Mythbusting: What is therapy really like?

I think this question is on the minds of lots of potential therapy clients: what will it really be like to be in therapy? If we’re not fortunate enough to know someone who is open about their own experiences in therapy and how it has helped them, we may have very little information about what the therapy process is like. And while therapy is often portrayed in tv shows or movies, the depiction of therapists is often designed to entertain more than be a realistic account of therapy. This could be potentially off putting to potential clients who may wonder - Is therapy really like that?.

For example, in one episode of the tv show Insecure, the character Molly visits a therapist who  listens to what she says, then connects her words to an overall general pattern by linking it to similar thoughts she had expressed in past sessions. This represents a fairly typical example of what happens in therapy. However, then therapist then talks for a long time while the camera focuses on Molly’s face as she looks disinterested. For me, if a client looked this disinterested in what I was saying, I would want to check in and ask about her response to my feedback. Instead of checking in with her, Molly’s therapist then asks “same time next week?” to which Molly responds “I’ll call you.” Again, this would be a major red flag for me and I would want to check in with my client about how she is experiencing therapy. In general, therapists want their clients to have a good experience in therapy, and talking about ways in which the therapy is not going well is an important part of being able to course correct and ensure the experience is a helpful one.

An even worse therapy experience comes from early seasons of the show Mad Men, where Betty Draper’s therapist literally sits and says nothing throughout her sessions. This actually did happen in therapy at one time, when it was believed that a therapist should be as quiet as possible to serve as a “blank screen” for fear of “influencing” the client. This is very far from the current philosophy in therapy, as now is it is widely held that therapy should be a collaborative process between the client and a therapist, not just a client talking without any input from the therapist. Even worse, the therapist also tells Betty’s husband about the content of sessions. This is a serious violation of confidentiality, as therapists are not allowed to discuss the content of sessions or even confirm that someone is a client without the client’s express permission. If a therapist violates this ethical standard, there are serious consequences, including fines and the possibility of having the therapist’s license being revoked so that they are no longer able to provide therapy.

So, are there any good representations of therapy in the media? Ironically enough, I think the SNL “Friendos” skit, (warning - adult language in link) imagining what would happen if a hip hop group went to therapy together, comes closest to the feel of an actual therapy session.  Although the skit is clearly tongue-in-cheek, and not everything that happens feels realistic - the therapist calling one of the men “bitch” after he refers to her as such hopefully does not happen in any therapy sessions! - other moments ring true. For example, the therapist encourages each person to participate, to use “I feel statements” and to listen to each other, and she offers interpretations (“You looked for him, and he was gone”) in hopes of clarifying emotional content.

Ultimately, it’s hard to make sweeping generalizations about what therapy is like, since there are so many different types of therapy and therapists. Some may provide “homework” and be directive, others may let the client take the lead. Some may go back into the client’s past, and some tend to focus on what’s happening in the present. It’s often very helpful to “shop around” for therapists, meeting with different therapists so you can get a feel for what therapy is like with different therapists before deciding on one . And regardless of the type of therapy or therapist, a good therapist treats client with respect and empathy, listening to their point of view, and working together with them to achieve a positive therapy experience.