Psychotherapy has an Image Problem

npd purp chair

(Reprinted from Psychology Today in 2013. Unfortunately, still applies 5 years later)

To say psychotherapy is in trouble is picking low-hanging fruit these days. It’s easy to point to the changes of Obamacare, the economic downturn, or the credibility-eroding dispute between the DSM-5 and NIMH when we anxiously profess the demise of the talking cure. While I recognize that these are clearly game-changing issues in need of attention, I’m afraid I need to introduce yet another harbinger of doom, one that is even more dangerous:

Psychotherapy has an image problem.

People have to want to come to therapy. They have to believe therapy is a socially acceptable, effective, economically viable response to emotional and relational problems before they’ll be willing to endure the emotional, social and financial risk and give therapy a try. Without this basic trust in the process, the issues mentioned above are a meaningless. If therapy seems like a waste of time, money, and effort, they’ll take the pill instead. Or suffer in silence.

I believe there are five (at least) reasons for this image problem, feel free to suggest more:

Disclaimer: I know there are unethical, under-trained, burned-out therapists still in practice. I’m not looking to become a lightning rod for bad therapist stories. Today I’m wondering why potential therapy candidates would avoid therapy with perfectly sound therapists. Here are my thoughts:

Therapy stigma: I work in greater Los Angeles, one of the most therapy-friendly regions of the world. I practice at 595 Colorado in Pasadena, a.k.a. Couch Canyon, Projection Projects, Transference Tower, Malaise Manor, and/or Superbill City. It’s home to over 100 therapists. Despite the full awareness that 94% of the people in the elevators are therapists or clients, the majority of passengers display a quiet downturned gaze followed by a calculated slink to their appointment. They’re ashamed, even though everyone is there for therapy. People don’t hesitate to tell co-workers about their toe fungus laser treatment at 2pm, but they still sneak away for their therapy session. Seeking help from a psychological professional still elicits shame in 2013. And that’s from people who actually come to therapy – what about all the people who won’t even consider it?

Insufficient data: The general public isn’t aware of therapy’s proven, lasting effectiveness. When our profession can be reduced to the phrase “rent a friend,” as I’ve heard in numerous contexts, we’ve lost our scientific foothold. The jargon-rich articles that tout evidence-based effectiveness for CBT and psychodynamic therapies are lost on regular folk. Even the APA’s extensive Resolution on Psychotherapy Effectiveness published last summer requires an MA in Psychologese to comprehend. I’ll summarize it for everyone: therapy is as effective as meds and the benefits last longer. For some reason, we’re not doing an adequate job of communicating this to the masses.

Psychology in the media: TV and movies present a distorted image of therapy and therapists, and unfortunately this is how most people are introduced to therapy. Many therapists have had clients ask if they could “just be more like Dr. Phil.” I certainly have. Even the psychotherapist darling drama In Treatment presents a whole career of ethical dilemmas in a single season. The confidential nature of our work adds an element of mystery the media is more than willing to distort. We’re letting screenwriters and celebrity therapists inform the public about the intricacies and benefits of therapy, and all too often therapy is the punch line.

Elitist distortion: As I prepared for the first National Psychotherapy Day I spoke with a consultant who specialized in building non-profits. In his devil’s advocate role he asked: “Why would anyone support therapists? Isn’t therapy just a luxury for the upper-middle class? Should we have a ‘corporate lawyer day’ too?” Yes, those words burned, but they helped reveal a distortion in the general consciousness. Private practice therapists do tend to focus on the middle-to-upper class, but therapy is for everyone. Low-fee counseling centers are meeting the needs of millions of people every year. And if you look nationwide, CMHCs are sparse, underfunded, and overwhelmed. We have to do something about this. People donate to many worthy causes, but low-fee counseling centers are rarely the recipients.

No unified promotional campaign: Every therapist reading this article will contribute some time and money this year promoting their own practice. That’s what we’ve been accustomed to doing, essentially competing against our friends and fellow therapists for business. Our professional organizations, the APAs and AAMFTs and ACSWs of the world are busy with political battles and just occasionally promote therapy limited to their respective degree. What if all therapists spent one day promoting the profession as a whole, not just their own practice? Just one day?

We have an image problem. We work hard behind closed doors, and people are afraid to talk about what we do and how it helps. What can we do about this? Stay tuned.

In the meantime, if you find a cool turquoise shirt, buy it.

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