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Psychologists’ Use of Motion Pictures in Clinical Practice
Georgios K. Lampropoulos
Ball State University Nikolaos Kazantzis
Massey University and Waitemata District Health Board
Cognitive Therapy Center
Frank P. Deane
University of Wollongong
Do professional psychologists use motion pictures in clinical practice? If so, do they consider motion
pictures to have therapeutic value? Of 827 licensed practicing psychologists, 67% reported the use of
motion pictures to promote therapy gains. Most of these practitioners (88%) considered the use of motion
pictures as effective in promoting treatment outcome, and only a minority (1%) reported them as
potentially harmful. Compared with their psychodynamic counterparts, therapists practicing within
eclectic–integrative, cognitive–behavioral, or humanistic frameworks were more likely to view or use
motion pictures as therapeutic tools. Psychologists provided individual evaluations of 27 motion pictures
that deal with a variety of mental health subjects, and overall they were characterized as “moderately
helpful.” Clinical applications and issues pertaining to using motion pictures in therapy are summarized.
There is increasing interest in the use of self-help materials, but
relatively little is known about psychologists’ actual use of self-
help materials in clinical practice. Recent advances in self-help
materials (books and self-help groups) include the use of cinema-
therapy or videowork, that is, the use of entertainment motion
pictures for therapeutic purposes (Berg-Cross, Jennings, & Baruch,
1990; Hesley & Hesley, 1998; Solomon, 1995; Sharp, Smith, &
Cole, 2002). Motion pictures hold several advantages over other
self-help materials because they are typically more available, fa-
miliar, and accessible, and they often represent easy, quick, and
pleasurable activities for clients (Hesley & Hesley, 1998). How-
ever, there is little information on the extent to which the general
psychologist population uses motion pictures in clinical practice
and on which motion pictures are considered to have therapeutic
value. The use of motion pictures in therapy may also vary as a
function of practitioners’ clinical experience, theoretical orienta-
tion, work setting, and other practice characteristics. The present
study was designed to provide data on using motion pictures in
clinical practice.
In the late 1970s Rhea Rubin provided a detailed account of the
rationale and benefits for the clinical use of the self-help materials,
such as psychological books, poetry, and literature (Rubin, 1978a,
1978b). The range of therapeutic self-help materials has since
expanded to include client autobiographies, the Internet, and mo-
tion pictures (L’Abate, 2004; Norcross, 2000; Scogin, 2003a).
Delphi polls of psychotherapy experts predicted that self-help and
self-change would be among the clinical interventions of the future
(Norcross, Alford, & DeMichele, 1992; Norcross, Hedges, &
Prochaska, 2002). This expansion is supported by a variety of
socioeconomic and clinical factors (Norcross, 2000), including the
study of client self-change within and outside therapy (Bohart &
Tallman, 1999; Prochaska & DiClemente, 1992).
Motion pictures are not only narratives that transmit the values
and ideas of our culture, but also a very popular and widespread
method of communication and expression. In treatment, movies
can be seen as therapeutic metaphors that can introduce clients to
material that is sensitive or perceived as threatening (Hesley &
Hesley, 1998; Heston & Kottman, 1997). Movie characters can
essentially act as cotherapists for clients. In addition, Hesley and
Hesley (1998) described how therapists use motion pictures to
promote therapeutic change by offering hope and encouragement,
GEORGIOS K. LAMPROPOULOS received his MA in clinical psychology from
the University of Crete, Greece. He is a doctoral student in counseling
psychology at Ball State University, Muncie, Indiana, and a scholarship
recipient of the Alexander S. Onassis Public Benefit Foundation, Athens,
Greece. He is also an intern at the Centre for Addiction and Mental Health,
Mood and Anxiety Program, Toronto, Ontario, Canada. His research
interests include psychotherapy process and outcome research, psychother-
apy integration, self-help, and psychotherapy training.
NIKOLAOS KAZANTZIS received his PhD in psychology from Massey Uni-
versity, New Zealand, where he currently holds an appointment as a
lecturer (equivalent assistant professor). He is also a clinical psychologist
and coordinator of research at the Waitemata District Health Board Cog-
nitive Therapy Center. His research program is focused on the role of
therapeutic homework assignments in cognitive–behavioral therapy.
FRANK P. DEANE received his PhD in psychology from Massey University,
New Zealand. He is a professor in psychology and director of the Illawarra
Institute for Mental Health at the University of Wollongong, Australia. His
research interests include help seeking for mental health problems, use of
homework in psychosocial interventions, treatment adherence, and recov-
ery processes for recurring mental illness.
THIS RESEARCH IS SUPPORTED in part by Grant 1157553216 and Massey
University Research Award PR56786.1207 MURF, a grant from the Illa-
warra Institute for Mental Health, University of Wollongong, and a grant
from the Lyell Bussell Memorial Graduate Fund, Ball State University.
CORRESPONDENCE CONCERNING THIS ARTICLE should be addressed to Geor-
gios K. Lampropoulos, Department of Counseling Psychology, TC 622,
Ball State University, Muncie, IN 47306. E-mail: g_lamp@hotmail.com
Professional Psychology: Research and Practice Copyright 2004 by the American Psychological Association
2004, Vol. 35, No. 5, 535–541 0735-7028/04/$12.00 DOI: 10.1037/0735-7028.35.5.535
535
deepening emotion, providing role models, enhancing client
strengths, reframing problems, improving communication, and
reprioritizing values. To these can be added the potential benefits
of providing clients with support and acceptance for their condi-
tion and facilitating emotional relief, information gathering, prob-
lem awareness, and preparation for action. For example, the de-
piction of the struggle to overcome alcoholism in a relationship in
When a Man Loves a Woman (Kerner, Avnet, & Mandoki, 1994)
and the importance of a child’s welfare in a custody battle in
Kramer vs. Kramer (Jaffe & Benton, 1979) are two well-known
motion pictures that address important clinical issues. Indeed,
there is a vast array of motion pictures that deal with abandonment,
abuse, adoption, alcohol and drug use, death and dying, divorce,
adolescence, family, vocation, friendship, gambling, eating prob-
lems, mental illness, physical illness, and sexuality. These mate-
rials have been supported by an increasing number of practitioner
recommendations on how to use them in clinical practice (see
Dermer & Hutchings, 2000; Hesley & Hesley, 1998, 2001;
Norcross et al., 2000, 2003; Solomon, 1995, 2001).
Evidence from experimental research has supported the asser-
tion that self-help materials can enhance therapeutic effectiveness.
Meta-analytic reviews have demonstrated that certain self-help
programs are superior to placebo and even equally effective with
therapist-facilitated interventions for a variety of psychological
problems (Cuijpers, 1997; Gould & Clum, 1993; Marrs, 1995;
Scogin, 2003b; Scogin, Bynum, Stephens, & Calhoon, 1990).
However, few studies have assessed the extent to which self-help
materials are used in clinical practice. Surveys of practitioners’use
of self-help books and client autobiographies have shown that a
substantial percentage of clinicians have used them for therapeutic
purposes (Clifford, Norcross, & Sommer, 1999; Marx, Royalty,
Gyorky, & Stern, 1992; Norcross et al., 2000, 2003; Starker,
1988).
Norcross et al. (2000) provided preliminary data on the clinical
use of movies from 401 members of the clinical and counseling
psychology divisions of the American Psychological Association
(APA). The researchers reported that almost one half of respon-
dents recommended movies to their clients and that 68% of these
practitioners found them helpful (2% perceived them as harmful).
Norcross et al. also obtained quality ratings for a list of motion
pictures across 20 problem areas, which they have since updated
with the evaluations of additional titles from a subsequent survey
of 316 clinical and counseling psychologists (Norcross et al.,
2003). Despite these emerging data on practice, there are no
published reports about the methods of motion picture use, or
whether practitioners with different levels of experience, theoret-
ical orientation, work setting, and other characteristics differ in
their clinical use of motion pictures. Similarly, there are no pub-
lished reports on the specific motion pictures most commonly
recommended to clients. This project provides such information by
surveying a sample of APA practitioners.
1
The Movies Project
Consistent with prior surveys of psychologists’use and evalu-
ation of self-help books and autobiographies for mental health
clients (Clifford et al., 1999; Marx et al., 1992; Starker, 1988), we
aimed to provide preliminary data that could assist practitioners in
evaluating and using popular entertainment motion pictures in
therapy. Do psychologists believe that motion pictures can be
therapeutic and used in treatment? Have they ever discussed or
recommended a movie to a client? If so, in what way have they
used it in session and what were the results? Are they familiar with
some of the commonly used motion pictures in clinical practice,
and would they recommend them to other practitioners?
The present study obtained information on demographics, the-
oretical orientation, attitudes, evaluation, patterns of clinical use of
motion pictures, and ratings of specific motion pictures. The latter
list was developed on the basis of the lists of motion pictures
described in the two major guidebooks on cinematherapy (Hesley
& Hesley; 1998; Solomon, 1995), from which we chose only those
titles that were also recommended by the mental health profes-
sionals in a small local survey by Dermer and Hutchings (2000).
This procedure was used to ensure title recognition and clinical use
of motion pictures in our survey. The final list comprised 27 titles
that covered a variety of problems and disorders.
In September 2000, a cover letter, the survey, and a postage-paid
return envelope were mailed to 3,000 randomly selected members
of the APA. The mailing labels were provided by the APA with the
constraints that psychologists (a) resided in the United States, (b)
were licensed practitioners, and (c) had indicated that the provision
of health and mental health services was their primary activity in
their primary or secondary work setting. Two weeks later a re-
minder card was sent to all participants, and 1 month later a second
survey was mailed to 1,200 randomly selected participants from
the original 3,000. The return rate of 28% yielded 840 returns and
a total of 827 usable returns. All responses were completely
anonymous. The return envelopes were not coded and were de-
stroyed on receipt.
To evaluate the representativeness of the respondents, we com-
pared their characteristics with those of the initial sample of 3,000
provided by the APA, as well as those of the APA members who
provide mental health services (provided by the APA research
department). The respondents had almost identical characteristics
with both of these groups in terms of gender, age, race–ethnicity,
highest degree obtained, number of years since degree, and area of
highest academic qualification. Forty-nine percent of respondents
were men and 95% of respondents were Caucasian. The mean age
of respondents was 52.43 years (SD ⫽9.64). In terms of profes-
sional degree, 84% had earned a PhD, 9% had earned a PsyD, 4%
had earned an EdD, and 3% had earned another advanced degree.
Respondents had been out of graduate school an average of 18.60
years (SD ⫽9.51). Seventy-six percent of respondents identified
with clinical psychology, 18% with counseling psychology, 2%
with school psychology, and 4% with “other.”Although the sam-
ple had similar characteristics to the initial APA-provided sample
and was similar to recent practitioner surveys (i.e., 30% in Addis
& Krasnow, 2000), the final response rate of 28% does suggest
that the findings should be considered indicative and preliminary.
Seventy-four percent of respondents reported independent prac-
tice as their primary employment setting, and 94% of respondents
indicated direct patient contact as their primary professional ac-
tivity. The mean percentage of respondents’annual caseload seen
in different therapy formats was 72% (SD ⫽19%) for individual
1
The results of the Norcross et al. (2000) study were not available at the
time we were planning and conducting the data collection for this project.
536 LAMPROPOULOS, KAZANTZIS, AND DEANE
therapy, 16% (SD ⫽12%) for couples therapy, 14% (SD ⫽15%)
for family therapy, and 10% (SD ⫽14%) for group therapy.
Respondents reported treating mostly adults (68% of yearly case-
load; SD ⫽25%), followed by adolescents (17%; SD ⫽15%),
children (17%; SD ⫽18%), older adults (12%; SD ⫽12%), and
infants (1%; SD ⫽4%). In terms of primary theoretical orienta-
tion, respondents self-identified with cognitive–behavioral therapy
(41%), psychodynamic–analytic therapy (25%), existential–
humanistic therapy (8%), interpersonal therapy (8%), family sys-
tems therapy (4%), behavioral therapy (2%), social learning ther-
apy (1%), and other therapies (integrative–eclectic; 12%). The
ranges and percentages of theoretical orientations were consistent
with a survey of APA Division 12 (Clinical Psychology) members
(Norcross, Karg, & Prochaska, 1997).
Attitudes and Use of Motion Pictures in Clinical Practice
Sixty-seven percent of responding practicing psychologists ei-
ther agreed (54%) or strongly agreed (13%) that “quality enter-
tainment motion pictures that deal with psychological issues can
be beneficial and could be used for therapeutic purposes (e.g.,
awareness raising, modeling behavior, and client inspiration).”
Twenty-five percent of respondents remained neutral, and only 8%
of respondents indicated they either disagreed or strongly dis-
agreed with the above statement (Mresponse ⫽3.67, SD ⫽0.90,
on a Likert-type scale with anchors 1 ⫽strongly disagree and 5 ⫽
strongly agree).
We were interested in examining whether theoretical orientation
was related to the perceived therapeutic value of motion pictures
for two reasons. First, assigning motion pictures in therapy has
been described as a type of homework assignment (Hesley &
Hesley, 1998), and homework has been traditionally associated
with the practice of cognitive–behavioral therapy compared with
other therapies (Blagys & Hilsenroth, 2002; Kazantzis & Deane,
1999). Second, the use of motion pictures as self-help adjuncts to
therapy is consistent with the tenets of humanistic therapy, where
clients are seen as active self-healers (Bohart & Talman, 1999).
Therefore, we recoded theoretical orientation into five categories
(cognitive–behavioral, humanistic–existential, psychodynamic–
analytic, interpersonal–family systems, and eclectic–integrative)
and conducted an analysis of variance (ANOVA) to examine
differences among practitioners of major theoretical orientations.
For the potential value of using motion pictures in therapy, there
were statistically significant differences among respondents of
different theoretical orientations, F(4, 760) ⫽4.70, p⫽.001. A
Tukey post hoc test revealed that cognitive–behavioral (M⫽3.76,
SD ⫽0.87) and eclectic–integrative (M⫽3.81, SD ⫽0.77)
therapists more frequently considered motion pictures as therapeu-
tic tools than did psychodynamic–analytic therapists (M⫽3.44,
SD ⫽0.95), p⬍.01.
When asked about the natural occurrence of in-session discus-
sions of motion pictures, 90% of respondents reported that they
had discussed a motion picture with a client in therapy without
necessarily recommending it. Sixty-seven percent of respondents
reported that they had recommended a motion picture to a client,
a substantially higher proportion than the 46% reported in the
Norcross et al. (2000) study.
Practitioners who had recommended a motion picture to a client
were asked to check up to four options describing the method they
used for incorporating motion pictures in therapy. Of the 536
respondents who recommended a motion picture to a client, 95%
discussed the movie in session, 53% recommended the movie but
did not discuss it in session, 29% assigned therapeutic homework
related to the movie, and 5% watched the movie or parts of it with
the client in session. The percentages reported for the use of each
method were comparable with those reported for self-help books
(Marx et al., 1992) and autobiographies of mental health clients
(Clifford et al., 1999), suggesting that the in-session use of motion
pictures may be similar to other adjunctive self-help materials.
A chi-square analysis revealed significant differences among
practitioners of major theoretical orientations in their use of mo-
tion pictures,
2
(4, N⫽772) ⫽35.48, p⬍.001. More specifically,
87% of eclectic–integrative practitioners had recommended mo-
tion pictures as a therapy adjunct, whereas 79% of humanistic–
existential practitioners, 65% of interpersonal–systemic practitio-
ners, 65% of cognitive–behavioral practitioners, and 54% of
psychodynamic–analytic practitioners had recommended motion
pictures. Additional chi-square tests between pairs of theoretical
orientations were conducted, with alpha set at p⬍.01 for all tests
(to reduce the likelihood of Type I error). These tests revealed that
(a) eclectic–integrative therapists were more likely to recommend
movies compared with practitioners with interpersonal, cognitive–
behavioral, and psychodynamic orientations, and (b) humanistic–
existential therapists were more likely to recommend movies than
their psychodynamic–analytic colleagues.
Statistical tests were also conducted to examine differences in
use of motion pictures in terms of the following five variables of
interest: practitioners’gender, clinical experience, primary em-
ployment setting (private practice vs. other), type of academic
degree (PhD vs. PsyD), and area of academic degree (clinical vs.
counseling psychology). Male respondents were slightly more
likely to have recommended a movie to a client than women (72%
vs. 60%),
2
(2, N⫽802) ⫽12.34, p⬍.001. Psychologists in
private practice were also more likely to have recommended a
movie to a client compared with those who reported a different
primary employment setting (70% vs. 58%),
2
(2, N⫽791) ⫽
10.12, p⫽.001. In terms of clinical experience, psychologists who
had recommended a motion picture to a client had more years of
clinical practice (M⫽21.41, SD ⫽9.08) than their colleagues who
had never recommended a movie (M⫽19.01, SD ⫽8.70),
t(797) ⫽3.58, p⬍.001. However, the use of motion pictures was
not significantly different among those who were PhD versus
PsyD trained or between those trained in clinical or counseling
disciplines.
To survey the perceived therapeutic effects of motion pictures as
a therapy adjunct, we asked psychologists to evaluate their own
experience with using motion pictures in treatment on a Likert-
type scale with anchors of 1 (very harmful)to5(very helpful).
Seventy-six percent of respondents rated the effects as somewhat
helpful and an additional 12% as very helpful, whereas 11% did
not perceive any effects and only 1% rated them as somewhat
harmful (and none rated them as very harmful).
Ratings of Therapeutic Value for Specific Motion Pictures
With the goal of providing preliminary data for practitioners
regarding the perceived value of recommending particular motion
pictures in treatment, we provided participants with the list of 27
537
PSYCHOLOGISTS’USE OF MOTION PICTURES
motion pictures. Table 1 presents motion pictures’titles, years of
release, and main psychological–therapeutic subjects. The latter
issue was not always clear-cut because most of these motion
pictures dealt with a variety of subjects, and descriptions were
based on a review of different sources (i.e., Dermer & Hutchings,
2000; Hesley & Hesley; 1998; Solomon, 1995).
Participants who recommend motion pictures (n⫽536) indi-
cated whether they had seen each movie, with responses ranging
from 27 (5%) to 501 (93%) respondents for the most popular
movie (see Table 1). The therapeutic quality of each movie for
treatment purposes was then rated on the following scale: –2⫽
extremely bad (this movie exemplified the worst of these type of
motion pictures); –1⫽moderately bad (not a good movie, may
provide misleading or inaccurate information); 0 ⫽neutral (an
average movie of this type); 1 ⫽moderately good (provides good
insight, can be helpful); 2 ⫽extremely good (outstanding, highly
recommended). This scale was based on those used in similar
studies of self-help books (Santrock, Minnett, & Campbell, 1994)
and mental health client autobiographies (Clifford et al., 1999).
Table 1 presents the means and standard deviations of therapeu-
tic quality ratings for the 27 movie titles. Movie ratings ranged
from 0.29 to 1.33 for the most valuable motion pictures, which are
presented in ranked order. Overall, these specific motion pictures
were considered to be moderately helpful, and none of them
received negative mean ratings. Practitioners were also given the
option to cite and evaluate their own motion pictures at the end of
our prepared list, in a response choice marked as “other.”
Respondents who recommend motion pictures (n⫽536) also
indicated which of the listed motion pictures they had recom-
mended to a client, with the number of therapists having recom-
mended each title ranging from 3 to 188 (see Table 1). As a second
descriptive analysis of these data, the percentage of the sample that
had viewed and subsequently used a movie in therapy can be used
to indicate how “recommended”a movie might be. The highest
percentage was for Ordinary People (41% of the sample who
viewed it used it in therapy), which also received the highest
quality rating. The proportion of therapists using any specific
movie ranged between 41% and 11%. Some infrequently seen
motion pictures may be used relatively frequently by the small
number of therapists who have seen them (e.g., Under the Influ-
ence, 19 of 71, or 27%, used it). These data may provide prelim-
inary guidelines to help clinicians select and assess the therapeutic
quality of specific motion pictures.
Summary and Implications for Practice
Our study attempted to clarify clinicians’attitudes and patterns
of use of motion pictures for therapeutic purposes and provide
Table 1
Frequency of Respondents (n ⫽536) Who Personally Viewed and Therapeutically Used Motion Pictures and Mean Ratings of Their
Therapeutic Quality
Motion picture (year and main subject)
Viewed Used Therapeutic quality
nn/% MSDnRank
Ordinary People (Schwary & Redford, 1980; multigenerational issues, loss) 453 188/41 1.33 0.72 412 1
Philadelphia (Saxon & Demme, 1993; AIDS and prejudice) 342 68/20 1.17 0.80 307 2
The Great Santini (Pratt & Carlino, 1979; father–son relationship, abuse) 252 89/35 1.14 0.85 227 3
On Golden Pond (Gilbert & Rydell, 1981; aging and relationships) 471 126/27 1.14 0.76 422 4
Trip to Bountiful (Vanwagenen, Forte, & Masterson, 1985; age and ageism) 198 40/20 0.97 0.77 179 5
My Life (Lowry & Rubin, 1993; terminal illness and dying) 84 21/25 0.94 0.85 83 6
Kramer vs. Kramer (R. C. Jaffe & Benton, 1979; divorce and custody) 462 97/21 0.93 0.81 409 7
Dad (Kennedy, Marshall, Spielberg, & Goldberg, 1989; aging and family) 78 15/19 0.91 0.64 75 8
Dead Poets Society (Haft, Witt, Thomas, & Weir, 1989; adolescence, family issues) 453 105/23 0.85 0.76 402 9
When a Man Loves a Woman (Kerner, Avnet, & Mandoki, 1994; alcoholism) 184 47/26 0.84 0.89 170 10
Terms of Endearment (Brooks, 1983; terminal illness) 436 77/18 0.84 0.85 384 11
Parenthood (Grazer & Howard, 1989; parent–child relationships) 192 44/23 0.78 0.82 172 12
Steel Magnolias (Stark & Ross, 1989; friendship, grief) 381 80/21 0.77 0.80 342 13
One Flew Over the Cuckoo’s Nest (Douglas, Zaentz, & Forman, 1975; mental health) 501 116/23 0.76 1.04 447 14
The Accused (S. R. Jaffe, Lansing, & Kaplan, 1988; sexual assault) 152 23/15 0.76 0.95 138 15
Under the Influence (Greene & Carter, 1986; alcoholism in the family) 71 19/27 0.75 0.77 71 16
It’s a Wonderful Life (Capra, 1946; meaning in life, suicide) 422 77/18 0.74 0.84 368 17
Four Seasons (Bregman & Alda, 1981; divorce and remarriage) 232 34/15 0.67 0.79 212 18
How to Make an American Quilt (Pilsbury, Sanford, & Moorhouse, 1995; intimacy) 136 18/13 0.67 0.61 121 19
Like Water for Chocolate (Arau, 1993; family of origin) 283 53/19 0.64 0.78 250 20
Forest Gump (Finerman, Starkey, Tisch, & Zemeckis, 1994; mental challenges, labeling) 475 87/18 0.64 0.86 427 21
The Big Chill (Kasdan, 1983; friendship, grief) 400 52/13 0.59 0.75 356 22
Nuts (Corman, Schwartz, Streisand, & Ritt, 1987; sexual abuse) 186 34/18 0.54 0.99 174 23
Bye, Bye Love (Goldberg, Hall, & Weisman, 1995; divorce) 27 3/11 0.37 0.79 27 24
Dolores Claiborne (Mulvehill & Hackford, 1995; violence and sexual abuse) 153 17/11 0.34 0.91 142 25
War of the Roses (Brooks, Milchan, & DeVito, 1989; conflict resolution) 352 65/18 0.29 1.18 315 26
Prince of Tides (Karsch & Streisand, 1991; sexual abuse) 397 82/21 0.29 1.32 362 27
Note. Viewed ⫽number of therapists who indicated they had personally viewed the movie. Used ⫽number of therapists who indicated they had used
the movie for therapeutic purposes with clients. % used ⫽percentage of therapists who had used the movie from those who had viewed. Therapeutic
quality ⫽ratings of perceived quality of the movie for therapeutic purposes (scale ranged from ⫺2⫽extremely bad to 2 ⫽extremely good).
538 LAMPROPOULOS, KAZANTZIS, AND DEANE
pilot data on the usefulness of specific motion pictures that deal
with psychological subjects. Overall, the findings are consistent
with those of Norcross et al. (2000) in that the majority of re-
sponding psychologists have at some point discussed a movie in
session, have positive attitudes toward motion pictures, and use
motion pictures in clinical practice. These preliminary findings
also suggest that motion pictures are almost as popular and helpful
as self-help books, at least according to practitioners’reports (see
also Norcross et al., 2000). However, a higher percentage of
respondents in the present study (67%) had recommended a mo-
tion picture to a client than in the Norcross et al. study (46%).
Consistent with this, 88% in the present study considered the use
of motion pictures to be helpful in therapy, whereas a lower
proportion (68%) rated them as helpful in the Norcross et al. study.
These differences may be due to our sample having more private
practitioners compared with Norcross et al. (74% and 41%, re-
spectively). Private practitioners seemed to be more willing to
recommend movies to their clients, as was also the case with
self-help books (see Marx et al., 1992). Similar to the attitudes
toward self-help books (Campbell & Smith, 2003), eclectic–
integrative, cognitive–behavioral, and humanistic therapists were
more likely to view or use motion pictures as therapeutic tools
compared with psychodynamic–analytic therapists.
Given such common use and the perceived value of motion
pictures in therapy, there remains a need for research to quantify
the effects on psychotherapy processes and subsequent outcomes.
However, because it may be unrealistic to expect that specific
studies will be conducted in the near future for each motion picture
as a therapeutic tool, it has been suggested that practitioners could
explore the clinical use of films that have already been positively
evaluated and recommended by hundreds of therapists (Norcross,
2003). The results of the present study, together with the Norcross
et al. (2000, 2003) studies have provided preliminary ratings on the
perceived value of several specific motion pictures that cover a
variety of problems. It is notable that the majority of the motion
pictures listed in this study were evaluated positively by practitio-
ners in the present study. At the very least, these findings can be
used as a preliminary clinical resource for selecting and using
motion pictures in clinical practice.
Although some practitioners described the use of motion pic-
tures more than others, our data suggest that practitioners of all
different orientations and therapeutic modalities have used them as
clinical tools. Practitioners’responses included a variety of in-
session uses of films, from simply discussing a film in session, to
assigning homework related to it, or even watching parts of it with
the client. Motion pictures can be useful therapy assignments,
because their accessibility, familiarity, brevity, and entertainment
value can spark client curiosity, build therapeutic rapport, and
enhance homework compliance (Hesley & Hesley, 2001). How-
ever, therapeutic viewing is different from entertainment, in that it
focuses on the analysis of movie characters, their relationships,
and behaviors and strives for client insight through conscious
identification with the characters (Hesley & Hesley, 2001). The
evaluations of movies provided by the present study can assist
selection, but we also recommend consulting other available
sources to obtain additional clinical guidelines with suggestions of
specific movies for specific problems (e.g., Dermer & Hutchings,
2000; Hesley & Hesley, 1998, 2001; Norcross et al., 2000, 2003;
Solomon, 1995, 2001). Alternatively, interested clinicians can read
actual cases of cinematherapy (e.g., Heston & Kottman, 1997;
Wedding & Niemiec, 2003) or even analyses of specific movie
titles from different theoretical orientations (e.g., Cocks, 1991;
Paden-Levy, 2000).
The following summary of general recommendations and cau-
tions are offered to clinicians who want to integrate cinematherapy
into their clinical practice.
1. Therapists should carefully consider who is and who is not a
good candidate for the therapeutic use of motion pictures. Some
prerequisites include at least moderate client functioning, client’s
interest and enjoyment in watching movies, and client’s ability to
understand the movie. The age of the client, degree of impairment,
as well as ability to distinguish between fantasy and reality are
important considerations. In addition, cultural and disability issues
should be considered, and special caution is advised for clients
with severe trauma or violence issues (Dermer & Hutchings, 2000;
Hesley & Hesley, 1998, 2001; Schulenberg, 2003).
2. Therapists should choose the timing of the intervention and
assign a movie that is appropriate for client’s problems. Movies are
used as therapeutic tools for specific purposes and should be well
integrated in the therapeutic process, case formulation, and treat-
ment plan. Using only one movie at a time is preferred to maxi-
mize the benefit of the experience and not overwhelm the client
(Hesley & Hesley, 1998, 2001; Solomon, 1995; Sharp et al., 2002;
Schulenberg, 2003).
3. Movie selection criteria include choosing titles that clients
enjoy or are familiar with and those recommended by other ther-
apists. Considering a client’s input and building on a client’s
previous movie-viewing experience may also increase cooperation
with the assignment and the client’s benefit from it (Hesley &
Hesley, 1998, 2001; Schulenberg, 2003).
4. Desirable movie characteristics include the ability to inspire
and evoke emotions, the depiction of characters solving problems,
and, generally, of appropriate role models. It is preferable that
clients have similar demographics, values, and lifestyles with
characters in the assigned movies, so they can better relate (Hesley
& Hesley, 1998, 2001; Heston & Kottman, 1997).
5. Therapists should view a movie before assigning it to a client
and have a clear rationale for doing so. Clinicians should first
normalize the exercise and explain it to clients. This includes
explaining expectations, identifying the characters the client
should focus on, and giving specific movie-viewing instructions
(e.g., watch focused, pause and replay important scenes, keep
notes of insights and emotions, and permission to turn the movie
off). In addition, therapists should discuss any scenes that may be
offensive or problematic ahead of time and address any client
concerns (Dermer & Hutchings, 2000; Hesley & Hesley, 1998,
2001; Sharp et al., 2002; Schulenberg, 2003).
6. Therapists should process the exercise in a debriefing session
and address any negative client responses. It is equally important
to consolidate client insights and benefits from watching the movie
as well as to examine and resolve any failed connections or
adverse effects. Last, therapists should adapt and connect the
movie to the client’s real-life context and make sure the exercise is
integrated in treatment (Dermer & Hutchings, 2000; Hesley &
Hesley, 1998, 2001; Heston & Kottman, 1997; Solomon, 1995;
Sharp et al., 2002; Schulenberg, 2003).
In conclusion, clinicians are encouraged to consider motion
pictures as an adjunct to in-session or between-sessions activity.
539
PSYCHOLOGISTS’USE OF MOTION PICTURES
Interested practitioners may find it helpful to follow the guidelines
for effective homework assignments (see Kazantzis, Deane, Ro-
nan, & L’Abate, in press; Kazantzis & Lampropoulos, 2002) as
well as the specific recommendations for using motion pictures in
therapy (Hesley & Hesley, 2001) to help clients gain therapeutic
benefit from watching movies. As part of a general scientist–
practitioner approach to clinical work, we also strongly encourage
practitioners to regularly monitor the process and outcome of their
clinical use of motion pictures (see discussions in Lambert et al.,
2003; Lampropoulos et al., 2002).
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Received July 28, 2003
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Accepted January 28, 2004 䡲
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