Therapy, Coaching, Psychiatry, Medicine: Let’s Stop Misinformation, Shall We?
In current politics, social discourse, and business, especially since the advent of the Internet and certainly with social media platforms, previously-reliable sources of information have become confused with not-so-reliable sources of information. In fact, with this, there has been a lot of misinformation on so many topics in politics, religion, sexuality, medicine, finance, education, law enforcement, national and global news, and entertainment.
For a while now, I’ve been noticing examples of misinformation in the fields I am most familiar with, psychotherapy, coaching, psychiatry, and medicine, from my now 32-year career as a gay men’s specialist psychotherapist and sex therapist.
I’ve noticed all this without much comment, but misinformation has reached such critical mass that I am moved to speak up and set the record (said the gay man) straight, so to speak. We have all been living in a media environment that is informed not so much by academics, researchers, scholars, and credentialed thought leaders, as we by social media entrepreneurs vying for attention (and the fame/money that comes with that), conspiracy theorists, cynical and paranoid skeptics who reject long-held science, people who don’t have much substance but that doesn’t matter if they have enough flash to put it all in a pretty package in an age of online images through photos and videos.
But that’s not reality, and it’s not fair to the general public worldwide that misinformation distracts and distorts their understanding of all kinds of resources, but we focus here on mental health, well-being, and their related professional services, particularly therapy, coaching, psychiatry, and medicine. Misinformation undermines fair access to resources by consumers, distorts the nature and history of these professions, and misleads consumers who just want to make their lives better, especially in my field of LGBTQ+ services. It is in these topics that a very concerning amount of misinformation is prevalent. As a very long-term practitioner, author, advocate, activist, academic, consumer, and researcher in these fields, I feel compelled to speak up and challenge misinformation and offer a clarification that is all too rare these days.
Let’s take each of these in turn: therapy, coaching, psychiatry, and medicine:
Misinformation About Therapy
Misinformation about therapy has been around for as long as therapy has, which is not all that long in the scope of world history; a little over one hundred years. Originally a branch of medicine and neurology, therapy has always had a mystique, an allure, a prestige, and a stigma about it, depending on who you talk to.
Let’s look at some of the most common points of misinformation that circulate disturbingly widely.
- One is the pervasive myth the vernacular of conversation among folks that you have to be “crazy” or severely debilitated to be “eligible” or “need” therapy. I’ve always said, anyone who as a goal in life can be in therapy. As an offshoot of medicine, it’s about changing your life for the better, reducing symptoms that undermine a person’s well-being and functioning in life, work, and relationships, and increasing empowerment to live, work, and love throughout the lifespan, in all settings and cultures worldwide, but particularly popular in Western countries. The “bar” to undergo therapy is low and is at the discretion of the patient/client who desires to be helped by it.
- Even though therapy can be seen as esoteric, ethereal, and even somewhat mysterious to many, it’s still considered a professional health care delivery service, provided by degreed professionals who are licensed in the state they practice in (could be more than one), or they are a graduate student of a Master’s or Doctoral program (MSW, MA, MS, PsyD, PhD, EdD) currently in a school-related clinical practicum or field placement, supervised by a licensed mental health professional, at a rate of one hour of clinical supervision per four hours of sessions, or they have graduated from their graduate program, and they are accumulating the hours of (again, supervised) clinical experience they need (California is 3,000 hours) before they are eligible to sit for the (two) licensing exam.
- As a health care delivery service, the mental health provider must give you some kind of clinical diagnosis that is published in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR), (American Psychiatric Association, 2013) or in some ways the International Classification of Diseases, 11th Edition (ICD-11). Health insurance plans will not pay for or even partially reimburse services unless a licensed health care professional is providing a service or procedure (called a “CPT Code,” such as one hour of psychotherapy in an office setting or Telehealth setting or hospital or clinic/agency). There are enough diagnoses to at least reasonably match to whatever any client or patient is coming in to see the therapist about.
- There is another pervasive myth that therapy is “free with health insurance;” too many people are led to believe this. If your mental health provider signs a contract with a health insurance company to take a discounted session pay rate in exchange for referrals of clients from their company, the provider would collect a “copay” that the client pays (such as $30) and then pay the provider the balance, up to the discounted rate (if the client pays $30, the insurance company might pay another $60, for a total of $90 per session, and no more). But the patient/client might have an annual deductible to meet (the amount they must spend out of pocket on their own care before insurance benefits start). If the client sees a therapist who is “out of network”, who hasn’t signed a contract with the insurance company to limit their fee (using the above example) to $90, but instead is $250, then the client would pay something $210 out of pocket and the insurance company might reimburse the client with “out of network benefits” with another $40 or so.
- There is another myth that therapists are just “in it for the money” and don’t care about clients. Actually, we do. The good ones, anyway. I enjoy going on a vacation like most people, but I miss my clients when I’m away and glad to see them when I get back. When a client finishes their course of therapy, we miss them. We feel bad if a client fires us or has to stop therapy because they are moving away, or lost insurance, or lost their job, or their income, or their insurance benefits.
- There is a myth that therapists make you lie down on a couch and “free associate” while the therapist just sits back and says “uh-huh”, takes notes on a pad, and perseverates talking about your mother and your unresolved Oedipal Complex. Almost no therapists anymore having clients lie down; you’re usually upright on a coach across from a therapist in a chair. Therapy has come a long way since the days of the old Freudians (follows of Sigmund Freud, MD), therapists who did Old School Psychoanalysis. Many more techniques have evolved since then, about 100 years ago, that have been found in formal research to bring relief of symptoms and increases in functioning and quality of life (which is called “evidence-based (research) practice.” Yet, myths like these persist, often spoken in a critical way that debases psychotherapy.
- There is the myth that “therapy is just like talking to a friend; anyone can do that; you don’t need to pay them.” Therapy is not like talking to a friend, even though the discussions can be “friend-ly”, sensitive, emotionally informed, and poignant. They can also be lively and funny. They can be profound. The full range of emotion applies. But therapists are trained professionals; even when we are “just talking” we are actually applying psychotherapy techniques and “models of intervention” that we have in our heads that don’t necessarily “show” to the patient or client. Therapists are trained with over six years of higher education after high school: four years (or more) of college to get an undergraduate Bacher’s degree, which is of course reading thousands of pages of textbooks, hearing hundreds of hours of lecture, writing hundreds of pages of papers, doing countless hours of research, and paying sometimes hundreds of thousands of dollars. And then, we do it again for graduate school, which can be condensed in some Master’s programs to one year, but it’s often two full academic years for an MSW, MA, or MS, and or more for a Doctoral program like a PhD or a PsyD or an EdD. And, they have hundreds of hours of clinical internship in addition to their school work.
Even after a therapist graduates, they are required to take additional courses or seminars on topics that most states want them to have, such as education about Child Abuse, Substance Abuse, HIV/AIDS, and Legal/Ethical Practice. And then they work, sometimes for very little money in non-profit organizations, to accumulate the 3,000 hours of clinical experience required before they can sit for (usually) two state exams to become licensed in that (one) state (at a time), having had one hour of case oversight and discussion with a clinical supervisor for every 4 hours of client sessions. It’s a lot.
Then, therapists are required to have about 36 hours every two years of additional courses (of their choosing, but still state-approved) of Continuing Education to renew their state license(s). All of these things are at the therapist’s expense, from college to well beyond licensure. But it’s all worth it, so that the public has at least reasonable confidence that they can put their trust in a trained professional in mental health, just like they might see a Medical Doctor (MD) or be treated by a Registered Nurse (RN) or Physical Therapist (PT).
So, no; you’re not just talking to a “friend.”
- Another common element of misinformation that is “out there” is that a “client is a client”, whether straight, gay, male, female, whatever demographic. That’s not so; the amount of information that many/most straight therapists, however well-meaning, do not know about the LGBT community is huge. The history, customs, traditions, vernacular, pressures, vulnerabilities, legal rights, and culture are very different. Even within the LGBT community, gay men are very different from straight men, lesbians are different from straight women, bisexual men are different from bisexual women, trans men are different from trans women, and even all these at different times of life, from different ethnicities, spiritual backgrounds, levels of education, national origins, levels of intelligence, professions and skill sets, and personal values individually and culturally – all take a lot of time and experience to understand the basics, let alone everything there is to know, and that’s just if you work with gay men, like me, for 32 years, which is longer than some people’s whole careers!
So while LGBT people, or in my practice, gay men, “can” see a straight therapist, it is a lot more work for that therapist to try to understand their gay male client in the same depth and detail that not only another gay man would, but also a gay men’s specialist who has worked with so many types of gay men. Same thing with couple’s therapy: “Oh, a couple is a couple!” Not so; the dynamics of two gay men (or more, in a polycule or polyamorous relationship, which many therapists can’t even conceive of) are very different from the Mars/Venus thing about men and women in relationships. Or any combinations of gender and sexual identities. (I had a year-long training course in Consensual Non-Monogamy and Polyamorous Families (gay and straight) from the Sexual Health Alliance, a leading professional educational body, as well as a year-and-a-half training to become an AASECT nationally Certified Sex Therapist. I’m a long-term specialist in HIV/AIDS mental health. I’ve also taught the semester-long LGBT course at the MSW program at USC, and Certified as a Psychiatric Social Worker, which is beyond the general Master’s trainings most therapists get, for people with challenges like OCD, ADHD/ADD, PTSD, Major Depression, Bipolar Disorder, Schizophrenia, Substance Abuse//Dependence, etc.
So, no, an LGBT client is not just like a straight client. Even the acronyms and terms gay men use culturally might be unfamiliar to the female or straight therapist, such as “PrEP”, “PEP,” “undetectable,” “top,” “bottom,” “side,” “daddy,” “queen,” “tina,” “twink,” “breeder,” “gym bunny” or so on. Within the community, we almost never use the terms “homosexual,” or “alternative lifestyle,” or even “lifestyle.”
Therapists often have to serve clients way outside of their own demographic, but it’s a challenge to cultivate “cultural competency” with so many different cultural backgrounds, including LGBT in general and gay men in particular, just like a therapist might specialize in working with teenage girls with Eating Disorders. Any licensed (or supervised license-eligible) therapist “can” treat them, but ethically, the therapist should have extra training or a specialization to do very specific work like that.
- There is some misinformation out there that “online therapy is not as good as in-person therapy”; they have studied this, and found similar outcomes and quality of treatment. So whether it’s in-person or online could be your preference, or what your mental health provider offers in their list of services.
- Another misinformation is that your average therapist for couples is a sex expert who can help couples with sexual problems in their relationship. Not exactly; while many therapists do try to help couples with sexual issues (usually heterosexual), therapy graduate programs tend to have very scant number of training hours devoted to human sexuality, sexual dysfunctions, sexual acts, and certainly about sexual and gender minorities. That’s why there are Certified Sex Therapists, who learn about all these things in order to help their clients (individuals or in relationships) who have these issues. But any therapist who has not taken hours and hours of extra training in sexuality and sexual issues is really kind of “guessing” at it based on their own self-study or the experiences of previous clients and learning from those experiences. And yet, so many couples (of all kinds) seek out “couples therapy” for help with sexual problems and expecting or assuming that therapist to be trained in them.
- Another myth is that “therapy is about ruminating about your feelings, not practical solutions.” This is a common denigration of the therapy profession, characterizing it as self-indulgent, self-important, erudite, privileged, and impractical. Many psychotherapy intervention models such as CBT, DBT, IPT, ACT, PST, EMDR, and more address the here-and-now challenges in mental health and well-being, and life functioning, like being able to hold a job, or get a better one, or navigate a personal or professional challenges (like having a boss with a personality disorder, when you don’t have one!).
- “Therapy never ends” – that’s another misinformation. The therapist and the client set goals together, driven by the client, and form a fairly formal Treatment Plan, with Goals and Objectives, and when those clinical (emotional, functional, social, professional) goals are met, the course of therapy comes to a smooth “clinical termination”, with the option to return at a later time with another course of therapy, probably with new goals, at some point in the future.
Misinformation About Coaching
- Coaching has a lot of misinformation around it or about it because it is such a relatively new service. It’s in its infancy, and unlike medicine, psychotherapy, physical therapy, chiropractic, nursing, radiology, or even cosmetology, there is no “state license” anywhere that is required in any state to practice coaching. Anybody can be a coach, even with theoretically no high school education or no GED, or just a high school diploma, college or no college, grad school or no grad school. It is just a completely unregulated business. So some of the misinformation out there is that coaches endure the same education, training, licensure, supervision, and professional requirements of those other professions.
- However, it would also be misinformation to paint all coaches as amateurs or charlatans. There are professional associations such as the International Coach Federation which has certification training courses, continuing education, supervision, seminars, codes of conduct, best practices, and things very similar to medicine or psychotherapy or the others. I know a great executive coach who has a doctoral degree in Coaching, which is still unusual, but very elaborate.
- Coaches can be life coaches, executive coaches (much like business consultants, on an individual or team level), relationship coaches, sex coaches, sobriety coaches, wellness coaches, and certainly coaching for sports performance. And, this is, like therapy, also not like “just talking to a friend” because coaches are trained, or self-trained, in helping others reach their goals, often incrementally, through specific mind-sets, behaviors, choices, interpersonal relationships, self-discipline, and personal values. I think it helps enormously if the person doing the coaching is also a trained mental health professional, social worker, MBA executive, even cultural anthropologist (I’ve seen that), but it’s not required, because the field of coaching is unregulated, except by itself, which is not state or federal law and is not binding or required to practice, except to hold a private credential such as the Master Certified Coach. My business coach is an LCSW therapist, like me, but she’s also an MBA and ICF Master Certified Coach.
- Unfortunately, I have observed much misinformation out there about when people ask about “the differences between therapy and coaching.” Often, it is coaches who like to answer this question, although they don’t know about therapy because they aren’t trained therapists.
I was on a panel one time for the City of West Hollywood on helping gay men in recovery from crystal meth, which is a big problem in the community, and someone in the audience asked this question, about the “difference between coaching and therapy.” A self-appointed “coach” (an unemployed actor) on the panel volunteered to attempt to answer his question, and said, “Well, a therapist is like an archaeologist, digging through the rubble of the past. A coach is like an architectmis, building toward a better future.”
I was much younger then, and far less curmudgeonly, or I would have really called that out. It’s presumptuous and misinformation for him to say that. Therapy is not “all about the past,” except to the extent that it can help a client reflect, understand, cope, and heal from any number or type of challenging or traumatic experiences from their childhood or their adult past. Many therapists, such as myself, have helped clients with many kinds of traumatic experiences, such as violent crime, accidents, illnesses, war combat, physical/sexual/emotional abuse, domestic violence, workplace harassment or bullying, white collar crime (such as blackmail), and so many. But that is about helping a client heal and grow, so that the traumatic symptoms such as those from PTSD don’t hamper the client’s current functioning and future quality of life in work and relationships. Therapy and Coaching, both, are about helping the client make their lives better, now and for the future.
But there is much concern from therapists about coaches who are not also therapists because of the magnitude in the differences in training, accountability, and oversight of the profession. There are many (I know some) coaches who are just as ethical and even talented as therapists to form profound professional interpersonal relationships with their clients, but this is by much happenstance as anything else; it’s not from academic and clinical training.
At worst, coaches can be people who want to in essence function as therapists through “talk services”, and earn as much (or more) per hour as therapists do, but they don’t want to do the (considerable) work it would take to undergo a graduate school program and the rigors of getting (and keeping) a state license. Or, they don’t want the overhead that therapists have, such as graduate school, continuing education, licensure fees, supervision fees, malpractice insurance, and so on. And in the eyes of the public, it is misinformation for them to think that coaches are on a training “par” with therapists; there is a drastic difference in time, investment, accountability, and sustained effort.
However, one of the cardinal tenets of clinical social work (which overlaps a lot with psychology, but is its own discipline) is the Client Right to Self-Determination. I’ve seen clients who see other therapists for different topics, who also see their coach(es), or providers like a psychic, or clergy, or spiritual leader. And the research on even psychotherapy shows that it’s not necessarily the therapist, or the psychotherapy technique that is being applied, that influences (hopefully) positive outcomes of the work, but the relationship that client has with the provider.
So, it’s entirely possible that they have a valuable, rewarding, productive, satisfying working relationship with a coach. There are countless “success stories” about this. However, if a client has a bad experience with a coach, there is very little recourse. There is no ethics body or state board or even professional association that has binding legal oversight, and there is no recourse except if the coach commits a crime that any other person doing would be civilly or criminally liable for. So, people put their faith in coaches, psychics, spiritual leaders, etc. with some risk, which is why state boards are strict about the requirements to become (and stay) a therapist, so that the trust of the public is at least often (not always!) protected. The state board in California, for example, that governs therapists, the Board of Behavioral Sciences, and similar boards of Psychology or Medicine, are under the California Department of Consumer Affairs, which aims to protect the public (in that state) from unscrupulous or incompetent/harmful practitioners.
Misinformation about Psychiatry
- Therapists often can have frustration with the misinformation about Psychiatry, which is a discipline within Medicine. Psychiatrists are a type of MD, just like a dermatologist, hematologist, oncologist, pediatrician, nephrologist, neurologist, endocrinologist, and so on. They get confused with psychologists and psychotherapists because the “psych” prefix of the words are the same, but the disciplines are very different.
- A big part of the misinformation about psychiatrists, of course, comes from the very powerful, very popular “Church” of Scientology, who portray psychiatrists, especially those who treat children, as nefarious villains of society out to sadistically exploit patients for unreasonable monetary gain or power/control in society. They make claims that are easily disproven in science, and much has been written about this. There have been books, documentary films, TV shows, exposes, etc. about this “Church” (known to be very anti-LGBT, by the way) and their intimidation tactics. They would, of course, rather that people pay them for help for mental health and well-being, “spiritually”, than a psychiatrist.
- Another misinformation about psychiatry is about the confusion that while many psychiatric medications provide patients profound relief and respite from psychiatric symptoms, partially or significantly, there are other times when psychiatric medications are not nearly as effective in treating depression or anxiety or OCD or Bipolar Disorder or Schizophrenia and so on as the patient would like. The response to those medications, we say, can vary greatly, even with very similar demographics and situations with the patient (age, race, ethnicity, general health status, etc.). It would be misinformation to say that psychiatric treatment is “always” effective as well as “never” effective.
- Another misinformation about psychiatry is that once you take those medications, you always have to – like a person who becomes addicted or habituated to a street drug like heroin, cocaine, or meth. If a medication is not effective enough to be worth taking, or if it cases intolerable side-effects, you simply coordinate with your psychiatrist to stop taking them, sometimes gradually, which some medications require. And you try something else, either another medication, or another approach, such Trans-Magnetic Stimulation therapy for depression, or Electro-Convulsive Therapy (ECT, which was a nightmare in the past but has grown in humanitarian use and procedures since then!), or Ketamine-Assisted Therapy, or just back to “talk therapy”. As a psychiatric social worker, I’ve helped hundreds of clients navigate between their therapy with me, and their treatment with their psychiatrist, in what we call the “Multidisciplinary Team” approach, which might also include people like a Sobriety Coach, a 12-Step sponsor, or a personal fitness trainer or nutritionist. “It takes a village” as Hillary Clinton said.
Misinformation about Medicine
- Misinformation about medicine is perhaps the biggest villain of them all. The anti-vaxxer movement. The snake-oil cures (that are either ineffective or even dangerous). The evolution of medicine from treatments of the past that were later found to be harmful (like using heroin or cocaine for “headaches”) are a part of national and world history. And when bloggers, podcasters, self-help book authors, talk show hosts, columnists, authors, speakers, and so on want attention (and the money that comes with that in modern society), misinformation about medicine is a dramatically effective (if often evil) way to get it.
I’m going to write and speak about misinformation in medicine at a later time, and discuss the clinical, administrative, social, and financial aspects of accessing and navigating medical care, especially in the United States, which has a uniquely bad approach to medicine from the rest of the world and low outcomes relative to other industrialized nations, which is a national embarrassment but with little political will to change anytime soon. This will be based on my work with my clients who have had medical challenges (which is nearly all of them), and of course my history working in HIV/AIDS mental health, and my own 34-year “career” in medicine as a person living with HIV and a cancer survivor and other conditions (and yet, as the Sondheim show tune says, “I’m still here”).
Yes, still here. And while I pride myself on a being a long-term clinician as a psychotherapist, and provider as Coach and Consultant and Expert Witness, and Author and Professor and Advocate and Activist, the work is about one mission, in my practice: the mental health and well-being of the LGBT global community in general, and the community of gay men in particular.
Misinformation needs to be identified, discussed, challenged, and clarified. Because the public in general and gay men in particular, as an historically oppressed group, globally and throughout much of history, deserves the most unsullied information and ethical/effective services available. That is a mission and commitment that must be kept constant, evolving, and evergreen. Our community deserves nothing less.
Ken Howard, LCSW, CST, is a Licensed Clinical Social Worker (#LCS18290) in California, an AASECT Certified Sex Therapist, and a retired academic (Adjunct Associate Professor) at the University of Southern California (USC) Suzanne Dworak-Peck School of Social Work, and the Founder of GayTherapyLA. He has been working in LGBT and HIV/AIDS activism since 1988. He is now the most experienced gay men’s specialist psychotherapist and life/career/relationship coach for 32 years in 2024, and is in full-time private practice in West Hollywood, California, where he lives with his husband of 22 years. A library of hundreds of blog articles are available on GayTherapyLA.com/blog, GayCoachingLA.com/blog, and his podcast is heard by over 10,000 people per month in over 120 countries of the world. For more information on therapy or coaching services or to make an appointment, call/text 310-339-5778 or email Ken@GayTherapyLA.com or Ken@GayCoachingLA.com.