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Welcome

I started this blog in 2013 to share my reflections on reading, writing and psychology, along with my journey to become a published novelist.​  I soon graduated to about twenty book reviews a month and a weekly 99-word story. Ten years later, I've transferred my writing / publication updates to my new website but will continue here with occasional reviews and flash fiction pieces, and maybe the odd personal post.

ANNE GOODWIN'S WRITING NEWS

How to create a convincing fictional therapist

27/11/2014

18 Comments

 
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In the midst of my writing, when I’m floored by a factual question to which neither Google nor my encyclopaedic husband can furnish the answer, he tells me to make it up. After all, it’s fiction I’m creating not the instruction manual for launching a rocket to Mars. While close attention to detail lends our work credibility, we should also cut ourselves some slack. It would be unreasonable to expect us to get everything right.

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:

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Real therapists stick to the fifty minute hour

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.

Disclaimer

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?

Thanks for reading. I'd love to know what you think. If you've enjoyed this post, you might like to sign up via the sidebar for regular email updates and/or my quarterly Newsletter.
18 Comments
Litlove link
27/11/2014 08:21:16 am

What a fascinating series. I love shrink lit - one of my favourites is a book you've reviewed here, Salley Vickers' The Other Side of You. Of course now I can't recall what else I've read (apart from The Examined Life, which IS by a psychotherapist and therefore reliably accurate). But I have The Good Psychologist by Noam Shpancer to read and one of my favourite therapy books (though non-fiction again) is One on One by Rosemary Dinnage. I'm now going to go through your reviews and see what to add to my tbr pile!

Reply
Annecdotist
29/11/2014 09:25:41 am

Thanks for reading, Victoria, and taking the time to comment, The Other Side of You is a lovely novel, even if the marathon therapy session isn't terribly credible. And the Examined Life, although non-fiction, reads like a beautiful collection of short stories. I'll have to look up The Good Psychologist as it isn't on my TBR pile right now. Do let me know what you think if you get to it first.

Reply
Paula link
28/11/2014 12:34:54 pm

I found your point about conversations with a supervisor interesting, as I wrote grants at one time for a 24 hour crisis center and knew the clinical supervisor there pretty well. I never overheard such a conversation, of course, but from what I know of the practice, I can well imagine those conversations being good material for advancing a plot. You're a smart cookie, as my friend Rachel would say. ;-)

Reply
Annecdotist
29/11/2014 09:29:05 am

Thank you, Paula, and great to find someone who has some notion of supervision from the "outside". Still waiting to find a psych-lit novel that encompasses the technique.

Reply
Geoff link
28/11/2014 06:31:03 pm

Fascinating as always. Interesting how you deconstruct the process. We could have done with a bit of that in my legal career. The other interesting point is about making it up. The novel I'm working on getting ready for launch has several elements where I have no expertise but naturally I want them to be credible. A religious evangelical preacher based in Oklahoma, a hospital in Nicaragua, a geneticist and embryo research. So far I've found willing volunteers who have expertise in all areas except running an evangelical church. Hopefully no one is going to come back and trash one fundamental element and all my careful research will stand the test of expert evisceration.

Reply
Annecdotist
29/11/2014 09:37:18 am

Thank you, Geoff, I'm waiting for you to do the same with novel involving lawyers!
As for making things up, I'm a lazy researcher and take my chances (oops – should i even be saying that here). I think there might be a difference between professions/businesses that are regulated in some way and others where our made up version is as valid as any other. As long as we've thought it through and it's internally consistent, why worry?
Having read a version of the novel of which you write here, I can confidently say that your depiction of an evangelical church fits nicely with my own prejudices – what more can you ask?!

Reply
Norah Colvin link
30/11/2014 04:12:05 am

This was fascinating, Anne. While I haven't read any of the books about fictional therapists, nor have I visited a therapist in reality, I was interested to read the list of qualities a real therapist would be likely to have or not have. I was particularly interested to hear that they deal more with the present than the past and on improving the current condition. That corrects one of my existing misconceptions. I think the discussions with colleagues or supervisors would be important, as would ongoing professional development, to ensure one was responding appropriately to client needs. Thanks for the enlightenment.

Reply
Annecdotist
30/11/2014 09:39:46 am

Thanks for your interest, Norah. I suppose the proportion of past versus present focus would vary with the model used and the nature of the individual's problem and, in my opinion, it's invaluable to review the person's past to get a stronger picture of what has made them the person they are, but the purpose would always be to impact positively on the here and now – and some models would do this more directly than others.
And you're right, not only ongoing supervision, but other aspects of continuing professional development through reading and courses would be essential to keep up-to-date. Perhaps I also should have added that the supervision discussions would also be kept confidential.

Reply
Norah Colvin link
1/12/2014 03:25:31 am

Yes, I can see the importance of looking at the impacts upon one's personality or character development.
I guess as I also work in a profession in which confidentiality is a given I took that for granted with yours. :)

Annecdotist
2/12/2014 10:48:30 am

You're right, Norah, confidentiality is central to most professions in the human services, but it's something some people particularly wonder about / worry about when consulting a therapist – and given that novelists like to steal ideas, and plagiarise overheard conversations, it might not always be at the forefront of the writer's mind.

Charli Mills
2/12/2014 11:36:35 pm

What a useful post in many ways! It's a great catalog to your fictional reviews as well as a tutorial to writers working on a character in the field of therapy. I'm wondering if it also helped you to distill your own experience in this field with writing about it in fiction?

Reply
Annecdotist
4/12/2014 03:37:11 am

Thanks, Charli, and thanks also for challenging me to do it. I certainly hope that people will find it useful (or even find it!) if they're writing fictional therapists.
Regarding my own experience, I was quite lucky to be able to do a fair bit of teaching and papers and conference presentations which required me to work out what I thought about my work. With my new WIP, it's the first time I've attempted any fiction based on my work (I think) – partly because of the need for absolute confidentiality and partly because I used to keep the two areas very separate more to safeguard my writing. Even so, I hadn't thought to include any talking therapy in the novel (if a novel it turns out to be), so you've given me something else to ponder.

Reply
Stuart Larner link
6/4/2015 11:11:06 am

Hi Anne
I must say that this is a very interesting series and tests the boundaries between fiction and reality as well as giving guidelines for a true account of therapy.
I felt that your points about time-keeping, inane questions, psychologically safe environment, casenotes security and therapist vulnerability are all defensible criteria for fictional representation.
However, I think that not all modern therapies are present-centred, (for example cognitive therapy for PTSD, and eye-movement desensitisation), so I think that the fictional therapist can be allowed a little excursion into past events, but they would have to be working a particular method. In fact, that might be interesting to see a fictional account of a particular therapy method in use.
Regarding putting people off therapy through misrepresentation, I think that this can be an attractant if the therapist is made interesting. For example, in the TV series" The Human Jungle" starring Herbert Lom, in the 1960's I was first attracted to a career as a psychologist by watching the episodes and reading the books. He was depicted as a detective, and that is what interested people about the process.
I also think that we need to give succour to people’s fantasies about therapy because that is what they expect, and in those circumstances, it might seem more acceptable to them. It fits in with their understanding. The real world of therapy might shock them.
It is a good point you make about supervision. Novelists might have missed a trick here in not exploring that. It adds another level of irony and perception that could really augment a novel.

Well done, keep up the good work.

Reply
Annecdotist
7/4/2015 03:38:17 am

Thanks so much, Stuart, for adding your informed perspective.
I take your point about the importance of the past focus. Perhaps I should have headed that section "real therapy is concerned with the present AS WELL AS the past". I think I put it that way to bust the illusion that it's all about uncovering repressed trauma. But we can't do a psychological formulation without going into the person's history and exploratary therapies generally entail reassessing past events.
Interesting that you mentioned PTSD in this regard. This was featured in one of the novels The Memory of Love (and seemingly appropriately, although I'm not qualified in the technique so can't save the sure) but I found it a little disappointing from the literary perspective. Seemed too much of a magic cure!
I do get a little po-faced with these reviews, so you're right to point out that people must be allowed their fantasies. And you make a great point that, even a misportrayal could be beneficial in simply raising awareness of the psy-professions. I think the psychologist-as-detective is certainly one that attracts people. Isn't there a Val McDermid version that's been very popular?

Reply
Clare Stevens link
14/5/2019 08:33:40 pm

As with every profession though, there must be some rogue/cowboy therapists out there who don't adhere to what 'real' therapists should do? And it must be so much more fun for an author to write about the ones that break the rules!

Reply
Anne Goodwin
15/5/2019 08:47:41 am

Thanks for reading and sharing your reflections, Clare.
Yes, there are rogues, and those rogues can be fun to write about, and even I enjoy reading about some. But I don’t see it as ‘as with every profession’, not even those working with vulnerable people, because therapy works by asking clients/patients to become more vulnerable, which is a helluva responsibility. For that reason, training puts a heavy emphasis on boundaries that should become second nature.
So a rule breaker would have to make quite an effort and have good reasons to cross a fortified boundary, but that’s rarely shown, suggesting to me that the author doesn’t understand the therapist-client contract. The rule breaking should BE the story, as in The Good Enough Mother which I’ve recently reviewed, but more often it’s treated as a minor plot point and part and parcel of the job.
Are you considering creating a fictional therapist, Clare? (Or have I put you off?)

Reply
website for therapists link
11/12/2023 02:05:22 pm

Therapists are unsung heroes, weaving a tapestry of healing with empathy and understanding. Their commitment to guiding individuals through life's challenges is truly commendable. In a world that often rushes, therapists offer a sanctuary of support, making a profound impact one session at a time.

Reply
Anne Goodwin
11/12/2023 05:21:35 pm

Thanks for your contribution.

Reply

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