Some ideas about therapy appear so often in fiction that I wonder how many writers are deliberately using them, and how many just don’t realize they are inaccurate. Here are six of the most common, along with more standard current practice information.

1. You lie down on a sofa

Reality: therapy clients do not lie down on a couch; some therapists’ offices don’t even have diapers.

So where did this come from? Sigmund Freud had his patients lie down on a sofa so that he could sit in a chair behind their heads. Why? Without a 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 difficult or embarrassing experiences and not only not being able to see them, but reacting silently. Why the hell would you want to go back?

The ideal therapeutic setup, and they actually teach this in graduate school, is to have both chairs turned inward at an angle of about 20 degrees (plus or minus 10 degrees), usually with 8 or 10 feet between them. Often times, the therapist and client end up facing each other because they turn toward each other in their chairs, but with this configuration the client does not feel as if they are confronting him.

Even if there is a couch in the room, the therapist’s chair will almost always be tilted toward it.

2. Therapists analyze everyone

Reality: Therapists don’t screen people any more than the average person, and sometimes less often.

Ironically, only people trained in Freud’s approach of making the patient lie down on the couch and interacting freely with the mother (also known as psychoanalysis) are taught to analyze. All other therapists are taught to understand why people do things, but it takes a lot of energy to understand people. And to be very frank, while therapists are usually understanding people who want to help their clients, in everyday life they are dealing with their own problems and do not necessarily have the time or space to worry about the problems of others. or behaviors.

And the last thing most therapists want to hear about in their spare time is the problems of strangers. Therapists get paid to deal with other people’s problems for a reason!

3. Therapists have sex with their clients.

Fact: Therapists never, never have sex with their clients, or with the clients’ friends or family, if they want to keep their licenses.

That includes sex therapists. Sex therapists do not watch their clients have sex or ask them to experiment in the office. Sex therapy is often about educating and addressing relationship problems, as those are two of the most common reasons people have sexual problems.

Therapists are also not supposed to have sex with train clients. The rule is that if two years have passed and the ex-client and the therapist meet and somehow get along (that is, this was not planned), the therapist will not be expelled from professional organizations and their licenses will not be revoked. . But in most cases, other therapists will continue to view them as suspects.

The reasoning behind this is simple: Therapists must listen and help without involving their own problems or needs, creating a power differential that is hard to overcome.

And truth be told, the roles that therapists play in their offices are just facets of who they really are. Therapists focus their full 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 true friendship involves sharing power and flaws, and caring for one another to some degree. Meeting a therapist as a real person can be disappointing, because now they want to talk about themselves and their own problems!

4. It’s about your mother (or childhood, or the past …)

Reality: One branch of psychotherapeutic theory focuses on childhood and the unconscious. The rest do not.

Psychodynamic theory maintained 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 flatly that your past is not important if it is not directly relevant to the current problem. Some believe that an extensive discussion of the past is an attempt to escape responsibility (Gestalt therapy) or avoid actively working to change (some types of cognitive-behavioral theory). Some believe that the social and cultural environments we live in today are what cause the problems (feminist and multicultural systems, therapies).

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

Fact: Electroconvulsive treatment (in the past called electroshock treatment) is a rare treatment of last resort for clients who have been in and out of the hospital for suicidal tendencies, and for whom more traditional treatments, such as medications, are a shelter didn’t work. In some cases, the client is so depressed that they cannot do work to improve until their brain chemistry is working more effectively.

By the time ECT is a consideration, some clients are eager to try it. They’ve tried everything else and just want to feel better. When death feels like your only other option, having someone run a painless current through your brain while you’re asleep doesn’t seem like a bad idea.

ECT is not painful, it does not shake or shake. The patients are given a muscle relaxant and, since it is scary to feel paralyzed, they are also briefly placed under general anesthesia. The electrodes are usually placed on only one side of the head and current is introduced in short pulses, causing a grand mal seizure. Doctors monitor electrical activity on a screen.

The seizure causes the brain to make and use serotonin, norepinephrine, and dopamine, all brain chemicals that are low when someone is depressed. Some people wake up feeling that a miracle has occurred. Usually, several sessions are required to maintain the changes, and then the individual can be switched to antidepressants and / or other medications.

ECT is no more dangerous than any other procedure given under general anesthesia, and many of the possible side effects (confusion, memory impairment, nausea) can be caused by both the anesthesia and the treatment itself.

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

Fact: Schizophrenia is a genetic-based biological disorder. It usually causes hallucinations and / or delusions (strong ideas that go against cultural norms and are not supported by reality), along with a deterioration of normal day-to-day functioning. Some people with schizophrenia periodically become catatonic, have paranoid thoughts, or behave in a disorganized way. They can speak strangely, becoming tangential (wandering verbally, often in a way that does not make sense to the listener) using nelogisms (made-up words), clang associations (rhymes), or, in extreme cases, producing word salads (sentences which sounds like a lot of mixed up 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” memories of the trauma. In DID, the division also includes the part of the “core” personality attached to that memory or series of memories. Dissociated identity often has its own name, traits, and quirks; and it may or may not age at the same rate as the rest of the personality (or personalities), if at all.

Therefore, referring to oneself as a “schizo” or “schizoid” or “schizophrenic” when one means that he has an alter ego or contradictory personality traits does not make sense (and is guaranteed to make the psychologically intelligent wince). .