Why I Declined to be Shadowed by a NYT Reporter
A NYT reporter contacted me recently with a request to sit in on sessions. Initially, I had surprisingly strong feelings arise. I felt irritated by the request, indignant, actually. But then I came around to wondering: what about this request is obvious to me as a therapist that might not be to people outside the profession?
As a culture, we’re curious to eavesdrop on therapy.
Therapy as entertainment is more popular than ever. I get it, I’m fascinated by therapy too; that’s why I chose it as a career. Shows that feature therapist characters like Shrinking, Ted Lasso, The Sopranos can give one an incredibly inaccurate sense of understanding therapy and the therapeutic relationship.
Yes, confidentiality
The reporter called this out as an obvious concern, and it is. Therapy rests on the foundation of confidentiality. But there were some potentially less obvious concerns as well:
Power dynamics
There is an inherent power imbalance in the therapy relationship. The therapist must work to not exploit their power and to empower the client. Commonly, clients feel gratitude or even indebted to therapists. They might want to be able to give after receiving so much. They may want to be liked, or to be a good client.
So a therapist must be careful of making requests of the client. Even a request like changing a standing appointment time has implications and should be treated carefully. Perhaps a client would agree to be shadowed. But why and at what cost?
Reverberations/ Changes
In the way adjusting the direction of a ship at sea by a few degrees dramatically changes the destination, small adjustments in therapy have significant impacts over time and reverberate in the relationship in unpredictable ways. If a therapist backtracks on the agreement of confidentiality, what else might not be trustworthy about them? What other boundaries are negotiable?
Therapy is always for the client
“What is the impact on the client?” is a priority question when making decisions about therapy. Adding an audience in no way benefits the client. Perhaps it would benefit the reading public, if the reporter used the information well, or the reporter, or the therapist (being featured in the NYT), but the person it would certainly not benefit, is the client.
Therapy is hard enough without adding this layer of scrutiny
It takes time for trust to form in the therapeutic relationship, and for people to feel finally able to bring in their shame, their deepest vulnerabilities. In therapy, people are working to drop the social mask, an audience undoes that.
Therapy doesn’t go to plan
Even if a client has come into therapy with a specific concern, it’s not likely the client is talking about that concern exclusively. Quite the opposite. Of course, as a therapist I do sometimes choose to exert influence on the topic of a session. When I do, it’s carefully considered and purposefully in support of the clients’ goals.
A behind the scenes look at therapy is never truly accurate because the observation changes it. Even if that weren’t the case, entering into an agreement of confidentiality and then changing the terms of that agreement is ethically dubious.
I’ll continue watching and enjoying shows featuring therapist characters, as well as the more documentary-style shows like Couples Therapy with Dr. Orla Guralnik, where people enter into the show knowing there will be an audience. And I’ll probably also continue to be annoyed by misrepresentations and misunderstandings of therapy. That said, I know that misunderstanding is often well-intentioned, and I’m always happy to discuss the ins and outs of therapy, to help accurately represent this thing I love so much.
