These days you can't turn on your television without sitting through a pseudo therapy session. From the trendsetter Dr. Phil to Tony Soprano's "shrink", to new series like HBO's "In Treatment," and reality TV series "Intervention" and "Celebrity Rehab," psychotherapy has become home entertainment. However, it is important to discuss how psychotherapy differs from its representation on television.

Although some shows do a reasonable job of portraying the real dynamics of therapy, (albeit slightly more dramatic at times) others can be misleading. As a psychotherapist, my greatest concern is that people are basing their decisions of whether or not to seek treatment on false representations of two critical issues: the prevalence of confrontation, and inappropriate relationships.

For instance, one of the best-known "therapists" in America today, Dr. Phil, claims to simply be offering "life strategies" from his experience as a psychotherapist. While this is technically accurate, many viewers still believe he is conducting actual therapy. They do not remember that in fact, he is creating ratings-generating entertainment based on a dialogue with a "guest" who has chosen to discuss personal issues on a public TV talk show.

Dr. Phil's familiar confrontational style, while popular with fans, is not an accurate reflection of a real therapist/client relationship. In therapy, the psychotherapist must act in the best interest of that client: it is his ethical duty, and that duty guides every interaction. Therapy is often challenging to the client: the psychotherapist seeks to help the client identify patterns of behavior, thinking, and likely the roots of these patterns, and attempts to help them modify them as necessary. Although therapy can be confrontational at times, if the client is not ready to handle that challenge, the therapist will not make it: the client's well-being, and not generating ratings, is always the paramount concern.

Certainly Dr. Phil has gained many viewers with his style, and many clients expect it when they enter therapy. What is harmful, however, are those potential clients who do not enter therapy because they are not willing to be confronted in the manner that they know from television. Confrontation does happen in therapy, but not with the manner or frequency as with Dr. Phil's gimmick.

When HBO's television series "In Treatment" first appeared, many psychotherapists agreed that the show is generally realistic. This is particularly true in portraying therapy, and dealing with issues therapists face. But it raises another popular misconception: that therapists often fall in love with clients. This scenario is unrealistically depicted far too often in the entertainment industry, usually with misleading happy endings. In real life, therapists unequivocally acknowledge that getting emotionally involved with a client is one of, if not the most, severe of ethical violations.

I am told that recently the therapist on "In Treatment" acknowledged his feelings for the client in his supervision session. This would be appropriate in supervision. However, this seasoned therapist asking his supervisor is a relationship is possible after a year or so is again a depiction of romanticizing therapy. Any seasoned psychotherapist is aware that there is never an appropriate time to engage in a romantic relationship outside of therapy with a client, former or not. This is an example of a boundary issue, and psychotherapists are often charged with the goal of helping client's establish appropriate boundaries in their lives.

Psychotherapy has the potential to be a rewarding growth experience. The goals of psychotherapy are personal growth, insight, and a more fulfilling life overall. My hope is that this article helps clarify the difference between psychotherapy in real life versus on reality TV, and dispels some of the misrepresentations created by the entertainment industry. Ideally readers now have more information to enable them to make an educated decision regarding entering therapy.