(Guest post by Dr. Ryan Howes, clinical psychologist in Pasadena, Calif.)
With all the depictions of psychotherapy in movies and on television, it’s tempting to assume that we’ve finally overcome therapy stigma. If Kourtney Kardashian and Metta World Peace (formerly Ron Artest) have openly disclosed the benefits of therapy, we’ve emerged from the shadows, right?
While therapy certainly has greater exposure, I see evidence every day that suggests we’re still fighting the shame and secrecy about seeking help through talk therapy. Research backs this up, with studies suggesting that people with mood disorders delay treatment six to eight years, rising to nine to 23 years for anxiety disorders. An Australian study found that less than one-third of those with distress seek psychological help. Something is keeping them away, and I doubt it’s inadequate parking options.
Therapy stigma has been defined as bluntly as “a person who seeks psychological treatment is [seen as] undesirable or socially unacceptable.” But I’ll reduce my criteria for stigma a bit – how do people refer to a therapy session versus an appointment with their physician? Many people don’t think twice about mentioning their “doctor’s appointment.” Psychotherapy remains discrete.
Here are my five unscientific signs that we still struggle with therapy stigma.
Many clients still feel they need to hide therapy from their friends, family and co-workers. We all recognize the need to keep the content of sessions confidential, but do clients need to deny its very existence? How many clients take long lunch breaks to attend their “appointment,” hiding the fact it’s therapy due to real or imagined consequences? I realize there are many legitimate reasons where talking about therapy would do more harm than good, but this is a stigma problem either way.
Have you ever heard someone say, “you need therapy!” in a less than compassionate manner? I have. As long as psychotherapy is viewed as a punishment or a remedial tool to correct the annoying behavior of others, we’ll have stigma.
As I mentioned above, therapy is more visible in the media than ever before. But does it look like any therapy you know? The exploitative, simplistic, resolved-in-twenty-minutes therapy depicted on TV makes me cringe. To its defense, Hollywood’s primary goal is entertainment to gain viewers and sell advertising space, not to provide accurate public education. Still, therapy that makes therapists out to be unethical buffoons and clients a spectacle contributes to the stigma.
We live in an age where primary care physicians carry the brunt of the mental health load, and they’re more likely to recommend pharmaceutical rather than psychotherapeutic treatments for emotional problems. The implied message is that their patients shouldn’t have to endure therapy when they can avoid the shame, the time, and the discomfort and just take a pill. Lost in that message are the fewer side effects, the longer-lasting benefits, and the desired insight and mastery over their problems. Gained? Therapy stigma.
The cocktail party dilemma
Now to point the finger back at me. There are times I don’t like admitting I’m a therapist. When meeting a group of strangers in a social setting, I know that announcing I’m a therapist will invite the standard “are you analyzing me?” jokes, the occasional solicitations for free therapy advice, and some boundary-oblivious “tell me about your wildest case” questions. As a psychologist who loves his job, this would be a great time for me to demystify our profession to a listening audience. But that feels like work, and sometimes I just want to enjoy the party. So I pass up an ideal opportunity to fight the stigma.
What can we do about this?
Tens of millions of people have been to therapy, if they told a few of their friends about their experience, therapy might move from the realm of reality TV to reality. I think initiatives like National Psychotherapy Day and the APA’s push to spread the news about psychotherapy efficacy is helpful as long as it lands in the hands of consumers, policymakers and physicians. But the best antidote to therapy stigma is clinicians doing quality, collaborative work with their clients. It’s difficult to disparage an effective solution.