When Good Therapists Break the Rules

I want to tell you about the show I can’t stop watching—and can’t stop worrying about.

My husband and I started Apple TV’s Shrinking the way many people watch TV: on a tired evening with low expectations. But by the second episode, I was laughing out loud, and by the end of the season I was incredibly moved, in the way good television is supposed to move you. Jason Segel plays Jimmy Laird, a psychologist whose wife has died and who responds to his grief by abandoning the conventional therapeutic frame entirely. He tells his clients exactly what to do. He shows up at their homes uninvited. He invites one client, a struggling veteran named Sean, to move into his household. He talks about his clients casually with the neighbors. The show gives this a name—“Jimmying”—and presents it as a kind of radical honesty that reaches people in ways ordinary therapy never could.

I loved Jimmy’s character. That’s the part I have to be honest about, because I think it’s the part that matters most. I’ve spent my 30-year career inside this profession. I teach its ethics codes in a program that prepares early-career clinicians for entry-level work in behavioral health. But I still found myself rooting for a man who breaks nearly every rule I ask my students to hold sacred. If the show could do that to me, imagine what it could do to a young therapist who’s never read the ethics code or sat in a supervision room watching a good clinician slow down and check herself.

Many of my students are already working in the field while they finish their degrees. These are psychological technicians, case managers, peer specialists, and residential staff, and they’re often the person in the room when a client is at their most frightened and most human. When I talk to them about boundaries, I’m not teaching abstractions. I’m talking to people who will be tested, week after week, by clients who need more than the structure allows them to give. And the culture they live in—the same culture I live in—has presented them with Jimmy, a hero who gives his clients more by ignoring the structure altogether.

This is why, every time I’ve begun an episode, I’ve thought about a Supreme Court decision finalized this spring.

In Chiles v. Salazar, the Court ruled that Colorado’s ban on conversion therapy likely violates the First Amendment. The majority reasoned that the state was regulating what a licensed counselor could say to a client, not what they could do to one, as the state had originally claimed. The science was in front of the Court, and it was not ambiguous. The research shows no credible evidence that sexual orientation can be changed, and it also shows that real harm comes from conversion therapy practices, including higher rates of suicidal ideation and suicide attempts among transgender adults who’ve been exposed to them as minors. The Court didn’t dispute the evidence, it ruled on speech. But that decision now puts similar bans in roughly two dozen states at risk.

To be clear, I’m not writing to relitigate the case. I’m writing because of what it does to the quiet architecture that holds our work together. Justice Ketanji Brown Jackson, in dissent, warned that the majority’s logic could shield almost any talk-based intervention from state regulation, including interventions that fall below the standard of care. When I read that, I thought about Jimmy. If a therapist’s words are simply an expression of who they are, then restricting those words starts to feel like restricting their humanity. That’s precisely the feeling Shrinking cultivates in its audience, season after season, with enormous skill.

What I keep saying to my students, and to myself, is this: warmth alone isn’t enough. Not because warmth is suspect. Warmth is most of the work. The same show that gives us Jimmy also gives us Jimmy’s colleague, therapist Gaby Martin, who’s funny, caring, and fully human while staying inside the frame, and she’s proof that the choice was never between being a good clinician and being a real person. The reason we hold the boundary is that the boundary is what protects the person on the other side of it when our own judgment is compromised—and our judgment is compromised more often than we like to admit. Grief compromises it. Exhaustion compromises it. The genuine, aching desire to help a client who’s not getting better compromises it most of all.

When I want to remember why this isn’t theoretical, I think about 10-year-old Candace Newmaker. In April 2000, Newmaker died during a 70-minute “rebirthing” session in Colorado, a restraint-based technique with no empirical foundation and significant documented risk. Seven times she told the therapists and their assistants that she couldn’t breathe. A licensed psychologist had referred her to the session, and by every account, that psychologist believed she was helping a child in serious distress, as did the practitioners who conducted the session. In all likelihood, everyone in that room meant well. What was missing wasn’t compassion, it was a commitment to require that any intervention, no matter how urgent the situation feels, must be grounded in evidence before it’s used.

This commitment is exactly what the ethics code exists to sustain, and it’s exactly what this cultural moment is wearing down. It’s  a moment that increasingly prizes instinct over training, and conviction over evidence. Just as the law has removed a support used to reinforce our standards, television, for all its warmth and craft, is unraveling therapy as well. It’s teaching the public that the best clinicians are those who trust their instincts over their training. Now it seems the entire weight of the standard of care is resting on something the public doesn’t see: our training, the reasons for it, and why we choose slow and careful over fast and direct, even though slow and careful sometimes looks like being cold or detached.

In the midst of all this, I’ve changed how I teach. I no longer treat the ethics code as a list to memorize. I treat each standard as the answer to a question: what harm did we learn about the hard way, and what does it cost our clients when we forget it? I ask my students to sit with the discomfort of loving Jimmy, because that discomfort is the most useful thing Shrinking gives us. It shows us how easy it is to mistake permission for caring.

If you do any public-facing work (and most of us do now), through a social media account, a podcast appearance, a classroom, or a conversation with a worried parent, speak up. I think we owe the public a fuller story than the one they’re being told. Not a scolding one, but a truer one. Ethical codes and structure aren’t a cage around good clinical work; they’re the foundation that allows our work to be good and safe at the same time.

I’ll keep watching Shrinking. It’s a beautiful show about grief, and I don’t think loving it is the problem. The problem is what happens when we stop noticing the difference between the therapist we’re moved by onscreen and the therapist we’re responsible for being.