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.

NPD 2017!


Hello, psychotherapy supporters! 

The sixth annual National Psychotherapy Day will be on Monday, September 25. I hope you’ll join us as we:

  • fight the stigma against seeking help from a therapist
  • talk about our own therapy to demystify the process
  • share articles that attest to the effectiveness of therapy
  • support low-fee counseling centers by donating time or money
  • wear turquoise in solidarity with other therapy fans

Every year people ask me what kind of program or campaign we’re conducting on the big day. It’s understandable, as we’ve done a few local projects and put on the Moments of Meaning storytelling evening a couple of times. But our local projects have a limited reach. A few therapists in Pasadena can only do so much. 

The only way NPD will make an impact is if you ask yourself what you’re doing for NPD. Are you inviting therapists to a happy hour that night? Are you collecting donations for your local community mental health center? Are you writing a letter to your local paper, talking about the effectiveness of therapy? Are you forming your own Moments of Meaning event? Are you giving a talk to MD’s or educators about the many uses for therapy? Are you writing a blog, creating a Facebook ad, Tweeting with the #TherapyHelps or #NPD2017 hashtag? Hiring a skywriter?

We’ll leave some ideas on our Facebook page over the next couple of weeks, but we encourage you to use your own creative brains to think of unique ways to tell people about many benefits of therapy. NPD was established as one day for therapists to join together to promote the profession instead of themselves, to move beyond any self interest and support the vocation we love, respect, and believe in. 

So, what are YOU doing for National Psychotherapy Day?

– Ryan

2015 Press Release

Hello psychotherapy enthusiasts!

The fourth annual National Psychotherapy Day, a day to reduce stigma and draw awareness to the effectiveness of therapy, is Friday, September 25.

People who support psychotherapy – therapists, clients, academics, policymakers, or any other interested party – are encouraged to talk about their own experiences with therapy, contribute to low-fee and community mental health clinics, share therapy effectiveness research (can be found here), and wear turquoise to show support and start conversations.

National Psychotherapy Day was started by me and several psychology graduate students because we believed psychotherapy as a profession had a significant image problem. Therapy takes place behind closed doors, so the public relies on movies and TV to tell them what therapy is like, and those depictions are rarely accurate. We set out to demystify our work, educate the public about what real therapy looks like and how effective it can be, and create a fun day to celebrate therapy, rather than hide it. We encourage therapists to take one day to promote the profession instead of their own practice.

You can find more information on our website,
or Facebook page,
or contact me at:

We’re proud to say we made some waves over the past four years. We’ve received endorsements from many of the top therapists in the field…

“I’m pleased to support National Psychotherapy Day and honor the therapists and patients who courageously travel together on this most intimate, meaningful and big-hearted journey.”Irvin Yalom, M.D.

“I was pleased to hear about the establishment of the first annual National Psychotherapy Day. I recognize the responsibility of psychotherapists to join together on this day to promote the field of psychotherapy, to share evidence-based research, to reduce the stigma associated with mental illness, and to emphasize the necessity for effective, low-cost counseling options.”Judith Beck, Ph.D.

“I’m honored and delighted to lend my support and I hope the day is wonderful. Psychotherapists are that part of nature which has been called to heal the most wounded part of nature, ourselves. It is a holy vocation, not a career or a job.”Harville Hendrix, Ph.D.

“The benefits and risks of psychiatric drugs, especially the antidepressants, have probably been oversold to the America public, and many of these medications appear to have few, if any, benefits above and beyond the placebo effect. I feel sad about that, because my colleagues and I have developed amazing new treatment methods. So I definitely support your effort to raise public awareness about psychotherapy, and wish you the best for your Psychotherapy Day!”David D. Burns, M.D.

… and we’re sponsored by, the socially-aware therapist referral organization with the most rigorous standards,

… and this year we held a storytelling event where therapists told true therapy stories (de-identified, of course) to demystify therapy. This event was called Moments of Meaning – the videos can be found here:

We’d love it if you would spread the word about National Psychotherapy Day. We believe therapy truly helps, and if more people knew that, the world would be a better place.


– Ryan