Why “Helping Profession” Sends the Wrong Message
False expectations make for bad therapy.
It rankles when people call psychotherapy a “helping profession” or “caring profession”—not because those descriptions are entirely wrong, but because they focus on the wrong thing and invite misunderstanding.
The purpose of psychotherapy is psychological change.
Patients are not passive recipients of care. They are active agents of their own change. If not, something has gone wrong.
The therapist’s primary job is not “helping” or “caring,” at least not in the everyday sense. It is to do work that enhances the patient’s agency and brings about lasting change.
“Caring” is even more problematic than “helping” because its meaning is slippery. A therapist is responsible for providing professional care. But no one can promise how they will feel about another person. That’s the meaning when we say, for example, that we care for a friend or loved one.
Love and support aren’t professional skills.
Meanings blur easily. If we say “caring profession” with the implication of emotional caring, we’re selling false promises—to ourselves, our patients, or both. If prospective patients hear it that way, they’ll come to therapy with false expectations. That’s not a sound foundation for psychotherapy.
There’s also a subtle framing that fuels serious misunderstanding: that psychotherapy is about caretaking, like a parent for a child. It implies therapy is love and support. But love and support aren’t professional skills, and that’s not why serious psychotherapists spend years in training. A professional must offer something else.
Therapists in an ongoing therapy relationship often do come to care for their patients. This kind of caring develops over time as we do the work of psychotherapy together, as connection and attachment grow through shared history and experience. It’s an effect, not a cause. It’s misleading to center “caring” instead of psychotherapy’s real purpose: psychological change that allows the patient to live more freely and fully.
(I suspect this will draw fire from some of those deeply caring therapists. At least we can appreciate the irony.)
We would set far more realistic and helpful expectations—and, paradoxically, help our patients more—if we kept our focus on the actual purpose of psychotherapy.
That purpose is helping people change things about themselves that
cause or perpetuate unnecessary difficulties,
they desire to change, and
psychotherapy can realistically help them change.
That’s the job.
If it’s not that, it’s not psychotherapy.
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I appreciate this, as someone who comes to this profession via disability and infant care work. These roles require a different disposition and frame. I think it is important to be discerning about helping and being in or of service to others in a particular manner. “Helping” in matters of the mind and meaning making, to me, requires us to see patients as incompetent or unskillful, rather than whole beings who have agency/autonomy. I care about my patients. I can’t imagine not caring about patients, since I am generally fond of people, but it is a relationship like any other that requires time to naturally develop a deeper sense of care and connection. I have found a degree of frustration in some training/professional development environments in which it is insinuated that I lack care or warmth, because I’m not an overtly kind of saccharine person, which I worry stems in part from this idea of needing to be stereotypically “nice” or “caring” to be “helpful.” I often perceive that, a veneer of nice and helpful, is preferred to authenticity, and perhaps a less obvious but nevertheless genuinely compassionate stance. I have found thus far in this role that patients respond well to challenges to this idea that I should be helpful to them. A part of them might want me to fix their problem or absolve them of something. A part of me may also wish I could as well. I typically light heartedly remind them, and perhaps myself, that I am neither god nor a priest, and I haven’t met many people who truly enjoy being told what to do. I find that folks are receptive to being supported in creatively exploring and developing their own agency when provided a rationale for my reluctance to “help.”
Yes, and…I strongly believe that without an attuned relationship the change can’t happen. The trouble is that we see care typically as warmth and nurture only. Sometimes attunement is playful aggression. Sometimes it is tolerating the feelings of uselessness. Sometimes it is in challenging a patient to consider their position or resistance. I would like to think of all of those positions as care. But I am a big Object Relations and Modern Analysis geek. I know we get criticized as the “touchy feely” therapists. But I think there is solid evidence to support the often intense and brave experience of meeting unmet relational needs.