Episode Transcript
[00:00:01] Hi, and welcome back to beyond the Chair, the Therapist Companion. Today we're going to be doing a deep dive into the show Brilliant Minds. And just as a quick reminder of how this all works, at the start of each month, members receive a case to think about.
[00:00:16] Sometimes those cases are going to come from TV shows, movies, documentaries, or potentially a real life scenario.
[00:00:25] And throughout the month, there will be space for members to share their thoughts, reactions, and what they might do in this specific situation.
[00:00:34] Then, at the end of the month, we come back here and unpack it all together.
[00:00:38] This month's case centers around Dr. Carol Pierce of Brilliant Minds. So as a recap for those that did watch, and then also just for information for those that didn't watch at all, Dr. Carol Pierce is a fictional psychiatrist on Brilliant Minds. Within the show, she's portrayed as a highly respected, confident physician working in a hospital setting where she conducts psychiatric evaluations and provides ongoing therapy to patients. She's positioned as intelligent, composed and professionally successful someone who appears to have authority and expertise both clinically and socially.
[00:01:18] Dr. Pierce often functions as a central decision maker in patient care, blurring the lines between center psychiatric consultation, psychotherapy and personal judgment in ways that are common in media portrayals of mental health professionals.
[00:01:35] Her character is written as deeply invested in her clients, sometimes to the point where her personal emotions and relationships begin to intersect with her professional role.
[00:01:46] Over the course of her storyline, Dr. Pierce becomes involved in a complex and ethically challenging situation that raises important questions about boundaries, dual relationships, conflicts of interest, and how clinicians manage personal crises while holding responsibility for client care.
[00:02:05] Her character serves as a useful, though exaggerated example of how ethical missteps can unfold when clinicians attempt to manage extraordinary circumstances without adequate help.
[00:02:20] When watching the show, the first thing that stood out to me as like a glaring issue is the misconception that people who write these characters have about mental like the mental health profession in general, but also us as clinicians or psychologists, psychiatrists, and just kind of what our roles are, what we do and what we do not do.
[00:02:45] And I always think that it'd be really easy to clear this up if they just did a consultation with a professional. And it seems like they never do.
[00:02:53] But I suppose that we can make the argument that the people who produce Law and Order, they did consult with police officers and whatever police officers they consulted with told them that this is how they interrogate people and this is what it looks like, and they're rough and tumble and all these things. And you can see over the course of time when looking at Law and Order, especially Law and Order svu, you can see how aggressive, like the Stabler character was. And then I think they like, basically they got rid of him. I'm sure that the guy who plays Stabler was kind of like done with the show anyway, but he was so aggressive. When we went and looked back at like some of the original episodes, because I didn't actually get into that show until a couple years ago, but we went and watched back in the first few episodes, it was just like really, really bad. It was so violent and so egregious and absolutely terrible. So what I'm saying is, is that maybe they do have a consultant who tells them that this is what the mental health field looks like and this is what they do and this is how it is. And maybe that one person that they consulted with has just been wrong. But my guess is, is that it probably isn't happening because it seems like in the media as a whole, everything kind of just seems to always go back to Freudian and like how many people, I don't even know how many people are actually doing Freudian type therapy now anyway. Like, who has their client laying down on a couch and is sitting like where they, the client can't even see them and talking about their dreams or whatever?
[00:04:36] You know, I, I, maybe there are therapists that still do that, but I have, I have not met them.
[00:04:44] So anyway, in the show we see a blending of psychiatrists, psychologists, therapists and counselors bleeding into one entity.
[00:04:53] And that is Dr. Carol Pierce, who is prescribing medication and also doing therapy.
[00:05:01] And in the real world that can happen. But in my brain I'm like, why would a psychiatrist who can make bank with a 15 minute consult do long term counseling?
[00:05:12] Unless maybe they're retired and they just want to do something on the side.
[00:05:17] And I'm not saying that they can't and I'm not saying that they don't, but I just don't feel like it's super realistic, especially in a hospital setting.
[00:05:26] So my big glaring, like, what is even happening right now? Moment was like, you have the same person prescribing medications and they're also doing outpatient therapy.
[00:05:39] Like, why would that be happening?
[00:05:43] Even if this really were happening in the real world, it seems like not, not an abuse of her time, but something like that. It's like abusive practices of this facility. Because why am I, why am I having to worry about medications and such and then also having to worry about outpatient clients who are coming in for Therapy, then don't even really have medication management.
[00:06:14] I don't know.
[00:06:15] It's just very strange and not logical.
[00:06:19] And it also kind of peaks up this, like, well, you know what? Things are going to fall through the cracks. Something bad is going to happen, because they're making her have too many roles in a huge facility that is probably needing med management, like, all over the entire hospital.
[00:06:37] So then we see Dr. Pierce has been working with this woman named Allison for a while now. And Allison has come in due to a recent breakup that caused significant distress in her life.
[00:06:48] And for us, the audience, it's not even clear why she became a talk therapy client to begin with. Dr. Pierce is a psychiatrist who does psych consults throughout the hospital. And. And Allison is not impatient. But I suppose that A perk for Dr. Pierce is that she has an absolutely massive office.
[00:07:06] It's a ridiculously massive office where she sees outpatient clients inside the hospital.
[00:07:13] And that in itself is weird. Is like, what is that? Not like hipaa, because you're, like, bringing people who are not on the unit into the unit.
[00:07:28] This just doesn't make any sense to me.
[00:07:31] And I also realized that sometimes I'm going to use terminology that other people might not know. So when I say the unit, I mean psych unit. I used to work on a psych unit, so unit is a vernacular that I would use and realize that maybe people don't know what that means.
[00:07:46] So why is a person who's not on a psych unit, like, admitted on the psych unit? Why is she getting therapy on a psych unit? Like, that's just really.
[00:07:59] That wouldn't happen.
[00:08:01] And then another thing that might not have anything to do with anything, but it is worth noting, is that Dr. Pierce always wears the most bangin outfits. She's dressed to the nines every single time we see her. And I'm not sure if that's meant to make her look like she's more put together, but I do remember that the doctors on the psych unit that I used to work on dressed really nicely in dresses or dress shirts, but nothing that screamed affluence. And Dr. Pierce's outfits, do they scream affluence, intelligence, and arguably, sex.
[00:08:33] So Dr. Pierce is this powerhouse figure.
[00:08:36] And then we have Allison, who's meek, very sad, downtrodden, with an increased anxiety after being broken up with by a man that she loved.
[00:08:47] She tells Dr. Pierce story after story about how much this man told her he loved her and how confused she is and how she doesn't understand how he could change his mind so quickly.
[00:08:58] And as a listener, you start to feel turmoil for Alison. You get this really good sense of what's happening for her. But at the same time, you notice that Dr. Pierce's spidey senses are kicking in. Like little breadcrumbs that Allison has been dropping start to make Dr. Pierce feel like something is off.
[00:09:16] And obviously, as the audience, we're supposed to feel that, too.
[00:09:20] Then things go from a slow simmer to astronomically terrible.
[00:09:25] In one session, Allison shows Dr. Pierce a photograph of the man that she's been talking about this entire time.
[00:09:32] And those breadcrumbs, they probably could have led Dr. Pierce to this conclusion anyway. But the man in the photograph was Dr. Pierce's husband.
[00:09:42] A layperson watching this might think, holy crap, I can't believe that even happened.
[00:09:48] But honestly, it felt blatantly obvious to me in the way that Dr. Pierce handles this situation in real time in that session, when she finds out that it's her husband that they've been talking about the entire time, I do think was handled very maturely.
[00:10:04] If I had found out that a client was talking about my significant other and we still had session time left, I don't think that I would have ended the session immediately.
[00:10:14] I think I'd regulate myself internally and go through the session and figure out what to do afterward.
[00:10:21] So from a realistic standpoint, it does make sense that Dr. Pierce didn't throw Allison out of her office.
[00:10:28] She continued the session, she regulated her emotions, and that all felt really incredibly normal to me.
[00:10:35] And ethically, I don't even know what I'd be thinking in that moment. My ethics would probably lean toward. I have to finish this session internally. I might be wondering, did she know the whole time?
[00:10:49] Did she seek me out intentionally?
[00:10:51] And if those thoughts didn't cross Dr. Pierce's mind at all, I would honestly be surprised.
[00:10:56] But like I say, I do think it was handled correctly. You finish the session, you show up for your client, and then you figure out what you need to do what once that session is closed, Especially because they only had, like, 10 minutes left.
[00:11:08] Once the session concludes, it's completely up to Dr. Pierce what she does next. And this is where I feel like real life diverges from the media.
[00:11:18] Faced with this horrible situation, her personal life and her professional life colliding, Dr. Pierce decides to continue to see Allison.
[00:11:27] She doesn't acknowledge that it's her husband, and she treats Allison like any other client.
[00:11:32] But the problem is, is that she can't hold her shit together, which is understandable. So she's trying to muddle through. And then at some point in time, she confronts her husband about the affair, which is a violation of hipaa.
[00:11:47] From a TV viewing standpoint, it's dramatic. From an ethics standpoint, she can't do that.
[00:11:54] So to recap, she's emotional, she's muddling through this. She's continuing to keep this person on as a client when she knows that she's already had some type of riff internally and she's in pain herself. She doesn't staff this with anybody. She doesn't contact her board, she doesn't consult her colleagues. She continues to see the client despite her visceral reactions to the client. And then she confronts her husband using client information.
[00:12:22] So basically, she's a hot mess express in really nice clothes.
[00:12:26] After two months, her attitude towards Allison worsens and Allison's mental health declines.
[00:12:34] Finally, Dr. Pierce tells Allison that she can't see her anymore.
[00:12:38] And I honestly don't remember exactly how she presents this, but it did feel abrupt. It was poorly explained and borderline abandonment.
[00:12:47] And even if Allison did know who Dr. Pierce was married to, it doesn't matter. The way that she handled it still felt unethical.
[00:12:56] So now we are at the pinnacle of this absolute ethical nightmare. And honestly, I hope no one ever has to experience this in real life. But let's talk about it as if it has or could happen in real life. And what should happen?
[00:13:10] If I were feeling like a client might be talking about someone that I know, especially my partner, I think the first step would be to reality check myself.
[00:13:20] First off, what are the odds?
[00:13:23] How far fetched is this?
[00:13:25] And is this paranoia?
[00:13:27] That's probably exactly where I would start.
[00:13:30] It's highly likely. If I have this feeling internally, then I'm probably going to staff with a friend, a colleague, meaning that I'm going to talk with my colleague about what it is that I'm experiencing when I'm working with this client. And, and the feelings that I have and the worries that I have, like, maybe this is my significant other. And then my colleague slash friend can kind of reality check me if I'm not able to do that or talk about what are some of the options that could happen? What could we do? How do we get ahead of this if this is something that is actually happening?
[00:14:09] And I think that it should be known also that I. I have a lot of friends that are therapists. Many of my friends are therapists. So when I say that I would staff with a friend I literally mean a colleague. It's just that they also happen to be my friend. And I want to make that differentiation, because I'm not saying that I'm just going to go and call Joe Schmo, who's my friend, and be like, hey, what would you do in this clinical situation? Like, that's absolutely ridiculous. This person that I just made up doesn't even work in the field. So. So that's not going to be helpful at all. Nor is it, like, actually clinically sound. So again, if I'm saying that I'm staffing with a friend, I'm literally staffing with somebody that's a therapist who is also a friend. So in this world where I'm not entirely sure exactly what I would do once that photograph shows up, everything changes. At that point, finishing the session makes sense. And after that, we should not be making those decisions alone.
[00:15:04] If I were Dr. Pierce, the very first thing that I would do is I would contact my board. I would lay out the facts and ask for guidance.
[00:15:13] I know that some people say that the board isn't there to protect us, but they are the ones who hold our license, so why wouldn't that be the first place that we go?
[00:15:23] Even if it's a non answer, it's documentable. If I were still under clinical supervision, which I am not, I would contact my supervisor first.
[00:15:34] And I am almost certain that they are going to tell you to stop seeing the client.
[00:15:39] What the supervisor should do is help you figure out how to do that ethically, softly, and without abandonment.
[00:15:46] And then finally, trusted colleagues. This is not about venting. This is not about gossip. It's actually staffing the situation or discussing the situation and understanding from their clinical perspective what it is that they would do and then documenting it.
[00:16:05] Because when weird, extreme situations happen, documentation protects you.
[00:16:11] And now some spoilers for season two. But Dr. Pierce is eventually reported to her hospital, and she risks losing her job. But honestly, she should have also been reported to her board because what she did was egregious.
[00:16:25] Because though continuing to see Allison was inappropriate, I do believe that owning her mistakes earlier could have changed the outcome.
[00:16:35] But hiding it made it so much worse.
[00:16:39] So that's where we're going to leave Dr. Pierce for today. In this tangled mess of ethics, emotion, and professional responsibility, this case reminds us that when something becomes personal, our professional role doesn't disappear.
[00:16:55] Boundaries exist for a reason.
[00:16:57] Supervision and staffing exist for a reason.
[00:17:00] And trying to navigate something this complex alone almost always makes it worse for us and for our clients.
[00:17:08] The reality is that mistakes happen.
[00:17:11] What matters is how we handle them.
[00:17:14] This case also highlights the importance of having a few trusted colleagues that you can go to when things get complicated.
[00:17:21] I took a training a few years back where we had a discussion that came up about Facebook groups, specifically counselor Facebook groups, and how often people go there to ask for insights on how to work with X, Y or z.
[00:17:34] The presenter, who also happened to be a lawyer in her earlier career, warned everyone about the sheer amount of misinformation on those spaces.
[00:17:43] What works for one clinician might not work for another, but also how candid can we really get in a private Facebook group?
[00:17:51] The privacy is only as real as the air quotes that I'm putting around it.
[00:17:55] And something else that she pointed out that really stuck with me.
[00:17:58] Some people's bark is just louder. That doesn't mean that their advice is better, more ethical, or more informed.
[00:18:06] Because of that, when I see it in the Facebook groups, I lean toward telling people that they should contact their state board when something that's truly complicated or ethically gray comes up.
[00:18:16] And every time I say that, there's usually one or two people that jump in and say the board isn't there for our best interests.
[00:18:24] And like, fine, but let's zoom out for a second.
[00:18:28] We're not asking the question to protect ourselves from inconvenience.
[00:18:32] We're asking the question to understand what is actually in the best interest of our client and to make sure that we're practicing ethically within the frameworks that governs our license.
[00:18:43] The board is the body that holds that framework.
[00:18:47] Even if you don't love the answer, even if the answer is vague, even if the answer is frustrating, reaching out shows due diligence, accountability, and a willingness to pause instead of acting impulsively in a high stakes situation.
[00:19:04] And in cases like these, where emotions, ethics, and professional responsibility collide, the pause can make all the difference.
[00:19:13] So as we wrap up, I really want to underscore this point.
[00:19:17] Situations like this are extreme, but the principles apply to so many things we actually encounter in practice.
[00:19:26] We will all, at some point, run into moments where things feel off, where our personal reactions get stirred up, or where the situation is more complicated than anything we were prepared for in grad school.
[00:19:41] And those are the moments where our ethics, our boundaries, and our support systems matter the most.
[00:19:48] You are not expected to know everything.
[00:19:51] You are not expected to handle these things alone.
[00:19:54] And reaching out for consultation, supervision, or guidance is not a failure of competence. It's a sign of it.
[00:20:03] Mistakes happen in this field.
[00:20:06] What protects us, and more importantly, what protects our clients is how we respond the way that we do.
[00:20:14] Transparency, consultation, documentation, and a willingness to pause instead of pushing forward. Anyway, that's what keeps situations like this from spiraling.
[00:20:26] The case with Dr. Pierce is exaggerated, yes, but it's also powerful reminder of why boundaries exist, why supervision exists, and why trying to just power through a complicated situation on your own almost always makes things worse.
[00:20:46] In future episodes of beyond the Chair, we'll continue using cases like this to talk honestly about the messy real world sides of being a therapist, the parts that don't fit neatly into textbooks or ethics codes, but that we still have to navigate thoroughly and responsibly.
[00:21:04] Thank you for listening and for thinking critically in this case, and for being willing to engage in these conversations. I'll see you next time. Beyond the Chair the Therapist Companion.
