Dr. Phil is great at his job. He cuts straight to the heart of the issue, elicits an emotional response from clients, and gets people to commit to making changes (whether they are ready to do so or not). Though he may be a bit like a bull in a china shop, what he lacks in finesse he makes up for in fortitude and enthusiasm. This is part of his appeal; viewers enjoy his direct, take-no-prisoners approach.
But this is not exactly what happens in your average therapist’s office.
In most cases, therapy is more like an archaeological dig; the client and therapist root around and sift through layers of history to make sense of things. Problems are identified by a particular shard or clue, which leads to a greater understanding of patterns and the interaction between self and environment.
Frequently (and increasingly, given managed care), goals are identified, and therapist and client embark upon a journey of exploration to create solutions and generally make things better.
What’s essential is that the client be involved in devising such solutions, so that they reflect her circumstances and goals. In other words, therapy is about the client’s needs, rather than the therapist’s agenda or Neilsen ratings.
I know, it sounds boring. It’s much less exciting than the high drama of Dr. Phil. In reality, therapists rarely say things like, “Stop doing that!” or, “Wouldya cut that out?”
And that’s exactly the point.
There are some issues which are appropriately suited to the stage tactics of Dr. Phil, or, for that matter, an advice columnist in your local paper. For example: “My son refuses to turn off the TV in his room, and spends hours watching his favorite shows instead of doing his homework. What should I do?” The solution is straightforward: “Take the TV out of his room.” (Duh.)
Whereas it’s obvious that such an exchange is not actual therapy, people assume that this advice-at-the-ready approach can be generalized to other, more nuanced and multi-dimensional problems, such as how to co-parent with a difficult ex or whether to invite your mother-in-law to move in with you.
Recently, many of my clients have come to therapy for quick answers to overwhelmingly profound questions. The underlying assumption is that, as a degreed and licensed therapist, I have omniscient powers which dwarf their own.
The best example of this was the couple who sought my help, and, after one 50-minute session asked, “Should we get a divorce?”
They were clearly desperate, and had agonized for years about whether to stay together. Despite (or perhaps because of) such desperation, they were not interested in addressing issues or diving into their murky relational waters; they did not want to invest in therapy as a way to engage with each other and, by so doing, decide whether theirs was a union worth saving. They wanted me to tell them what to do and be done with it.
Clients often hope that their therapist will reveal The Truth and provide them with The Answer, in the same way that a soothsayer (or Dr. Phil) might. Those who are desperate, scared, or just plain tired of thinking and feeling and wondering, might hope to be rescued, delivered from problems which seem intractable and unassailable.
It’s likely that this is a universal fantasy, something we all experience at times. On a symbolic level, it probably represents a desire to return to childhood, to be cuddled and told what to do by a loving, parental figure. And to be relieved of the burden associated with making a difficult decision.
Though shows like Dr. Phil didn’t create this fantasy, they certainly 
perpetuate it. And they give people false hope that therapy will provide an easy answer, one that doesn’t involve struggle or introspection.
Which brings us to another part of the problem: advice, though often sought, is rarely taken. Before people attempt therapy, they usually ask friends and family what to do. It’s likely that they’ve told others about their slacker boyfriend who refuses to get a job and spends his days surfing the internet. And it’s equally likely that the predictable suggestion (“Ditch that dude!”) has been ignored.
Why are we so likely to reject advice? At times, it may be because we believe that the advice is poor; we just don’t like it. In other instances, we don’t want to hear feedback from others because they have not walked in our shoes, and don’t truly understand our experience.
Alternately, we might feel weak-willed or submissive if we heed someone’s advice, so we prioritize our need for autonomy and self-determination over our need for resolution. Finally, we might discard suggestions because we’re not ready to hear them, even if we know they’re spot-on.
In short, advice-giving is often ineffective. People make changes when they are ready to do so, and when motivation comes from within. This is why, though guests agree to stop their self-destructive behavior in front of the cameras and under extreme pressure, they may not actually do so once they leave Dr. Phil’s stage. Techniques that make for great TV do not necessarily make for great therapy.
So next time your therapist declines your request for advice, or offers a mere suggestion rather than an absolute mandate, you might (after your frustration subsides) consider that she is doing you a favor. Sometimes, a therapist’s best answer is, “I don’t know.”
Because ultimately, you’ll find out for yourself. And you’ll know much more than any therapist—including Dr. Phil—could ever tell you.
Photo credits: 1. greggoconnell; 2. laughlin; both via Flickr’s Creative Commons License.
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I’m quite thankful that my therapy isn’t Dr.Phil therapy – On t.v. he’s not necessarily speaking to people who have been suffering from severe depression. I think in that case his approach would be quite different – it would have to be. But how he addresses poor behaviour of some people is right on the money. Mental illness is different from someone who is simply being a jerk.
Good reminder that these days we all want instant results (the Dr. Phil approach) rather than doing the hard work of therapy, which involves the risk of discovering a whole range of related issues just under the surface of the problem.
This post is EXCELLENT and should be required reading! Thanks for sharing such important information. Well done.
Sheila, you are right that being a jerk is different than being mentally ill. I worry, however, that the audience will fail to make this distinction, and that they will misunderstand what therapy is about.
Thanks all for taking the time to read and comment!
Good article. Thank you.
Regarding jerks on Dr. Phil: there is a difference between mental illness and being a jerk. However, how many of the jerks on Dr. Phil also happen to be suffering from a mental illness? There are various mental disorders that can play a part in “jerkiness”.
I have only watched Dr. Phil’s show occasionally, so my impressions may be inaccurate, but it seemed to me that Dr. Phil can be all too quick to ignore the causes of the jerk’s behavior, simply because demonizing the bad guy is much better at garnering ratings.
That’s just one of the many reasons why I haven’t had a lot of respect for Dr. Phil’s “psychology.”
If what the article says is true the ‘average’ therapist has been getting it wrong for a long time. The process of psychoanalysis has long been found to be very damaging to those most vulnerable. Spending hours going over and over life events and looking at previous mistakes is definitelynnotnhelpful. Introspection is the last thing they need. Rather, a solution-focused approach which examines the components of a healthy future has proved to be much more efficacious in helping people overcome anxiety, depression, and many other mental ‘illnesses’. Emotional nourishment comes from outside us, not from within. A client in a therapy session has come to borrow the therapist’s cortex because they only have limited access to their own at that time.
Thanks for your comment, John. I think the research on psychoanalysis is mixed, but regardless there are times in which I use a solution-focused approach with clients. If the problem is amenable to a quick solution, and if the client is ready for this, then the approach can help. But, there are cases in which the issue is deeper, and exploration, rather than problem solving is important.
What I was trying to say is that clients needs to be involved in coming up with solutions. Too often, clients ask therapists what to do, and therapists are often tempted to give (or actually do give) their own answers, without inviting the client to participate in coming up with a solution.
I also completely agree that emotional nourishment comes from the outside. We need others to heal, and therapists play a crucial role in this process for many people. But, what seems most relational and feminist and helpful to the client is to work in a collaborative, rather than dictatorial way. Dr. Phil offers much advice without empowering clients to be truly active participants. Although I do think that we are too results-oriented when it comes to therapy, it is mostly the hierarchical approach that I contest. And the idea that results should be expected right away.
I have been in therapy for over ten years with the same therapist. I agree with parts of this article, but therapy, just like anything is work, and is “change” work. It has been my experience that I allow myself to be let down by my therapist because of the attachments issues. It is very hard to seperate from someone who has helped you so much, even if only on a professional level. I have improved greatly, but still hate physical “loss” of people around me that I care about…..it is still abandonment for me.
John, how does “emotional nourishment come from outside us instead of inside? Most did not get the parenting needed, etc., these things can only be found from within and nothing on the outside can ever fill that void. It is like the old saying of “you can never be truly in love until you love yourself”, and it is true although difficult for some with bad pasts. All of this must come from inside though and one connecting with their inner child is very important and healing.
Dr. Udall-Weiner,
Thanks for this great post. I like Dr. Phil’s solution oriented style. Sometimes that is exactly what someone needs when he or she enters therapy. Different concerns might send others to a confidential setting to discern, to process, to grieve. That’s why I believe who one chooses for a therapist needs to be done selectively and specifically if we even know why we are seeking counseling in the first place.
I’ve written something about that and it seems appropriate that I share it here today. I called my thoughts “How to Choose a Good Therapist.”
http://www.wheneverydaymatters.com/?p=96
Kindest regards,
Mary Jane Hurley Brant, M.S., CGP
The true jerk is Dr. Phil. Occasionally (as with the adolescent and the television set), he might give appropriate advice. At other times, I CRINGE when he gives what he perceives to be “common sense” advice but is really sexist or homophobic. For instance, I repeatedly have seen him advise a wife to stay with a husband who has neglected or even verbally–or physically!–abused her. I do not mean to say that such wives should never stay in such a marriage in certain circumstances, but his answers are always far too facile and based on patriarchal assumptions.
I never have watched the “phil Circus.” I never have b/c When it comes to human beings there is no magic bullet. The first and most important universal truth is only I have the power to change me. I believe wholly that a wonderful avenue towards positive change can be greatly enhanced through good therapy and medication if needed. One hour does little to help and may cause irreparable harm.
The therapist’s response to a need for “advice” can vary based on the issue, right? Last week I described how I felt overwhelmed by everything I needed to do this month, how I worry that I won’t get everything done.
Sample responses, pick the one that helped:
1) Wow, that sounds tough, having so much on your plate. What do you think you will do?
2) You do sound worried. What technique are you using to deal with the stressful feelings?
3) No one manages to get everything done. So, let’s make a list right now of what you need to accomplish, and give a priority to the items.
Other types of challenges in life DO require the extensive dialog that slowly leads to the commitment on my part to undertake the relationship and communication changes needed to bring about a happier life. Dr. Phil is not the therapist who can help with this challenge!
I learned long ago, *real* therapy isn’t the same as portrayed on TV, whether it’s a talk or reality show like Dr. Phil, or in fictional TV shows. On TV, psychiatrists and psychologists ask lots of questions and offer suggestions. I haven’t gotten much of that in the 32 years I’ve been in therapy.
I, too, feel Dr. Phil is often judgmental and, frankly, I think he’s a bully. I would veer off-topic and get too general to share my thoughts on this, so I’ll just keep it short: People who accept advice from TV therapists as if it were manna worry me. Sometimes the patient is more right than the doctor.
My psychiatrists gives me meds, but not much advice. He doesn’t treat OCD (one of my conditions) with exposure-response prevention or in the ways I’ve seen psychiatrists and psychologists on TV documentaries and shows. Those who expect what they see on TV are in for a major letdown.
I think you’re right that what is done in a clinician’s office is much different than what is portrayed on TV, and that this can create expectations that are totally off base. Thanks for your comment!
Great point. I hear tell lawyers and law enforcement are having similar problems with expectations.
Thanks for the sensible and honest truth about the therapeutic process. Dr. Phil, In Treatment and other TV shows and theater misrepresent the real process of therapeutic work. In, “The Road Less Traveled” M. Scott Peck noted in his introduction: “There may, however, be some distortion by virtue of the brevity of the case presentations, Psychotherapy is seldom a brief process, but since I have, of necessity, focused on the highlights of the case, the reader may be left with the impression that the process is one of drama and clarity. The drama is real and the clarity may eventually be achieved, but it should be remembered that in the interest of readability, accounts of the lengthy periods of confusion and frustration inherent in most therapy have been omitted from these case descriptions.”
In other words, sometimes, it is necessary to slough through the mud before the discovery, insight, or solution is achieved. I agree 100% that good therapy is a mutual effort born out of a therapeutic alliance.
Thanks for your comment, Ellen. M. Scott Peck’s words are perfect; I only wish that they could be aired before every episode of Dr. Phil so that people would understand the difference between his show and actual therapy!
Thank you for your excellent piece. It’s important for people to understand the differences between what we do as therapists – and what Dr. Phil does on a ratings motivated tv show.
Lisa Brookes Kift, MFT
Thanks, Lisa. Yes, the motivation of good ratings can really alter how things are portrayed.
Perhaps, we should write to Doctor Phil? Perhaps, he need to have some reality testing. Fat chance. Ellen
Thanks for an excellent piece. An important wisdom to realize– one that Dr. Phil completely overlooks and undermines–is there’s no such thing as the great wise superparent with all the answers.