major spoilers for The Shrink Next Door, available to stream on Apple TV+. At first, Marty Markowitz wanted nothing to do with Isaac Herschkopf. Sure, he panicked when he had to confront problems as the new head of his family's fabric company and missed his recently deceased parents but it was his sister Phyllis who felt he needed professional psychological help. So, to appease her, he went to see Herschkopf, a psychiatrist. Soon, Dr. Ike, as Marty called him, had not only convinced Marty that he needed his therapeutic help, he has also wormed his way into other parts of Marty's life. Between 1981 and 2010, Dr. Ike took a job at Marty's company, started a charity with Marty that he used for his own gain, isolated him from his sister and the rest of his family, and even took over Marty's vacation home, while getting Marty to act more or less as his butler. This is the basic plot of Apple TV+'s series The Shrink Next Door, in which Paul Rudd plays Dr. Ike and Will Ferrell plays Marty. Even though the premise seems fantastical, this is a true story of a mental health professional exploiting his patient for his own gain for almost 30 years. The show may leave viewers wondering how they can avoid a similar situation if they decide to seek out therapy. While studies have shown that therapy can be remarkably beneficial for the vast majority of patients and the case shown in The Shrink Next Door is extreme, some therapists and counselors do violate ethical boundaries in the therapist-patient relationship and cause harm, with research indicating a minority of patients experience adverse effects. If you're concerned your therapist may violate boundaries with you, here's what you need to know to protect yourself. Crossing Boundaries In the Patient-Therapist Relationship Mental health professionals are trained to establish and adhere to healthy boundaries between themselves and their patients, and professional bodies like the American Psychological Association provide ethics codes that their members must adhere to. In addition, Allison Forti, PhD, Associate Director of the Online Master’s in Counseling Program at Wake Forest University, notes that during a therapist's first session with a new patient, they should "provide informed consent about the boundaries of the therapeutic relationship," and discuss what therapy will be like. Clear guidelines enable the mental health professional to be transparent about the expectations for both the therapist and the patient in the clinical setting and gives the patient an opportunity to ask any questions they have, which according to Forti, "creates a stronger sense of safety and connection" that ultimately reassures the patient that the therapy is focused on meeting their goals. Nonetheless, therapy is built on an interpersonal relationship between a therapist and a patient, and therefore, therapists might cross a boundary with a patient once in a while. However, there is a big difference between a "boundary crossing," which is a benign, and possibly helpful, break in patient-therapist boundaries, and a "boundary violation," which involves breaches in patient-therapist boundaries that exploit or harm the patient. In Marty's initial session in The Shrink Next Door, Dr. Ike does something that would be considered boundary-crossing almost immediately: when Marty is reluctant to talk, Dr, Ike suggests he and Marty complete the rest of their session while walking the streets of New York. While viewers may have found it unusual that Dr. Ike suggested continuing the therapy session outside of his office, it's not unheard of for a therapist to suggest a walk as a way to break down a patient's barriers. In fact, Dr. Forti observes there is growing interest in alternative settings for therapy, and walking and talking can be especially beneficial to teenage clients. Before agreeing to take a session outside, however, the therapist should discuss confidentiality with the patient and explain that delicate information may be heard when the patient and therapist are in public. So while boundary violations are never acceptable, the therapeutic context is flexible enough to allow for the periodic boundary crossing if, as Dr. Forti puts it, the therapist believes "it benefits the client." For example, if a patient is going through a particularly tough time, a therapist may hug or touch a patient if they first receive the patient's permission. Or the therapist might provide some personal information about themself during a session if they believe it will strengthen their relationship with their patient. Generally, though, these crossings are limited, brief, and done with the best interests of the patient in mind. How to Set Boundaries With Therapist Nedra Glover Tawwab Boundary Violations While Dr. Ike's relationship with Marty starts with a minor boundary crossing, his behavior quickly escalates to full-blown boundary violations in which Dr. Ike manipulates, exploits, and ultimately harms Marty. Boundary violations can be divided into three categories: sexual, emotional, and financial. Dr. Ike's exploitation of Marty falls into the latter two. For example, soon after they first meet, Dr. Ike suggests that Marty have another Bar Mitzvah as a way to make up for what went wrong at his Bar Mitzvah when he was a child. Marty doesn't just have the Bar Mitzvah, he pays for the party to which mostly Dr. Ike's friends are invited. Yet, according to Melissa Brierley LCSW, psychotherapist at Cobb Psychotherapy, "it is not ethical for therapists to encourage patients to spend money on something that may not be [therapeutically] effective." Instead, adverse childhood experiences should typically be explored during therapy sessions. Similarly, when Marty's sister Phyllis starts to question the advice Dr. Ike is giving her brother, Dr. Ike tells Marty his relationship with his sister is toxic and suggests Marty cut Phyllis and her family out of his life. Yet, according to both Forti and Brierley, an ethical therapist wouldn't instruct a client to end a relationship. "Instead," Forti explains, "they provide psycho-education about what a healthy relationship looks like, including healthy communication, boundaries, and safety. Then they help clients explore whether or not they would label their relationship healthy or toxic. If clients determine they are in a toxic relationship, then the counselor may help them explore the best way to move forward." Brierley notes working with a patient this way is all in the name of encouraging their self-determination, which is key to the therapeutic process, including what the patient chooses to discuss and how they decide to deal with the issues uncovered over the course of therapy. As Dr. Ike's exploitation of Marty gets more and more egregious, many viewers may wonder why Marty puts up with Dr. Ike's behavior. But as the person with the power in the relationship, Dr. Ike strengthens Marty's dependency on him by making Marty feel special, isolating him from his loved ones, and preventing him from forming any new relationships. Through it all, Marty seems to idealize Dr. Ike and everything he has to offer. Patients sometimes temporarily idealize their therapists and if the therapist addresses this and works through it with the patient, it can inform and benefit the therapeutic process. However, by encouraging and exploiting Marty's idealization of him, Dr. Ike instead causes harm. Verywell Mind's 2021 Online Therapy Awards Red Flags That a Therapist May Violate Boundaries There are many different types of therapy, from psychodynamic approaches to cognitive-behavioral orientations, and they all have slightly different perspectives on crossing boundaries with a patient. However, there are some red flags that anyone can look for that indicate a mental health professional may violate a boundary, possible leading to exploitation or harm. Informed Consent Isn't Taken Seriously First, Forti suggests that new patients, "Notice how seriously the therapist takes the informed consent process in the initial session. A red flag should go off if they gloss over this process or neglect it. A therapist who does not take this seriously might welcome connecting over social media, provide their personal cell phone number in case you need them anytime, or ask you questions that aren’t relevant to initiating counseling." Making the Patient Uncomfortable Forti also notes that touching without permission, pushing ideas that feel intrusive and irrelevant to what a patient wants to discuss, and asserting power over a patient are all red flags. Dr. Ike does some of these things during his initial session with Marty, including hugging him without asking for his permission first and demanding that Marty tell his ex-girlfriend that he won't pay for her trip to Mexico even though Marty is reluctant to do so. But Forti observes, "Ethical therapists are aware a power differential exists with clients, but they attempt to minimize the impact and, instead, empower clients to look within to make decisions about their lives." In addition, Brierley notes that there are a variety of signs both early or further into therapy that indicate a boundary violation could happen, including "if a therapist is using the patient's time to talk about themselves, if they're asking questions that are very intrusive and not giving any sort of response as to how this might be clinically appropriate, or the patient may sense some counter-transference, which is a phenomena where the therapist over-identifies or transfers their feelings onto that client." The therapist leads the patient too much Brierley also points to limiting a patient's right to self-determination as a big red flag. This is something that Dr. Ike repeatedly does to Marty throughout The Shrink Next Door, as instead of letting Marty guide their therapeutic relationship, Dr. Ike insists that in order to get over his psychological issues, Marty must follow his suggestions no matter how reluctant he is. The therapist pursues a relationship outside of the office What's more, both Brierley and Forti agree that, under most circumstances, an ethical therapist would never pursue a relationship outside of patient-therapist with a patient, as Dr. Ike does with Marty. While Forti explains that the boundaries of the patient-therapist relationship may be extended in certain situations this is "more likely to occur in less densely populated areas where the benefit of extending the boundary outweighs the risk. For example, some rural areas have limited access to mental health services so the only counselor in town may be on the PTA board with a client and relate to the client in a friendly way during board meetings." In this instance, the therapist may determine that the benefits of maintaining the relationship with the patient both in therapy and on the PTA board benefit the patient. However, when Dr. Ike proposes he and Marty start a charity together or persuades Marty to let him host parties at his house, he is putting his own needs ahead of those of Marty, making these relationships unacceptable. Can You Be Friends With Your Therapist? Acknowledging and Ending Inappropriate Patient Therapist Dynamics Boundary violations sometimes happen in therapy, and Brierley says that if they do it's inappropriate for the therapist to continue working with the patient. She observes that in terminating the therapeutic relationship, "The therapist should also model appropriate behavior by acknowledging their error and apologizing as well as uphold their duty to provide referrals [to other mental health professionals]." This is something we never see Dr. Ike do. In fact, even in the show's final episode after Marty has finally severed his relationship with him, Dr. Ike is defensive and unwilling to admit any wrongdoing. Unfortunately, Marty didn't have the tools to notice Dr. Ike was manipulating him during their lengthy relationship. However, Forti recommends that throughout your relationship with a therapist you should notice how your therapist is responding to you. For example, it's a red flag "if your therapist becomes defensive, frustrated, or angry if you are reluctant to follow their suggestions or disagree with them. Ethical therapists meet clients where they are and walk next to them on their journey of exploration, rather than direct the journey." Hollywood vs. RealityWhile The Shrink Next Door serves as a cautionary tale for the way some unethical therapists might breach boundaries, seeing a mental health professional can be profoundly beneficial, and situations like this one are rare. Most therapists genuinely want to help and adhere to a code of ethics that would prevent them from ever manipulating, exploiting, or harming a patient the way Dr. Ike does. While The Shrink Next Door serves as a cautionary tale for the way some unethical therapists might breach boundaries, seeing a mental health professional can be profoundly beneficial. Most therapists genuinely want to help and adhere to a code of ethics that would prevent them from ever manipulating, exploiting, or harming a patient the way Dr. Ike does. In order to ensure you find the best therapist possible for you, Forti suggests asking for referrals, while Brierley observes that, if they're available, it can be valuable to schedule a consultation call before an initial session to see if you and the potential therapist will work well together. Forti adds that, although "the unknown can be intimidating" when entering therapy, therapy, and mental health counseling "can be an opportunity to be fully understood and valued; it can be life-changing." How Accurate is The Depiction of Stalking in Netflix's You? 4 Sources Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Time. The true story behind The Shrink Next Door.Hook J, Devereux D. Boundary violations in therapy: the patient's experience of harm. BJPsych Advances. 2018;24(6):366-373. doi:10.1192/bja.2018.26.Zur O. To cross or not to cross: Do boundaries in therapy protect or harm? Psychotherapy Bulletin. 2004;39(3):27-32.Gabbard G. Patient-therapist boundary issues. Psychiatric Times. 2005;22(12).By Cynthia Vinney Cynthia Vinney, PhD is an expert in media psychology and a published scholar whose work has been published in peer-reviewed psychology journals. See Our Editorial ProcessMeet Our Review Board Share FeedbackWas this page helpful?Thanks for your feedback!What is your feedback? 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