A Therapist's Take and Therapy Questions Answered: The Valley
Hi all! I'm an avid watcher of all things Bravo and noticed a lot of questions and misinformation about the depictions of therapy on the Valley this season, particularly in the last few episodes. I wanted to invite other therapists to chime in and answer questions you all might have. Important caveat: I will not be sharing diagnostic impressions about anyone on the show. While cast members are public figures and their personal lives are of public interest, I have not personally evaluated or treated anyone on the show and cannot ethically or responsibly comment on possible diagnoses. I will share my reactions only to what was shown and described on the program.
Background: I'm a licensed psychologist and work as an individual and couples therapist. A lot of the themes on the show are commonly discussed topics in therapy.
Some things that jumped out at me:
*Luke's assertion that he doesn't want to go back to therapy because he was being asked about his feelings, the past, how they resolved conflicts in past, and that this felt pointless.*
Discussing all these things is a critical part of effective couples counseling. A couples counselor needs to have a full history and deeply understand each couple's unique relational dynamic before treating the identified problems. Anyone seeking couples counseling should be prepared to discuss these things before getting to a treatment plan.
*Kristin's statement that her individual therapist told her they are not ready for couples counseling and discouraged them from doing so at this time.*
This can be a responsible and ethically sound assessment for a number of reasons.
**1.** If one or both parties are in a fragile emotional state (recently postpartum) and struggling with symptoms that have not been effectively managed yet.
**2.** If there is physical or emotional abuse in the relationship.
**3.** If one or both participants are not able to consistently engage in the process for any reason (busy schedules, health problems, etc)
**4.** If one or both parties are not adequately socialized to therapy--meaning, they lack understanding of the processes of therapy and what they require for productive participation (see: Luke's comments about talking about the past and his feelings)
**5.** If, for any reason, one or both parties are not prepared or unwilling to accept feedback and consider different perspectives. These are not "good candidates" for couples therapy, and yes, as a therapist, part of our job is to assess whether a type of therapy is appropriate. It is not ethical or appropriate to continue treating a client or couple simply for financial gain.
*Accountability in the therapy process*
It is appropriate for an individual or couples therapist to point out when a client is using unproductive language to share their experience. This is not "taking a side" or "attacking" a client; rather, it encourages them to pause, reflect on the impact of their language, and try again using "I statements" and sharing emotional vulnerability. "When you do this, I feel..." A huge part of therapy is considering not just verbal language, but the language of our thoughts and how it informs our perspectives and therefore our behaviors.
*Therapists as "Blank Slates" in treatment - Is it ok for my therapist to visibly react in session?*
A therapist looking shocked, sad, angry, or smiling, is not unprofessional. The therapy model of the "blank slate" is from an older form of therapy, psychoanalysis, in which the therapist serves as a completely blank page for the client to project their experiences. Modern therapy forms allow space for culture, context, and accepts therapist's humanity. After all, therapy is a human relationship that thrives on trust, which is difficult to do when we see a therapist as merely a cold outside observer. It is therefore acceptable and an effective therapeutic tool to model an appropriate response to language or behavior, and can also be validating. Often, a client or couple becomes so immersed in their subjective experience that they become desensitized past a healthy response. "Inappropriate affect" or "incongruent affect" are terms we use when an individual has an abnormal response to what they are saying or what is being said. For example, a client laughing when saying or hearing something cruel. Or demonstrating a flat expression when describing happiness.
*Truth v.s Cruelty*
Honesty and vulnerability of expression is absolutely critical to productive therapy and I encourage it always. But honesty without compassion becomes cruelty with no purpose. It can be harmful rather than constructive to a relationship. Example: telling your partner *"You don't seem to care about your baby. You're a bad father."* Or, *"I proposed before I met you pregnant."*
There are great and effective ways to express these sentiments without pushing your partner away. Once your partner becomes defensive, they will stop listening and will instead focus on how to protect themselves, which can include fighting back. If we want things to change, it is in our best interest to use language our partners can actually hear and respond to. Such as *"when you lashed out at me while you were pregnant, I began to feel scared about where our relationship was heading, and that I would never get the 'old you' back. I'm so angry at how you acted back then."* Or, *"when you centered going to bars and fishing during the worst time in my life, I felt so abandoned and worthless. It made me want to make you feel as low as I was feeling."* Even, *"I love you and our baby, but I'm having doubts about our relationship. I don't feel ready to get married with the way we've been arguing and disagreeing."*
*Anticipating changes in life transitions, such as a new baby*
It's completely normal for both parents to experience identity loss with a new baby and have the desire to retain their "old" identity. Nobody is wrong or selfish for feeling that way. It can be valuable to engage in support groups, self-help/psychoeducational books, therapy, and structured discussions with your partner about that loss of identity in order to move towards acceptance of major lifestyle changes that will take place after having a child. One helpful part of this is recognizing some of these changes are temporary, and more profound during the first years of a child's life. Things like your sex life, your ability to travel, your time for self-care and socialization. Accepting these changes doesn't have to mean overcorrecting and completely giving them up either. It's so important to carve out some reasonable time for these activities on a weekly basis when possible and to support your partner in doing so.
*Finding a good therapy "fit"*
Every client needs to feel understood in order to trust their therapist. We can have all sorts of responses to people based on gender, race, age, etc. Finding the therapist that's right for you can include a consideration of these factors in addition to therapy orientation, personal style, a clinical vs. humanistic approach, etc. As a consumer of therapy myself, I tried out three different therapists before finding the one who helped me confront uncomfortable truths and work towards my goals. It is acceptable to end treatment and look for a new therapist for any reason. It's also important to be mindful of the impulse to leave therapy simply because it feels challenging, scary, or uncomfortable. Give yourself and the process enough time before making a decision.
*What do I do if therapy makes me feel bad?*
Express your concerns to your therapist, including your reactions. Most of us actually love it when you do that! Good therapy is collaborative and requires your feedback. "It made me feel misunderstood/angry when you did that" can actually be the starting point for deeper understanding and increasing trust. Yes, you are absolutely allowed to say "I didn't like that"! We will change our approach, explain our strategy, and ask the right questions when we have more of this information. It also helps the client learn to effectively communicate their concerns and needs in order to work towards a different outcome instead of giving up when they feel uncomfortable or distressed about something, which is a huge skill outside of therapy.
I know this is a long read but I hope it can be helpful to anyone watching and considering therapy, in therapy, or experiencing some of the issues depicted on the show.