I’ve often wondered, as I’ve picked fault with my nine fictional psychologists and psychotherapists, if I’m being overly harsh. (I’ve wondered about that even more after reading a Catholic priest’s condemnation of John Boyne’s excellent A History of Loneliness in The Irish Times.) Surely it’s the story that matters above all else? While I’d defend the writer’s right to offend, many would prefer not to perpetuate unhelpful stereotypes. As M Kelter describes in his post Why Fictional Therapists Suck, inaccurate portrayals of psychotherapists in fiction can do real harm by putting people off accessing the help they need.
So how do you create a credible fictional psychotherapist? While I can’t offer the definitive guide, I can suggest, based on my reading and on my experience as both therapist and therapped, some pointers:
Okay, some therapists might run shorter or longer sessions, but the fifty minutes is fairly standard. Most importantly, the client/patient will know in advance how long the session is expected to last and the therapist will not run over time when things get more interesting (on the assumption that people bring sensitive matters up at the end because they know they won’t have time to delve deeply). A seven-hour therapy session is beyond the pale.
Real therapists don’t bombard the client/patient with inane questions
While feelings and relationships with parents are the core business of some therapies, a competent therapist doesn’t repeatedly ask, like a broken record, How does that make you feel? Tell me about your mother! A therapist might ask for clarity, link a recent statement with something the client/patient has mentioned in the past, prompt them to consider what they’re saying more deeply, or sit in reflective silence while their client/patient gets more in touch with their thoughts and feelings. A real therapist won’t try to control the content of the session but, depending on their therapeutic orientation, will have either agreed an agenda in advance with the client/patient or will follow where their client/patient leads.
Real therapy is concerned more with the present that the past
Readers and writers enjoy delving into a character’s history to discover the “big secret” that stands between them and their goals. While Freud believed the talking cure depended on uncovering repressed trauma, this plays a much smaller part in contemporary therapies. Of course, examining how the person got to where he/she is today, including looking back at early childhood, remains important, the focus is on improving current functioning rather than exhuming trauma from the past.
Real therapy is conducted in a psychologically safe environment
The location of therapy varies, dependent on whether the therapist works privately or is a health or social care employee. But even when a therapist works at home they will see people in a room where there is no possibility of the conversation being overheard and free from interruptions. Usually, they will see each given client/patient at the same time each week in the same room. A safe space is essential for both participants: a wheelchair-bound therapist would not see an adolescent with a history of violence in conditions in which she would be unable to escape an attack.
Real therapists are extremely careful with confidential casenotes
Note-taking practices vary, depending on the requirements of the employer and the specific professional governing body, as well as, occasionally, the therapist’s personal preferences. But whatever client records are held, the therapist will be at pains to ensure their confidentiality, generally by keeping them in a locked filing cabinet in the therapy room. An appropriately trained and conscientious psychotherapist would be very unlikely to smuggle them out of a hospital to read in a cafe.
Real therapists receive regular clinical supervision
Scenes depicting the therapist in conversation with a supervisor are ripe with possibilities for character and plot development. Yet not a single one of my nine fictional psychologists and psychotherapists were given this opportunity. A couple came close, but a panic-fuelled telephone call to a distant expert and a chat over dinner with a sympathetic husband cannot substitute for scheduled meetings with a suitably-qualified colleague to discuss one’s clinical work.
The therapist’s vulnerability is both an asset and a liability
Readers love flawed characters and therapists as characters are no exception. It’s also the case that many are attracted to the therapy professions because of unresolved issues of our own. But my reading for this series suggests that writers might be at risk of overplaying the therapist’s vulnerabilities. Training, personal therapy and/or ongoing supervision assist real therapists in recognising when personal stressors risk destabilising their practice or when personal agenda take precedence over their clinical work. Fortunately, most therapists would never seduce or be seduced by their patients/clients. But if your plot requires an extremely flawed therapist, don’t forget that therapists can receive therapy too.
One of my former colleagues used to borrow a line from a famous tinned-soup manufacturer in referring to the “57 varieties” of therapy – and that was probably an underestimate. So if you look hard enough, you can probably find a wacky therapy that subverts every one of these points. I can’t cover all bases in a 1000-word blog post, but these are the main issues that have arisen from my reading so far. Don’t let me put you off the novels in this series – just don’t go there looking for a therapist.
I’ve got a few novels lined up to continue this series, starting with one penned by a clinical psychologist: Luana Lewis’ Don’t Stand so Close. I wonder how long it will take to get through another nine?