- The “golden age of television” has not only introduced viewers to innovative storytelling techniques, it’s also helped destigmatize topics like mental illness through its characters.
- Some TV therapists, however, don’t reflect what actual therapy is like, and others cross serious professional boundaries.
- INSIDER spoke with several mental health professionals about what TV gets right and wrong about therapy.
- Here are fictional therapists from TV shows, ranked from worst to best.
- Visit INSIDER’s homepage for more.
When “The Sopranos” debuted on HBO in 1999, it was widely credited for launching the “golden age of television,” thanks to its innovative storytelling and riveting plotline. It also broke significant barriers in delving into subject matter seldom seen on the small screen – mental illness and therapy.
Twenty years after “The Sopranos,” television has embraced tales of mental illness more than ever before. For that, Amy Cirbus, licensed social worker and manager of clinical quality at Talkspace, is grateful.
“It’s been really heartening to have more therapists portrayed on TV because it feels like it normalizes that therapy is part of people’s every day existence,” Cirbus told INSIDER.
However, fictional therapists vary widely in both how good they are at their jobs and how accurately they reflect real-world mental health services.
“One of the things that is really sad and frustrating for me is how therapists are oftentimes made to be these villains in their roles, while at the same time tasked with being heroes,” Anissa Moody, an associate professor of psychology at the City University of New York, told INSIDER. “It’s as though [the shows] don’t necessarily know how to place what a therapist does.”
INSIDER spoke to mental health professionals about which fictional therapists best serve their patients and which are more likely to damage, not improve, their patients’ psychological state. See our ranking, from best to worst, below.
16. Dr. Melfi, “The Sopranos” (1999-2007)
“The Sopranos” is largely recognised as the first television show to delve into the world of therapy. And while Tony Soprano’s psychiatrist, Dr. Jennifer Melfi, wasn’t always above board in her approach to treating notorious mobster Tony Soprano, experts have long agreed the portrayal is pretty accurate.
“It’s the best representation of the work we do that has ever been in film or on television,” Dr. Philip Ringstrom, an analyst at the Institute of Contemporary Psychoanalysis in Los Angeles, told The New York Times in 2001.
Relationship therapist Kelly Scott is also a Dr. Melfi fan. “She has moments where she sets boundaries really well with a Tony, who isn’t accustomed to having boundaries,” she said.
In one scene, for example, a fuming Tony smashed objects in Dr. Melfi’s office. Rather than freak out, she calmly told Tony his actions weren’t acceptable and that he crossed a boundary. Following her comments, Tony apologised – a rarity for the fictional mobster.
Dr. Melfi is also well-regarded by mental health professionals because she wasn’t overly set in her approach and was willing to be flexible in order to help Tony work through his problems. “If she were rigid, he wouldn’t have stayed with her,” Scott said.
What’s more, “The Sopranos” humanized Dr. Melfi. When, for instance, she saw Tony at the same restaurant as her, she said hello instead of ignoring him and going about her day.
15. Dr. Akopian, “Crazy Ex-Girlfriend” (2015-2019)
Part dramedy, part musical, “Crazy Ex-Girlfriend”set itself apart not just for its whimsical format, but also for its honest depiction of treating mental illness while navigating heartbreak.
Viewers first meet talk therapist Dr. Akopian when the life of high-spirited protagonist Rebecca Bunch begins to spiral out of control. After an ill-informed move across the country to win back a ex goes awry, Rebecca’s demons come back to haunt her.
Though she had been in therapy previously, Rebecca is reluctant to return and does everything possible to cancel her early sessions with Dr. Akopian, who is persistent without being pushy in urging her to continue. During the course of the series, Dr. Akopian helps her understand her feelings and behaviours in a constructive way that feels genuine, with a portrayal that celebrates therapy rather than stigmatizes it.
Cirbus expects positive portrayals like this to become more common as the stigma of seeking mental health help is reduced. “More and more people are going to therapy and they’re talking about it outside of the room,” she said.
14. Jeff Rosso, “Freaks and Geeks” (1999-2000)
On a show like “Freaks and Geeks,” a cult-classic that revolves around a group of misfit teens, it makes sense that the students’ guidance counselor would play an integral role. Jeff Rosso, played by Dave Allen, is that man and his character toes the line between approachable and stern.
In one scene, for instance, high schooler Lindsay cuts class. When Rosso finds out, he picks Lindsay up in his car and drives her back to school. On the trip back, she refers to Rosso by his first name, something Rosso has allowed as a way to help students feel more at ease.
According to Scott, an approach like Rosso’s can be helpful because therapists who overlook the importance of a patient feeling comfortable could end up alienating that patient.
When that happens, the patient “sees the therapist as someone who doesn’t understand or who is pushing an agenda,” Scott said. “It leaves the patient alone when the whole point of therapy is not being alone.”
13. Dr. Daniel Shin, “Crazy Ex-Girlfriend” (2015-2019)
“Crazy Ex-Girlfriend” was novel for showing not just one type of treatment for mental illness, but several, reflecting the reality of how nuanced the process can be. After seeing Dr. Akopian for some time, Rebecca sinks into further despair and eventually seeks additional help from a psychiatrist, Dr. Daniel Shin.
Dr. Shin not only provides her with a clarifying diagnosis of borderline personality disorder (the catalyst for the emotional ballad “A Diagnosis”), but also helps her find the right medication (prompting “Anti-depressants Are So Not A Big Deal”). He also introduces her to group therapy.
12. Dr. Ocean, “United States of Tara” (2009-2011)
Perhaps one of the most ambitious small-screen depictions of mental health, “The United States of Tara” tells the story of a woman battling disassociative identity disorder, also known as multiple personality disorder.
As the episodes journey through the many facets of Tara (played by Toni Collette), she cycles through a couple different therapists but she begins with Dr. Ocean. When Dr. Ocean refers Tara to a specialist in order to progress to the next stages of her treatment, Tara expresses she feels like she’s going through a breakup.
Moody said that though Tara’s representation of dissociative identity disorder is “way off” – most people with the condition display subtler symptoms than Tara’s intense and eccentric personalities, she said – the relationship between Tara and Dr. Ocean is healthy and realistic.
Further, a real, yet often painful, part of mental health treatment is occasionally having to part ways with a therapist to seek treatment that better suits the patient.
“In a healthy therapeutic relationship, the patient has choice and isn’t controlled,” Moody said. “It also showed the role of meds and that sometimes they are necessary.”
11. Molly’s therapist, “Insecure” (2016-)
Molly’s journey on HBO’s “Insecure” is riddled with bad relationships, perhaps most notably when she learns she’s the “other woman” in a couple’s open marriage.
Molly is sometimes seen sharing her trials with her unnamed therapist in the therapist’s picturesque Los Angeles office. While the therapeutic relationship isn’t a main focus of the show, the the therapy office itself – filled with books on wooden floor-to-ceiling shelves, art work and photographs in decorative frames, and unique ceramics and statues – suggests it’s a relatively good one, Scott says.
Displaying personal knick-knacks, books, and photos “can show humanity” in a therapist, which in turn helps with the therapist-patient relationship.
They can also act as conversation starters for nervous patients or visually represent that a therapist is also a mother and wife, and understands to an extent the problems her patients may have, Scott said.
10. Justina Jordan, “You’re The Worst” (2014-2019)
“You’re The Worst” chronicles the unlikely romance of Los Angeles misanthropes Gretchen Cutler and Jimmy Shive-Overly. As the series progresses, viewers learn that Gretchen’s proclivity toward self-destruction and flippant attitude is a mask for her larger struggles with mental illness.
After a debilitating bout of depression in season 2 – a portrayal Los Angeles Times television critic Libby Hill wrote was “truly revolutionary” and “the best explanation of clinical depression that television has ever produced” – Gretchen finally seeks help from therapist Justina Jordan.
Jordan helps Gretchen ultimately see that therapy is not a Band-Aid or silver bullet that will instantly fix her, as she had originally hoped. Though Jordan’s role is fairly minor, it shows how technology like FaceTime can enhance the therapeutic process.
9. Betty, “Broad City” (2014-2019)
In Comedy Central’s “Broad City,” a sitcom about two 20-something best friends navigating life in New York City, the character Illana – who’s known for her openness with sex and all things taboo – can’t orgasm after Donald Trump was elected President.
Enter Betty, a sex therapist who reassures Ilana she’s normal, saying “orgasms have been down 140% since the election.”
While the exchange was crafted for laughs, not as medical advice, some of Betty’s insights are legit. For instance, she tells Ilana that it’s ridiculous society thinks women can just climax when someone penetrates them with a penis. “Orgasms are a journey. They start in your mind,” she said. “It’s not going to be easy.”
Indeed, orgasms are just as mental as they are physical because when a person climaxes, different areas of their brain react and release hormones like dopamine and oxytocin.
“It may also be that, evolutionarily speaking, since this activity increases blood flow across the brain so dramatically, it may have developed in part to help keep the brain healthy, too,” cognitive psychologist Kayt Sukel previously told INSIDER.
In the end, Ilana used Betty’s advice and was able to reclaim her title as “come queen.”
8. Angela Bowden, “Wanderlust” (2018-)
In the show about therapist Angela Bowden trying to reassess her own marriage after a cycling accident, Bowden struggles transitioning from a monogomous relationship to an open marriage. Viewers see that struggle come up during patient sessions.
Bowden’s habit of letting her “personal life bleed into work without acknowledging that” could be harmful to patients if she counseled in real life, Scott said.
“It’s a little controversial, bringing your own humanity into sessions,” she said. While Scott sometimes uses her “experiences as reference points or to illustrate something,” other patients know nothing about her because she doesn’t think that knowledge will be helpful. In some cases it could even be harmful.
Bowden also has sex in her office. Although it’s not with a patient, the move makes her a less-than-ideal TV therapist.
7. Julia Sasaki, “Atypical” (2017-)
When viewers first meet Julia Sasaski – the therapist of “Atypical” protagonist Sam Gardner, a suburban teenager with Asperger’s syndrome navigating the difficulties of adolescence – she is even-keeled and thoughtful. She listens attentively and helps Sam through his struggles to forge meaningful connections with his peers and women.
Unfortunately, when Sam develops feelings for Julia that culminate into stalking behaviour and a major violation of privacy, Julia takes out her frustration on her patient with a verbal rant.
“She’s a pretty good representation initially, but then lashes out which is something that is, well, atypical,” said Cirbus.
6. Mr. Porter, “13 Reasons Why” (2017-)
The show’s troubling depiction of teenage suicide isn’t its only concerning aspect; high school guidance counselor Mr. Porter is too. When Hannah refuses to tell him the name of the student that assaulted her, he responds that there’s nothing he can do and that her only course of action must be to move on.
The conversation is cringeworthy, but Moody said the portrayal is unfair since it fails to realistically depict the challenges of high school counselors and the lack of resources at their disposal.
“It wasn’t really fleshed out – his role and his interactions,” she said. “He has a lack of information and we don’t see how difficult a school psychologist job can be, especially in under-resourced schools.”
5. Dr. Wayne, “Mad Men” (2007-2015)
In season 1 of “Mad Men,” a highly-acclaimed drama following adulterous ad man Don Draper in 1960s New York City, Draper’s capricious and well-coifed wife Betty visits a psychiatrist after a case of nerves leads to a car accident.
Dr. Wayne is an “old-school analyst” type whose patients lie on the couch – a depiction that’s not off-base when it comes to what psychotherapy looked like at the time, Moody said.
What’s concerning, and also telling of the era, is how Dr. Wayne supports Don as an “automatic proxy and overseer” of his wife, Moody said. This is seen most clearly when Don calls Dr. Wayne for intel on his wife, betraying modern practices that honour doctor-patient confidentiality.
“What you saw is this idea of this cold, male psychiatrist,” Moody said.
4. Paul Weston, “In Treatment” (2008-2010)
“In Treatment” follows psychotherapist Paul Weston as he counsels patients and also sees his own therapist.
Scott, a fan of the show as well as Weston’s therapy style, says the character is “adaptive and responsive to his patients and what they need from him,” she said.
For example, he worked with one couple, Jake and Amy, who are arguing over whether Amy should get an abortion. Rather than pit the couple against each other or egg them on, Weston “does an amazing job humanising Jake to his wife Amy,” Scott said.
But Weston is flawed. Most egregiously, he started a sexual relationship with one of his patients, a major ethical issue. “The one cardinal offence is having sex with a patient,” Scott said. “You cannot do it.”
According to the American Psychological Association Code of Conduct, it is unethical to have a sexual relationship with a current client, and sexual relationships with former clients is strongly discouraged. Therapists who sleep with current patients could be reported for their behaviour and potentially have their licenses revoked.
3. Dr. Reisman, “Big Little Lies” (2017-)
Although Dr. Reisman is a minor character in season 1 of “Big Little Lies,” a show that follows the lives of five mums embroiled in a small-town murder, she comes back with a vengeance in season 2. It’s then she tries to make Celeste feel guilty about missing her now-dead and once-abusive husband.
Dr. Reisman is also shown counseling married couple Ed and Madeline after Madeline cheated on Ed.
In one scene, Dr. Reisman attempts to make Madeline’s affair a black-and-white situation, becoming visibly frustrated when Madeline can’t seem to vocalize why she cheated on Ed.
Scott said her counseling style could ultimately isolate her patients, which is the opposite of therapy’s goal.
“My overriding feeling is that the therapist is provocative without a goal. She’s just trying to stir up conflict without framework [for helping her patients],” Scott added.
2. Heidi Bergman, Homecoming (2018-)
“It’s a well-established relationship and there’s banter back and forth that happens in therapy, and I think that’s really accurate in real life,” she said. “We get to know our clients really well and it seems like just a conversation, but they’re actually in session.”
However, the story quickly takes a turn when Heidi acts on her romantic feelings and the two forge a romantic relationship, a move that could be career-ending in the real world.
1. Jean Holloway, “Gypsy” (2017)
If you want to see an unrealistic portrayal of therapy, watch “Gypsy,” a psychological thriller about a therapist who loves to interject herself into her patients’ lives.
In one episode, for example, Holloway, played by Naomi Watts, tracks down the ex-girlfriend of one of her patients and befriends her under a fake name, “Diane.”
Holloway continuously disregards therapy ethics and constantly blurs the lines between work and play for her own self-serving reasons.
“Holloway is the hottest of hot messes,” Scott said. “I can’t believe she’s a therapist. It’s like the ‘Real Housewives of Therapy.'”