Television has been flooded in recent years with “reality” shows about psychological disorders. From trichotillomania and OCD to compulsive hoarding sufferers, documentary-style programs have attempted to capture the experiences of these individuals in their daily lives and in snapshots of evidence-based treatment for public display. Public reaction seems to be generally positive, as evidenced by the continued growth of this television genre; however, there is also a consistent undertone of questioning whether there is an exploitative nature of such programming. Is it helpful to the public, or, is it simply voyeuristic, like a train wreck we cannot help but watch?

Disadvantages in Potential Inaccuracies

Intervention shown on television can be unintentionally distorted or misleading. Remember, this is television; good TV needs to hold the attention of its audience and audiences like TV that evokes emotion. Therapists do not make these shows, the film industry does. They have different goals and very different timeframes.

For those readers who have never been engaged in quality psychotherapy, know that many of the shows seen on TV that are promoted as being therapeutic in nature do not depict therapy as we truly conduct it. For example, on hoarding television shows, a therapist goes into the home with an organizer over the course of a few days to help sort through the clutter and clean up the home.

In reality, yes, we do home visits, but the goals are quite different. In evidence-based treatment for hoarding, we focus on helping the individual to learn more about their attachment to items and their erroneous beliefs, develop cognitive flexibility, problem-solving skills, decision-making skills, and coping skills, and learn how to experience emotion and let go. True therapy is a process that takes time and does not easily lend itself to being accurately summarized in a 27-minute television segment.

Keep in mind that these ‘shoots’ are edited for television. The editor’s challenge is to keep the program moving, while holding interest, and telling a provocative story. For example, the therapist may have felt he or she had some great breakthroughs with a participant during a shoot, but these moments wind up on ‘the cutting room floor’ in exchange for provocative interpersonal conflict between family members. Unfortunately, the end result can minimize the role of psychotherapy (because it frankly does not make for good TV), emphasizes the drastic change from start to finish, and can set up unrealistic and misleading expectations for individuals who are seeking treatment in their lives and have seen these shows. I frequently find myself at the outset of treatment for these disorders, educating the new patient and dispelling any misconceptions or anxieties regarding treatment borne out of the individual’s assumptions based on what he or she has seen on TV. For example, in treating OCD, panic disorder, or phobias, I frequently find myself explaining to patients that exposures are done in a gradual, structured, hierarchical manner, and that the extremely anxiety-provoking exposure they saw on TV must have been toward the end of treatment, after smaller exposures that worked up to it.

Disorders depicted do not often occur without a lot of other history to consider and process or co-occurring psychopathology that also needs to be treated. In the interest of ‘story’ simplification and time restrictions for TV shows, these important aspects of case conceptualization and treatment can be left out; thus, the problem is oversimplified.

It is important to remember that although the producers frequently have the best of intentions in providing the public with accurate information, the information is only as good as its sources. Some shows are better than others in terms of accuracy. For example, I have seen two shows that have stated that trichotillomania is a type of OCD (It is not) and one that focused on mood instability, anger, aggression, and noncompliance with treatment, in a man with trichotillomania, when although he did have trichotillomania, these characteristics were features of a poorly managed co-occurring bipolar disorder.

Misleading depictions are also borne out of the tendency for these programs to choose to show extreme cases. Although these cases may be very interesting to the viewer, they may also serve to lead some to believe that less significant problems are not significant (and, perhaps fail to seek treatment). For example, hoarding shows have shown dead animals, infestations, rotting food, toxic mold, feces, and other extreme examples of problems in the home. Although cases such as these do exist, these squalid conditions are seen less often than what may simply be described as extreme clutter.

But, these shows do have their advantages. I’ll weigh in on those and ask you to determine if these shows are more helpful or harmful in Part II, “Sensationalism at Its Best: The Undisputed Advantages” To be continued…

Dr. Deibler

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