New Reality Show: What About Psychology's Reputation?!

Let's be honest: The change has been coming for a while. Reality television has inserted itself into the field of psychology as countless shows over the years have begun to use psychotherapists as a part of their cast. Therapy has long been a subject of at least mild intrigue because what is said to the therapist behind closed doors - well, one never really knows unless you're either the client or the therapist. For the most part, the psychotherapy room has historically acted as a sacred chamber, the rare place where the client feels safe and listened to, and the therapist acts as the supportive mirror, guide, and confidant.

The first reality show I ever saw which had a therapist, Breaking Bonaduce (2005), focused on the life of former TV star Danny Bonaduce. I remember thinking at the time how unusual it was that a therapist was actually having a session with clients - drumroll...and cameras! - in the same room. Back then, I didn't think too much of it, probably dismissing psychotherapy on TV as a passing fad. (It is worth mentioning, however, that the therapy I saw conducted on the show was actually pretty good.)

Over the years, we have seen more therapists in reality television and audiences have sat through excerpts of more therapy sessions than I can - or want to - count. As the medium of TV therapy has become more common - heck, even expected on your average reality show - it's caused me to reflect on 1) what possesses the clients to be interested in venting their problems in such a public way, and 2) what possesses the therapists to want to show the therapy with their clients on TV. When it comes to the clients' motivations, I have heard many people say, "Oh, they just want attention." First, I'm not sure it's that simple.

I give psychotherapy clients an awful lot of credit for having the strength and courage to work on their issues, and I see it as my job as a therapist to protect them and their (often potentially) vulnerable feelings. Even if a client of mine said he wanted to appear on television in a therapy session, I'd have to really think about whether it would be good for him or her. Perhaps for some it would be okay, while it would be problematic for others? My sense, although no one can say for sure, is that it is probably the ideal for a client to discuss their issues with the world later, once they're out of the woods and can look back on a hard time with the solace of knowing they're stronger now. Nevertheless, I've worked with clients on talk shows (e.g., The Doctors) where cameras documented their issues (e.g., problems with road rage) as well as my interventions to help them. In some ways, that's not so different from reality TV therapy, right?

Which brings us to L.A. Shrinks, the new show on BRAVO. The show, instead of focusing exclusively on the lives of the clients, also focuses on three therapists and - wait for it - their private lives! The show gives the audience a backstage pass into the personal lives of the therapists, and includes footage of emotional and dramatic moments for each of the therapists. Quite honestly, this show takes psychotherapists on television to a whole other level. Incidentally, casting people for the show contacted me a while ago and asked me if I would be interested in trying out for the show. I said "no" because the idea of the show confused me: Would it bring the usual magic of reality TV, replete with crafted editing that makes the therapists look nuts? Would my clients end up feeling exploited? I felt instantly protective of the profession of psychology and psychotherapy, as well as the clients who seek it out.

The truth is that good therapy is one of the most wonderful and life-changing experiences a person can have, and I hate to think that therapy will ultimately seem like a dog-and-pony show that's full of emotional fireworks or, God forbid, turning over tables, which occurred on a Real Housewives of New Jersey episode on the same network. Simply put, the show worries me for fear of the reputation of psychotherapy.

I can see both positives and negatives to showing excerpts of therapy sessions, provided that the client and therapist and doing it for the right reasons: plain and simple, to help themselves and show the viewing audience that they can get good help, too. So, what about showing the private lives of therapists? With that, too, I can see the positives and negatives.

Because there is a power differential between therapist and client, the client can sometimes idealize the therapist, despite the fact that the client consciously understands the therapist is a real person, with faults and all like everybody else. Unconsciously, however, the power differential can cause the client to see the therapist as perfectly well balanced, and that's never true. In this way, showing the real-life side of the therapist can be a positive. But we're talking about reality TV here, so we must discuss the possibility that the therapists might end up looking a little unprofessional or, worse, insane in the membrane. (Remember that song from the 90s?)

The greatest possible danger in showcasing the lives of therapists is that it the focus on the therapist takes the focus away from the client. It's hard to say where the future reputation of psychotherapy is headed given its new incarnations (reality TV, telemedicine, and even online therapy), but talking about it as a professional community is important. After all, we need to practice what we preach to our clients: It's all about insight and understanding the motivations.