Welcome to the Back to School for Writers blog series. Every Wednesday until the end of September, a guest poster will share their knowledge and expertise on a specific topic. Today’s guest is therapist and writer Tami Clayton who dispels 5 myths about the mental therapy profession.
I’ve worked in the field of mental health for the past sixteen years, most of that as a child/family therapist, and in all that time, I have yet to read about or see in a movie or T.V. show a therapist that isn’t portrayed as unethical, devious, deceptive, coercive or in some way inaccurate. It’s no wonder many people see therapists and therapy as suspect. And if you only went off of what you read or saw in those forms of entertainment, then you’d be right.
In preparation for this post, I asked several colleagues about the characterizations of therapists in books, movies, and T.V shows. Before any of them answered my question, every single one of them said if they knew there was a therapist in a movie or T.V. show, they would avoid watching it (or at least the part with the therapist) because of how inaccurately (and terribly) we are portrayed. After I explained why I was asking, all of them were eager to share what the inaccuracies they’ve seen. Here’s what they mentioned:
(Note: I’m using the term ‘therapist’ to also mean ‘counselor’ and consider the two interchangeable for the purposes of this post.)
Myth #1: All therapists subscribe only to Freud’s theories and techniques – you know, the bespectacled, bearded older man psychoanalyzing the client while he or she reclines on the sofa talking about their dreams filled with obvious phallic symbols.
Reality: Psychoanalysis is just one theory among many out there for a therapist to use and claim as their theoretical orientation and in my humble opinion, a good therapist draws from a few different theories in order to best meet their clients’ needs. As for the sofa bit, I’ve always worked in social service (read: underfunded, underpaid and overworked) so many of us have offices that are so tiny there’s no room for one. Also, unless you have sought out a psychoanalyst and want to lie down on a sofa, clients are usually sitting up on the sofa or in a chair.
And for the record, in regards to dream analysis – sometimes a carrot is just a carrot.
Just sayin’.
Myth #2: Therapists must always be overly solicitous about a person’s feelings and only ask questions like “And how does that make you feel?”
Reality: Yes, therapists do ask about feelings, but in all the years I’ve been a therapist, I can’t think of one time I inquired about it in this manner with a child or an adult. A person’s feelings are just one aspect on which we guide clients to focus their awareness. Current patterns of thinking, coping mechanisms, past trauma, past and present relationships, self-esteem, self-awareness, and many, many more topics can be delved into in therapy depending on what a client is seeking it for at that time.
Myth #3: Therapists become close friends with, date, have sex with or have some kind of an outside-of-the-office relationship with their clients.
Reality: Aside from this going against everything you’re taught in your counseling or psychology program, this kind of thing is considered unethical for therapists to do and it can get you a nice malpractice lawsuit and/or the revocation of your license if the infractions are severe enough. The breaking of boundaries is probably the biggest inaccurate portrayal of therapists in movies, T.V. and books. Unless the therapist in your story is the antagonist and needs to engage in such nefarious activities, please reconsider having him or her be a blatant boundary breaker. It’s giving all of us a bad rap.
Myth #4: A client is “cured” when the big epiphany comes wrapped up the big “Aha!” moment.
Reality: Therapy and the therapeutic process is rarely, if ever, a neat, tidy, linear process in which a client reaches a total resolution and is cured of what was ailing them. Therapy is not like getting over the flu or a cold. It can be filled with many ups and downs, a lot like life itself. While epiphanies can certainly be a part of it, they hardly denote a “cure” or complete absence of the mental health symptoms that previously plagued the client. Resist the urge to have your character reach an easily obtained epiphany that somehow cures them. Therapy is a process with many steps forwards and backwards. (Sadly, this is something the insurance companies completely fail at comprehending, but that’s a rant post for another day.)
Myth #5: Therapists are always “on”, assessing people and passing judgment about others’ mental health every moment of the day. This myth is played out in movies, T.V. shows and books, but is just as prevalent at a cocktail party where the inevitable question of “what do you do?” arises when meeting new people. As soon as the word ‘therapist’ is out of my mouth, people often become wary and think I’m assessing the state of their mental health and passing judgment on them.
Reality: I diagnosed you ten minutes ago.
Just kidding.
Well, sort of.
Those of us drawn to this helping profession are obviously interested in human behavior and human nature which is why we’ve chosen to do what we do. Even so, we are not always “on the clock” writing mental health assessments in our heads of everyone we meet. Sure, I may wonder about a person’s underlying motivations for saying or doing certain things and yes, I may have a vague notion of what that person’s thought patterns or coping mechanisms might include. But unless you are going to pay me for my time and effort, I’m not usually going to spend much more time thinking about it beyond that. And as far as passing judgment, unless you are behaving in an utterly deplorable manner, I’m typically not in the habit of casually passing judgment on the state of other people’s mental health. We all have baggage and we’re all on a journey, even us therapists. Personally, I’d rather lend a hand than stand aside passing judgment.
There are also a lot of misconceptions and misunderstandings of the different terminology used in the field of mental health. Here are some terms and their definitions to help in better understanding the field:
A psychologist is someone who has obtained his or her PhD in the field of psychology. They can be refered to as therapists or counselors if they so choose, though most go by the term psychologist.
Therapists and counselors are not psychologists. Therapists and counselors have typically have obtained their Master’s in counseling psychology, psychology, or marriage and family therapy.
Social workers (someone who has completed their Master’s or PhD in social work) can also be considered a counselor or therapist. Quite often, the term social worker is used in movies, T.V. shows, and books as synonymous with someone who works in child welfare. This is not the case. One is a job/career (child welfare caseworker) while the other is what someone who has graduated from a social work program (social worker).
The term “shrink” refers to a psychiatrist, a medically trained doctor who can prescribe psychotropic medications. Psychologists, therapists, and counselors are not psychiatrists and the terms are not interchangeable, though the two types of professions often work in together when treating a client.
I won’t go into detail about different diagnoses here because this post would become far too lengthy. If anyone has questions about a diagnosis for their character or would like further information about symptomology of a particular diagnosis for a character, feel free to contact me and I would be happy to help.
Hopefully this was useful to those who are writing about someone who works in the mental health field or to anyone wanting to learn more about therapists/therapy in general. For an example of an accurately portrayed and well-written therapist, check out This Much I Know is True by Wally Lamb. Aside from being a fantastic book, it has one of the few well-written therapists in it that I’ve ever read.
Tami Clayton is a YA and Middle Grade writer with a passion for travel, all things dark chocolate and coffee, and reading everything she can get her hands on. She is a child and family therapist by day, writer by night, and a dreamer of far off lands she hopes to one day explore in person. Visit her online at Taking Tea in the Kasbah.
Thank you, Tami, for your informative post.
It sometimes seems to me that writers will give their fictional characters mental health issues (like OCD and phobias) as a kind of a quirk, like having a habit of twirling hair when nervous, for instance. Can you talk about some of the real issues that a character with OCD or a phobia would face?
Thank you, Rabia, for hosting me here today!
As for a character with OCD or a phobia, it would be difficult for me to sum it up in general terms because OCD looks different for different people as do the various phobias one can have. Someone with OCD can have symptomology in which they must count things (number of steps taken, number of times they perform a task, number of times they check something, etc), clean things a certain way, organize their environment a certain way, or create patterns of going about their day in a certain way. The main underlying thing about OCD is that the person is trying to keep something bad from happening by doing these rituals and behaviors. Many people with OCD can tell you they know it’s irrational to think counting your steps will prevent disaster from happening but they MUST do it or their already high anxiety will become even more intensified.
Phobias look a little different. They are about avoidance – avoiding unpleasant or traumatizing stimuli at all costs.
Great question! I hope I answered it for you. If not, or if you have more questions, please ask!
A couple more questions about OCD and phobias..
1) Are phobias generally caused by a traumatic incident in the past? Frex, if a person was trapped in a small space for a large length of time with spiders crawling all over them, would that be cause for them to develop arachnophobia and claustrophobia? And is it possible for people to have two opposite phobias–for instance a fear of tight, closed spaces AND a crowded, open space?
2) I imagine that OCD behavior is graded on a spectrum. I have this *thing* about locking my front door when I go out. I lock it, then I check it, then I recheck it, and sometimes when I’m ready to drive away, I put the car in park and check again. I’ve had times where I’ve turned around after 10 miles on the highway to come back to check the front door, convinced I forgot to lock it (I never have). Many times, though, I have suppressed the compulsion to turn around to check by talking myself out of it. Do people with OCD not have the ability to reason with themselves (and have it work)?
3) And bonus question… if you were to list the top 3-5 most common mental health issues you see, what would they be?
You’ve got some great questions, Rabia. I’ll do my best to answer them here:
1) Not all phobias are caused by a traumatic incident, though many of them are. For example, I am very fearful of birds but I’ve never had an traumatic experience with them. They just really unnerve me and cause me great distress so I avoid them. As for opposing phobias, it is possible to have two phobias that seem to be at odds with each other. Some people have just one phobia where others have several.
2) OCD is certainly seen on a spectrum. What you described about yourself sounds relatively mild, though not knowing more about you or any other symptomology it’s difficult to say with certainty. That said, even those with mild symptoms can have a hard time reasoning with themselves to not perform the compulsive behaviors. It really depends on the person’s overall coping mechanisms and how many OCD behaviors he/she engages in. It sounds like you have found ways to cope with it and can reason with yourself when needed. I believe we all have a little OCD symptomology in us, those things we are driven to do without fail “just because.” It’s when the symptoms start impeding a person from living their life (meeting their basic needs, being able to hold down a job or profession, being in positive, healthy relationships, etc.) that there is cause for concern.
3) I have always focused my work on traumatized kids with extreme behavioral problems so the most common mental health issues I see include Post Traumatic Stress Disorder (PTSD), Generalized Anxiety Disorder, Attention Deficit Hyperactivity Disorder (ADHD), Oppositional Defiant Disorder, and diagnoses on the Autism spectrum (including Autistic Disorder and Asperger’s Disorder).
This checklist is soooooooo helpful. I had wondered for a very long time what the difference was between all the professions and titles.
I do think they handled the dueling therapists in Awake well. They both seemed competent, intelligent, and different in their approaches.
I’m so glad it was helpful to you! I haven’t seen Awake but am now intrigued to watch it.
Uh oh, reading this I am now horrified to admit that clearly everything I THOUGHT I knew about therapists was gleaned from movies and TV, definitely NOT reality.
Not only do I appreciate this super informative post for writing purposes, it is a treasure trove of valuable insights as they apply to the rhelms of Real Life and the very Real People we know and share space with.
Fabulous!
No need to be horrified, Barbara! That’s why I agreed to do the post here – to dispell the myths and give accurate info. You’re not alone in thinking the way therapists and therapy are portrayed in movies and t.v. is reality. Outside of my little professional bubble, I have encountered many, many people who thought therapy was all about lying down on a couch talking about your mother and father. And we have t.v. and movies to thank for that! 😉 I’m glad this was informative and useful for you.
Excellent post. Many of us that seek therapeutic/psychiatric help often search through a lengthy process until we find ‘just right fit’ for us. Our family has encountered some tough situations with my husband being bipolar but we are so appreciative of his doctor for the past 7 years and his therapist, we know we’ve hit pay dirt.
On the flip side of the coin, each time we see someone portrayed as bipolar on TV or I read a book and a character is bipolar – the characters seems to be a gun swinging, stoned, and abusing person. Not true with my husband. Thanks for an excellent post.
I’m so glad to hear that you’ve found a good fit in your husband’s therapist. You bring up an excellent point: the “fit” between the clinician and the client. There are tons of very capable, very talented therapists out there but not all of them will be the right clinician for every person. It can take a little bit of time and trial and error to find the right person and there’s not shame or harm in visiting several different providers until you connect with someone you can work with on your mental health issues.
I agree, characters with bipolar are usually shown in the extreme – the far ends of the spectrum of behaviors and symptomology. My guess it’s done for dramatic effect, just like portraying any other mental health issue or boundary breaking therapists. Sadly, it distorts the public’s view and in many cases, allows stereotypes and misconceptions to persist.
I like that point about the fit between client and therapist. I’ve only seen it from the cliet’s point of view, but it makes all the difference in the world. {Smile}
Anne Elizabeth Baldwin
Nice post, ladies. And knowing that you diagnosed me ten minutes ago has recast every conversation we’ve ever had, Tami!
😉
Lol! I was off the clock those times. Honest. 🙂
I work in a field “technical writing in high-tech” where being OCD is seen as an asset. I guess I’m channeling my character flaw in a positive way. 😉
A very informative and insightful post Tami. All aspects of the mental health profession need greater exposure. I think it is “healthy” to seek therapy when anyone is going through a tough time. And we all do at one time or another. There needs to be a greater awareness on mental illness so there aren’t the stigmas associated with the various diseases, as there are today. I applaud you for helping those who are in such great need.
You make a good point, Elizabeth – there are certain aspects of mental health “disorders” (I’ve always hated that word) that can be used as assets, especially as long as the other parts of your life aren’t suffering because of it.
And yes, there does need to be more unbiased, accurate information put out there regarding mental health issues. The stigma associated with mental health issues and the need for going to therapy gets exacerbated every time those things are inaccurately portrayed in the media, in books, in movies and on t.v. Reaching out for help is a sign of strength and a higher level of self-awareness. It’s sad to me that it’s not seen that way more often.
There’s so much information here to mine, both for “real life” and fiction. Thank you for the informative post and the question and answer session afterwards. Great stuff!