A Collective NYC Therapist Conversation On Therapy Clichés

Couches, mothers, Freud–there are a lot of clichés about therapy. In the latest of our collective conversations with the therapists in our NYC therapy practice, we take on these clichés:

Matt: I like to think that, as therapists go, we're fairly self-conscious about the expectations and lived experiences of New Yorkers who seek therapy. People have an image of what a typical New York City therapist's office looks like and a set of ideas about what therapy is and how it works. Many folks, who have had great experiences in past therapies, come with high expectations, but we also seem to attract therapy-seekers who don't have such a favorable picture of therapy, but seek help in therapy despite this.

Therapy often is both misunderstood and caricatured–it seems like half of all New Yorker magazine cartoons are a dig at therapy and therapists. Some of this humor is no doubt a reflection of therapy being, in some ways, inherently uncomfortable, but I also believe that therapists, on the whole, haven't done themselves any favors in terms of managing their reputation. Much of how therapists present themselves is ripe for ridicule. Their offices and practices are anachronistic and seemingly walled off from the goings-on of the world. There remains, in many corners, an old-school, Freudian, "blank slate" posture of therapists, presenting themselves with an intentionally flat affect. Cognitive therapy, in particular, is riddled with clichés that seem snatched from O Magazine.

I don't think we pretend to be somehow immune to invoking or embodying some of these clichés. Some we staunchly and proudly reject and others we embrace in spite of their status as fodder for jokes. What therapy clichés do you see in the world? What expectations do some of your therapy patients show up with? What are some examples that don't fit and what are some that do?

Heather: The cliché that feels least applicable to our practice, in particular, is the cliché that when you walk into a therapist’s office you are greeted by a wall of dusty psychology textbooks. There is something stale and outdated about this image. Pretty much the only books you will find in our office are the art books in the waiting room. This speaks to our non-diagnostic approach–we have plenty of know-how and seriousness when it comes to our therapy work with people and we don't need books to prove it.

Rachael: To continue Heather’s thought on the cliché about the therapy office, ours isn't stuffy with books, dust or light. I walk in everyday to a well-lit space with a high ceiling.  We are not in a basement or a hidden hallway. We are out there. The biggest symbol of this is our chalkboard.

Our chalkboard: is an opportunity to put the work out there and show how our therapy lives and breathes outside of this office. Often, therapy work is so isolated. Without a doubt our work is confidential and yet, the chalkboard gives our patients a space to play, improve and safely explore the work we do here.

Heather: Gosh, Rachael, that phrase "we are out there" just stopped me in my tracks. I think that is such a wonderful encapsulation of who we are and how we do therapy. Therapy does not need to be stuffy, hidden or shameful, like a lot of these clichés you point to. The chalkboard is such a reminder that–even though therapy is done with privacy and confidentiality, we are both a creative and social species.

Kiran: One cliché that comes to mind is that all therapists do is "analyze" people.  While some analysis is critical in understanding our clients, there is so much more to therapy that gets lost in this description. Therapy involves listening, connecting, witnessing and humanizing others’ experiences. It involves creativity, empathy and helping to create healing, growth and transformation in different ways at different speeds.

Matt: It's interesting that Heather and Rachael went to the aesthetics of our office first. On the one hand, that seems trivial–how important can that be? I'm sure great therapy can happen just about anywhere, but I think about our space as, in some sense, the scenery in which our “therapy plays” happen over and over again. I like that, with a new patient, hanging out in the waiting room sets a certain expectation–not unlike the experience of sitting in a crowded theater, anticipating what's going to take place on the set on stage.

I think people often have an expectation–a cliché, for sure–that therapy is something that is, in a sense, done to them. "I'm going to get my head shrunk." The traditional frame of therapy borrowed from medicine is that you tell the doctor "where it hurts" and then, he or she walks you through a series of tests. Your job is to say "ah" when the doc says "Say 'ah'" and cough when the doc says "cough.” There are times, especially when I'm really worried about someone where I may be very directive in this way, but I do see these little therapy plays as something we create together. There's a huge cliché that is part of this that we as therapists "know how to help." I'm not sure that's true. We create the help together. That's pretty "out there" as Rachael put it.

What feels important to me in raising this is the ways that we both meet and challenge our patients' expectations. The fixed idea of what therapy can and should look like–including its limits (for example: don't talk about politics, don't ever ask personal questions, etc)–are part of what we have to work with and around as therapists. I was hoping folks could speak to some ways clichés function as creativity-limiting in their therapy conversations–keeping people coloring within the lines, so to speak. What are folks struggling to break out of and how do you help them do that?

Heather: Whenever a patient has an idea of what therapy "should" be, it is creativity-limiting. Some folks believe that therapy is only a place where you can talk about feelings and relationships, which is greatly untrue. Absolutely anything about a person's life and experience is fair game, whether it be career-planning, race and politics or where their kid should go to school. Sometimes, in my work with someone, I will realize that they have been operating with a set of unspoken "therapy rules.” It is always so gratifying and eye-opening to be able to get those rules out in the open and redefine all of the boundless opportunity within our work.

Matt: I suppose one rule is that therapy has to be verbal. I'm a pretty verbal guy but in formal ways especially with young people, some of the best work is done with music and art.

Maybe the biggest rule has to do with how people see their relationship with me. A huge cliché is that you're somehow not supposed to have a "real" relationship with your therapist. There are limits to the relationship, to be sure, and it includes a fiscal element, but I am a very real person. I show up for my patients and the time we spend together must be focused on their needs, their feelings and their growth. But I'm a living, breathing person and I'm not neutral. Spending the sort of time we do with people in our practice often builds a very intense closeness. That's very real.

Rachael: I think that folks struggle to break out of how we do therapy. They want to know what my method and tools are. And yes, there is a method and tools here, but that's not all. And it's not going to fully help my patient to rely on method alone. There is, as Heather says, space to talk about everything. “Mundane,” political, cultural and playful conversations can be useful in developing our work and our relationship, as Matt says. I utilize a method, but I also don't solely lean on it to direct or limit therapy.

Karen: In thinking about clichés it drew my mind to the first session. A lot of folks have expectations about how I might be judging them or diagnosing them. There is a history to psychology and social work–a complicated one, especially around how people of color, women and children have been treated–that is in the room with us. I want that to be something we can talk about. I suppose, I make sure that I am transparent in exposing my views on this. This goes against the cliché of the therapist as a blank slate. I want to name power differentials that exist and not hide from these things. This may be awkward at times, but this is another cliché–therapist as perfected. I am not afraid to be awkward with my clients and I encourage this in them as we try new ways of being on.

Matt: Definitely want us to talk more about the therapist as perfected (I like the word perfected as opposed to perfect–it implies that there's been a completed polishing project). Would love to hear what other people think about that. It's huge.

But at the moment I'm so compelled by what you're reminding us about class and racial experiences in therapy and realizing with this big "Ah, hah!" that cliché is sometimes a pretty French word for bias. "People of color don't go to therapy" is a pretty big cliché, but there are also ideas about who gets the privilege of not being diagnosed and being invited to participate in structuring the process of therapy. There are different implicit rules for different groupings of people in therapy. It related as well to what Rachael was raising about talking about race in therapy–the implication that we don't do it. The net effect of that has big consequences for certain groupings of people.

Thinking as well about the clichéd ideas of what brings someone into therapy–that there are a set of maladies or experiences that are legitimate catalysts for seeking therapy, like depression or trauma, and others that aren't. These are likely different for people from different groupings, but it's also the case that the set of ideas we have for what is a "legitimate" reason to seek therapy are biased towards the challenges of a particular group of people. The trauma of discrimination and racial violence, for example, is obviously hugely distressing emotionally, though there isn't much conversation in the world about where therapy might fit in. Why not? I'm sure it has a lot to do with the privileged place white therapists have in these discourses and the clichéd assumptions we make about who are prospective clients are and what their needs are.

Heather: The therapist as perfected is an interesting and apt cliché-perhaps this is just the caricature of the "analyst," but when I think of a clichéd therapist I think of an older, white male who is studious, well-spoken, all-knowing and perhaps, a bit blank slate-y. As therapists, we don't know it all. We help lead in the process of discovery and there is certainly a great deal of expertise and experience there. But sometimes, shit is messy and all we can do is acknowledge that and the uncertainty around what to do next. Or sometimes, sessions and subject matter are particularly awkward or intimate, and what that looks like really challenges this therapist as perfected image. We roll our sleeves up and dig in with our patients, rather than resting on our literary and diagnostic laurels.

As far as all of this other great stuff that you all are raising about privilege, power and race in treatment, it makes me think of how people feeling fearful of being stuck in their own cliché can be a part of treatment. I have worked with African American men who were reticent of expressing their anger in session because of having to fight the typecast of "Angry Black Man" since childhood. Or I have worked with men who, other than with blood relatives, have only had relationships with women of a sexual manner. Therefore, they literally did not know how to have a close, intimate relationship with me without the sex component. These are just some of the ways that people have been boxed in and our therapeutic relationship has given us a powerful opportunity to explore and break out of that mold.

Matt: Realizing, Heather, that "therapy clichés" are both those specific to the domain of therapy and, of course, relate to any clichés about a certain group of people or people in general. People clichés are therapy clichés. With clichés that function as bias, as well as of all of these others that we've mentioned, it's helpful to know to look for them so they can be spotted and worked with. We can be curious about whether or not a given cliché is in the room, impeding the process.

Kiran: When thinking of therapy clichés, I am thinking that the therapist as an "expert” is one that I struggle with. While I do feel that I have knowledge and wisdom regarding relational dynamics and individual and family growth, I see my clients as the experts of their lives. The client plays a significant role in mapping the journey of therapy. As the therapist, I am seeking to understand my clients and have them collaborate on the direction of our work together. Another cliché is that "problems" can be solved immediately. While I do believe that some issues can be solved quickly, some cannot. Oftentimes it has taken a long time for an issue to come to be and it takes some time to fully understand the underpinnings of the issue–let alone create a pathway of change. Rewriting parts of our lives takes time. Coming to therapy, in itself, is a significant action towards change.