August 20, 2015
As a therapist, I am often asked: “Isn’t it scary to let strangers into your apartment?” Each person entering my space is vetted or comes by referral, so I feel as safe as one can.
I try to be Zen about allowing a parade of troubled souls into my home. What causes my insides to churn is the fear of letting one of them reach too deeply into my head. Particularly a sociopath who is such a master manipulator that it’s nearly impossible to recognize you’re being psychologically seduced until it’s too late.
This fear was triggered anew by June’s third season premiere of NBC’s critically acclaimed yet low-rated show Hannibal, with Mads Mikkelsen as Thomas Harris’s famed forensic psychiatrist and serial-killing gourmand and Gillian Anderson as his analyst Bedelia Du Maurier. “Former analyst” is a more apt description: The second-season-finale shocker featured Bedelia fleeing with him to Europe after his cannibalism was finally revealed to the team with whom Hannibal was “working” to catch, well, himself in his secret role as the Chesapeake Ripper.
The devolvement of the relationship between Hannibal and Bedelia is, one hopes, an exaggerated imagining of the dangers a therapist can face when a sociopath walks into her office. But the truth for any analyst: There is no psychological scarlet S emblazoned on the forehead of the patient on the couch. Yet according to the American Psychiatric Association approximately 3 to 5 percent of the general population demonstrates sociopathic traits, i.e., they are lacking in empathy, conscience, and the ability to connect with humans or animals, while taking pleasure in exploiting others.
Hannibal Lecter manipulates miles better than the “garden variety” sociopath because he has training as a psychiatrist, so he can understand, decode, and persuade people to listen very seriously to his dictates (it helps that he’s a fictional character). But real-life con artists who lack a Ph.D. in human behavior yet possess keen powers of analysis and observation can fool someone they see once a week in an office setting.
“A sociopath can best us because they are unemotional,” says Jean Kim, a psychiatrist for the U.S. State Department, adding that, “we get frustrated with a blank canvas. Frustrated and distracted with our discomfort.”
The nature of the work is so intimate that the analyst needs to care about the person on the couch … But not care too much. Caring clouds our judgment, which is not a good idea when dealing with a dangerous and/or manipulative patient. Yet our manifest as “healer” makes it difficult to stay detached as we build a therapeutic alliance. Caught up in a patient’s well-being, there is danger of insufficiently safeguarding our own.
To avoid the counter-transference snare, it’s imperative for us to rigorously self-monitor and visit a supervisor, with whom we regularly decompress and discuss our cases. We also need to commune with our own psychological holes through visits with our trusted therapist.
Even with these safeguards in place, a sociopath’s most potent weapons—the ability to fascinate or strike at our most vulnerable point—can occasionally hold sway over even a seasoned shrink. Dr. Kim explains, “There is always a risk of a patient charming us.”
Like Hannibal, most sociopaths are narcissists. Emotional and/or physical abuse, trauma, neglect by their caregiver, has left them with self-loathing, depression and anger so profound they repress it, retreating inward. Emotionally and spiritually on empty, they project a false self to others, a self they believe will win them acceptance. In actuality, the void is filled only through the rush of using others.
This does not mean all sociopaths commit violent crimes; there are many levels of being conscience-light: Think of politicians and Wall Street executives who caused the 2008 crash.
The majority of people who do therapy are motivated to find a way to better deal with their issues. True, everyone lies to some degree on a conscious and/or unconscious level. For the most part, though, people are honest with their therapist.
Sociopaths in treatment are not willing to lower their guard, find insight or take responsibility for their actions. There can be varied motives for seeking help.
Some want symptom relief without ridding themselves of the source of pain. Another fictional example, Tony Soprano (the late, great James Gandolfini), had no desire to change his mobster ways when he sought out Dr. Jennifer Melfi (Lorraine Bracco). He was desperate to relieve the anxiety his profession caused. Knowing this, Melfi treated Tony responsibly, looking out for her patient’s best interests despite her personal repugnance at his profession. (Until she abruptly terminated him during the show’s final season. After seven years: wham, bam, adios.)
A major difference between Melfi and Bedelia: When the former was raped, much as she longed to confide in her powerful patient, she decided to remain silent and deal with the trauma on her own. Which is to say, she chose carefully not to violate their boundary—there was no weakness her patient could use to weave an impermeable Machiavellian web. Refusing to breach the fourth wall allowed Melfi to maintain her sanity and power in the relationship.
Bedelia abandoning her ethics, career, and possibly life to go on the lam was especially shocking since several episodes earlier she had pronounced herself no longer capable of serving as Hannibal’s psychiatrist: “My conclusion based on glimpsing the stitching underneath the ‘person suit’ you wear is that you are dangerous.” Yet she boards the plane and becomes his quasi captive/co-conspirator.
In one sense, freed from the confines of traditional therapy, Bedelia has the opportunity to conduct the ultimate psychiatric field study of a brilliant sociopath ne psychopath. However, a larger part of her apparently has felt beholden to Hannibal, even blackmailed into accompanying him, as he is the only person who knows she killed a patient—one he referred to her—after being attacked.
And for most of this final season, we were left to wonder, did Bedelia murder the patient (Zachary Quinto), and Hannibal arrive in time to help clean up the scene (an affair made messier by her arm shoved inside the throat of the now-dead patient)? Or did Hannibal convince his analyst, in her most profound moment of vulnerability, panic, and dependence, that she committed the murder rather than him?
Living under assumed identities (an easy feat when your “faux husband” is an expert slicer and dicer) in Florence, Bedelia can no longer retreat behind the protection of the 50-minute hour. Her words no longer designed to solicit trust and secrets, she has sheathed herself with bon mots like: “I still believe I’m in conscious control of my actions … Given your history that is a good day.” To a dinner guest of the “couple,” she declares, “My husband has a very sophisticated palate. He is very particular about how I taste.”
Few of the therapists I spoke to for this article admitted to ever being manipulated by a patient. Then there are these honest souls:
Tanya Jacob, Ph.D. tells me, “If I’ve had a client who was a sociopath I didn’t know it.” After a moment of reflection, the California-based clinical psychologist adds, “I often feel a dynamic with straight, male clients that they want to best me. Two years ago a client said with a flicker of excitement in his eyes: ‘I could be a sociopath if I wanted.’ I thought, This man is about to rape me. He’s so angry and sadistic, if he does I’m going to let him do it. I’ll have to give up. I believe he felt like, ‘You’re a Ph.D. and you know all my secrets. I want you to feel small and powerless.' He found a way to do that.”
Since the client had said nothing overtly threatening, he remains Jacob’s patient two years later.
The story that haunts me was recounted by *Dr. Martha Singler (the names in this anecdote, as denoted by an asterisk, have been changed). The threats made by her patient *Cindi were direct and obscene. Indeed, their termination session, after two years of treatment, ended with the police being called. Dr. Singler, a Missouri psychologist, recalls that “Cindi was a respected, very wealthy, high-powered business woman who was on every board and charity of our small community. I saw Cindi privately as well as her teenage children.”
A year into the therapy Cindi asked her psychiatrist to come to the mansion. Her son *Peter was strung out on heroin. Sitting at the marble dining room table Cindi accused her shrink: “I know you’re in love with Peter. I know you want to have sex with him like I do.”
Dr. Singler’s blood froze as she forced words through her throat: “No, I don’t have sexual thoughts about children. Do you have sex with your children often?”
When Cindi realized the psychiatrist was poised to contact Child Protective Services she said coldly, “If you make that call I will ruin you. Everyone knows me in this town. You can’t prove anything and I will tell everyone you talk about your patients to other people. As of today, you are ruined.”
Dr. Singler made the call (“I’m a mandated reporter”) but still quakes from the experience. “There was something very broken in this woman, but I hadn’t seen it until the mask dropped and she let the full crazy out. I felt so intimidated and frightened I was tempted to let her get away with the crimes she was committing. The fear she induced in me was so great that’s probably what I would have done if children weren’t involved.”
For the Cindis and Hannibals of the world, therapy is a chess game, with their shrinks dispensable pawns to whom they can show “the full crazy” when they feel the therapist is under their control.
Early on in my practice, I allowed a rage-aholic to scream at me for 20 minutes because I hadn’t made him feel “safe” in our previous session. My counter-transference was to feel guilty, thus obligated to be this person’s verbal punching bag. But I terminated our therapy after this session and referred him to someone else “who might make him more comfortable.” My desire to feed my ego by positively impacting another was outweighed by my need for self-protection. I wouldn’t be anyone’s prey.
As recently revealed, Bedelia was not Hannibal’s prey, but his pupil. When the flashback scene finally unfolded, viewers saw the patient never threatened her life. Rather, he collapsed in convulsions and Bedelia’s efforts to clear his pathways morphed into an impulse to kill a weaker being because observing Hannibal had taught her she could.
Counter-transference with Hannibal led to Bedelia’s evil side being plucked out from beneath her “person suit,” much as she plucked out her vulnerable patient’s tongue from his throat as he lay helpless and suffering.
In his 2012 book, Why We Love Sociopaths: A Guide to Late Capitalist Television, Adam Kostko explains the appeal of watching a fictional portrait of psychopathy as our opportunity to “engage in a vicarious thought experiment. We project our own desires onto characters’ and on some level, wish we could be as manipulative as they are.”
Perhaps that underlies part of the appeal for taking on or maintaining a sociopathic client. However, when our primitive urges and fears are unleashed, it’s inevitably a bumpy ride to maintain control.
Dr. Martha Singler, nearly bested and still haunted by her former sociopathic patient Cindi, warns, “Take the risk, jump in the water but have your life jacket handy!”