Analyzing prime time's analyst: 'Sopranos' serves as teaching tool

PORTLAND — Dr. Alysa Zalma, a fourth-year resident at Oregon Health & Science University (OHSU), has designed a lecture series based on the psychiatry of the television show "The Sopranos."

Zalma said she became intrigued by the show after meeting in New York with actress Lorraine Bracco, who plays mob boss Tony Soprano's psychiatric therapist, Jennifer Melfi.

She decided to help launch the elective program at OHSU designed to train psychiatric residents to become — using Zalma's words — "Dr. Melfi-esque."

The inaugural lecture for the new Psychotherapy Pathways program was delivered Aug. 23 by Dr. Glen Gabbard, professor of psychiatry at Baylor College of Medicine. He is also author of the new book, "The Psychology of The Sopranos: Love, Death, Desire and Betrayal in America's Favorite Gangster Family."

Television has long helped shape American culture with everything from hairstyles to common expressions gleaned from the tube. But "The Sopranos" may mark the first time television has so deeply influenced psychiatric training and discussion.

Sure, psychiatrists know full well that Prozac and twice weekly talk therapy is no sure cure for a sociopath.

Most of them say they'd send the lethal Tony Soprano elsewhere for help. And everyone recognizes that Melfi's skirts are too short, she talks too much and her office is too swanky.

The fascination with "The Sopranos" among mental-health professionals has a lot to do with the fact that it is a "pretty accurate" depiction of psychotherapeutic treatment, says Dr. George Keepers, interim chairman of psychiatry at OHSU.

Even with its flaws, this is the first time Americans have had a collective listen to the most intimate of conversations between patient and therapist.

Gabbard noted during his OHSU lecture that Hollywood has typically portrayed psychotherapists as either ineffectual (Woody Allen movies) or crazier than their patients (Richard Dreyfuss in "What about Bob?"). The women, from Ingrid Bergman in "Spellbound" to Barbra Streisand in "The Prince of Tides" typically end up romantically entangled with their patients.

"The Sopranos" is different. The show's opening scene began in Melfi's office and, over three seasons, 14 million viewers have watched Tony Soprano's therapy proceed from initial reluctance to recognition that he needs help.

The course of Soprano's therapy has prompted articles in professional journals, including the Psychiatric Times; a three-hour discussion during the American Psychiatric Association's May meeting; and eager anticipation among scores of analysts watching the show's fourth season on HBO.

OHSU residents enrolled in the new Pathways program won't be asked to form study groups to watch "The Sopranos." They'll see patients from the community in private offices, supervised by members of the Oregon Psychoanalytic Society & Institute.

But "The Sopranos" will likely be part of informal discussions, says Dr. Donald Rosen, who oversees the program as a member of both OHSU's Department of Psychiatry and the executive committee of the Oregon Psychoanalytic Society & Institute.

"All too often in psychiatric training programs, students don't get to watch experienced clinicians interview patients," Rosen says. "The TV show, though it's not meant for educational purposes, offers them an opportunity to see what a therapist does."