Movies are storytelling in high definition. Have you ever used movies to teach your students or residents? Have you ever prescribed therapeutic movie watching to your patients, families, or couples? Movie watching helps us to understand and process the challenges we face. Movie watching helps us to imagine new stories for ourselves.

Stories connect us to our own families. The experiences of our elders and other family members are the story of our family and give coherence to our own life story. We may identify with a family member whose life experience resonates with our life experience; maybe it is the relative who perseveres, or the black sheep, or the one with depression, or the pioneer, or the one who settles for happiness or the alcoholic or workaholic. Maybe we cherish stories that connect us to our generation rather than our family, such as stories about a generational war experience or the stories and camaraderie of Alcoholics Anonymous meetings.

Stories help us understand ourselves. Stories give us scripts, maps, mental models, metaphors, and narratives to help us navigate through our lives. Stories are how we explain our lives to others, reach decisions, understand our place in the world, create our identities, and define and teach social and moral values. Many children come to understand the morals of the world by reading about the lives of animals in Aesop’s Fables. How often do parents have to read the same story over and over to their child? Familiar stories give our lives a narrative structure that is familiar, predictable, and comforting.

Storytelling is fundamental to all cultures. Stories live in our imagination. We can rehearse imagined experiences and imagine our life story in many different ways. Stories help us step out, step forward, see the world and ourselves. Story reading and movie watching help us imagine. Psychotherapy is a therapeutic way to help patients relinquish old stories and begin to construct a new story about themselves.

Movie watching can be used in therapy and has been studied as a therapeutic tool. Cinema therapy, or movie therapy, is considered a form of supplemental therapy and a form of self-help. Cinema therapy was popularized by Gary Solomon, Ph.D., the first to write on using movies as therapy (“The Motion Picture Prescription: Watch This Movie and Call Me in the Morning.” Santa Rosa, Calif.: Aslan Publishing,1995).

Watching movies was used in one arm of the first long-term investigation to compare different types of early marriage intervention programs. In this study, 174 couples in their first 3 years of marriage were enrolled in one of three treatment arms: conflict management, compassion and acceptance training, or relationship awareness through film. Each arm was equally effective in reducing the 3-year divorce/separation rate for newlyweds from 24% to 11%.

The first arm

The conflict management group learned “active listening” or the “speaker-listener technique.” This technique slows down communication and helps individuals focus on what their partner is saying. The practice requires one spouse to listen and then paraphrase back to the partner what the spouse heard to ensure the message has been properly understood. This technique has been shown to be effective at promoting happier and more satisfying relationships for 3-5 years (see the Prevention and Relationship Enhancement Program). This model provides couples with training in communication and problem-solving skills, as well as relationship expectations, friendship, and commitment.

The second arm

The compassion and acceptance training cohort focused on couples working as a team. Through a series of lectures and exercises, couples were taught to approach their relationships with more compassion and empathy by doing things like listening as a friend, practicing random acts of kindness and affection, and using the language of acceptance. Both programs involved weekly lectures, supervised practice sessions, and homework assignments over the course of a month, for a total investment of roughly 20 hours, with 18 hours of therapy time.

The third arm

The movie-and-talk group attended a 10-minute lecture on the importance of relationship awareness and how watching couples in movies could help spouses pay attention to their own behavior, both constructive and destructive. They spent 10 hours on “movie and talk” with 4 hours outside of the home. After each movie, the couple discussed a list of 12 questions about the screen couple’s interactions. Questions included: “How did the movie partners handle arguments? Were they able to open up and tell each other how they really felt, or did they tend to just snap at each other with anger? Did they try using humor to keep things from getting nasty?” The couple was asked to consider in what way the movie relationship was “similar to or different from your own relationship in this area.”

All couples in the third arm met with a therapist to watch “Two for the Road,” a 1967 romantic comedy about the joys and strains of young love, infidelity, and professional pressures across 10 years of a marriage. They were then led by the therapist in a guided discussion. They went home with a list of 47 movies with intimate relationships as a major plot focus, and were asked to watch 1 a week for the next month, followed by a guided discussion for about 45 minutes. For couples interested in trying the film discussions for themselves, the website ofRonald D. Rogge, Ph.D., offers interactive tools to help with the process, including lists of movies and the discussion questions used.

What happened?

The couples invested in their relationship and began to examine their own behavior. Watching a movie together and having a discussion was therapeutic but did not pathologize their relationship, nor did the partners seek to blame each other. The therapist-led marriage intervention programs available usually require trained therapists, and are expensive and intensive. Can couples work on their relationships on their own? The assumption has been that you need to teach couples skills to manage conflict; this might not be true. This study indicates that relationship storytelling can be a step that couples and families can take, on their own.

Movies also can be used in teaching

Family medicine teachers Catherine M. Weber, Ph.D., and Dr. Hugh J. Silk (Fam Med. 2007;39[5]:317-9) developed a movie-watching curriculum to deepen trainees’ understanding of patients and their families. The curriculum was divided into sections. The family and illness section focused on how family members find a will to help their loved ones, even in the midst of a lack of resources or medical futility. They watched “Lorenzo’s Oil” (1992), “The Straight Story” (2006), and “A River Runs Through It” (1992). The family and loss section examined how families become dysfunctional in the presence of the loss of a loved one and what it takes to heal. They watched “Ordinary People” (1980), “The Barbarian Invasions” (2003), and “The Trip to Bountiful” (1985). The section on family and caregiving identifies the strain of illness on family members who provide direct care to ill patients. They watched “Marvin’s Room” (1996) and “Iris” (2001). The section on the family and substance abuse identified how family members got caught in roles and included “When a Man Loves a Woman” (1994) and “The Days of Wine and Roses” (1962). The section on the extended family and illness illustrated how illness brings people together. They watched “Flawless” (1999), “My House in Umbria” (2003), “Beaches” (1988), and “The Barbarian Invasions (2003).

A more specific look at family systems is provided by the curriculum of Dr. Robin O. Winter and Bruce A. Birnberg (Fam Med. 2005;37[2]:96-8) in a series called “Family Systems at the Movies.” Their overarching objective was to promote an understanding of multigenerational issues, the impact of family secrets and family dynamics, the effect of stress on family life, and the attributes of a functional family. Concepts such as homeostasis, boundaries, coalitions, and scapegoating were then applied to the clinical setting. Selected scenes were chosen from three works: “The Joy Luck Club” (1993), “Shine” (1996), and a TV series called “Secrets and Lies” (2015-).

Regarding early marriage, Dr. Salman Ahktar and Dr. Zoe Billinkoff (Am J Psychoanal. 2011; 71[2]:110-20) used movies to discuss how identity, the development of mutuality, and the synthesis of affection and sensuality develop in early marriage. Their goal was to help therapists develop greater empathy with newly married individuals. They focused on three movies: “Barefoot in the Park” (1967), “Raising Arizona” (1987), and “The Quiet Man” (1952). Regarding divorce, Toni Mandelbaum(Am J Psychoanal. 2011;71[2]:121-33) used movies to illustrate the interplay between dependence and independence using “Eat Pray Love” (2010) and “Kramer vs. Kramer” (1979).

Many psychiatry residency programs have journal clubs and film clubs that use movies as a jumping-off point to deepen trainees’ understanding of psychopathology. Implementing these curricula is a simple way of beginning family training in residency, especially when the use of family videos are curtailed by strict confidentiality rules.

Future ‘family and film’ events

Dr. Francis G. Lu, (www.francislumd.com), a regular presenter at many conferences, including the American Psychiatric Association annual meetings, uses film to promote a deeper understanding of the world around us and within us. In 2007, he and Brother David Steindl-Rast, Ph.D., a Benedictine monk, co-led a 7-day seminar entitled, “Families in Film, Now and Forever” at Esalen Institute (go to www.gratefulness.org, then search “films”). From July 10-17, 2016, Dr. Lu and Dr. Steindl-Rast will co-lead “The Resilience of the Family in Film: Epics of Love, Loss, and Recovery” and from July 17-24, 2016, “Through Compassion to Serenity in the Mindful Viewing of Japanese and Western Films.” Registration opens in January 2016 at www.esalen.org. If you have ever attended one of Dr. Lu’s seminars at the APA, then you know you will be in for a rich experience at Esalen.

Dr. Heru is with the department of psychiatry at the University of Colorado Denver, Aurora. She is editor of “Working With Families in Medical Settings: A Multidisciplinary Guide for Psychiatrists and Other Health Professionals” (New York: Routledge, 2013).

Storytelling that heals: Movies and families