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This series is in the vein of several other series or articles where authors discuss the psychological profile or diagnosis of fictional characters, but taken a step further to talk about how I would actually go about psychotherapy with this character. My goal with this series is to show the variety of options in the world of psychotherapy – there really is something for everyone! Also to show some of the thinking that goes into psychological treatment – the theory, the research, and the adaptations that skillful therapists make to complex cases.

As always my disclaimer applies here, and be warned of spoilers ahead.

Case Conceptualization

I’m going to skip a couple of steps here and refer to the extensive write-up of Rick’s psychological profile presented here, where they go into detail describing his background, symptomology, diagnostic considerations and treatment recommendations. This is a great (if a little dry) write-up of what’s going on with Rick, with hyperlinks to the relevant episodes and references to the DSM and everything. So I’m not going to remake the wheel here, but I do want to pull out some relevant points.

Rick Sanchez C-137 (AKA Terrorist Rick) is the smartest person in the universe. He is a quintessential mad scientist (although probably better described as a mad engineer) who, along with his hapless grandson, engages in a series of adventures across the multiverse that range from wacky hijinks to horrifying atrocities. Over the course of the past 3 seasons, we have seen Rick outsmart the devil, destabilize an intergalactic government, construct a biotechnological exoskeleton using nothing but his tongue, and defeat an intergalactic superhero team while blackout drunk.

The write-up that I linked above diagnoses Rick with Antisocial Personality Disorder and Alcohol Use Disorder. I’m not going to argue with those; he definitely seems to hit on the diagnostic criteria for each, but I think they might be missing the forest for the trees. For example, they talk about Rick’s use of alcohol to numb out emotional pain, referencing Bird Person’s comment that ‘“wubba lubba dub dub” actually means “I am in great pain. Please help me.”‘ but they never really talk about that pain. They also miss the implication from the same episode (The Wedding Squanchers) that Rick is a veteran of guerilla warfare. Just in the course of the 3 seasons we have seen Rick get shot multiple times. In Rest and Ricklaxation we see Rick have a breakdown:

Rick: That was seriously fucked up. We almost died. Morty: So you agree? Rick: Fuck yes! That w… T-This was insane! That was pure luck. I was not in control of that situation at all. Morty: (continues crying) Rick: (notices his hands shaking) Look at this, Morty. Look at my fucking hand. Look at this shit. Morty: Why do you… Keep doing this to us?! Rick: I don’t know, Morty. Maybe I hate myself, maybe I think I deserve to die. I-I-I-I don’t I don’t know!

So look, I can’t say that Rick has PTSD. I think a lot of people don’t realize that just because you have a traumatic event and, perhaps even more surprising – just because you have a traumatic event that changes who you are as a person, doesn’t mean you have PTSD. We don’t see enough signs of some of the hallmark re-experiencing symptoms (flashbacks, nightmares, etc.), although Rick’s efforts to turn the family home – especially his workshop in the garage – into a fortified bunker are some pretty good signs. I’m almost as prone to diagnose suicidal depression given Rick’s obvious self-destructive behavior. We witness at least one near-miss suicide attempt across the course of the show, and you could make are argument for several more. The thing is, with someone like Rick Sanchez, this isn’t going to matter a whole lot.

Previous Therapy

In Rest and Ricklaxation, we see Rick lose the rage, narcissism and misanthropic aspects of himself. He becomes calmer, happier, someone less in pain, but he also seems to lose his drive and his ambition. By the end of the episode, he chooses to bring that toxicity back into himself, becoming the original bitter, self-destructive Rick that we know and love. So we know the goals can’t be fundamental change of Rick’s personality or some kind of clinical excision of his problematic personality traits.

Similarly, in “Pickle Rick,” we actually get to see Rick in therapy, albeit family therapy. The therapist, Dr. Wong (played by Susan Sarandon), gives what I think is a spot-on rundown of Rick’s problem with therapy:

Rick, the only connection between your unquestionable intelligence and the sickness destroying your family is that everyone in your family, you included, use intelligence to justify sickness. You seem to alternate between viewing your own mind as an unstoppable force and as an inescapable curse. And I think it’s because the only truly unapproachable concept for you is that it’s your mind within your control. You chose to come here, you chose to talk -to belittle my vocation- just as you chose to become a pickle. You are the master of your universe, and yet you are dripping with rat blood and feces. Your enormous mind literally vegetating by your own hand. I have no doubt that you would be bored senseless by therapy, the same way I’m bored when I brush my teeth and wipe my ass. Because the thing about repairing, maintaining, and cleaning is it’s not an adventure. There’s no way to do it so wrong you might die. It’s just work. And the bottom line is, some people are okay going to work, and some people, well, some people would rather die. Each of us gets to choose.

This is a great example of some of the mental judo that therapists can do. Rick had challenged her, saying that he’s in control, he’s in charge, and she says yes you are in charge, and look at where being in charge has gotten you. And then she counters with her own hypothesis – that Rick is really just not interested in putting in the work of therapy.

So while I do agree with the message, she totally bungled the actual therapy of it. Unless you’re Sigmund Freud, Marsha Linehan, or Aaron Beck, therapy shouldn’t really have an uninterrupted soliloquy like that. It makes for good story-telling, but all the therapist is doing is lecturing, and how are you supposed to lecture the smartest guy in the universe?

Treatment Plan

The reason that I said diagnosis is not going to matter a whole lot is that there is no scenario where I would recommend a specialized or evidence based treatment with Rick Sanchez. The benefit of all of these treatments is that they are based on good science: well derived theories, behaviorally oriented strategies, and empirical testing of results. But Rick Sanchez is going to be so far ahead of me and the whole rest of the human race on the science. His mind is just better than mine – better than anyone’s – so if there’s a scientifically derived way to help Rick deal with his pain and self-defeating behaviors, he will have already thought of it and rejected it. I’m not going to find something that he hasn’t already come up with, and I’m not going to talk him into something that he has already rejected.

But none of this is to say that I think Rick is a bad candidate for therapy. On the contrary, I think he would get a lot out of it. It just won’t be one of the more modern, CBT-derived treatments. Research has shown time and time again that regardless of the particular type of therapy or techniques utilized, often it is the therapeutic relationship that makes the most difference. This, I think will be particularly true for Rick Sanchez.

I think Rick is a great example of the need for Wise Mind – where the rational or scientific mind balances with the emotional mind. Rick tries to live fully in the rational world, but he can’t escape his emotions, and his attempts to do so (through drugs or distraction) are central to his problems. Rick also seems to yearn for an authentic, caring relationship, while at the same time undermining his own attempts to get it. He seems at times to treasure his relationship with his family, but his manipulative behaviors, and the family’s own baggage, keep this from being a real authentic relationship. You just have to look at how much Rick treasured the minimal validation he received from Noob Noob in “Vindicators 3: The World-Ender” to see how much Rick needs some emotional support.

This is where Carl Roger’s Person Centered Therapy comes in. This therapy focuses the therapist providing genuine Unconditional Positive Regard and empathy, giving the client the support and comfort needed to find their own path towards growth. This is a non-judgmental, non-directive approach that would be a good counterpoint to Rick’s tendency to seek conflict and confrontation.

Prognosis

Fair. We know that Rick will show up to therapy, and we know that he treasures authentic relationships, so I think he would actually sit through a good course of treatment here. The fun but scary part of some of these non-empirical treatments like person centered therapy is that it’s not exactly clear what we would accomplish. At least some research supports person centered therapy for antisocial personality disorder. Rick might not stop or cut back his drinking, he might still be a narcissistic, antisocial mad scientist. That’s probably ok, I wouldn’t be able to make any of those changes without getting into an unwinnable tug-of-war with an evil genius. Hopefully, Rick would just feel a little bit better and not get in his own way so much, and every once in a while get schwifty in here.

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