Dear Therapist Colleagues: I Watched The Shrink Next Door, So You Don’t Have To!

At the forty-eight-minute mark of our session, I ask *Hilly, “So, have you seen The Shrink Next Door?”

“No,” she says carefully, “and I’m not planning on it.”

“Oh, I get it.”

I am a psychotherapist, having this conversation with my therapist, with whom I have recently resumed to assist with burnout I incurred from — you guessed it — being a therapist.

“Yeah, I saw an announcement go by on my feed, and I love Paul Rudd, but. No,” she says, tactfully.

“Well I have,” I say, leaning in, “It’s like having your fingernails pulled out, one by one!”

I tuck away the precious personal tidbit (we are taught to be judicious with self-disclosure) about my counselor Hilly — that she loves Paul Rudd — perhaps so much, in fact, that she cannot bear to see him as an unethical therapist.

Can you blame her? I almost passed out seeing him in the party getup of his opening scene.

“Don’t worry,” I say, heroically, “I’ll watch the whole thing for you.”

At first I try to write an episode-by-episode breakdown of The Shrink Next Door, starring not only the beloved Rudd, but heavyweights Will Ferrell and Kathryn Hahn. My story idea is to tally all of the ethical violations in the series, discussing them from the point of view of a mental health professional.

Ha.

Turns out, seeing a reenactment of a true story of someone in the mental health field doing that kind of harm, and then detailing every little harm, episode by episode, would not only be like having your fingernails pulled out one by one, it would then be like shoving your nail-less finger stubs into a vat of rubbing alcohol.

So I’ll summarize.

In 2010, former New York Times reporter Joe Nocera bought a house in the Hamptons. He attended a party thrown by the next-door neighbor, a celebrity-obsessed Manhattan psychiatrist. There was a man at the party, serving the guests, whom Joe had seen on the grounds before and thought was a butler or maintenance man.

A year or so after, the man whom Joe had mistaken for staff at the party showed up at Joe’s house with the story of a lifetime. Marty Markowitz, fabric heir, turned out to be the real owner of the house, and Isaac Herschkopf, whom not only Joe, but just about everyone at the parties and in the neighborhood had thought was the owner of the house, was actually Marty’s psychiatrist, who had been financially and personally entangled with him (unethically!), for thirty years.

Over the course of those three decades, Dr. Ike, as Herschkopf was called, got Marty to cut off family members emotionally and financially, and then created a philanthropic foundation with Marty and Dr. Ike as the two main account holders. The foundation became the sole beneficiary of Marty’s will, except for the Hamptons house, which Ike had taken over: Marty changed his will so that Isaac Herschkopf’s daughters were to receive that. Over thirty years, Marty typed ten (bad) manuscripts for Ike, he lived like a servant in the back, while Isaac Herschkopf spent hundreds of thousands of dollars of Marty Markowitz’ money on parties, buying an adjacent house and making a large compound, buses to transport guests from the city, and, of course, charging therapy fees seemingly all the while. Ike decorated the house with photos of himself and celebrities.The good doctor even put his name on the mailbox and encouraged the idea that he owned the house.

On the day in the early 2010s that Marty showed up at Nocera’s house next door, he brought his sister Phyllis with him. They told the NYT reporter that they had not spoken for thirty years because of Ike. Joe recognized a story when he saw one, and eventually told it as a podcast in 2019. Writer Georgia Pritchett then developed the story into a television miniseries starring Paul Rudd and Will Farrell in 2021.

I inhaled it all, starting with the show and then toggling back-and-forth with listening to the podcast, to get both the detailed true story while absorbing the emotional impact of the dramatized version.

The boundary violations in the series had me gasping. During (the dramatization of) their first-ever session, Ike breaks all the known and accepted stabilizing frameworks of the therapeutic container: space, time, and money. After Marty says he is “fine” and not interested in a session, but would pay Isaac for his time anyway, Isaac suggests that, since his time is paid for anyway, they take a walk, which of course turns into a non-confidential therapy session in the street, which obviously turns into an emasculating basketball game with local youth, which naturally segues into lunch over which Isaac berates Marty for his timid lunch choices, then ends with Marty accompanying Ike to a frame shop, where he has a panic attack. The frame shop guy takes better care of him than the shrink. After that entire shit show, Isaac charges him more money because they “went over” (darn those time-consuming panic attacks!). Not to mention that, but Ike’s hourly psychiatrist fee in 1986 is almost the same as the going rate in the Bay Area now.

The series goes on to depict how Ike tore Marty away from his life, using Marty’s lack of confidence against him like a weapon, infantilizing him until Isaac has his hooks in Marty’s family life, love life, home, and business (he receives fat checks as a business “consultant”). Soon after a bar mitzvah that Dr. Ike throws for Marty as an adult as some sort of bizarre do-over (a real event in the true story) Marty severs his relationship with Phyllis and her children, even though Phyllis is recently divorced and Uncle Marty was the reliable male role model in her children’s lives. Dr. Ike over Marty’s house and redecorates it, and even cuts down the tree that Marty’s departed mother had planted (a fictional conceit to tell the story). The podcast explains that Dr. Ike encouraged many patients to cut themselves off from their families.

Nauseating.

How, when so many of us are mindful and careful of ethics, painstakingly creating the frames of therapy, setting and reinforcing appropriate boundaries, can this psychiatrist abuse the power he has been entrusted with, to the point where it obliterated a man’s confidence and stole thirty years of his life? How did it take a podcast, a television show, and years of hearings for this man to finally lose his license in 2021?

The idea that you could seek help and then be taken advantage of by the very person you trusted to help you is devastating. Somehow even more devastating still that Isaac Herschkopf did seem to help in some ways, but was ultimately harmful. Marty states plainly in the podcast that he is done with therapy, and who can blame him? The vast majority of the therapists I know find this kind of thing abhorrent. Maybe Hilly avoided it because she, like the rest of us, knows that while it’s essential to document these breaches, it’s stories like this that gives therapy a bad name, and dissuades those who need help from seeking it.

Joe Nocera’s podcast shows a Dr. Ike who showed no remorse or insight into what he did wrong. He even said to Marty, “What did I do to you?” after it was over.

Was he such an egomaniac that he really didn’t see his actions as victimizing? Did they not teach ethics at NYU Medical School in the psychiatry residency? Don’t board certified psychiatrists have to go through the same amount of hours of training in law and ethics that the rest of us doctorate and masters-level therapists do? Dr. Herschkopf was ultimately forced to resign from prominent organizations that promoted ethics in the field. Did those organizations not have guidelines of ethics for their members, and were they ever held to any scrutiny to uphold them?

I know that in the 1980s, the boundaries of psychotherapy were different. There are some wild stories. Early on in my private practice I rented office space from an aging colleague, who reminisced about the glory days where you could smoke in your office and flirt with patients. He denied sneaking cigarettes in his own office, even though the smell filtered into mine. When he retired from practice, I found some of his old progress notes in the office trash. He didn’t even bother shredding them.

I dated a man whose grandmother married her psychoanalyst in the 70s. Jung slept with patients in the 1940s and 50s. My mom’s former therapist had her over for dinner and wine, something I found ironic once my mom started down the road of drinking herself to death. The history of the profession is littered with shadowy anecdotes of therapists who have abused power, and that is why there are such rigorous standards now.

But, how do they get enforced, in real life? My own brand of professional caregiver burnout was the fear of making a terrible ethical blunder, causing me to ruminate over my own clinical work, searching through my memories for mistakes I may have missed, or things I wish I had handled differently, or things I know I didn’t handle well. The smallest misstep plagued me, but here is Dr. Ike, starting charitable foundations with patients and writing himself checks!

I have made the gut-wrenching decision to cut contact with family members, and felt deep guilt for it, even though it saved my mental health. Hilly never pushed me one way or the other. What a gut punch to see someone in the same vulnerable situation I was in being conned into cutting off family by their therapist.

It took a mountain of documents, a reserve of stubbornness, and a decade for Marty Markowitz to prove his case. What does that say for smaller-scale ethical violations that don’t get documented or reported?

One thing patients can do is talk to their therapist at the first sign that something doesn’t feel right. If they don’t handle that conversation well, leave. That sounds simplistic, but we all have that little voice telling us that something is off. Our professional associations and licensing boards must create a much better system of patient education, and standardize that across the MA, PhD, PsyD, and MD licenses.

The current system tasks the mentally unwell with being a good judge of character at their most vulnerable in order to get help. It also asks therapists to uphold the ethical standards of their profession, which are laid out specifically in guidelines by our certifying boards and professional associations. We are expected to undergo ongoing training. What kind of guardrails do we need in the profession so that this does not continue to happen? It would be neither practical nor helpful to conduct large scale ethics audits of counselors. Perhaps we need peer review boards within our licensing bodies that investigate reports on unethical behavior, and a more thoroughly codified system of repercussions.

There has to be a better way of weeding out the bad seeds than there is now.

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Lia Prusha

Lia Prusha

Writer, Podcaster, Psychotherapist.