Common misconceptions about psychotherapy

Common misconceptions about psychotherapy

Some ideas about therapy appear so often in fiction that I wonder how many authors use them intentionally and how many simply don't realize they're inaccurate. Here are six of the most common, along with some information about current standard practice.

1. You are lying on a couch

Reality: Therapy clients aren't lying on a couch; Some therapist offices don't even have couches.

Where did that come from? Sigmund Freud had his patients lie on a couch so he could sit in a chair behind their heads. Why? No deep psychological reason - he just didn't like people looking at him.

There are many reasons why modern therapy clients would not be happy with this. Imagine telling someone about a difficult or embarrassing experience and not only not being able to see them, but also having them respond with silence. Why on earth do you want to go back?

The ideal therapeutic setup, and they actually teach this in graduate school, is to turn both chairs inward at an angle of about 20 degrees (give or take about 10 degrees), usually with 8 or 10 feet of space between them. Often the therapist and the client are facing each other because they turn in their chairs to face each other, but with this attitude the client does not feel like they are being confronted.

Even if there is a couch in the room, the therapist's chair is almost always turned at an angle to it.

2. Therapists analyze everyone

Reality: Therapists analyze people no more than the average person and sometimes less frequently.

Ironically, only people trained in Freud's lie-on-the-couch-and-mom-free approach to Freud (also known as psychoanalysis) learn to analyze at all. All other therapists are taught to understand why people do things, but it takes a lot of energy to figure people out. And to be completely honest, while therapists typically care for people who want to help their clients, in everyday life they deal with their own problems and don't necessarily have the time or space to deal with everyone else's problems or behaviors.

And the last thing most therapists want to hear in their free time is strangers' problems. Therapists are paid to deal with other people's problems for a reason!

3. Therapists have sex with their clients

Reality: Therapists never have sex with their clients or clients' friends or family members if they want to keep their licenses.

This includes sex therapists. Sex therapists don't watch their clients have sex or ask them to experiment in the office. Sex therapy is often about clarifying and addressing relationship problems, as these are two of the most common reasons people have sexual problems.

Therapists should also not have sex with former clients. The rule is that if two years have passed and the former client and therapist meet and somehow get along (i.e. this was not planned), the therapist will not be expelled from professional organizations and the licenses will be revoked. But in most cases, other therapists will still view them as suspicious.

The reason for this is simple: therapists must listen and help without including their own problems or needs, which creates a power differential that is difficult to overcome.

And to be honest, the roles therapists play in their offices are just facets of who they really are. Therapists focus all their attention on clients without ever complaining about their own concerns or insecurities.

When people think they want to be friends, they usually want to be friends with the therapist, not the person, and real friendship involves sharing power and mistakes and looking out for one another. Getting to know a therapist as a real person can be disappointing because now they want to talk about themselves and their own problems!

4. It's all about your mother (or childhood or past...)

Reality: A branch of psychotherapeutic theory focuses on childhood and the unconscious. The rest don't.

Psychodynamic theory upheld Freud's psychoanalytic belief that early childhood and unconscious mechanisms are important for later problems, but most modern practitioners know that we are exposed to many influences in everyday life that are equally important.

Some therapists will tell you firmly that your past is not important if it is not directly relevant to the current problem. Some believe that extensive discussion of the past is an attempt to evade responsibility (Gestalt therapy) or to not actively work on change (some types of cognitive behavioral theory). Some believe that the social and cultural environment we live in today causes problems (systems, feminist and multicultural therapies).

5. ECT is painful and is used to punish bad patients

Reality: Electroconvulsive treatment (historically called electroshock treatment) is a rare treatment of last resort for patients who have been in and out of the hospital for suicide and for whom more traditional treatments such as medication have not worked. In some cases, the client is so depressed that she cannot do the work to get better until her brain chemistry works more effectively.

Until ECT is considered, some clients are eager to try it. You've tried everything else and just want to feel better. When death feels like your only other option, having someone pass a painless current through your brain while you sleep doesn't sound like such a bad idea.

ECT is not painful and does not make you shake or tremble. Patients receive a muscle relaxant. Because it is scary to feel paralyzed, they are also put under general anesthesia for a short time. Electrodes are usually placed on only one side of the head and the current is delivered in short pulses, resulting in a grand mal seizure. Doctors monitor electrical activity on a screen.

The attack causes the brain to produce and use serotonin, norepinephrine, and dopamine, all brain chemicals that are low in depression. Some people wake up and feel like a miracle has happened. Multiple sessions are usually required to maintain the changes. The person may then be switched to antidepressants and/or other medications.

ECT is no more dangerous than any other procedure administered under general anesthesia, and many of the possible side effects (confusion, memory impairment, nausea) may be due as much to the anesthesia as to the treatment itself.

6. “Schizophrenia” is the same as “multiple personalities.”

Reality: Schizophrenia is a biological disorder with a genetic basis. It usually causes hallucinations and/or delusions (strong ideas that violate cultural norms and are not supported by reality), as well as a deterioration in normal everyday life. Some people with schizophrenia regularly become catatonic, have paranoid thoughts, or behave disorganized. They can speak strangely and go tangential (wandering verbally, often in a way that makes no sense to the listener), using nelogisms (made-up words), clinking associations (rhymes), or in extreme cases, producing word salads (sentences that sound like a bunch of jumbled words and may or may not be grammatically correct).

Dissociative identity disorder (formerly multiple personality disorder) is caused by trauma. In some abusive situations, the normal defense mechanism of dissociation can be used to “split off” memories of trauma. In DID, the division also includes the part of the “core” personality that is associated with that memory or set of memories. The dissociated identity often has its own name, characteristics, and quirks. and may or may not age at the same rate as the rest of the personality (or personalities), if it ages at all.

Therefore, calling yourself “schizo” or “schizoid” or “schizophrenic” when you think you have an alter ego or conflicting personality traits makes no sense (and is guaranteed to make the mentally challenged person cringe)!

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