Are Therapists on Reality TV Shows Acting Unethically?

Source: Ron McClenny / Unsplash

Watching reality TV is like eating fast-food red meat: We know it wasn’t ethically produced, but we’re enjoying it too much to think about how it was sourced. It’s painful to look behind the curtain and see how cast members are lied to, mistreated, manipulated, and discarded, all while receiving little to no money and then being silenced by restrictive non-disclosure agreements while the internet tears them apart over inaccuracies they can’t correct.

This is an issue society needs to face. And part of the issue is the role therapists play on reality television shows. From psychological evaluations to on-set support, licensed therapists are participating in the creation of these shows — and, unlike viewers, they do see what happens behind the scenes.

Most therapists probably have the best of intentions and try to follow their ethical guidelines. But they are also being used as a false indicator that production teams are fulfilling their duty of care to contestants, and possibly violating critical legal or ethical requirements in the process.

Let’s look at the most concerning practices of reality-TV therapists.

1. Psychological Evaluations

Many shows order extensive psychological evaluations of potential cast members, reportedly to rule out anyone with mental-health concerns who would not fare well under the pressures of filming. If this were the only purpose, there would be no problem. Unfortunately, former producers have disclosed that these evaluations are also used to learn people’s emotional sensitivities, attachment wounds, struggles with addiction, trauma histories, and historical relational challenges, all so these weaknesses can be exploited and amplified on the show.

Therapists conducting assessments may do so with good intentions, but the results of their work are being abused. Cast members do not have access to their testing results and thus can’t know what a production crew has learned about them. Then, contestants unknowingly enter "confessionals," where a producer asks pointed questions about recent interactions, linking them to painful historical wounds or fears, all for a dramatic reaction, without caring about the personal emotional cost.

Psychologists completing evaluations are responsible for ensuring that the results are being used ethically and in the best interest of cast members, but this is not currently the case.

2. On-Set Support

With the growing interest in supporting mental health, shows are starting to verbally affirm that they provide psychological support to cast members. Some go so far as to say that a therapist is always available. However, many cast members have said they were never given access to a therapist, and if one was available as a resource, they didn’t know about it.

Any therapists who actually do provide care on-set find themselves in an ethically murky position, as they are being paid by the show to assess or treat cast members. There is no assurance of confidentiality, given that on many shows cast members are being filmed almost 24/7, and contracts do not indicate that conversations will be kept private or that therapists have an ethical duty to the cast members over the production company.

More concerningly, therapists have no decision-making power. They might advocate that a cast member be allowed a filming break or to leave a show entirely due to their psychological state, but production teams can ignore this request and may even use this new information to poke at the cast member for another dramatic reaction that will lead to a memorable TV moment.

In their efforts to support and protect contestants, therapists may fuel the very emotional damage they’re working to mitigate.

3. Therapists as Participants

Perhaps the biggest ethical dilemma the psychological community faces around reality TV is allowing therapists to be part of the cast. Whether they are providing on-screen therapy and interventions, or acting as coaches and judges, their role as part of the cast complicates their ability to provide ethical treatment.

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We have to assume that cast members sign waivers for their HIPAA rights, but is there actual informed consent as to what that means? Do therapists have to sign contracts indicating that they will practice ethically? Do they put the interest of their clients (the contestants) above the desires of the production company that pays them? And if therapists are signing onto shows under a title other than “therapist,” (such as being an "adviser" or "coach") to sidestep regulations, but promoting themselves with their psychological credentials, isn’t that still unethical?

We Need Better Standards

Psychologists follow a comprehensive ethics code that guides our practices, ensuring that we are not causing harm and are providing the best possible care to our clients. This code has not kept up with the expansion of participation in reality television.

The American Psychological Association (APA) has one article that touches on this topic, almost two decades old, and it is woefully incomplete. A brief excerpt:

In the reality TV context, psychologists may be used in a very particular way, namely, to help demonstrate that a producer has exercised due diligence in the participant selection and rejection process... Pay particular attention to how vulnerable individuals with whom you interact fit into this analysis. Put simply, ask yourself, “Who may get hurt if this project goes badly, and in whose interest does it lie to make sure that doesn’t happen?” (APA, 2008).

Any therapist reading this who has seen the most negative outcomes for contestants would have a hard time justifying their participation. Cast members are vulnerable — financially, emotionally, socially, and psychologically. They have few rights during or after filming, and aren’t given sufficient support to process the experience or weather the deluge of public opinion post-airing. How are therapists continuing to provide cover for productions that so clearly mistreat and then discard the very people who are making them millions?

Given the impact that reality-TV shows have on contestants and viewers alike, and the modern championing of mental health, the APA needs to address this ethical blind spot. Therapists need standards to guide their practice and ensure that cast members aren't being mistreated.