What a therapy supervisor thinks of Dr. Khan's therapy

Image courtesy: Indian express.

Was it excellent therapy? What could be better? What happens in the real life?

The purpose of this blog is to help therapists fine tune their therapy and not take away wrong messages from the movie Dear Zindagi, and to help audience get the right perspective too. The purpose is not to criticise a wonderfully made movie. Dr. Khan did make some mistakes though. 

I understand that dramatization of the therapy was essential to make it appealing in a commercial movie. The glamorization of therapy too is the need of the time, and will go a long way to de-stigmatize therapy, and help people understand what actually happens in therapy, and what doesn’t. Picking up SRK for the role served the purpose well. 

Every therapist is unique in their style and the type of therapy they use. Dr. Khan has been shown to use insight-oriented style where he doesn’t take an active role to help the client resolve specific issues. 

All said and done, let’s not have a halo effect about Dr. Khan’s therapy- that all therapy was excellent or bad because some of its aspects were so. 

At the beginning of therapy the client asks how therapy works. Dr. Khan replies that he’s clueless how it works. Though it was masked with humor, this can quickly break therapeutic alliance- the essential pillar of therapy, which means a professional relationship of trust and willingness to work on problems. Its like going to a surgeon and asking him how will the operation work? And the surgeon says he’s clueless. A more helpful answer could be ‘I can help you learn skills to manage your difficult feelings, understand how you could achieve your goals in relationships or profession by making you more efficient, and learn new habits of thinking and acting’.  He also praised the client by her looks, which is an absolute no-no. For many reasons, one of them being that this client’s self-image is negative and any praise will bounce off anyway. 

The goals of therapy were never set, nor a roadmap of therapy given to the client. Interestingly the client made progress just by insight. This doesn’t happen in the real world. We all often know why we are acting in an unhelpful way, but its not sufficient to get us back on track. Insight of why one is feeling and acting in a way, and an insight that its their own thoughts, beliefs and attitudes are responsible and not the past, and knowing and acting on a technique to get out of this cycle is what’s required to make progress. 

Conducting outdoor sessions is fine, but not picking up the client when she fell off the bicycle and was hurt physically is insensitive. Will only reinforce her fear of abandonment, as opposed to what Dr. Khan thought- that it will make her stronger. Ending sessions abruptly with the ring of bell only conveyed sticking to the rules, but also models rigidity. Thus, the warmth meter of the therapist was swinging between 0-10. Ideally it should be around 5 depending on the situation. Not too cold, not too warm. 

Assigning and checking homework is very helpful, and for simplicity in the movie, it wasn’t shown to be done in all the sessions, which therapists rather do in all sessions. He didn’t explain the rationale behind the homework, and when a therapist does this in real life, the client just doesn’t do the homework.

Dr. Khan portrayed himself as genius and not just another human being. He never sought feedback about the session, nor checked the client’s understanding of what he taught in the session. Ideally every therapist must seek feedback. Often times, the client takes away a wrong message home, which needs to be clarified.

The use of stories (the mountaineer) and analogies (chair as relationship) was done nicely, and using such things creatively is recommended. Dr. Khan appeared to be lecturing most of the times. In reality this doesn’t work in the long run for the client when they experience a difficulty again. Asking questions to self like, “What’s the proof I will be abandoned again, and is it the end of the world?” are more helpful.

Dr. Khan also made some technical errors. Though he identified the fear of being abandoned again and the fear of experiencing the same pain again as the root of her issues in the relationship, his reply was ‘Try looking at your parents as human beings who can make mistakes’. Its like ‘the dish has less salt, why don’t you add a pinch of black pepper to it’? Doing this will only address her Hurt towards her parents and not Anxiety towards relationships. A more accurate reply could be ‘You have gone through the pain and survived. Worst case it happens again, you can deal with it, and no pain kills us. Besides, its unlikely everyone will abandon you’.

The termination of therapy is ideally decided by the client and the therapist together and not the therapist alone. Dr. Khan didn’t seem to work collaboratively with the client. Its time to say good bye when the client has learnt new ways of relating to themselves, the world and problems, have learnt skills to deal with difficulties and manage a relapse. Keeping the doors open to come back as a client with firm boundaries drawn is more helpful than a curt termination.

Dr. Khan demonstrated a high commitment towards ethics and rules of therapy, which is to be modelled, but can be done without sitting on the arm of the couch close to the client. 

Dr. Shishir Palsapure MD MSc (Psy), Associate fellow and Supervisor of Albert Ellis Institute, New York is a certified supervisor and trainer for psychotherapists. He has trained thousands of mental health professionals and supervised their therapy so far internationally.

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