A Taxonomy of TV Therapists

Therapy sessions are catnip for TV writers. They've got the bulit-in drama of two people discussing intimate things, and because of doctor-patient privilege, there's a justifiable reason to focus on juicy secrets that characters might not tell anyone else.

But even if the set-up is usually the same, TV therapy sessions serve all sorts of narrative ends. We're breaking down the five major types of fictional TV shrinks and the stories they help tell. After you read the list, feel free to lie back and discuss how it makes you feel.

The Patient's Plaything

What if a patient has a horrifying secret? And what if they manipulate their therapist's oath of confidentiality in order to escape justice? That's the premise of FX's new miniseries thriller The Patient, which premieres August 30 on Hulu. It stars Steve Carell as Alexander Strauss, a therapist who's horrified to discover that one of his patients (Domnhall Gleason) is a serial killer who wants Alexander to cure his homicidal tendencies.

There's an exciting imbalance of power when a therapist is at the mercy of a patient like this. It not only creates the drama of a dangerous person exerting control over someone who's ostensibly there to care for them, but it also gives the therapist an internal conflict about when or if it's ok to break doctor-patient privilege. You could argue that the entire history of Prestige TV hinges on this very problem, since Tony Soprano (James Gandolfini) spends most of The Sopranos manipulating and lying to Dr. Melfi (Lorraine Bracco). A funnier twist on this theme turns up in Crazy Ex-Girlfriend, when Rebecca (Rachel Bloom) spends two seasons antagonizing Dr. Akopian (Michael Hyatt) in one way or another, up to and including a plot to break into her house and steal her prescription pad.

The Dastardly Doctor

Sometimes, of course, it's the therapist who's twisted and not the patient, and when that happens, we have to face our fears that the people we trust to help us are actually trying to do us harm. Hannibal Lecter is the definitive example, and the NBC series Hannibal thrived by focusing on the era when nobody had yet knoew that Lecter (Mads Mikkelson) was a murderous cannibal. Every time he said something perceptive about FBI profiler Will Graham's (Hugh Dancy) inner life, we got the dark thrill of knowing his kindness came with a price.

Not every Dastardly Doctor is so macabre. In Apple TV+'s miniseries The Shrink Next Door, Paul Rudd plays a therapist who slowly insinuates himself into the life of a patient played by Will Ferrell. Eventually, the doctor is running the poor guy's life, and in some ways that's scarier than an analyst who might eat your liver. Almost none of us will meet a man-eating psycho, but any of us might know a seductive schemer who wants to use our inner lives agaisnt us.

There's a similar anxiety running underneath Showtime's Web Therapy, which stars Lisa Kudrow as a therapist who builds a business model to keep her patients from talking too much, and the first three seasons of HBO's In Treatment, where Gabriel Byrne plays a shrink who gets in morally compromising positions with his patients.

Honorable mentions to both Elizabeth Olivet (Carolyn McCormick) and Emil Skoda (J.K. Simmons), the court-appointed psychologists on Law & Order. Though they typically do good work, their juiciest plots involved them framing people or generally being surly to them.

The Helpless Bystander

Sometimes a therapist is there to underline how unmanageable a situation has become. In a classic early episode of The Simpsons, Dr. Marvin Monroe tries to help the Simpson clan during a group therapy session, but before long he's reduced to watching them give each other electric shocks. The point is that even a licensed professional can't help this family get it together.

Meanwhile, on Apple TV+'s Severance, Ms. Casey (Dichen Lachman) inititally seems like a Dastardy Doctor, since her so-called therapy sessions are actually elaborate forms of psychological torture inflicted on Lumon workers who act out. By the end of the season, however, we learn that Ms. Casey is the pawn of her corporate overlords, and no matter how hard she tries, her gestures toward healing conversation are going to be crushed.

Honorable mention goes to Julia Roberts' character in Amazon Prime Video's Homecoming. She's technically a social worker and not a therapist, but her efforts to help soldiers in one-on-one sessions are likewise crushed by a sinister corporation.

The Analyst in Name Only

For the roughly 1000 years that Kelsey Grammer has played Frasier Crane on Cheers, Frasier, and the upcoming Frasier reboot on Paramount+, he's always been a therapist. But he's mostly a therapist in name only. His profession is more of a symbol of his status, erudition, and prissiness than it is a meaningful pathway to storytelling. (And his call-in radio show is an excuse for famous actors to make voice cameos as call-in guests.)

That's basically what happened on CBS' short-lived sitcom Out of Practice, where Christopher Gorham played a therapist who couldn't get out of the shadow of all the other doctors in his family, including parents played by Stockard Channing and Henry Winkler. Again, his work was mainly a stand-in for "professional competence", which was supposed to make it funnier when his life fell apart.

American Horror Story's Dr. Ben Harmon (Dylan McDermott) also fits in here. Though he sees ghost patients for regular sessions at the murder house, he's mostly trying to keep himself busy while facing the endless afterlife. And we can't forget the animated Dr. Katz (Jonathan Katz) from Dr. Katz, Professional Therapist. He may not be much of a shrink, but since he sits back and lets his patients deliver their funny spiels about sea cows and such, everybody wins.

The Helpful Friend

Maybe it's a hopeful sign that the most common type of fictional TV therapist is the one who's legitimately trying to help, leading to satisfying episodes about personal breakthrough and emotional closure. Sometimes it also leads to Emmy attention, from Dianne Wiest winning for her nurturing character on HBO's In Treatment to Sarah Niles getting nominated this year for playing the tough but wise team therapist onTed Lasso. Of course it was Bob Newhart pioneered this type with his good-natured shrink on The Bob Newhart Show, while Oprah Winfrey played Ellen's helpful therapist in the coming-out episode of Ellen. If that doesn't signify the dignity of the profession, nothing will.

The Patient premieres on Hulu Tuesday August 30, 2022

Mark Blankenship has been writing about arts and culture for twenty years, with bylines in The New York Times, Variety, Vulture, Fortune, and many others. You can hear him on the pop music podcast Mark and Sarah Talk About Songs.