February 2001
THE SOPRANOS: Art Imitating Life and Vice-Versa
Why Dr. Melfi Will Not
End Up in Bed with Tony Soprano
by Mark I. Levy, M.D.
As fans eagerly anticipate the new season of The Sopranos, many enjoy speculating about when, where and how Tony Soprano and Dr. Jennifer Melfi will end up sleeping together. The erotic tension the two characters display during their psychotherapy sessions almost sets the screen on fire. Despite their obvious passion for one another, I believe there are several reasons that Tony and Dr. Melfi will not become lovers.
The passion that is depicted between the patient and the doctor on The Sopranos is not uncommon. Tony and Dr. Melfi feel anger, attraction, maybe love, and most certainly, affection forone another. Intense psychotherapeutic relationships between real patients and real doctors are often filled with these same emotions. But there are boundaries in all psychotherapeutic relationships to help keep these emotions in check. The first and foremost of these rules is that no physical contact can be made between patient and doctor. By withstanding all of Tony's seductive invitations and attacks, Dr. Melfi has truly stood the test. Admittedly, she did hug Tony during one episode, but The Sopranos' audience can forgive this error because she is so tough in the trenches when Tony needs her to be. As a psychoanalyst, I am very impressed that the writers of the show understand Dr. Melfi is a professional clinician and she must remain above the sexual tensions that draw she and Tony together. In fact, Dr. Melfi cares so neurotically for her patient that she seeks the supervision and treatment of another psychoanalyst. Psychoanalysis alerts its practitioners to the vulnerabilities of their own history. Often, one patient can trigger amorous feelings within a doctor. Something in the doctor's mental and emotional history resonates with the patient. If the doctor is able to ride this wave of attraction without giving in to it, she can learn some very useful things about herself as well as about her patient. Similarly, I believe Dr. Melfi will hold her ground and remain "out of bed" in her relationship with Tony. Then, the upcoming season of The Sopranos may reveal to the audience the missing details in Dr. Melfi's life. What is it about her own personal psychological history that makes Dr. Melfi so easily seduced by Tony? This unexplored area could provide fodder for many episodes to come. I applaud the writers of The Sopranos for their factual and realistic portrayal of a passionate psychotherapeutic relationship. They have an uncanny insight into the subtleties of an analyst's relationship with her patient. The writers are so sophisticated that they understand a sexual liaison between Tony and Dr. Melfi will poison the central relationship on The Sopranos and destroy the dramatic tension that propels the story. While it is fun to speculate, only the naive will believe that Tony and Dr. Melfi will end up as lovers during the show's new season.
Now that Dr. Levy has cogently explicated why Dr. Melfi and Tony Soprano are unlikely to end up in the sack, viewers may still be pondering what it would take for Dr. Melfi to turn Tony in to the authorities. Tony struggles between "open confession" of his misdeeds to Dr. Melfi and keeping his cards close to his chest. How concerned need he be that Dr. Melfi might turn him over to the authorities for any of his criminal activities? Under what circumstances would that be ethical, or even required by the law? What would it take?
The rules vary from state to state, but we can look for some generic answers. By and large, communications between a patient and psychotherapist in the course of psychotherapy are confidential. Like the priest-penitent and lawyer-client relationships, society accords a special value in protecting the confidences patients relay to their psychotherapists. At the very least, this is for the purpose of promoting an unhindered relationship in which one can not just feel, but actually be, free to say whatever one thinks. In most jurisdictions this privilege is unrestricted. But there are some limitations, the most important and prominent of which is the case in which a patient voices an immediate threat to an individual. Depending upon the jurisdiction, the law may require the therapist to take certain specified actions if the therapist takes the threat seriously. So, Tony can wax on profusely about his past hits without fear of recrimination. But if he starts in about a future hit, there is a good chance that Dr. Melfi is going to have to report him, in accordance with the requirements of a Tarasoff warning. As life is prone to imitate art, the following case came before the Court of Appeals in New York in September, 2000. A physician was charged with murdering his wife and disposing of her body by throwing her out of an airplane over the Atlantic Ocean on July 7, 1985. A year and one-half earlier he had consulted three mental health professionals two psychiatrists and a psychologist - each of whom, with the consent of the defendant, spoke with the defendant's wife and/or her parents and each of whom warned that the defendant might harm his wife. At trial, the prosecution claimed that since the defendant had permitted each of the mental health professionals to talk about his treatment, he had waived the confidentiality to which he had been entitled and now their testimony could be introduced at trial. The Court decided otherwise: "Notwithstanding the fact that the defendant gave his permission to the practitioners to do so in advance, the breach of the physician-patient privilege by the psychiatrist in this case in order to provide Tarasoff warnings and/or confer with defendant's wife and parents about the defendant does not result in a waiver of the privilege." Applying the foregoing to Tony Soprano's situation, Tony should feel quite comfortable confiding in Dr. Melfi about his past(mis)deeds. Even if, inadvertently, he were to discuss an upcoming event and Dr. Melfi felt obliged to administer a Tarasoff warning to the victim, she would neither be permitted nor obliged to reveal Tony's past. Unless Tony makes some major missteps, he should have nothing to fear from Dr. Melfi and he can safely remain Tony Soprano rather than Tony Contratenore. We can look forward to another season and, as with Rick and Louis in Casablanca, more of "the beginning of a beautiful friendship." To interview Dr. Levy and Dr. Gottlieb on these topics, please call Mary Tressel, San Francisco Psychoanalytic Institute Media Consultant, at 925-686-2958.