What Really Happens in Therapy (Hint: It's Nothing Like What You See on TV)

I watched a police drama recently where another traumatised officer had an intense relationship with their trauma counsellor where clear professional boundaries were not only crossed, the counsellor was inappropriate, provocative and borderline irresponsible. The officer was certainly not ready to return to active duty.

I'm sure many police officers scoff at the numerous procedural inaccuracies but, as a watching therapist I am concerned at the stereotypes these fictional dramas often reinforce, so I wanted to right those injustices for myself!

The truth is, what we see on our screens bears little resemblance to the actual therapeutic process. Whether it's a Hollywood blockbuster or your favourite TV drama, counselling is routinely misrepresented in ways that can genuinely harm public understanding of mental health support.

Having worked with clients in clinical practice for many years, I can tell you that what really happens in therapy is quite different from its media portrayals. Let me take you behind the scenes of authentic therapeutic work:

The dramatic licence problem

Television and film writers face a challenge: real therapy doesn't make for particularly exciting viewing. Authentic counselling sessions involve careful listening, gentle questioning, and gradual progress over weeks or months. That doesn't create the dramatic peaks and valleys that keep audiences glued to their screens.

So instead, we get what I call "Hollywood therapy" - a world where breakthrough moments happen in single sessions, where counsellors either solve everything or make everything worse, and where professional boundaries are routinely crossed for the sake of a good story.

Research analysing over 400 films found that only three portrayed mental health professionals sympathetically. The majority fell into harmful stereotypes that emphasise incompetence, danger, or unrealistic perfection. This matters enormously because most people form their first impressions of therapy from what they see on screen, not from personal experience.

The three faces of fictional therapists

When I watch dramas with counselling scenes, I notice that therapists typically fall into one of three problematic categories:

The harmful therapist

These are the counsellors who break confidentiality, manipulate their clients, or - perhaps most damaging of all - become romantically involved with those they're meant to help. Films like "Prince of Tides" exemplify this stereotype, showing a psychiatrist developing feelings for her patient's brother. In reality, such behaviour would result in immediate licence revocation and potential criminal charges.

The well-meaning but useless therapist

This therapist listens empathetically but offers no real insight or practical strategies. They nod sympathetically, perhaps offer a tissue, but clients leave sessions no better equipped to handle their challenges. Whilst empathy is crucial in real therapy, it's only the foundation - not the entirety of the therapeutic process.

The magical mentor

This is the therapist who provides instant insights and life-changing wisdom, often whilst breaking professional boundaries. Robin Williams' character in "Good Will Hunting" is beloved by audiences precisely because he seems to "get" his client immediately. Yet even this well-intentioned portrayal shows a counsellor meeting clients in parks and sharing extensive personal details - behaviours that would be highly problematic in professional practice.

Television's particular problems

TV dramas, especially police procedurals, add their own layer of misrepresentation. I've noticed several recurring themes that particularly concern me:

The "quick-fix" fantasy

Police dramas are especially guilty of portraying "soundbite therapy." An officer experiences trauma, has one intense conversation with a counsellor, and emerges ready to face the world again. In reality, therapeutic change requires multiple sessions with gradual reflection - not instant breakthroughs.

This portrayal is particularly harmful because it sets unrealistic expectations. People may try therapy, expect immediate results, and feel disappointed when real healing takes time, commitment and a certain amount of "work" on one-self.

The therapist as best mate

Television often shows counsellors as glorified friends who offer emotional pep talks and unconditional support. Whilst therapeutic relationships do involve care and empathy, they're fundamentally different from friendships. Professional boundaries exist to maintain the safe space necessary for healing.

Exaggerated stigma

Whilst some stigma around mental health support does exist, particularly in high-pressure professions like policing, television often amplifies this to dramatic extremes. Officers are shown being told to "toughen up" or face career consequences for seeking help. This portrayal can actually reinforce the very attitudes that prevent people from accessing support.

What Really Happens in Therapy: The Professional Reality

Having worked with clients for many years, I can tell you that authentic therapeutic work is quite different from its media portrayals:

It's a collaborative process

Real therapy isn't about a wise counsellor dispensing advice to a passive client. It's a partnership where we work together to understand patterns, develop coping strategies, and create lasting change. I might ask, "What do you think might help in that situation?" rather than simply telling someone what to do.

It takes time

Meaningful change rarely happens in a single session. Most therapeutic work unfolds over weeks or months, with each session building on the last. We might spend entire sessions simply building trust or exploring how past experiences connect to present challenges.

Boundaries matter

Professional boundaries aren't cold or uncaring - they're what makes therapy safe. I don't meet clients in coffee shops or become their friend on social media. These limits allow for a unique kind of relationship focused entirely on the client's wellbeing.

It's structured but flexible

Sessions follow a framework whilst remaining responsive to what the client brings. In Emotional Therapeutic Counselling, we might use tools like timeline work to explore significant life events, or letter writing with the non-dominant hand to connect with the inner child. These techniques require proper training and careful application.

Progress isn't linear

Real healing involves setbacks, breakthroughs, and everything in between. Someone might feel worse before they feel better as they process difficult emotions. This natural part of the therapeutic journey rarely appears in media portrayals that prefer neat, upward trajectories.

The harm these misrepresentations cause

When people don't understand what really happens in therapy, these fictional portrayals create several genuine problems that can prevent them from seeking the help they really need:

Unrealistic expectations

People may expect immediate results or become discouraged when therapy requires sustained effort. I've had clients worry they're "not doing it right" because they haven't had a dramatic breakthrough like they've seen on television.

Increased stigma

When therapists are portrayed as unethical or incompetent, it undermines trust in the profession. Some people may avoid seeking help because they fear their counsellor will be like those they've seen on screen.

Misunderstanding of the process

Media portrayals rarely show the day-to-day reality of therapeutic work - the gentle questioning, the homework assignments, the gradual building of coping strategies. This can leave people unprepared for what actual therapy involves.

The encouraging signs

Not all portrayals get it wrong. Some productions have made efforts to represent therapy more accurately:

"Ordinary People" consistently ranks among therapists' most recommended films for its authentic portrayal of teenage depression treatment. The HBO series "In Treatment" earned particular professional recognition, with mental health professionals rating it 4.8 out of 5 for realistic therapy depiction.

These examples show it's possible to create compelling viewing whilst respecting therapeutic reality. They demonstrate therapy as it actually is: challenging, gradual, but ultimately transformative work.

What Really Happens in Your First Therapy Session (And Beyond)

If you're wondering what really happens in therapy and considering counselling, please don't let media portrayals put you off or create unrealistic expectations. Here's the truth about real therapeutic work:

• A safe, confidential space where you won't be judged

• A collaborative process where your insights and experiences are valued

• Work that takes time but can create lasting change

• Provided by trained professionals who follow strict ethical guidelines

The therapeutic relationship is unlike any other - deeper than casual friendship but with clear professional boundaries. Above all, it is built on trust. It's this unique dynamic that creates the safety necessary for real healing to occur.

If you've tried therapy before and felt disappointed, consider that your expectations might have been shaped by fictional portrayals. Real counselling work might feel different from what you've seen on screen - and that's exactly as it should be. Understanding what really happens in therapy can help you approach counselling with realistic expectations and an open mind. The process might not look like what you've seen in films, but it offers something far more valuable than any dramatic Hollywood moment: genuine, lasting change that you'll build together with your counsellor.

Remember, seeking support isn't weakness - it's wisdom. Despite what some dramatic portrayals suggest, therapy is an investment in your emotional wellbeing that can genuinely transform how you experience life. The journey might not look like what you've seen in films, but it can be far more meaningful than any Hollywood ending.

If you're struggling with anxiety, relationship issues, or life transitions, counselling can provide a safe space to explore your thoughts and emotions without judgement. Real therapy might not be as dramatic as what you see on screen, but it offers something far more valuable: genuine, lasting change.