Don't you love it when a television show or movie stimulates lots of discussion? This last episode of The Sopranos has certainly done that this week with a great deal of discussion to be found in all kinds of places about the ethical lapses of both Melfi and Kupferberg. CNN has an article reporting on reactions of a number of psychoanalysts in New York to the episode.
I have been asked by several people if in fact when therapists get together they talk about patients as the characters did in the dinner party scene. I must first say that I can't imagine going to a dinner party where all the guests were therapists -- my social circle doesn't work like that. And on those occasions when I am with a close friend who is also a therapist, it is true we may talk about our work, but only in broad terms, never revealing names of patients -- that is simply taboo. The one exception is in clinical supervision and even there I have rarely found it necessary to reveal the identity of the patient. So what happened at the dinner party is too far out of the norm to even begin to be considered acceptable or common.
"Why did Kupferberg commit such a sin? He didn't think Melfi should be treating Tony, whom he considered a manipulative psychopath. Be that as it may, his disclosure was "a very egregious ethical violation," said Dr. Jan Van Schaik, chair of the Ethics Committee at the Wisconsin Psychoanalytic Institute." -- CNN
I also have reservations about whether or not Tony fits the diagnosis of sociopath. First, within his subculture, his behavior is normal. We can certainly say that the subculture lies outside the acceptable norms of mainstream culture but that does not make any member of it a sociopath, in the DSM IV sense. Tony also shows affect, has significant relationships with people he cares about and seems to have at least some insight into his own behavior.
At some point Melfi described him as alexithymic, that is someone who is unable to talk about feelings due to a lack of emotional awareness. Tony's "panic attacks" appear to be what happens to him when he experiences emotions he is unable to talk about or express, so he faints. Emotions arise first in the body, after all.
Would Tony benefit from continuing in therapy? I don't know. His family relationships likely would improve as indeed his marriage has. But therapy would never turn Tony into an upstanding normal law abiding citizen as he does not see his life in the Mafia as a problem to be worked through.