A Few Things Writers Need To Know About Psychology & Psychotherapists

Need to portray a therapist in a story or roleplay? Planning to have a character go to therapy? Not too terribly familiar with how the whole thing works? Here's some stuff that everybody should know about if they plan to use a psychotherapist character or have psychotherapy involved in any of their stories.

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Some essential terms to know

It's very important to know some of the terms that psychotherapists use and what they mean in context, or else it'll be next to impossible to write such a character with any semblance of authenticity. Some vital-to-know terms are:

Consent. Essentially, permission given to a psychotherapist to try something. (Legally, this often requires signing forms and waivers.) For consent to be meaningful, it must be given freely - the client cannot have been pressured or coerced. It must also be informed consent - IE, the client was made fully aware of what a given treatment plan entails and what its risks are.

Disclose. To make something known to someone else. To self-disclose is to talk about one's own life or personal matters. Clients are expected to disclose pertinent information about themselves and their lives to their therapists so their therapists can try to help them.

Projection. Projection is essentially the act of presuming and believing as fact that others share the same traits or qualities as oneself - EG, opinions, feelings, hopes, fears, virtues, flaws, and motivations. This frequently happens when people wish to distract others (or even themselves) from their own flaws. For example, an emotionally unstable person might accuse others of being emotionally unstable, or someone who frequently gaslights others might accuse them of doing the gaslighting. Less acknowledged is non-aggressive/non-defensive projection: for example, a compassionate person may incorrectly presume that a jerk secretly harbors a heart of gold for the fact that the jerk seems to have a few traits that the compassionate person identifies with, such as similar opinions on morality or similar life experiences. (People who do this may feel flawed or guilty over something and feel that through redeeming the bad guy, they are redeeming themselves.)

Transference. Where emotions that apply to one thing end up applied to another (usually unintentionally). For example, someone who loved a grandparent very much might "transfer" those feelings of affection onto another person who resembles that grandparent in some way. Someone who deeply despised a parent might transfer these feelings onto another authority figure and thus feel an irrational hatred toward this figure.

Resistance. Where a client refuses to cooperate with the therapeutic process. This can include refusing to talk about relevant topics, refusing to try any suggested treatment methods, or refusing to make any personal changes in general that might be of help.

Boundary. A set rule or commonly-held convention regarding what one can and cannot do to or with a person or a person's property. As an example of a set boundary, one might say, "you can't use my stuff unless I've given you permission first." Examples of conventional boundaries are the general beliefs that private property is not to be trespassed upon and that private journals are not to be snooped into. Boundaries cannot impose on what others do that has nothing to do with oneself - IE, "you can't associate with those people!" is not a boundary. Psychotherapists also have certain boundaries they are not supposed to cross for ethical reasons - for example, unloading their own personal problems onto their clients or making romantic gestures toward them. When someone crosses a boundary, this is known as a boundary violation.

Respect. Regarding and upholding boundaries set by others, and behaving in a way that is considerate, fair, and appropriate toward them and their goals.

Psychotherapists come in all shapes and flavors

Plenty of psychotherapists are perfectly good and helpful people, but just as with any profession, there are plenty of them who aren't so great. The not-so-great ones range from well-meaning but inept to deliberately abusive, and all of them can potentially leave clients worse off than when they started. Here are some ways that psychotherapists can be bad:

They make up their minds early on what sorts of problems their clients have or what kind of people their clients are. Then, they only listen to what fits their preconceptions or what can be twisted to fit their preconceptions, and ignore everything else. They may chalk up clients' refusals to go along with this pre-decided narrative to resistance. They may use all manner of questionable means to get the answers they want, including asking leading or loaded questions, asking the same questions (even if reworded) over and over, or displaying hostility or disapproval when clients give "wrong" answers. People like this are very likely to end up gaslighting their clients.

They get it into their heads that they know best in general. They might think that because they know best, they need not properly discuss treatment options (including possible side effects or alternatives), or that they need not obtain proper consent from the client. Or they might even try to pressure a client into religious conversion. They might openly criticize or disapprove of a client's lifestyle, political views, or personal choices, or make their disapproval clear through contemptuous tones of voice, facial expressions, or body language.

They pressure or bully their clients into unwanted action. Such as pressuring or bullying them into disclosing information that they aren't comfortable or ready to disclose yet, or into taking or dropping particular courses of treatment. They might do this by claiming that their way is the only way if they really want to get better, or by mocking and belittling their clients for not doing what they want, or by insisting that their clients really need to do this if they're going to proceed, or by outright refusing to assist their clients further until they comply.

They go on power trips and lord their authority over others. They might be quick to remind their clients that they are the ones with the degrees here and that if they want to get better, then they better start listening and cooperating. They might position themselves as mighty or noble saviors who are the only hope their clients have. They might choose to wear imposing clothing or to physically put themselves above their clients by sitting their clients down on seating lower than their own. They might try to position themselves as the "voice of reason" when they're really just control freaks.

They demoralize their clients. They might continuously find faults with them, all the while minimizing or ignoring anything good about them and giving them little to no encouragement or means to help themselves. They might make snide or sarcastic comments, or give them covert insults or backhanded compliments. Some may even do this out of sheer sadism - they enjoy breaking people apart and watching them crumble. These ones may even make up faults or claim that their clients have disorders that they probably don't have.

They exploit their clients. They might unload their personal issues onto their clients (IE, self-disclose to clients), or they might try to maneuver them into intimate or otherwise unprofessionally close relationships, or they might try to get their clients to do personal favors for them, or they might only offer "help" that keeps their clients dependent upon (and therefore, still paying) them.

They don't give their clients proper time and effort. They might cut sessions short or put them on hold to go and do something else. Or they might only half-listen to their clients, then give them uselessly generic and banal advice or feel-good platitudes.

They don't actually help their clients work on their problems. They might just tell their clients that all is well and that they don't need to do anything when just the opposite is true, or they might tell their clients that what they need to do is suck it up and deal when what they need to do is stand up for themselves or walk away from a situation, and so on and so forth. They might give their clients no end of emotional validation, but never actually give them anything they can use to deal and cope with their situations. Or they might refuse to give help for the problems the clients want help with, and instead insist on focusing elsewhere.

On the other hand, good and competent therapists will make an effort to avoid these problems. They are good listeners who try to avoid passing judgment onto their clients, and they try not to force or impose themselves on to them. They do not try to intimidate or dominate their clients. They aim to behave with compassion, and they respect their clients' boundaries and goals. They aim to help their clients in a way that their clients find agreeable and feasible, and they aim to help their clients help themselves.

More things to know and check out

Psychotherapists often legally need to obtain informed consent forms from patients. Such forms describe what a therapist can and cannot do, will or will not do, what rights and responsibilities their clients have, and informs the clients of any potential risks or unknowns, if there are any. Here is one example of such a form. Here is another example. Ethical therapists will always, always make sure they have informed consent from their clients.

In most cases, psychotherapists cannot legally share information about their clients' cases that identifies them to others. Without a court order or the permission of their clients, psychotherapists are not allowed to share information about their cases in such a way that the clients can be identified. If for any reason a psychotherapist wishes to discuss a particular case without permission or court order, then identifying information must be omitted.

Psychotherapists can't usually force people into a mental hospital for just any reason. Forcing patients into a mental hospital used to be more common in times past, but today is typically considered a human rights violation. While it can happen sometimes (and laws in the US vary from state to state), it's typically only possible when clients present a danger to themselves or others. Also worth noting is that mental hospitals are not inclined to try and keep a patient forever these days (if anything, it's usually just the opposite), and physical restraints often aren't legal to use unless a patient is potentially physically violent. The (offsite) article Will I Be Committed to a Mental Hospital if I Tell a Therapist about my Suicidal Thoughts? has more information on this.

Drugs aren't used quite as intensively as some imagine. In many stories, doctors will immediately jump to forcing powerful drugs on someone, even if the problem is apparently a relatively minor one. In reality, the patient would be examined and questioned by doctors to try and figure out what the actual problem might be and what might be causing or aggravating it, and then they'd treat the patient accordingly. If it's a problem that seems like it can be treated with therapy and perhaps some mild antidepressants (eg, self-harm), then that's what they'll go for first. Jumping straight to a high dosage of a powerful drug the patient has never tried before would be extremely irresponsible, as there's no way to know whether it will even have the desired effect, or whether it will harm the patient or even make the problem even worse. (Some people have what are called "paradoxical reactions" - essentially, the drug will do exactly the opposite of what it's supposed to do.)

It's inappropriate and unethical for therapists to have romantic or sexual relationships with clients. Because psychotherapists are in a position of authority over their clients, there is a massive power imbalance involved. Any psychotherapist who initiates, encourages, or allows the development of this type of romantic or sexual situation, or tries to suggest any sort of client-therapist interaction that in any way mimics or resembles a romantic or sexual situation (even for alleged therapeutic purposes!), is not behaving ethically.

There's a fair amount of disagreement among psychological professionals over what's what. And here's where we get to a really frustrating bit for writers who just want to get their psychological terms accurate! Just try and search for the difference between a psychopath and a sociopath, and look at how many people have different views on just what the differences are, or whether there's even a difference at all. Best you can do here? See whether there's actually a real consensus on what something means or entails. If not, write a character who has a particular stance or viewpoint, but write with the knowledge that the disagreement exists and that your character is just one person with one perspective.

If you're aiming to write a good and competent psychotherapist, you might take a look at On Writing & Roleplaying Wise Characters. Good/competent psychotherapists should exhibit most of the traits listed.

If you need some idea of what therapy sessions might look like or what therapists might say, websites like The Company Therapist and The Bright Sessions have (fictional, of course) transcripts of therapy sessions. Though it might not be real, it can still give you a workable frame of reference for how this sort of thing can work.

Many therapists do suffer from mental issues of their own, some of which can be job-induced. The article Why Shrinks Have Problems has more information on this subject.

More articles that might be useful:

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