What Pop Culture Gets Wrong About Therapy
A real-life, down-to-earth overview of what therapy is really like.
Posted Jan 04, 2021
What comes to mind when you think of a therapy session? For many people, the first image they conjure up is of a serious-looking man taking notes, pausing every once in a while to ask the person stretched out on a chaise lounge, “And how does that make you feel?”
Or perhaps you think of that scene in Good Will Hunting, where Robin Williams’ character, a therapist, keeps repeating "It's not your fault," until his patient breaks down and cries in his arms.
In real life, therapy isn’t like the movies. At least not the vast majority of the time.
People don’t lie down anymore; they sit and face their therapist so they can engage in a collaborative dialogue. We therapists also understand that cornering a patient and forcefully and repeatedly insisting they change their mind about something they believe is not effective.
And most importantly, therapists in real life do not and should not have relationships with their clients. This is a big ethical no-no. It always blows my mind when movies and TV shows make it seem normal, and even romantic when therapists and their clients start flirting.
Maybe our imaginations run wild about what happens in therapy because it seems so mysterious. I mean, what could two strangers possibly talk about for an entire hour every week?
It’s a real shame that so many people are hesitant to try therapy or give up after a session or two. Therapy is still seen as a taboo topic of discussion, meaning many people that could benefit from the practice don’t try, either because they don’t know what to expect, have no confidence it will work, or go into it expecting a quick solution to all of life’s problems, only to end up disappointed. While therapists aren’t miracle workers, we do know from plenty of research that psychotherapy is effective for:
- Alleviating depression, especially when added to antidepressant medication
- Decreasing symptoms of anxiety disorders and obsessive-compulsive disorder (OCD)
- Helping people overcome trauma
- Improving the quality of life in general
In my clinical experience, I've seen patients make life-changing decisions, repair flawed relationships, overcome fears, and learn to value themselves in a way they never knew existed.
Let’s demystify therapy. The more you understand what it’s all about, the more likely it is that you’ll take advantage of this potentially life-changing experience.
Three reasons for seeking therapy
First, we can’t assume that everybody has the same ideas about why therapy exists.
For individuals, therapy is about working collaboratively with a professional who is trained in psychology to improve functioning.
I tend to think of three major reasons for doing psychotherapy:
1. Getting emotional support during a troublesome time
Moving away from home, grieving a death, adjusting to a serious diagnosis, losing a relationship. I can’t think of a single person in my life who has completely avoided all of the lemons life hands us.
Friends and family can, and often do, provide the much-needed emotional support we all need in times of hurt. But sometimes, we can't lean on the people we’re close to because they’re the cause of the hurt, or maybe they themselves are hurting, or there is awkwardness or secrecy that prevents us from pouring our hearts out to them.
No matter what type of specific treatments therapists are trained in, we all get a solid grounding in being really good at empathizing, listening, and not being judgmental. Sometimes, that little bit of common humanity is all you need to get through a rough patch.
2. Gaining insight about the self or about a specific life problem
Maybe you’ve been doing some self-reflection and noticed that you always have trouble saying “no.” Why are you afraid that you’ll let people down?
Or maybe the latest in a string of explosive breakups hurt more than usual and you’re wondering why you always end up with people who are bad for you.
Or maybe you’re trying to decide whether you should have kids or not, and you’ve exhausted all of your pros and cons list-making abilities without getting to the root of why this question tortures you so much.
A therapist may be able to help you untangle your web of worries. Sometimes a fresh, objective perspective can help you notice patterns you didn’t notice before. Like the fact that you reject people before they have a chance to reject you, leading you to miss out on vulnerable but meaningful connections.
Or a therapist can use their knowledge and experience to catch red flags. Like connecting the dots between your inability to relax with some troubling ways you talk about your partner.
Or if you’re stuck in a seemingly impossible decision, a therapist might be able to ask a few key questions from angles you hadn’t considered to shed new light. Like wondering if you’d leave your job if you didn’t place all your self-worth on your career status.
3. Reducing psychological symptoms that get in the way of your life
Of course, on top of normal life stressors and emotional hangups—and who doesn’t have those?—some of us also have psychological disorders or symptoms.
Psychological symptoms are anything that you often think, feel, or do that gets in the way of you living a fulfilling life. This could be feeling sad or unmotivated most of the time, struggling to get quality sleep, acting as if food were an enemy instead of a pleasure and need, not being able to leave the house without checking the light switches multiple times, dreading meeting new people, or being so impulsive that you’re losing money and friends. Our brains can get stuck in ways of thinking, feeling, and doing that is unhelpful.
Some psychotherapies are specifically designed to address these problems. They work by taking psychological science—what we know about how the brain works—and turning it into teachable skills for improving our hardware. It’s similar to how physical therapists turn their knowledge of how muscles and bones work into exercises to help you heal and strengthen them. Healthy ways of thinking, relating, and behaving can be strengthened too.
Different types of therapy and how they help
Not all therapy looks the same—and how could it when we all have different psychological needs? There are a lot of forms of therapy out there, but these are the main categories you’ll find being practiced today.
Supportive therapy tends to not be very structured or goal-oriented. The therapist usually follows the client’s lead and provides what they need in the moment. This might be simply having a nonjudgmental place to cry and an empathic ear to hear their story.
For people who have depression, supportive therapy can be helpful, especially because a big chunk of why people’s depression gets better with therapy is from “non-specific factors” like trusting the therapist and feeling like someone cares.
These are the “old school” therapies, evolved from Sigmund Freud’s theories of the unconscious in the late 1800s. The main idea is that we have unconscious drives versus conscious thoughts, and when there are conflicts between the two, issues arise.
The therapy process is meant to “liberate” the unconscious through the therapist’s guidance, often by examining unmet needs from childhood. They can be helpful for the second reason for psychotherapy I mentioned—gaining insight about the self.
Research shows that psychoanalysis has, on average, small to medium effects for improving symptoms and functioning, but is not as effective when compared to other therapies that are designed to treat specific mental disorders.
Cognitive-behavioral therapies are designed to treat specific symptoms like social anxiety, depression, insomnia, tinnitus, the list goes on. We keep inventing new CBTs for various psychological and physical problems.
Some components and variations of CBT are called “cognitive therapy,” “exposure therapy,” “exposure and response prevention,” and so on. They’re all based on the science of how our brains work, and they teach patients skills to re-train their brains for better functioning.
These treatments are very good at addressing the third reason for therapy—to alleviate psychological disorders and symptoms. I particularly recommend CBT (and its variants) to people who struggle with anxiety disorders, lingering effects of psychological trauma, obsessive-compulsive disorder (OCD), and insomnia. You may be surprised at how quickly your symptoms can change.
I know the name sounds very flower child, but third-wave psychotherapies are really just variations on CBT with an added central component—mindfulness.
These therapies also alleviate psychological symptoms, but there’s more emphasis on acceptance, life values, and overall health. Some well-known third-wave psychotherapies are Acceptance and Commitment Therapy and Mindfulness-Based Stress Reduction. These are great for people who are emotionally struggling with situations outside of their control—chronic illness or stress, financial issues, estranged relationships, burnout, or just the general sense that life feels like a struggle and happiness seems hard to reach.
Another type of third-wave therapy is Dialectical Behavior Therapy (DBT) of which I’m a big fan. This is an intensive form of CBT (with mindfulness as one of several central foundations) for people who struggle with a combination of big mood swings, chronic life drama, and self-esteem issues.
Other types of therapy
You may hear about other schools of thought or other types of therapies, person-centered therapy, EMDR, contingency management, expressive, transpersonal, there are lots of fancy names. But I’ll level with you right now: All of these are variations on one of the main categories we covered today. They’re all just different roads to Rome with different names. Often, therapists will guide you along a few different paths because each of them contributes to your overall journey.
A version of this article titled What Therapy Is Really Like (And How Pop Culture Gets It Wrong) also appeared on Quick and Dirty Tips.