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Merriam Saunders: 20 Things Writers Should Know About Therapists

Have you ever watched a movie where a character says or does something you know is wrong, and you find yourself tearing your hair out, screaming at the screen? As a psychotherapist, this happens to me a lot. So much that my family now just rolls their eyes. “Yeah, Mom. Whatever. Who cares?”

In many professions, maybe it isn’t a big deal if the author gets it wrong when showing a drywaller drywall, a conductor conduct, or an accountant account—but when it comes to health care, misrepresentation can be dangerous.

While almost everyone will go to a doctor at some point in their lives, not everyone will have an experience in psychotherapy—even though they might benefit. And often this is because of the stigma associated with mental health issues. Where does this stigma come from? Its origin is for another blog, but I would argue certainly in part from the media.

I teach a graduate course on Professional Law & Ethics in Counseling Psychology. As part of that course, I have the students watch the film The Prince of Tides because the psychiatrist, one of the main characters in the film, breaks the law and violates her ethics code in nearly every scene. She talks to her client’s brother without consent, doesn’t disclose her fee, flirts with the client, asks him to be her son’s football coach, throws a book at his head, and sleeps with him. Ack! If I needed therapy, but saw this movie, I would run fast and far. And that’s not good.

So, if you have a therapy scene, or a therapist in your novel, please run it by a therapist! And while you write, here are some important things to know...

1. Therapists never disclose patient names. To anyone. Not unless we have a signed release allowing us to do so. It is against the law to break confidentiality. Even without disclosing names, a therapist would never say to a patient, “I have this other patient who…”. We would not say hello to you if we saw you in the grocery store but would wait for you to approach first. We would not turn to our husband when he says, “Who was that?” and say, “Just a client.” We would say, “No one.” And our husbands would know not to ask further. Confidentiality is a BIG DEAL.

2. Therapists do not have “dual relationships.” This means your therapist cannot be your friend, your son’s football coach, your massage client, etc. Sometimes dual relationships are unavoidable – your therapist is the parent of a child in your son’s class. But if that happens, the therapist would be super discreet.

3. Therapists don’t usually talk about themselves. The whole point is to make space for the client and for the therapist to remain a neutral sounding board, which gets murky if the therapist is sharing personal experiences.

4. Therapists don’t give advice. Therapists generally ask guiding questions and make interpretations that help the patient come to an understanding and make their own decisions. Good therapists never say, “You should…”

5. Therapists that see children don’t usually spend a lot of time talking. Child Therapy is frequently play-based, and the therapy comes from building a trusting relationship, the boundaries set by the therapist, and the safe space to act out feelings during play.

6. Therapists that see teens don’t usually tell the parents what happens in session—unless they feel the teen might be in harm’s way and intervention is necessary.

7. Therapists in schools often need parent permission before seeing the child if the counseling is for mental health.

8. Therapists are mandated to report suspected child abuse, but they don’t investigate it. This means a therapist would never ask a child to pull up their sleeve to look at bruises “to be sure.” Corporal punishment would be reportable abuse if it left a mark or an object was used. Witnessing domestic violence is considered abuse in many states. Therapists are only mandated to report abuse they come to know about in the course of their duties—so for example, not something they see at the grocery store.

9. If Child Protective Services is called because of abuse, it is a myth that the child will automatically be removed from the home and the parents will lose custody. CPS’s goal is to investigate, intervene and provide support to keep the child safe, but mostly to find a way to keep the family together. This may include mandated counseling and parenting classes, or the removal of the abusive parent who must undergo treatment and supervised visitation. Only under extreme circumstances where the child is in imminent danger is he/she removed.

10. Therapists are mandated to report abuse of someone over 65 and also of a dependent adult (developmentally or physically disabled).

11. Therapists are not mandated to report suicidal ideation—but they are required to intervene by contacting a relevant party -- whether a friend, relation, or in an emergency, calling 911. They are allowed to break confidentiality to keep the client safe.

12. Therapists are not mandated to report domestic violence but would determine a safety plan with that client. If there is domestic violence, a couple’s therapist would not continue the therapy, as couple’s therapy often exacerbates the abuse.

13. Therapists do not have to report their clients’ crimes—but do have a duty to protect the public if they have reason to believe their client will imminently harm someone by informing police or the intended victim.

14. I read a book once where the therapist invited their teen client to their house. Would not happen. We typically don’t go to weddings or graduations either.

15. We don’t accept gifts (unless they’re small).

16. Unless you are a psychoanalyst, which is a specialty, our clients don’t lie on couches.

17. Hypnosis is nothing like in the movies. It requires special training and not all therapists are trained in hypnosis.

18. We don’t constantly delve into clients’ childhoods. We don’t analyze everyone we meet. We’re not all wounded.

19. Sex Therapists do not have sex with their clients. Yes, there are slimebag therapists who have been known to sleep with clients. It’s against the law. Even if you terminate therapy, a therapist cannot have a sexual relationship with a former client until a certain period of time--2 years in most states--has lapsed. Therapists can’t sleep with clients’ family members either.

20. Since states regulate licenses, licensed therapists are subject to a whole host of laws and can go to jail if found guilty of things like “unprofessional conduct” or not delivering the “standard of care.” If the psychiatrist in the Prince of Tides were real, she would have lost her license, potentially paid $2500 in fines and been subject to six months in county jail. In my opinion, she would have been getting off easy!



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