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Can therapy help when it’s not your own?

Reviewed by Stephanie Steinman

Female podcaster sits in front of a laptop adjusting settings on a soundboard

It’s a typical Saturday. I wake up, pour some coffee, let the dogs out, and settle in to listen to other people talk about their most intimate problems. No, I’m not a therapist—but I can’t get enough of their podcasts.

For several hours a week, I sit riveted as an elderly woman struggles to move through childhood trauma or a newly married couple navigates trust issues. I may just be a fly on the wall, but I can share their frustrations and feel their pain. Sometimes these shows even spark a breakthrough conversation with my own therapist.

Over the past decade, hugely popular podcasts like Lori Gottlieb and Guy Winch’s “Dear Therapists” and Esther Perel’s “Where Should We Begin?” have given me and millions of other listeners a seat in the middle of a sacred space in our culture: the therapy session.1, 2

Occasionally I wonder if should feel a twinge of guilt for eavesdropping. On the other hand, there’s a case to be made that these shows encourage people to try therapy because they get to hear firsthand how much it helps. After all, it’s much less scary to sit down on that couch if you feel like you’ve been there before.

Are these therapy sessions real?

The idea of publicly asking for experts for advice isn’t new: We’ve been doing it since the 17th century.3 But broadcasting our voices, reactions, and innermost thoughts for the world to hear is a more recent trend. Given our culture’s current obsession with reality TV—and how much editing of footage happens in that world—I couldn’t help wondering if podcast therapy is true to life.4

Lori Gottlieb, LMFT, best-selling author of “Maybe You Should Talk to Someone” and cohost of “Dear Therapists,” walked me through how her show gets made. Gottlieb and Guy Winch, PsyD, choose their guests from among hundreds who send in letters each week. The participants are real people who have a problem and reach out.

“We treat it like if you actually set foot in our office and we truly don’t know anything about you yet,” Gottlieb says. Part of that means going in cold. Though their guests are screened in advance by the show’s staff, she and Winch “meet” their patient for the first time on a video chat, and that’s what listeners ultimately hear—along with commentary provided by the hosts. Then they have a chance to follow up in special episodes where Gottlieb and Winch check in with former guests to gauge their progress.

Alicia Muñoz, LPC, a couples therapist and senior writer-editor for therapist.com’s sister publication, Psychotherapy Networker, believes that what you’re hearing on shows like “Dear Therapists” is authentic. However, she notes, there are some key differences from a traditional therapy setting—mainly in establishing the relationship between the client and the therapist, known as the “therapeutic alliance.”5

“In that brief amount of time,” says Muñoz, “there’s really no way to build trust and a therapeutic alliance, which research shows is the single most potent factor in any therapy.”6

Muñoz also notes that by their nature, podcasts have people beyond the show’s guests in mind. “It needs to be entertaining,” she says. “Otherwise it wouldn’t have an audience.”

In service of “Dear Therapists” listeners, Gottlieb often tries to point out what she’s seeing during a session. “You’ll hear us say something like, ‘Oh, I see you’re tearing up,’” she explains. “I’m not necessarily saying that for the guests, I’m saying that for the audience.” (If you tune in to any audio news show, you’ll hear reporters use this technique all the time.)

Broadcasting tactics aside, though, Gottlieb confirms that the conversation and the reactions are genuine.

How helpful is a single session?

A therapist-client relationship can take years to cultivate. Depending on the diagnosis, clients may require many sessions or just a few. (The recommended number for posttraumatic stress disorder, for example, is 15 to 20.)7 So how effective is the model of a single session?

Gottlieb says she and Winch help their guests in three ways: the initial session, actionable takeaways offered during the session, and the finalized episode. “When you listen back, you may hear things you weren’t ready to hear the first time,” she says. She and Winch also add post-session thoughts to the episode in the hopes that their guests will be listening when it airs.

One limitation of the single-session model, Muñoz says, is that the therapist doesn’t have as many chances to touch base. “Ideally, there’s this constant moment-to-moment checking in,” she explains. The therapist might ask, “How is this for you? I just said something pretty intense, are you having a reaction?” In a podcast session, there may be less checking in because guests have signed consent forms, or we just don’t hear it because the conversation has been edited.

Gottlieb has learned to work with this time constraint. “We’re going to do things differently than we would in a regular session,” she says. “We might do it in a different order, for example, or we might do something that we would have saved for session three in session one because we only have one.”

But despite the accelerated pace, Gottlieb believes a single session can be a jumping-off point for people to view therapy differently—as an active process. “We’re helping them make a shift so that they can then go out in the world and do the work and start from a proactive place,” she says.

The benefits of listening in

Why are we so drawn to these podcasts? Why am I nestled in my oversize chair listening for hours every week? Gottlieb and Muñoz have some ideas.

We get to see the good, the bad, and the ugly. Therapy podcasts show their audience a real person: struggles, flaws, and all. “We don’t get that in any other context. We get a curated version on social media, and we don’t see the real moments of humanity,” says Gottlieb.

We see ourselves in these stories. “So many problems fall into buckets of universal themes,” Gottlieb says, so the audience feels seen and connected. In a 2018 interview with the Guardian, Esther Perel shared the pre-session questions she asks her podcast guests, including, “Are you okay in understanding that your story will become a collective story?”8

They help us believe change is possible. “People have so many misconceptions about what therapy can do for you, how it can tangibly help you,” says Gottlieb. For this reason, she often gives her guests what she calls “actionable takeaways” at the end of each session. These help people move beyond the session in a more meaningful way. “Insight is a booby prize of therapy,” Gottlieb says. “You can have all the insight in the world, but if you aren’t making changes out in the world, the insight is useless.”

They offer access to therapy. “Listening is a way to get deep and get access to these kinds of frameworks and ways of approaching things without paying $200 a session,” says Muñoz. Gottlieb says she started “Dear Therapists” with a singular goal in mind: to “democratize therapy.” Chances are you’ll hear a story that resonates with you, then listen as a highly skilled clinician walks through the steps to resolution. Especially for people with limited access to mental health care, these shows can provide meaningful feedback and even guidance.

Weighing the potential risks

Gottlieb and Muñoz agree that shows like “Dear Therapists” make a positive impact overall. Muñoz often hears from friends and colleagues who recognize their own patterns and behaviors as a result of listening to therapy podcasts, and Gottlieb and Winch get letters every week affirming that their version of therapy resonates with fans.

There have been sessions when she and Winch could have done things differently, Gottlieb admits. But they share this perspective openly with their audience, airing special episodes in which they discuss a case they might have handled more effectively.

Given format limitations, therapist-hosts don’t have the chance on a single podcast episode to explore avenues they might head down in an established, multi-session relationship. For instance, it can take years to unravel the impact of childhood trauma, yet the hosts are limited to an hour or two of session time—so they need to focus on only the most pressing issues.

There’s a risk that’s some listeners may be triggered or retraumatized by certain topics. An episode about assault, for example, could bring up painful memories. Be sure to check episode titles and descriptions for content warnings that may be relevant to you.

Finally, there’s the issue of expectations. Not many problems can really be solved in an hour. It’s also unlikely you’ll walk into a therapy office and find your very own Lori Gottlieb or Esther Perel waiting for you—but that doesn’t mean you won’t build an amazing bond with your therapist. Finding the right fit takes time. Get started by browsing our therapist directory.

Building a bridge for conversation

As mental health professionals work to make therapy more accessible, shows like “Dear Therapists” and “Where Should We Begin?” can offer inspiration. “The podcast is a transitional object, a bridge for conversation,” said Perel in her Guardian interview, and that bridge can be powerful to cross.9

These conversations clearly connect with listeners: Both shows consistently rank in the top 100 in their category on Apple Podcasts. And they’re resonating with participants as well, as Gottlieb and Winch have learned from regular post-episode check-ins with their guests.

“They so often exceed our expectations,” Gottlieb says. “That’s great for us to hear, but I also feel like it’s great for the people listening to hear.”

About the author

Amye Archer, MFA, is a senior writer at therapist.com. She is the author of “Fat Girl, Skinny” and the coeditor of “If I Don’t Make It, I Love You: Survivors in the Aftermath of School Shootings,” and her work has appeared in Creative Nonfiction magazine, Longreads, Brevity, and more. Her podcast, “Gen X, This Is Why,” reexamines media from the ’70s and ’80s. She holds a Master of Fine Arts in creative nonfiction and lives with her husband, twin daughters, and various pets in Pennsylvania.

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