Dubious psychiatric breakthroughs

Therapists, we've long known, are among the biggest fans of The Sopranos. So pleased were they with the credible therapy scenes between Tony Soprano, pop culture's most famous mobster/patient, and the appealing Dr. Jennifer Melfi, played by Lorraine Bracco, that the American Psychoanalytical Association once gave the show and Bracco an award.

But professionally speaking, they could only scratch their heads at the latest developments on HBO's hit drama, which telecast its penultimate episode last weekend.

Just as Tony Soprano's life seemed to be imploding with dangerous speed - in short, just when he needed some really good therapy - Melfi and her own therapist made some highly questionable moves.

Not only therapists were distressed. Some patients were actually furious when they showed up for appointments this week, one New York psychoanalyst said.

"You wouldn't believe the outrage I am hearing," said Arnold Richards, who'd missed the episode but was filled in by his patients. He was talking about a serious ethical lapse by Elliot Kupferberg, played by Peter Bogdanovich, at a dinner party full of therapists. Across the crowded table, the character callously revealed - over Melfi's protests - the identity of her star patient.

Why did Kupferberg commit such a sin? He didn't think Melfi should be treating Soprano, whom he considered a manipulative sociopath. Be that as it may, his disclosure was "a very egregious ethical violation," said Jan Van Schaik, chair of the Ethics Committee at the Wisconsin Psychoanalytic Institute.

"A patient needs to know that what gets said in the doctor's office stays there," said Van Schaik, who has never witnessed such a violation. "I've been at gatherings where people talk about patients in a more disguised form. Even that can be inappropriate. A good therapist should do the best they can to protect the anonymity of patients."

Melfi had reluctantly read a study, brought to her attention by Kupferberg, claiming that therapy doesn't actually help sociopaths - it further enables their bad behavior by sharpening their manipulative skills. Demoralized, guilt-ridden and almost speechless with hostility, Melfi literally showed Tony the door.

A tidbit that had some therapists buzzing this week: The study is a real one - albeit hardly new - from authors Samuel Yochelson and Stanton Samenow, psychiatrists specializing in the criminal mind. But the way the fictional Melfi shoved aside her patient was anything but real, therapists said.

"You don't just drop a patient like a hot potato, even if they aren't responding to therapy," said Joseph Annibali, a psychiatrist and psychoanalyst in McLean, Va. "She should have taken several months to do it."

Annibali said he'd heard that Bracco, the actress who plays Melfi, may be appearing in the final episode next Sunday. Which means there may still be time to reverse her professional missteps.

"My hope," Annibali said, "is that she and Tony will get together again."