Clearing the Misconceptions of Therapy

Myths about Therapy

Right now, I consider myself extremely fortunate, because I am in graduate school, studying to become a licensed therapist, a field I am indescribably passionate about. Part of our school requirements includes the process of attending our own personal psychotherapy sessions to witness what the other side of the couch feels like. In my experiences of learning how to be a professional, while subsequently being a client, I have realized that our society promotes many stubborn myths regarding the therapeutic process entails. I hope this article clears some of these unfortunate misconceptions.

“Therapists are the experts.”

Actually, therapists are humans. They are not walking, compassionate fountains of knowledge who understand the textbook symptoms of every disorder or situation to inflict mankind. Yes, they are rigorously trained and educated. Yes, they are prepared to work through a variety of situations. And, yes, of course, they must hold a strong base of understanding and interpreting the complexity of human behavior. No, they do not know all the answers, nor do they pretend to. Therapists are required to take on clients of whom they are competent to treat; this is an ethical requirement. Likewise, they do not exist to provide expert knowledge to a client. That is what Google, textbooks, and self-help books are for. Therapists aim to guide the client’s feelings, thoughts, and perceptions in a safe and non-judgmental environment. Therapists aim to make the client accountable for being the expert of his or her own life.

“A good therapist will solve my problems.”  

Therapy introduces and raises awareness to a client’s conscious and subconscious problems, but, at the end of the day, the client holds the responsibility for making the necessary changes. Therapists do not hand-hold. They are not the puppet masters controlling a client’s actions. Therapy encourages clients to come to terms with accepting, working through, improving, and hopefully overcoming life adversities. Although solving problems is an ideal reason to pursue therapy, this does not always happen. Clients who seek therapy with the pretense of one problem often discover that this identified concern is really just a manifestation of deeply-rooted, complex issues. Likewise, not all clients benefit from therapy. Those who are unmotivated, in denial, or strongly resistant to receiving professional help may find that therapy does not fix any of their problems. This is a major cause for professional burn-out. Again, the therapist does not do the fixing or take an action initiative. That is the client’s job.

 “Therapists are trained to provide the best advice for me.”

Therapists are not trained to give advice. They are trained to help explore the layered, interactive process that involves helping a client make the best decisions regarding his or her well-being. Humans come from an endless variety of backgrounds, cultures, and opinions, thereby making them intrinsically unique. In other words, the right decision is not a black-and-white solution. Therapists who give advice risk jeopardizing the client’s quest for independence. He or she can lead the client in the “wrong” direction for him or her.

“I’m not crazy; only crazy people go to therapy.”

Just like only smart people go to college, moral people attend church, and people who love each other get married. Actually, the bulk of therapeutic treatment focuses on depression, anxiety, and adjustment disorders. Symptoms of these disorders often result from the difficulties and pain from coping with everyday life stressors. An overwhelming majority of clients seek therapy to improve situations in their lives. They are not on some fanatical quest to achieve sanity. Besides, the term “crazy” is highly offensive, and a good therapist would never perceive a client in such a way.

 “If I go to therapy, all I will do is lie on a couch and talk about my mother.”

Freud fathered this stereotype; almost every subsequent therapist exploration has debunked it. Sure, there is usually (but not always), a couch, but no therapist would make a client lie down on it if he or she did not want to. In fact, establishing rapport and trust is an essential feature of the therapist-client relationship, and most interpretation is based on nonverbal, rather than verbal, behavior. Lying on a coach can make this task very difficult. Moreover, while some therapists explore familial relationships, this plunge into the past is becoming more outdated. Newer, short-term therapies tend to focus on immediately identifying problems in the “here-and-now” present and providing viable solutions.

 “I’ll have to go to therapy forever.”

The length of treatment largely depends on individual. Some can achieve substantial progress in a few sessions; others may spend years working through problems. However, a therapist will never force a client to stay in treatment. In fact, ethical guidelines require therapists to appropriately assess their clients’ progress and reduce or terminate sessions once the client achieves measurable levels of success. Yes, some clients do attend therapy for years and years, but that is because they find the treatment helpful and beneficial to their lives. Therapists do not promote long-term dependency. This dissuades from the major goals of encouraging self-confidence and independence.

 “People who seek family or couples counseling have failed in their relationships.”

The maintenance of interpersonal relationships can be extremely stressful and difficult. While dysfunction in itself is not necessarily a problem, ignoring it is. Unaddressed issues do not just disappear; people tend to just adopt destructive coping mechanisms to handle them. Oftentimes, the unit fails to recognize the foundation of their toxic communicative or behavior patterns, thus resulting in resentment, anger, or a sense of hopelessness. By that point, the family or couple may believe the situation is simply irreparable. However, therapy can help identify core conflicts, restructure perceptions, and increase the resiliency of interpersonal relationships. Families or couples who seek therapy have not failed. Rather, they have made the brave and proactive choice to succeed.

 “I don’t need therapy. I need medication.”

Medication serves a clear purpose in the biophysical realm, as it can reduce severe symptoms and improve chemical and neurotransmitter imbalance. Indeed, for some disorders, a medical prescription may be essential. However, clients who are only interested in taking medication deprive themselves of working through the core issues that can improve cognitive awareness, happiness, and well-being. Medicine treats the biological scope; therapy treats the cognitive and behavioral scope. Furthermore, clinical research supports the notion that clients taking medication have a greater likelihood of achieving progress and stability if they attend conjunctive therapy.

 “Unless he or she has experienced my problem first-hand, there is no way a therapist will be able to understand what I’m going through.”

This thought process is common for people undergoing tremendous pain. Grief often demands support, familiarity, and strength in numbers. This is, in fact, the main premise for Twelve-Step programs, and indeed, this mantra has likely contributed to their high rates of success. People dislike contrived sympathy or the sugarcoated, “everything will be all right.” Therapists will not pretend to understand every client’s pain or trauma; they will not pretend to know exactly how it feels. Trauma inflicts every individual differently. What therapists will do, however, is provide true and genuine empathy, sit with the client, let him or her explain the problem, and discuss any vulnerabilities or fears. Clients often threatened to expose deep internal wounds, fearing misinterpret or judgment. It is the therapist’s job to provide comfort and offer the best treatment for that client. For this reason, they are trained to offer unconditional regard.

Mental Disorder Diagnoses: do they help or hurt us?

The decision to diagnose a client remains one of the most controversial issues in the mental health sector.

What is a diagnosis? It is essentially a title summing up a careful, methodical  arrangement of symptoms. It can be analogous with a recipe, in that a diagnosis has precise ingredients.  The universal code for diagnosing can be found in the DSM-IV-TR (Diagnostic and Statistical Manual: 4th edition revised). The fifth edition will be released sometime in 2013. This book provides a comprehensive overview of all the diagnosis (from anxiety-related disorders to schizophrenia to sleep disturbances to depression) and it is very specific in determining which diagnosis or diagnoses a client may have. It is a universal language understood among all mental health clinicians, from therapists to social workers to psychiatrists to psychologists.

 So, why do we diagnose? 

Several reasons. A diagnosis gives a name to an issue or several issues. It offers verifiable proof that the client is not “the only one experiencing this,” and gives a sense of strength in numbers. Diagnoses can aid in providing the appropriate course of treatment (mode of therapy, expected results, medication possibilities, etc.). For this reason, diagnoses can be beneficial for both the client and the practitioner. The client begins to understand his or her the problematic or distorted behavior, which, in turn, paints a clearer picture for the therapist in deciding the best, appropriate action. Diagnoses can also make room for more support and networks. Nowadays, there is an abundance of resources and treatment methods available for nearly every type of disorder. Clients may join online forums, participate in group therapy or community outreach programs to build that camaraderie and realize they are “not alone.” 

Moreover, diagnoses can help clients receive the materials and tools they need for treatment. Diagnoses are often necessary to receive insurance reimbursement, sliding-scale treatment and medication, and affordable and available assistance.  

There are, however, drawbacks in diagnosing. Some clients may find “living with a label” deliberating and painful. Some individuals will “become” that diagnosis, acting in such a way that fits a self-fulfilling prophecy. He or she may believe they are exempt from faulty behavior or simply feel hopeless and untreatable. Reactions such as deflated self-esteem, isolation, and the sense that “everyone else is normal” are common and can be traumatic for both the client and his or her loved ones. 

Likewise, while mental health professionals take all the steps and procedures necessary for absolute accuracy, mistakes do happen. Clients may lie, forget, or omit information when being evaluated. Symptoms can be overlooked, exaggerated, or minimized. Consider the evaluations medical doctors must provide when diagnosing a patient. Let’s say that an individual comes in complaining of “nausea, fatigue, irritability, and headaches.” He or she may be experiencing a head cold or fever. Possibly pregnancy. Possibly an autoimmune disease, such as diabetes, fibromyalgia, or multiple sclerosis. Possibly a gestational issue or brain tumor or indication of spreading cancer. Or a combination of several problems. In other words, the possibilities can be endless, and the same overlap can occur when diagnosing mental illness.

If that same individual comes to a therapist complaining of “nausea, fatigue, irritability, and headaches,” further probing and analysis will occur. He or she may be experiencing general anxiety or dysthymia. Possibly a dissociative disorder or sleep disturbance. Possibly an eating or adjustment disorder. There are several different options (all which seem very close and similar), and just like with a physical illness, misdiagnosing poses a variety of serious problems, from legal issues (giving the wrong kind of medication) to ethical issues (serious, psychological distress).

 Diagnosing also tends to ignore individual differences, because diagnoses generalize several symptoms and lump them into a concise category. While this provides a black-and-white solution, we all know that human behavior can be surprising, evolving, and differing, depending on the social context, time frame, culture, and individual history. Theories on this often vary. Some believe that people all fall into certain categories of behavior, whereas others believe that we are all absolutely different and, thus, unable to be categorized.   

Clients and therapists respond differently to diagnoses, as does the general public. We are so quick to stereotype or label behavior (“she’s so bipolar,” “she looks anorexic”, “he’s a psychopath,” “he’s an alcoholic”), that we often fail to realize how harmful these quick, automatic statements can be for people who are suffering from these disorders. Furthermore, once we do find out people may have a diagnosis, the stereotyping can be even worse (“oh, she has OCD; no wonder she’s so anal about cleaning” or “of course he has ADHD; he can’t sit down for two minutes!”

These perceptions can be deeply-rooted and we often fail to believe the person can improve, change, or even rid themselves of certain mental disorders. We may “expect” them to act in certain ways that are in accordance with their diagnoses, and when they do, they are reinforcing our beliefs, and when they do not, they make us question the validity of their diagnosis (“she can’t have bipolar disorder; I’ve only seen her depressed” or “he can’t have narcissism; he’s just really confident and self-assured.”

In conclusion, as a society, because diagnoses are a mainstream part of therapy and medical treatment, we must be careful with how we interpret, label, and react to them.

A mental disorder does not make a person less of a person.

It also does not mean they are that disorder.

Suffering from something is not synonymous with being something.