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Why do fictional therapists get it wrong?

As a former clinical psychologist who now reviews and writes fiction, I’m somewhat obsessed with fictional therapists. Although the therapists I’ve encountered across almost 50 contemporary novels do not constitute a scientific sample, it’s my impression that there are more ineffective therapists in fiction than competent ones. Why might that be the case, and does it matter anyway?

Building tension While there is a degree of overlap in the business of psychotherapy and fiction, their overall goals don’t completely align. In therapy, tension might be considered a side-effect of the healing process; in fiction, it’s what keeps us turning the page. A character achieving what they want without much effort isn’t a story; our hero must be thwarted at every turn. A therapist who fails to help or understand them can raise the stakes and enhance the reader’s empathy. It’s just one way of making the protagonist’s journey tougher and keeping the reader hooked.

This is particularly true of thrillers, so we shouldn’t be too surprised when Luana Lewis’ fictional psychologist, Stella, agrees to an unscheduled session in an otherwise empty building in Don’t Stand So Close. But it also applies to general fiction, which is why I gave a clinical psychologist a walk-on part in my own debut novel Sugar and Snails. Although I feared being disloyal to my profession in creating Chris Edmonds, I was reassured that a contemporary therapist would approach the situation differently.

Here’s the central character, Diana, remembering receiving aversion therapy as a teenager in the early 1970s:

The mere thought of these appointments gave my mother a headache, so my dad had to take me, and he wasn’t happy about it. He didn’t like Chris with his shoulder-length hair and smiley-face T-shirt, and I suppose he didn’t like sitting in the corner without his pipe. I didn’t think he would object to the treatment – after all, there was nothing namby-pamby about it – but, on the third or fourth session, he sprang from his chair: “This is barbaric! I thought I’d fought the bloody Nazis to put a stop to this malarkey.”

Embarrassed, I expected Chris to stick up for himself and explain, yet again, the theory of operant conditioning, but he shrugged and set about detaching the electrodes from my chest. “Yeah but I thought it was working,” I mumbled. I’d believed in Chris, even more than I’d believed in St Bernadette of Lourdes.

“Let’s see how things are next week,” said Chris, but I knew there wasn’t going to be a next week. If my dad said no, then no it was. (p163-4)

Humour A character who misreads a situation can be a source of humour, and that applies to therapists as much as anyone else. As I mentioned in my previous post, a novelist can build on our stereotypes of therapy to raise a laugh. I don’t know what a Lacanian would make of him, but Russell Watts in Jonathan Coe’s The House of Sleep provides a prime example of a therapist’s narcissism and lack of common sense. In this passage, he’s pontificating to fellow delegates at a training day, oblivious to the fact that the client he’s overanalysing (and with whom he feels no reason to check his assumptions) suffers from a medical condition:

Sarah was unable – or unwilling – to answer my last question, but this was of little consequence, because I now had all the facts at my disposal, and was satisfied that the cause and extent of her problems were perfectly clear to me. And while it would have been highly irresponsible of me to share any of my insights with the patient herself, I shall conclude this paper with a sketch of the most salient points, for the benefit of my listeners (p291)

The therapist’s limitations bring depth to the narrative Some authors put their fictional therapists into situations in which most would struggle. For example, Aminatta Forna brings additional depth to her novel about Sierra Leone following the Civil War, The Memory of Love, through the character of British clinical psychologist Adrian Lockhart.

Despite his interest and expertise in PTSD, Adrian feels overwhelmed by the degree of trauma he encounters and disheartened by his apparent ineffectiveness: he had imagined lines of patients – patients, not clients – and in responding to his patients’ needs his workload would create itself and he would end each day gratifyingly exhausted. So he had thought. But they have stopped coming now, more or less entirely. And, he suspects, his colleagues have stopped bothering to make referrals (p64)

Similarly, through the character of white clinical psychologist Martin van Deventer in an alternative South Africa where apartheid still reigns, Nick Wood explores power dynamics and the ethics of helping relationships within morally corrupt systems in his debut novel Azanian Bridges. Martin continually misunderstands the experience of his black client, Sibusiso Mchunu, who has been severely depressed since being assaulted by police while taking part in a peaceful protest. But at least, unlike some fictional therapists, he’s willing to learn.

Author misconceptions

This approach only works if the author has a good enough understanding of what therapy actually is. Although there is much more openness about therapy and mental health issues these days, it can be difficult for those who haven’t experienced therapy to appreciate how much it differs from an ordinary supportive conversation between friends. Like the public in general, an author might be unaware that their perception of therapy and therapists is distorted. That might be why many fictional therapists tend to blur therapeutic boundaries and are rarely in receipt of personal therapy or supervision.

Of course, this is unlikely to matter to most readers as long as the story is strong. But counsellors and psychotherapists beware: if your client arrives clutching a novel, you might want to check there isn’t a failed therapist inside.

What do you think? Do fictional therapists get it wrong? If so, why might that be?

I’m planning a series of posts on fictional therapists, so if there’s anything in particular you’d like me to address, please let me know via the comments. I’d also be interested to know if you’ve come across any fictional therapists in your own reading; you can follow the link to check whether they’re already in my collection.

Author's Bio


After a twenty-five year career as a clinical psychologist, and extensive personal therapy, Anne Goodwin now explores issues of mental health and well-being in fiction. Her debut novel, Sugar and Snails, about a woman who has kept her past identity a secret for thirty years, was shortlisted for the 2016 Polari First Book Prize. Her second novel, Underneath, about a man who keeps a woman captive in his cellar, was published in May 2017. Her short story collection, Becoming Someone, is scheduled for publication in November 2018. Catch up on her website: annethology or on Twitter


Coe J. The House of Sleep. London: Penguin, 1998. Forna A. The Memory of Love. London: Bloomsbury, 2011. Goodwin A. Sugar and Snails. Derby: Inspired Quill, 2015. Lewis L. Don’t Stand So Close. London: Corgi, 2014. Wood N. Azanian Bridges, Alconbury Weston: Newcon Press, 2016.

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