I was recently listening to an interview with actor Jason Segal on his new show Shrinking. The concept of the show is that a therapist has a crisis and starts bluntly telling his clients what to do with their lives. During the interview, Segal said something along the lines of “Therapists aren’t supposed to do this, but they’re probably thinking of what the other person should do. They don’t say it to keep the person in therapy.”
As many of you know, I was a therapist for over a decade before I pursued the lucrative career of ‘starving comedy writer.’ So as you may imagine, I had a couple of strong reactions to this comment. First off, I’m definitely not watching that show.
More importantly - do people actually think that? That a therapist has the magical ability to ‘cure’ someone but holds it back to make money? When I started thinking about this, I realized that most people don’t fully get what a therapist actually does. Apparently, there is a lot of mystery behind the curtain.
Well baybays - I’m here to shatter the illusions by answering your burning questions about what it is like to be a therapist. What are we thinking? What do we do? How do we manage listening to all that heavy shit without losing it? I’m here to tell you. Let me start with Mr. Segal’s assertion…
Do therapists know exactly what people should do to solve their problems?
Nope. We learn pretty early in the process that giving advice is about the most useless thing you can do. Advice is just “This is what I would do if I were you.” But guess what? I’m not you. I don’t have the foggiest idea of what it’s like to be you. I don’t even bother having an opinion on what you should do.
What do you mean you don’t have an opinion? Surely, you must be secretly thinking what people should do.
I really don’t. I know it’s weird for a ‘civilian’ to think about, but for the most part therapists don’t have an opinion on what someone else should do with their lives. We’re just kind of built differently. For people who are really good at being therapists, non-judgment is an ingrained part of their personality before they even get into the field. Then the training reinforces that quality by emphasizing humility and respect for the client. If I had an opinion about what you should do with your personal life, that implies that I am smarter or ‘above’ you in some way and I simply don’t believe that is true. You are the expert on your life. Who am I to think I know better than you?
So if you’re not giving advice, what do you actually do?
Every clinician is different, but this is basically the process of how I did therapy:
Step 1: Help you identify your ‘wiring’. When we grow up, we have automatic thoughts and beliefs that are programmed into us by life. The first step is to identify what messages about yourself are knocking around in there.
Step 2: Figure out what parts of the wiring you actually still believe and what parts are bullshit.
Step 3: Replace the bullshit automatic thoughts with more reasonable ones. For example, if I have bullshit wiring that says “No one will ever be attracted to you,” I’d replace it with “Some people will be attracted to me and some people won’t.”
Step 4: Notice when the bullshit automatic thoughts come up in real life and replace them with the reasonable ones. Over and over again until the new thought becomes the habit. This mostly happens outside the session and my role becomes the coach. Your life is the game.
And that’s essentially it! There is another important piece: the relationship between the therapist and the client. Most clients identify the relationship as the most helpful part of therapy. Not surprisingly, spending time with a non-judgmental person who accepts you and cares about you is incredibly healing.
But do you actually care about the clients? They are paying you.
I really do. Yes, they are paying me for my time and my skills. But that doesn’t stop me from caring about them. I’m sure no matter what business you are in, you can think of an example about caring about someone with whom you also have some sort of a financial relationship. Also - when someone is being vulnerable and human with you, it is nearly impossible NOT to care about them.
But it is a different kind of caring. Again, this is difficult to describe to ‘civilians.’ I don’t care about a client the same way I care about a friend or a loved one. There is a specific context in which I care about them. For the hour they are with me, my wants and needs from the relationship don’t exist. It is all about them. And so we have a sort of unusual relationship that doesn’t really parallel anything else in life. But the compassion and empathy is definitely real and - at times - overwhelming. The problem therapists (particularly new ones) tend to run into isn’t ‘not caring.’ It’s caring ‘too much.’
Does that mean you like every client?
Mostly, yes. But not always. In my career, I have worked with some very difficult folks: pedophiles, domestic abusers, and (worst of all) teenagers. Often, the way they relate to you mirrors the way they relate to the world - and it’s not always fun. So while it is not fully accurate to say that I have ‘liked’ every client, I definitely felt connected, empathetic, and deeply concerned about every client’s well being.
How do you deal with all the heavy shit?
Practice. The major part of the training is how to deal with the heavy shit. I spent the first two years of my career crying in the shower most mornings. But as you get into it, you learn the ability to care without owning. So it’s a lot of letting go of the part you can’t control. It’s a good skill for being a therapist and also being alive.
Are you trying to keep your clients in therapy?
Definitely not. Quite the opposite, actually. When I am doing therapy, I am actively working myself out of a job. My goal is to have you internalize my ‘voice’ coaching you so that you can do it on your own. I am successful when you don’t need me anymore.
What about those people who are in therapy for decades?
That is rarer and rarer these days. When Freudian therapy was all the rage, it would take years. While a small percentage of people still engage in that type of work, most therapy these days is goal-directed and designed to treat specific conditions. With the broken insurance system, people are actually getting less care than they need, not more! Hooray?
Now - are there unethical therapists who extend treatment longer than needed? I’m sure there are. But a couple of things you have to remember: first, there is a looooooong waitlist of people who want to see therapists. Getting new clients is not generally a problem.
Secondly, the therapy profession is - as a rule - highly ethical. Of course there are exceptions, but we tend to pay attention to ethics like bulldogs. Trust is everything in our field. We realize that if one of us erodes trust, it ruins things for the rest of us. If a confidentiality is broken or a client is mistreated, people say “Therapists suck” not “That particular therapist was unethical.” So it is in our best interest to keep an eye on each other. Unlike some professions reliant on the public trust (cough*POLICE*cough), the mental health field does not circle the wagons and protect our own. We actively try to weed out our ‘bad apples.’ I have personally been a part of costing fellow therapists their licenses when they make serious ethics violations. It doesn’t feel good, but I didn’t hesitate. Clients are the vulnerable ones and need to be protected at all costs.
Isn’t it depressing?
Quite the opposite, actually. I spent a large part of my career working with folks battling heroin addiction. Every day, I got to witness people showing up and trying something really fucking hard. I find trying really inspirational. And yes - sometimes addiction won a few rounds. And that sucked. But as long as people were still alive, they tended to show up for the fight. And I found that incredibly hopeful.
So that’s it! A peek into the magical world of therapists. Tah daaaaah! Hopefully, this little ditty demystified some of your misconceptions. I am happy to answer any questions so just reach out and let me know. And pay the secretary on your way out.
Boogie Writes is a completely independent endeavor by one hard-working funnyman trying to make his way in the world today (which takes everything you’ve got.) If you like what you read, please subscribe, support, and tell a friend! Also - do you need advice? Of course you do! Send your queries to brendan@brendanboogie.com with “Dear Boogie” in the subject and get some solid or at least passable advice!