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Abstract

Cinema is riddled with negative portrayals of psychotherapy. In a media-saturated culture, public attitudes regarding the prevalence of mental illness, the symptomatology that defines abnormality, and the professionals who address such disorders are profoundly influenced by the images and messages in cinema and mass media. It is imperative for psychologists to maintain an awareness of the cinematic portrayals of psychotherapists, psychotherapy, and mental illness in order to better understand clients' expectations for therapy. By increasing awareness of the role of the media in shaping the image of professional psychology, clinicians can hope to decrease the stigma surrounding mental health care through engaging in discussions of these media stereotypes and advocating for more realistic portrayals of psychotherapy. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Cinema and the Valuing of Psychotherapy: Implications for
Clinical Practice
Lindsay M. Orchowski, Brad A. Spickard, and John R. McNamara
Ohio University
Cinema is riddled with negative portrayals of psychotherapy. In a media-saturated culture, public
attitudes regarding the prevalence of mental illness, the symptomatology that defines abnormality, and
the professionals who address such disorders are profoundly influenced by the images and messages in
cinema and mass media. It is imperative for psychologists to maintain an awareness of the cinematic
portrayals of psychotherapists, psychotherapy, and mental illness in order to better understand clients’
expectations for therapy. By increasing awareness of the role of the media in shaping the image of
professional psychology, clinicians can hope to decrease the stigma surrounding mental health care
through engaging in discussions of these media stereotypes and advocating for more realistic portrayals
of psychotherapy.
Keywords: cinema, movie, media, psychotherapy
Before entering the therapy room for the first time, many clients
perhaps ask themselves, “What exactly am I getting myself into?”
Such a question is understandable, given that aside from an indi-
vidual’s own experiences in psychotherapy or the anecdotal expe-
riences they collect from other sources (i.e., literature, peers, the
Internet), research suggests that one’s conceptualization of psy-
chotherapy and its uses is formulated through the often stereotypic
portrayals of psychologists in TV programs or film (i.e., Jorm,
2000). According to Wolff, Pathare, Craig, and Jeff’s (1996) study
of adults in the United Kingdom, 32% of respondents cited the
media as their main source for obtaining information on the
experience of psychological distress. Therefore, when people
make decisions about health care services or providers in a media-
saturated culture, their behavior may in part be influenced by
various mass media messages regarding the experience of illness,
what constitutes effective treatment, and the expected behavior of
health care providers (Signorielli, 1993). The role of media in
influencing consumers’ mental health care decisions is of utmost
concern to the field of professional psychology, especially in view
of research findings indicating that the general public is not well
informed about mental health and mental health disorders, partic-
ularly in comparison with physical health and disease.
For example, Jorm (2000) suggested that consumers’ “mental
health literacy” is quite low in that much of the general public
cannot recognize specific types of psychological distress. Jorm
(2000) also noted that consumers’ beliefs regarding appropriate
mental health care treatments are vastly incongruent with the
accepted and effective treatments recommended by mental health
care practitioners. Focus groups and telephone surveys conducted
by the American Psychological Association to address the image
of professional psychology also have suggested that whereas the
majority of individuals recognize the importance of mental health
care, they nonetheless feel uninformed regarding how and when to
access such services (Farberman, 1997). Data also have suggested
that, overwhelmingly, “the public has very little understanding of
the qualifications and credentials of psychologists and cannot tell
one mental health provider from another” (Farberman, 1997, p.
128).
Given current levels of mental health care “illiteracy,” it follows
that clients are (inappropriately) socialized to the media version of
psychotherapy long before they choose to enter the therapy room.
Gabbard and Gabbard (1999) go so far as to suggest that the public
perspective on professional psychology was constructed within the
film industry itself. Arriving from Europe at the same time as the
movie industry, in essence, the disciplines “grew up together”
(Gabbard & Gabbard, 1999, p. xxi). The first psychotherapist
appeared in Dr. Dippy’s Sanitarium (American Mutoscope and
Biograph Company & Bitzer, 1906) as a laughable, bearded med-
ical doctor, who spoke with an accent and was arguably more
disturbed than his sanitarium of unruly clientele. Over the decades,
therapists in film have evidenced “multiple personalities,” ranging
LINDSAY M. ORCHOWSKI received her MS from Ohio University in 2006.
Currently, she is a doctoral candidate in clinical psychology in the Depart-
ment of Psychology, Ohio University. Her clinical and research interests
include risk factors for sexual victimization, development and evaluation of
sexual assault risk reduction and prevention programming, and profes-
sional issues in psychology.
BRAD A. SPICKARD received his MS from Ohio University in 2005. Cur-
rently, he is a doctoral candidate in clinical health psychology in the
Department of Psychology, Ohio University. His clinical and research
interests include health psychology, neuropsychology, chronic pain, head-
ache, and cognitive performance.
JOHN R. MCNAMARA received his PhD from the University of Georgia in
1972. He is the currently a professor in the Department of Psychology,
Ohio University. He has published on a variety of topics related to
professional psychology and is also interested in the development of
instruments to measure the effects of partner abuse.
CORRESPONDENCE CONCERNING THIS ARTICLE should be addressed to Lind-
say M. Orchowski, Department of Psychology, 200 Porter Hall, Ohio
University, Athens OH, 45701.
Professional Psychology: Research and Practice Copyright 2006 by the American Psychological Association
2006, Vol. 37, No. 5, 506–514 0735-7028/06/$12.00 DOI: 10.1037/0735-7028.37.5.506
506
from heroic or evil to peculiar or disheveled (Schneider, 1999, p.
xvi). Notably, over the past century, Hollywood producers have
provided a surplus of nutty, debased, or sexualized psychothera-
pists for viewers to draw on in forming their opinions of the field.
According to the filmography in Psychiatry and the Cinema, for
example, over 450 films depict some form of psychotherapy ex-
perience (Gabbard & Gabbard, 1999). Such negative portrayals of
therapists within cinema are particularly disturbing given consum-
ers’ current manifestation of mental health care illiteracy.
Schultz (2005) suggested that negative portrayals of psychother-
apists are even more damaging to the discipline of professional
psychology than are the negative depictions of other professional
disciplines. Deviant lawyers and physicians also riddle the cine-
matic archives. However, the frequency with which the general
public visits physicians, and even lawyers, as compared with
mental health providers, affords such disciplines a buffer against
negative screen stereotypes that professional psychology simply
does not enjoy (Schultz, 2005). With relatively few alternative
experiences or examples with which to compare these images of
villainous or disheveled onscreen psychotherapists, moviegoers
are left with potentially aversive images of what psychotherapists
look like, how they act, and what they do (e.g., Donino, 1983;
Gharaibeh, 2005). The cinematic portrayal of individuals who
experience psychological distress is also concerning given that
individuals are often depicted as seriously disturbed and often
potentially dangerous (e.g., Hyler, Gabbard, & Schneider, 1991).
With a few notable exceptions, professional psychology has
paid relatively little attention to the portrayal of psychotherapy in
film and its influence on the discipline. For example, the American
Psychological Association (1996) Public Education Campaign ex-
plored several barriers to accessing mental health services
(Schultz, 2005). Symposiums and publications from Division 46 of
the American Psychological Association, the Division of Media
Psychology, have been noteworthy in initiating much needed dis-
cussion and research into trends within cinematic portrayals of
psychotherapy. Proactive initiatives regarding cinematic influ-
ences on professional psychology are also beginning to emerge,
such as consultation services with Hollywood producers in order to
provide more accurate depictions of therapists in movies. The
MediaWatch Committee of Division 46, for example, has devel-
oped an award for TV and movie producers showing excellence in
the responsible portrayal of mental health professionals, the
Golden Psi Media Award (Schultz, 2005).
Despite the notable efforts of researchers and Hollywood con-
sultants, by and large clinicians have paid little attention to cine-
ma’s role in shaping the public’s view of mental health care
provision, its contribution to the potential devaluation of the pro-
fession, and how this information might be incorporated into
psychotherapy. As such, the purpose of the present review is to
provide an overview of the types of cinematic images of psycho-
therapists, the therapeutic orientations common to psychothera-
pists portrayed in movies, the mechanism of change typically
depicted in films (i.e., quick-fix medications vs. long-term lifestyle
changes), as well as the types of disorders portrayed in film.
Hypotheses as to how such stereotypes may influence clients’
expectations for treatment and the therapeutic alliance are inte-
grated throughout the description of cinematic stereotypes. A
second objective of the current review is to discuss how such
negative and often unethical cinema portrayals may be addressed
within clinical practice and through advocacy on behalf of the
discipline.
Cinema Portrayals of Psychotherapy
Surprisingly, cinema and the field of psychology have many
commonalities. Both disciplines are primarily concerned with the
intricacies of human emotions, thoughts, motivations, and experi-
ences and, “in pursuit of their common subject, movies and psy-
chiatry have frequently intersected” (Schneider, 1999, p. xvi).
According to the authors of Psychiatry and the Cinema (Gabbard
& Gabbard, 1987, 1999), the construction of psychotherapy within
the public eye was inextricable from the growth and development
of the movie industry. In fact, psychotherapists may be depicted in
American movies more often than any other type of medical
professional, simply as a result of their cinematic convenience
(Gabbard & Gabbard, 1999). Eager for an efficient mechanism by
which to explicate the hero’s motivations and inner thoughts, the
movie industry in many ways has exploited the profession of
psychology as a mechanism by which to quickly provide the
viewer with insight into the hidden motives of characters. As
Gabbard and Gabbard (1999) observed, “like telephone conversa-
tions, psychiatric consultations have offered filmmakers the per-
fect device for unearthing dark secrets and simplifying exposition”
(p. 6). Like the strings of a puppet, psychotherapists provide a
quick-and-dirty means for moviemakers to add complexity and
movement to their plot (Gabbard & Gabbard, 1999).
Accordingly, it may be unfair to expect that the motion picture
industry present a balanced or fair depiction of the ever changing
field of psychotherapy—such a venture would be potentially un-
profitable (e.g., Schultz, 2005). A realistic portrayal of psycho-
therapy would hardly meet the quotient of alliance ruptures and
slips of the tongue necessary to earn high ratings as a reality TV
show (Schultz, 2005). Rather, the primary objective of the film
industry is to create an evocative and entertaining storyline, not to
accurately display the theoretical complexities and sophistication
of the world’s professions. Unfortunately, however, when utilized
for such cinematic conventions and plot descriptions, the movie
industry represents little—if any— of the complexity of psycho-
logical science (Gabbard & Gabbard, 1999). Instead, portrayals of
psychotherapy, psychologists, and their clients in cinema fre-
quently depict stereotypical conventions and caricatures of the
discipline.
Early research by Schneider (1987) characterized psychothera-
pists within cinema into three categories: (a) Dr. Dippy, (b) Dr.
Evil, and (c) Dr. Wonderful, corresponding to the trifold cinematic
prototypes of therapists as either bumbling, villainous, or salvific.
Throughout early 20th-century film, “every idealized healer was a
thick accented, incompetent, and frequently malevolent quack”
(Gabbard & Gabbard, 1999, p. 74). The review presented here is a
collection of the various stereotypes and conventions reported
within critiques of cinematic psychotherapy. Our aim is to provide
the clinician with a practical framework from which to understand
the preconceptions that many clients may bring with them to
therapy.
507
CINEMA AND THE VALUING OF PSYCHOTHERAPY
Types of Psychotherapists
As previously discussed, few filmmakers have broken from
narrow generic conventions and put cinematic psychiatrists to
imaginative uses. Often the portrayal of psychotherapists in film is
dualistic— either good or bad. Gabbard and Gabbard (1999) iden-
tified attributes of therapists within cinema and noted the opposing
portrayals of these attributes within “good” and “bad” psychother-
apists. Generally, therapists are perceived as good when they work
to benefit the patient and adhere to ethical standards. Films may
depict therapists working passionately with their patients, even if
the individuals’ interactions with the therapist are minimal. How-
ever, equally common within cinema are portrayals of “bad”
psychotherapists. Notably, bad therapists need not completely em-
body Dr. Evil. The bad therapists can be inappropriate or unethical,
subtly harming the patient or failing to maintain professional
boundaries. The dualistic presentation of good and bad therapists
extends across a range of stereotypic psychotherapeutic personal-
ities— encompassing therapists as eccentric, faceless, sexual, or
oracles of the future— each with varying consequences for the
audience. As such, an examination of some of these attributes
noted by Gabbard and Gabbard (1999) is warranted.
The Oracle
The therapist as prophet is a common cinematic trope. Accord-
ing to Gabbard and Gabbard (1999), psychotherapists often serve
as “oracles” within film, claiming to have brilliant insight into the
patient’s psyche. As reported by Gabbard and Gabbard (1999),
psychotherapists often play such beneficent roles in crime and
detective movies, in which they are frequently (and conveniently)
bestowed with miraculous oracular abilities. However, when
oracularity is contemptuously portrayed, the therapist is depicted
as an erudite and pretentious know-it-all who provides misinfor-
mation. The role of the therapist as prophetic oracle is problematic
in the illustration of both “good” or “bad” cinema therapists,
encouraging the myth of a magical cure for psychological distress
(Gabbard & Gabbard, 1999).
The Societal Agent
Another dualistic representation of psychotherapy is witnessed
in the role of psychotherapist as social agent. According to Gab-
bard and Gabbard (1999), when “bad” therapists are depicted in
this role, they are frequently witnessed forcing nonconforming
members of society into alignment with cultural norms. For ex-
ample, Director Milos Forman’s Academy Award winning film
One Flew Over the Cuckoo’s Nest (Douglas & Zaentz, 1975)
depicted the deinstitutionalization movement of the 1970s and, by
doing so, vilified all “mental health” programs in the eyes of its
viewers (Wilson, 1999, pp. 78 83). The character of Nurse
Ratched, the mental health professional in the film—and conse-
quently the “representative” for the discipline of professional psy-
chology— encourages the misperception that mental health profes-
sionals frequently betray the people they intend to help for their
own personal gain. Witnessed overmedicating the patients in order
to ensure their compliance, Nurse Ratched depicts a mental health
system that exploits the individuals that it was established to help
(Wilson, 1999).
Although such “bad” mental health professionals, and conse-
quentially poor client outcomes, are easy to spot in cinema, the
most concerning and most prevalent form of therapeutic experi-
ence is a “bad” therapist resulting in a positive client outcome.
Such portrayals present the eccentric and often unethical behavior
of the psychotherapist as a curative factor in psychological care,
encouraging the audience to align and sympathize with “bad”
clinicians and to “cheer them on” in pursuit of ethical dilemmas
(Gabbard & Gabbard, 1999). The two most common depictions of
such role-blurring behaviors are witnessed in eccentric and roman-
tic portrayals of psychotherapists.
The Eccentric and the Romantic Therapist
Frequently depicted as odd, eccentric, or even crazy, the positive
depiction of a bumbling psychotherapist is often interpreted by
audiences as a sign of the professional’s humanity. However, when
the character of the therapist with an odd persona is negative, the
result is a disheveled, clownish, and unorganized professional who
conducts largely ineffective psychotherapy. This myth is taken to
an extreme in portrayals of psychotherapists as “crazy” or out of
touch with reality (Schultz, 2005). The therapist in The First Wives
Club (Rudin & Wilson, 1996),for example, advocates for Diane
Keaton’s character to release anger by hitting her with a plastic bat.
In another comedic representation of this popular myth, Jack
Nicholson, a therapist in the movie Anger Management (Bernardi
& Giarraputo, 2003),climbs into bed with his client, Adam
Sandler.
The boundary between “good” and “bad” psychotherapists is
ever more problematically blurred in the portrayal of psychother-
apists who fall in love with their patients. Although acting on
sexual countertransference is strictly unethical, such instances are
frequently portrayed in cinema therapy. However, rather than
illustrate the incident as an abuse of power and authority, films
often encourage audiences to sympathize with the “lovers.” Al-
though viewers may have a vague sense that such interactions are
inappropriate or, at the very least, bizarre, the general public does
not understand the subtle complexities of dual relationships within
professional psychology (Schultz, 2005). As Gabbard and Gabbard
(1999) noted, these problematic exhibits of sexual countertrans-
ference “contribute to the de-medicalization of psychiatry, sug-
gesting that disturbed people need only love and that if psychia-
trists really care, they can save their patients by supplying that
love, even if they also must give up their profession and the
possibility of healing anyone else” (p. 20). Films that depict
curative therapy as a result of sexual interactions between client
and patient send the strong message that unethical behavior is
permissible so long as it benefits the patient. Although the film
industry is not to blame for the incidence of sexual boundary
violations between psychotherapists and their clients, it is quite
plausible that such depictions serve to maintain popular beliefs of
the commonness of inappropriate client–therapist relationships
(e.g., Bram, 1997).
508 ORCHOWSKI, SPICKARD, AND MCNAMARA
The Wounded Healer
Another popular myth that Schultz (2005) illustrated is that of
psychologist as the wounded healer. Schultz (2005) cited the
movie Good Will Hunting as an example of this myth: The psy-
chologist in the movie, Robin Williams, grabs his client by the
throat after he disrespects his wife during a therapy session.
Despite this altercation, the mourning therapist learns that he is just
as distressed as his patient, and the two characters learn and grow
from their shared experience. Such portrayals of psychotherapists
as poor limit setters often blur the boundaries of acceptable and
unacceptable behavior within the therapeutic relationship. Whereas
such behavior is recognized by therapists as a clear encounter with
countertransference, moviegoers develop a sense of compassion for
the misguided professional, viewing his disclosure as an acknowledg-
ment that even professionals are fallible (Schultz, 2005).
Researchers have only begun to test the reasonable assumption
that these movie stereotypes of psychotherapists serve to construct
clients’ expectations for treatment and treatment-seeking behavior.
A unique study was recently presented at the annual conference of
the American Psychological Association that addressed physiolog-
ical arousal and attitudes toward stereotypic portrayals of psycho-
therapists. Flowers et al. (2004) utilized physiological skin condi-
tioning through an eight-channel polygraph, as well as real-time
data of skin conductance and heart rate, to measure the effect of
exposure to four types of cinema therapists: (a) Dr. Wonderful
(i.e., idealized), (b) Dr. Dippy (i.e., bearded 19th-century medical-
ized therapist with erudite accent), (c) Dr. Flawed (e.g., Good Will
Hunting), or (d) Dr. Evil (e.g., One Flew Over the Cuckoo’s Nest).
Changes in mean heart rate and skin conductance level were
measured from baseline to the video clip presentation of each
therapist type. Results of these measurements suggested that whereas
participants did not perceive Dr. Dippy or Dr. Evil to be realistic
portrayals of psychotherapists, they did perceive Dr. Flawed to be a
realistic portrayal of a psychotherapist (Flowers et al., 2004).
Flowers et al.’s (2004) research supports reports of lingering
negative attitudes toward psychotherapy within the general public
For example, although clients generally perceive psychotherapy as
helpful, the public perception of therapy contains many fears of
stereotypical mistreatment arising from stories of institutionaliza-
tion (McCarthy & Frieze, 1999). Coursey et al.’s (1991) study of
204 chronically mentally ill patients revealed that although 90% of
respondents found individual therapy to be helpful, their percep-
tions of therapy reflected general themes of power, authority,
discrimination, and perceived mistreatment. As this study sug-
gests, generalized anecdotal reports of the perceived mishandling
of more severely mentally ill patients—as witnessed in One Flew
Over the Cuckoo’s Nest—indicate that cinematic stereotypes may
play a large role in maintaining the stigma surrounding mental
illness and individuals’ perceptions of, and engagement in, psy-
chotherapy (Karlinsky, 2003).
Therapeutic Techniques
Although psychotherapy has expanded far beyond its psycho-
analytic roots, movie portrayals most often represent psychologists
in a customary psychoanalytic role—interpreting dream sequences
and talking about the role of early childhood experiences. In fact,
as Gabbard and Gabbard (1999) noted, “If filmmakers have stud-
ied the history of the psychoanalytic movement, it would seem that
they stopped reading Freud’s work at this particular historical
point. Most of the positive portrayals of psychotherapy or psycho-
analysis revolve around the de-repression of a traumatic memory”
(p. 28). Undoubtedly, Freud would have harshly objected to the
prevalence of “celluloid shrinkage,” resulting from the media’s in-
ability to truthfully illustrate the abstractions and art of psychotherapy
(Greenberg, 2000, p. 330). Greenberg’s (2000) observation of cinema
psychoanalysis is quite pessimistic: “Whatever diagnosis invoked,
celluloid shrinks generally continue to provide mere catharsis without
deep insight, an occasional shot of hypnosis, and a plethora of sim-
pleminded advice one could get across the garden fence” (p. 337). The
result of such limited insight into the complexities of therapeutic
techniques and orientations unquestionably limits clients’ perceptions
of how therapy might meet their particular needs and the specific tasks
and activities that treatment may involve.
Similarly, the most frequently depicted myth of psychotherapy
is the omnipresence of the “talking cure.” In this sense, the cinema
has played a large role in the development of public confusion
between the roles and practices of various mental health profes-
sionals. As Gabbard and Gabbard (1999) suggested, American
cinema has failed to distinguish psychoanalysts from social work-
ers and psychiatrists from guidance counselors. For example,
although psychiatry continues to distance itself from the talking
cure, film most often portrays both psychologists and psychiatrists
in the client–patient talking role. If medication is even prescribed
within the film, it is frequently unclear where pharmacological
interventions derive from, who prescribes the medication, and how
medication is used in conjunction with therapy. In fact, the work of
the therapist is often so vague that it could be confused with that
of religious counsel or advice columnists in a newspaper (Gabbard
& Gabbard, 1999). Such limited portrayal of different types of
therapeutic experiences on the silver screen (i.e., images that do
not portray psychoanalysis or a magical cure) is also likely to
preserve the general public’s overall confusion regarding the spe-
cific tasks and activities that treatment involves, potentially limit-
ing consumers’ desire to seek treatment.
Mechanisms of Change
Despite the role confusion of psychiatrists and psychologists,
social workers, and religious figures, a perhaps more frightening—
and influential—aspect of cinema is its depiction of recovery and
change within the therapeutic relationship. Cinematic portrayals of
therapy often show clients walking out of the therapist’s office
smiling at the sun after a brief and miraculous moment of recovery
(Gabbard & Gabbard, 1999). Whereas such portrayals of psycho-
therapists may seem, at first, to recognize the usefulness of mental
health care, such magical reductions in symptomatology are rare
phenomena, and moments of miraculous recovery of memory and
instantaneous healing rarely, if ever, occur in practice (Schultz,
2005). Such portrayals are quite problematic when placed in the
context of managed care, which emphasizes short-term therapy in
order to reduce the scope and cost of mental health treatment. The
expectation of a miraculous minute cure may set up a client, who
is limited to short-term therapies, for experiencing significant
distress when such expectations are not quickly satisfied.
509
CINEMA AND THE VALUING OF PSYCHOTHERAPY
Types of Mental Illness
In cinema, individuals with emotional difficulties and concerns
are frequently presented in a dramatized fashion, providing a
skewed frame of reference for the audience on the constitution of
various psychological dysfunctions (Hyler, 1988; Hyler et al.,
1991). For example, a myth that is commonly depicted is the
psychiatric patient as a “homicidal maniac” (Hyler et al., 1991).
The popularity of this myth can be observed in a large percentage
of slasher films such as Nightmare on Elm Street and Friday the
13th (Wedding & Niemiec, 2003, p. 208). Several more detailed
conceptualizations of the portrayal of mental illness in cinema are
summarized in a recent analysis by Wedding and Niemiec (2003).
For example, these authors described Wahl’s (1995) data-driven
schema of cinematic mental illness according to the following five
principles: “(a) some people with mental illness are dangerous;
however, (b) the vast majority are neither violent nor dangerous,
(c) violence, when it does occur, is seldom directed at strangers,
(d) the insanity defense has not resulted in the release of large
numbers of dangerous individuals into the community, and (e) the
portrayal of mental illness in media is highly inaccurate” (as cited
in Wedding and Niemiec, 2003, p. 208). Another approach to the
cinematic mythology of mental illness has been provided by Hyler
(1988), who suggested that three main myths are perpetuated by
the movies, including (a) “the belief that harmless eccentricity is
frequently labeled as mental illness and inappropriately treated”;
(b) the “myth of the schizophrenogenic parent who is cold, distant,
and aloof, and demonstrated classic examples of double binds”;
and (c) “the ubiquitous presumption of traumatic etiology“ (as
cited in Wedding & Niemiec, 2003, p. 208). Finally, Wedding and
Niemiec’s (2003) compendium generated two additional—and
highly specific— cinematic myths of mental illness not discussed
by previous authors, including the idea that love alone can heal
psychological distress and that schizophrenia and dissociative
identity disorder are equivalent forms of psychological illness.
The above types of mental illness that are portrayed in films
may play a role in the formulation of a client’s beliefs of the types
of personal difficulties that warrant psychological intervention.
Specifically, such portrayals may result in the creation of a media
template (e.g., Kitzinger, 2000; as cited by Seale, 2003) that acts
as a “ready-made set of stereotypes, judgments and interpreta-
tions” (p. 519). Just as a media event, such as an episode of child
abuse, creates a template for every reported child abuse case
following that, a similar phenomenon occurs in a film’s illustration
of a given pathology.
Clearly, the public receives a plethora of information on what it
looks like to experience psychological dysfunction from the por-
trayals of mental illness on the silver screen. It is highly unlikely,
then, that these stigmatizing images result in a positive public
perception of professional psychology or encourage individuals
with seemingly less serious problems to seek psychological coun-
sel. Instead, such portrayals likely further buttress enduring doubt
and disapproval of the mental health profession (Karlinsky, 2003).
For example, there is evidence to suggest that the disproportionate
portrayal of serious mental illness in cinema may be linked to
increased treatment-seeking behaviors for serious mental illness as
opposed to less severe forms of psychological distress (Lauber,
Nordt, Falcato, & Ro¨ssler, 2001). For example, Angermeyer and
Matschinger’s (2005) survey of 4,005 randomly selected West
German adults suggested that over the course of the 1990s, “the
German public became more inclined to recommend [individuals]
to seek help from psychiatrists or psychotherapists in case of
schizophrenia or major depression. There was also an increase in
the willingness to recommend therapy in general, which was
particularly pronounced with regard to drug treatment and psycho-
therapy of schizophrenia” (p. 68). Although such research is a
positive sign of increased treatment-seeking behavior for more
serious mental illness and positive attitudes toward psychiatric
care, it remains unclear how the apparent lack of portrayals of less
serious mental illness in cinema may decrease help-seeking be-
haviors among individuals who rate the seriousness of their own
distress as less than homicidal.
Implications for Clinical Practice
The stereotypes of cinema psychotherapists are unflattering to
say the least. Nonetheless, whereas several assumptions may be
drawn from these representations of psychotherapists within the
movie industry, additional research is sorely needed in order to
understand the precise influence of cinema therapy on the current
climate of psychotherapy. Other than the movie industry’s survey
of an audience’s likelihood to “pay to see it,” psychotherapy
research has largely failed to empirically address viewer response
to cinema therapy (J. V. Flowers, personal communication, May
23, 2005). Given the paucity of information about cinema thera-
py’s influence on clients’ expectations for treatment and treatment-
seeking behavior, it may be premature to conclude that portrayals
of therapists in film have a specific influence on the discipline of
professional psychology (Flowers et al., 2004). Nonetheless, cli-
nicians can take several proactive steps to address the potential
influence of the media on the practice of professional psychology.
Addressing Countertransference
Clearly, how psychotherapists and mental health professionals
view themselves and the work they do frequently clashes with the
on-screen image of psychotherapy. As such, clinicians can begin to
address the potential influence of film on their practice of psy-
chology by examining their own attitudes toward psychotherapy in
the cinema and their experiences of viewing psychologists in film
and through developing a better awareness of how these stereo-
types have influenced their own identity as therapists and under-
standing of psychological distress.
For example, Atkinson (1999), a practicing therapist and self-
proclaimed “film junkie,” reviewed an extensive filmography for
“authentic” portrayals of therapeutic relationships, defined by eth-
ical standards of practice and authentic client–therapist interac-
tions. Like Gabbard and Gabbard (1999), Atkinson found spar-
ingly few genuine cinematic portrayals of therapeutic experiences.
Not only are the majority of cinema-portrayed psychotherapists
male but these characters are frequently faceless, with few iden-
tifiable personality traits or signs of a social life. The skeleton of
the psychotherapist that remains is characterized instead by a
singular stereotypical hobby (i.e., collecting stamps) and stereo-
typed personality traits, such as blind compassion or authority.
One must then also wonder, how does cinema therapy influence
510 ORCHOWSKI, SPICKARD, AND MCNAMARA
therapists’ own identities? Again, it is doubtful that these glaring
characterizations of cinema therapists draw individuals into the
field or bolster practicing therapists’ pride in their profession.
Consequently, Gabbard (2001) has provided several suggestions
on how therapists can manage their film-related countertransfer-
ence. As Gabbard (2001) advocated, therapists should “view the
distortions [of therapists in cinema] with detached curiosity, with
empathy and with understanding, just as they approach attitudes in
patients” (p. 369). From this awareness and understanding of the
depictions of psychotherapy in film, therapists may engage in a
more collaborative discussion about how such portrayals may
potentially influence clients’ expectations for treatment and con-
tribute to treatment barriers. Gabbard (2001) also noted that ca-
reers in professional psychology require an individual to “serve as
a target” for the clients’ transference reaction as well as accom-
modate the transferential projections of therapists on the big-
screen. As such, he suggested that therapists must, for the time
being, come to terms with the negative portrayals of psychotherapy
in film and settle with deriving some comfort from the fact that
psychotherapy is mentioned at all.
Incorporating Film Into Clinical Practice
Cinematherapy represents a new and growing collaboration
between media and psychology that draws together the alluring
and entertaining qualities of film with the facilitative processes of
modeling and social learning (e.g., Hesley & Hesley, 2001; Ho-
renstein, Rigby, Flory, & Gershwin, 1994; Sharp, Smith, & Cole,
2002; Solomon, 1995). Berg-Cross, Jennings, and Baruch (1990)
coined the term “cinematherapy” to describe the therapeutic tech-
nique of using films to induce a specific therapeutic effect or as a
stimulus for in-session discussion. According to Hesley and Hes-
ley’s (2001) model, a film may be “prescribed” as a homework
assignment. After viewing the film, the client and the therapist
discuss the insight gained from the film.
Wedding and Niemiec (2003) discussed films’ ability to act as
a catalyst in therapy, enabling clients to discuss topics that they
may otherwise be too uncomfortable discussing. In this manner,
films can be used to introduce clients and family members to
mental disorders (e.g., Wedding & Boyd, 1999), to educate clients
about specific types of psychological distress (e.g., Finlayson,
Schneider, Wan, Irons, & Sealy, 1999), to provide clients with
hope and encouragement, to demonstrate alternative perspectives
on psychological distress (i.e., reframing problems), to help clients
identify internal strengths and values, and to encourage emotional
expression and in-session communication (Hesley & Hesley,
2001). Similar to the use of bibliotherapy as an adjunct activity to
therapy, Berg-Cross et al. (1990) suggested that cinematherapy
also fosters collaboration within the therapeutic alliance. As
Calisch (2001) noted, when clients talk about films in therapy, they
have a common ground on which to relate to the therapist, which
may aid the client in perceiving the therapist as less threatening
and more of an “equal” within the therapeutic relationship. The
growing use of films in psychotherapy may parallel a burgeoning
interest in other action-oriented therapies and experiential psycho-
therapies, such as psychodrama (e.g., Moreno, 1972), which en-
courage individuals and groups to engage in role-playing activities
in order to experience new roles in a safe environment while
gaining insight into alternative perspectives.
As Karlinsky (2003) noted, the use of film within therapy,
although creative, has yet to be evaluated as an efficacious thera-
peutic intervention. Certainly, films have the capacity to influence
individuals both positively and negatively. It is possible, that the
representation of therapists in some films may be so askew that
using the media within therapy could have potentially detrimental
effects for the client, the therapeutic relationship, and therapy
itself. For example, films that portray sexualized relationships
between therapists and their clients may have no reason to be
integrated into treatment. As with any intervention, it is necessary
for therapists to evaluate the usefulness and purpose of including
a particular form of media within therapy and to assess possible
risks before incorporating cinema into their practice. Calisch
(2001) suggested that clinicians can minimize the risks of utilizing
inappropriate or ineffective films within therapy by choosing films
strategically, providing guidelines and boundaries for viewing the
media, and considering the messages that assigning a film may
send to both the client and their family members.
Karlinsky (2003) documented several resources that clinicians
may access when searching for particular films to use within
therapy. Peske and West’s (1999) self-help book on cinematherapy
and Pinterits and Atkinson’s (1998) review provide useful re-
sources for clinicians who are searching for movies to utilize in
clinical practice. Calisch (2001) suggested that asking for recom-
mendations from colleagues who use movies in therapy may be
another resource for identifying films that are specifically tailored
to clients’ needs.
Addressing Expectations for Psychotherapists,
Psychotherapy, and Mental Illness
Even if films are not directly incorporated into therapy, cinema
may nonetheless be a useful avenue through which to discuss
clients’ preconceptions about psychological distress and expecta-
tions for therapy as well as for introducing the tasks, goals, and
structure of therapy. For example, clinicians may discuss with
clients how their expectations for therapy developed. Such discus-
sion may include images of psychotherapists, psychotherapy, and
mental health that the client may have witnessed in mass media
and how these images have shaped clients’ expectations of the
experience of therapy. Such a discussion could also provide the
client with an opportunity to discuss potential fears about therapy
or mental illness. Within this context, the clinician may provide
educational information regarding the tasks and goals of therapy.
If noted, the therapist can provide corrective information to ad-
dress any potentially harmful misconceptions about therapy or the
therapeutic relationship.
Use in Clinical Training
If cinema can be utilized within the therapeutic relationship
itself, it follows that cinema must also be integrated into the
training of graduate students in the psychological sciences (e.g.,
Alexander, 1995; Alexander, Hall, & Pettice, 1994; Fritz & Pope,
1979; Koren, 1993; Pinterits & Atkinson, 1998; Tyler & Reynolds,
1998). Sierles (2005) suggested that movies can play an important
511
CINEMA AND THE VALUING OF PSYCHOTHERAPY
role in educating psychiatric residents about cultural experiences,
including different experiences of gender, race, socioeconomic
status, religion, and sexual orientation. Films provide a rich source
for discussion and also afford students a nonthreatening opportu-
nity to develop expertise in applying various theoretical orienta-
tions and models of case conceptualization by describing and
analyzing the characters and relationships within a film (Anderson,
1992; Toman & Rak, 2000). Accordingly, it follows that licensed
practitioners can also benefit from the use of film media as
avenues toward thinking more critically about therapeutic relation-
ships, cultural experiences, and conceptualizations of psychologi-
cal distress.
Avenues for Advocacy and Change
Addressing the widespread doubt toward the effectiveness of
psychotherapy and its potential harm requires taking a critical
stance toward media depictions of psychotherapy and the media’s
influence on the valuing of mental health care. Although the portrayal
of psychologists in the cinema most likely is regulated by marketing
standards and a drive for profits, psychologists must still work to
minimize bias in media communication in order to protect, maintain,
and advance the public image of the profession (Carll, 2005).
Division 46 of the American Psychological Association, the
Division of Media Psychology, provides a positive example of the
strategies psychologists can adopt to counteract the negative por-
trayals of psychotherapists within the cinema. In 2004, the Media-
Watch Committee of Division 46 began presenting two annual
awards for positive portrayals of psychotherapy in the media.
Movies are rated on the competency of the psychologists and their
ability to respect boundaries as well as the media’s accurate and
realistic portrayal of the therapeutic encounter. As Schultz (2005),
the MediaWatch Committee Chair, reported in 2004, two episodes
of Law & Order Special Victims Unit received the Golden Psi
Media Award, which was published in USA Today, bringing
publicity to the TV show but also informing the public of the
potential misinformation they may receive about psychotherapy
and mental health within media portrayals. According to a recent
review, the committee eventually plans to collaborate with Holly-
wood producers and moviemakers to help foster more accurate
illustrations of cinema therapy (Sleek, 2005).
Especially in the age of new media, where the Internet has
drastically changed many of the constraints traditionally imposed
on the communication of information, psychologists can be pro-
active in communicating their own image and depictions of psy-
chotherapy (i.e., Stöber, 2004). However, whereas individuals may
access a more diverse and extensive content area through the
Internet, new technology bears equal potential for consumers to
access inaccurate information (Kunst, Groot, Latthe, Latthe, &
Kahn, 2002; Schulz, 2004). Alarmingly, in considering consum-
ers’ Internet research of health information, Hensley, Wyatt, Hart,
and Smith (2003) found that “there was almost no awareness of
who or what organization was publishing the information being
assessed” (p. 605). As such, though the Internet has succeeded in
lifting the gatekeeping arm of Hollywood producers from provid-
ing the sole depictions of psychotherapy, this does not prevent
potentially unlicensed or uncredible “professionals” from creating
and selling a variety of services under the guise of mental health
care. As such, more informed consumers may not be considered
more effective consumers (e.g., Hensley et al., 2003).
Professional psychologists may acquire greater control over the
accuracy of information through the use of TV and movies as a
publication medium, similar to bibliotherapy. In fact, Gregerson
(2004 –2005) suggested that TV and movies as an adjunct resource
to therapy may soon substitute for bibliotherapy. For example,
media featured on the Public Broadcasting Service (PBS) has
highlighted an array of psychological topics ranging from Alzhei-
mer’s disease (e.g., The Forgetting: A Portrait of Alzheimer’s;
Arledge, 2004) to domestic violence (e.g., No Safe Place; KUED,
1998). Such television broadcasting companies, committed to the
distribution of educational and informative programming, may
provide a promising avenue for psychologists to collaborate in the
production of films documenting accurate and informative depic-
tions of a broad array of therapy mediums, ranging from relational
psychotherapies to behaviorally based treatment paradigms. The
creation of these resources and their distribution will require
careful research and evaluation, with the concomitant vast poten-
tial for the fraudulent provision of service and potentially damag-
ing portrayals of psychotherapy. With these future directions on
the horizon, it will be the responsibility of psychological organi-
zations and service providers to create the face of psychology
within the growing media domain.
Conclusion
It is likely that the public’s interest in cinema portrayals of
psychotherapy is a reflection of curiosity in the discussions and
interventions that are produced behind the closed doors of the
psychotherapy room. In a culture so influenced by the media, it is
essential for therapists to maintain an awareness of the portrayal of
psychotherapy in the cinema. Not only do cinematic portrayals of
psychotherapy likely influence what expectations clients bring to
therapy, media portrayals of psychologists often form the backdrop
within which the individual is socialized to therapy. As the current
review depicts, a vast array of prototypical therapists have already
reached the public through the experiences of cinema therapy,
observed in the comfort of their living rooms or from cushioned
move-theater chairs.
Although the competition between psychology and media for
the public’s construal of what constitutes mental health care leaves
psychologists with potentially little agency, it is vital that psychol-
ogists consider how to counteract negative cinematic portrayals of
mental health care. Motivated by the demand for high ratings,
profit, and public approval, television and cinema cannot afford to
make accurate and comprehensive illustrations of mental health
and its treatment paradigms a priority. There is hope, however, that
psychological science can benefit from further collaboration with
the creators and disseminators of public media. Given the increas-
ing reliance on new media sources as quick and expansive repos-
itories of information, the collaborative use of Internet and film
(e.g., cinematherapy) may allow professionals to guide clients
toward accurate and correct information on how and when to
access mental health care. Developing an awareness of these
stereotypic prototypes, and bringing a discussion of their influence
into the therapy room, is certainly the very least that psychother-
apists can do.
512 ORCHOWSKI, SPICKARD, AND MCNAMARA
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514 ORCHOWSKI, SPICKARD, AND MCNAMARA
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Background and aimTalking to one another is a key feature of psychotherapy, even from the perspective of people without experience in therapy. It can be assumed that persons without experience in psychotherapy develop ideas about how therapeutic talking to one another is helpful. These perceptions and preconceived expectations can influence the therapeutic interaction in psychotherapy. To gain a better understanding of the expectations of processes in psychotherapy, the images made by people without therapy experience on talking to each other in psychotherapy are examined.Material and methodThis is a mixed methods study (qualitative category formation followed by quantitative frequency analysis). A sample of 225 adults without therapy or counselling experience (mean age 27.53 years, SD ± 9.93, range 19–91 years, gender 207 female, 18 male) participated in the cross-sectional online survey. In addition to sociodemographic data the open-ended question “How and in what way does talking to each other help in psychotherapy?” was asked and evaluated using qualitative content analysis.ResultsThe participants expected efficacy of talking to each other in psychotherapy in terms of four major categories: 1) experiencing therapeutic rapport, 2) providing relief, 3) gaining insight and 4) facilitating change. Each of these major categories were assigned between 1 and 8 subcategories. The subcategories of getting something off one’s chest/getting rid of baggage and changing perspective were mentioned particularly frequently.DiscussionThe present results indicate that persons without psychotherapy experience have differentiated and individually varying assumptions about how talking to each other in psychotherapy can heal. Thus, an exchange about which of the respective expectations patients come to psychotherapy with, could be helpful.
... The media is a powerful source of information and the portrayal of individuals with mental disorders in movies and television in general has an important influence on public perceptions of those individuals and their conditions (Pirkis, Blood, Francis, & McCallum, 2006). In fact, research has shown that a substantial part of the population obtains their information and knowledge about mental disorders primarily from the media (Orchowski, Spickard, & McNamara, 2006;Wollf, Pathare, Craig, & Leff, 1996). ...
Thesis
Objective. The relationship between crime and mental disorders has long been a topic of debate. While in public perception these two phenomena are often seen as inextricably linked, research has painted a more complex picture, with only little consensus about the precise nature of the association. The aim of this thesis is to further unravel the interrelations between offending and mental disorders and to contribute to a more comprehensive understanding of their association over the life-course. Methods. First, a broader view is adopted as a strategy to assess the current understanding of the relationship. Then, a more specific stance is taken within the theoretical framework of developmental and life-course criminology in order (1) to link research into offending pathways with the study of longitudinal effects and intergenerational transmission of mental health problems and (2) to investigate the link between family socio-psychological factors, violence, and personality disorders over the life-course by using different quantitative methods and drawing on data from the Cambridge Study in Delinquent Development. Results. Having drawn attention to the importance of studying different offending pathways in the development of mental health problems, the considerable heterogeneity of mental disorder symptoms, and the role of early-life family context, findings demonstrate (1) that those with more severe offending pathways have an overall greater vulnerability to developing internalising problems in middle adulthood, (2) that certain personality disorder symptoms, specifically cluster A and cluster B disorders, are associated with lifetime violent behaviour, and (3) that early life paternal offending is associated with adult children’s internalising and externalising problems. Conclusions. It is suggested that early-life interventions targeting families as part of their work can play an important role in preventing the development of both later-life internalising and externalising problems. Further, results highlight the importance of recognising the heterogeneity of people with internalising and externalising problems in order to offer responses that are effectively tailored to an individual’s needs. Finally, the thesis supports further efforts to improve mental health awareness and knowledge to reduce stigma.
... Unsurprisingly, the language used in the media to depict mental health services and mental health professionals has been identified as a key source of this disconnect between what professionals can offer and how they are perceived (Timpson, 2010). A robust body of research has explored the inaccurate portrayals of mental health professionals in the media, with consistent findings that these portrayals of psychotherapy or counseling influence viewers' understanding of counseling and the qualifications of counselors (Dew & Bickman, 2005;Farberman, 1997;Orchowski et al., 2006;Robison, 2013;Wahl et al., 2018). ...
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... Cinema is a powerful medium of building a public belief system, and when it comes to mental illness, cinema has always played and will keep playing a crucial role in disseminating knowledge and forming beliefs and attitude towards mental illness. [3][4][5][6] Like international cinema, Hindi cinema also has an old relationship with mental illness. However, the depiction of mental illness in Hindi cinema has undergone several changes. ...
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Indian Hindi Cinema has remained the face of Indian cinema for several decades. An undeniable fact about cinema is that projecting an idea, thought, and message through it creates a long-lasting impression on society. Hindi cinema has experimented extensively with mental illness in the last few decades. Since cinema is considered an effective tool for disseminating ideas and thoughts, the impression of mental illness on public has remained controversial. The current paper provides insight into mental illness in pre and post-media convergence through the principle of production, representation and reception. It explains how reception tends to change and changes the production and representation of ideas through a vivid global health issue called mental illness.
... Cinema is a powerful medium of building a public belief system, and when it comes to mental illness, cinema has always played and will keep playing a crucial role in disseminating knowledge and forming beliefs and attitude towards mental illness. [3][4][5][6] Like international cinema, Hindi cinema also has an old relationship with mental illness. However, the depiction of mental illness in Hindi cinema has undergone several changes. ...
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Indian Hindi Cinema has remained the face of Indian cinema for several decades. An undeniable fact about cinema is that projecting an idea, thought, and message through it creates a long-lasting impression on society. Hindi cinema has experimented extensively with mental illness in the last few decades. Since cinema is considered an effective tool for disseminating ideas and thoughts, the impression of mental illness on public has remained controversial. The current paper provides insight into mental illness in pre and post-media convergence through the principle of production, representation and reception. It explains how reception tends to change and changes the production and representation of ideas through a vivid global health issue called mental illness.
... Answers 6 , che hanno carat-3 Un ulteriore sviluppo dell'indagine, già previsto, è quello di prendere in considerazione anche i video multimediali scambiati in YouTube (il secondo motore di ricerca più diffuso al mondo dopo Google). L'analisi di questi videoche costituirebbero un aggiornamento importante, vista la rilevanza acquisita nello scenario attuale delle nuove tecnologie digitali rispetto ad un filone di studi che -sebbene non strettamente riferito alla teoria delle rappresentazioni sociali -ha indagato l'immagine della psicoanalisi e/o della psichiatria nel cinema (Metz, 1977;Gabbard and Gabbard 1999;Schneider, 1999;Orchowski, Spickard, McNamara, 2006). posto di lavoro, scuola e religione; -gli utenti possono creare profili che spesso contengono foto e liste di interessi personali, scambiano messaggi privati o pubblici e fanno parte di gruppi di amici (la visione dei dati dettagliati del profilo è ristretta ad utenti della stessa rete o di amici confermati); -è consentito agli utenti di inserire annunci, che sono visibili solo da utenti presenti nella stessa rete; -include alcuni servizi che sono disponibili sul dispositivo mobile, come la possibilità di caricare contenuti, di ricevere e rispondere ai messaggi, di mandare e ricevere poke e scrivere sulla bacheca degli utenti usando SMS, e la possibilità di navigare sul network; -il "mini-feed", che mostra le proprie azioni e quelle degli amici, in una timeline pubblica; -la disponibilità (a partire dall'autunno del 2008) di un sistema di API utlizzabili per integrare i siti esterni con il social network. ...
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trasformano e si dif-fondono in interazione con i vari sistemi mediatici e forme di comunicazione tra indivi-dui, gruppi, istituzioni e organizzazioni. I fenomeni studiati, in riferimento alle nuove forme di socializzazione della conoscenza e alle sue strategie comunicative nei più diversi ambiti, sono di estrema attualità e alta-mente rilevanti per le politiche sociali nel mondo contemporaneo. Oltre alla traduzione di testi classici-come l'Opera prima di Serge Moscovici "La Psychanalyse, son image et son public"-, la collana prevede la pubblicazione di testi i-nediti, basati su recenti programmi di ricerca o scaturiti da eventi scientifici internazio-nali, ispirati dalla teoria delle rappresentazioni sociali in un dialogo critico e costruttivo con altri paradigmi delle scienze sociali. La collana multi-lingue è destinata alla diffusione in contesto accademico e non:-nel mondo accademico i testi possono opportunamente essere inseriti nei programmi di vari corsi universitari delle Facoltà di Psicologia (tra i quali Psicologia sociale, At-teggiamenti e rappresentazioni sociali, Psicologia della comunicazione) e in altri corsi nelle scienze sociali, nei vari ambiti disciplinari nei quali l'interesse per ricerche ispi-rate alla teoria delle rappresentazioni sociali si è ampiamente diffuso: dalla sociologia all'antropologia, dalle scienze della comunicazione all'epistemologia ecc. I testi sono ovviamente anche destinati a dottorandi, ricercatori e studiosi interessati a settori specifici d'indagine nelle diverse aree tematiche concernenti i più svariati oggetti di ricerca, negli ambiti delle scienze della salute e della medicina, dell'educa-zione e della comunicazione, degli studi ambientali e del marketing ecc.-nel mondo professionale alcuni testi, in funzione della loro specificità tematica, pos-sono essere destinati anche un target di lettori esperti in vari ambiti d'intervento, in cui la comprensione dei processi simbolici di costruzione della conoscenza sociale sia rilevante per l'esercizio della professione (dalla comunicazione politica all'assistenza sanitaria, dall'architettura all'urbanistica, dal turismo all'economia ecc.).
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