This article examines the therapeutic possibilities of the emerging genre of reality television therapy (RTVT) – a term I have proposed to describe commercial programming that features therapeutic interventions with members of the public who have applied (or in some cases have been invited) to participate.

These programmes, which include shows such as Dr Phil, Celebrity Rehab, Hoarders, The Biggest Loser USA, Losing it with Jillian, Intervention, Supernanny, call in coaches and therapists to address issues ranging from relationship problems and parenting issues to addiction, obesity and compulsive hoarding. They are watched by millions of viewers worldwide. Yet little if any research has been conducted on their therapeutic value for their audiences.

RTVT has been critiqued within the academic disciplines of media studies, cultural studies and sociology, yet the focus tends to be on the genre’s failure to consider the wider social and economic context of therapeutic issues (a critique also levelled at therapy generally). The counselling world has given comparatively little consideration to the genre, except perhaps to wonder at the ethical conundrums it seems to present. But does RTVT make therapy more accessible to more people and, crucially, is watching these programmes a therapeutic experience for audiences?

Therapy as TV show

The emergence, in the late 20th century, of self-help as a billion dollar industry coincided with a cultural and political shift in perceptions of state provision of welfare in the US and UK, from benevolent to bureaucratic, authoritarian and likely to foster dependency.1

Alongside, the deregulation of television, the introduction of satellite and cable technologies created more channels and more airtime to fill. Lifestyle and reality TV programming can be relatively cheap to produce.2–4 As viewers became ‘customers’ in the emerging TV programming ‘market’, this ‘market model’ became central to lifestyle television where, as Palmer argues, ‘the idea that one can create oneself from a supply of commodities is fundamental’.5

Ouellette and Hay4 propose that RTVT helps to produce self-managing and ultimately self-caring individuals who fit better with the demands of advanced consumer capitalism. However, the genre takes us beyond simple self-help: audiences seem drawn by the chance to gain insight into the closed world of therapy and the lives of therapy clients, traditionally hidden from public view. RTVT might even be indicative of TV viewers’ desire that programme makers go beyond merely documenting to actually helping – a kind of commercially viable altruism.

What happens in RTVT therapy?

Palmer5 notes that TV self-help gurus such as Dr Phil and Paul McKenna tend to use less ‘time intensive’, more ‘media friendly’ CBT style models of therapy. This appears to reflect wider trends in public awareness and therapy provision. Conservative MPs have praised in Parliament the CBT methods used in the reality TV show Supernanny;6 CBT has become the talking therapy most commonly offered by NHS IAPT services (although CBT practitioners might argue that some RTVT shows present a superficial version of the model).

However RTVT shows also draw on a wider range of therapeutic techniques. Celebrity Rehab, for instance, (as its name explains) follows a group of celebrities through an addiction rehabilitation programme. While the show reflects the medical understanding of addiction, it adopts the Alcoholics Anonymous model of peer support where former-addicts become the counsellors, and the daily process group, often more associated with person-centred approaches. Similarly, alongside the confrontational and CBT-based sports coaching interventions, shows such as The Biggest Loser USA also use therapist self-disclosure and techniques such as self-acceptance, releasing anger, writing letters and making photo scrapbooks. In the weight loss show Losing it with Jillian, personal trainer Jillian Michaels takes a holistic approach, acknowledging some social issues, helping clients to work through relationship problems and unresolved emotional issues, giving contestants money to resolve financial difficulties as well as addressing diet and exercise habits.

The appeal of reality TV

Mearns argues: ‘… counselling is probably only seen as a relevant possibility by about 10 per cent of troubled people. We need to be... actively exploring creative models for taking the profession to the other 90 per cent.’7

Considered in relation to RTVT, this statement raises the issue of the genre’s potential to widen access to therapy: to offer a kind of therapy for the masses where the medium of television preserves a sense of the intimacy of a more personal relationship with the on-screen helper. Aslama and Pantti8 argue that, although reflective of increased cultural acceptance of emotional expression, RTVT is indicative of a wider trend towards the ‘commodification’ or ‘McDonaldisation of emotion’, evident not only in TV lifestyle programmes, film and drama but also in advertising, news media and wider corporate and political culture. However, in their feminist analysis, they also acknowledge the ‘visibility of the ordinary’ in the genre and the valuing of emotional expression and personal experience in contrast to ‘the patriarchal enlightenment ethos and authority power of television’.

Despite the commercial nature of RTVT, it potentially normalises discussion of emotions and offers viewers access to therapeutic ideas in their own home. Programme websites often allow viewers to create their own action plans and in this way RTVT may make therapy more accessible, by cutting out the long waiting lists for NHS treatment or having to pay for expensive private therapy.

RTVT may also reach more isolated or socially excluded groups who would not normally engage with therapy services. RTVT audiences may be more active participants, as viewers may make their own, more subversive readings of shows, questioning or rejecting ideas presented and potentially mitigating the therapist’s power or influence. Ultimately, the TV viewer is perhaps not as invested in the therapy as a paying client or someone who has been on a long waiting list for treatment, and the viewer can, after all, simply switch off the TV if the therapy isn’t right for them. RTVT may further offer viewers practical strategies to overcome some of the social inequalities and barriers to health and social mobility that they face.

Is watching RTVT therapeutic?

So how might RTVT work as a therapeutic experience for audiences? RTVT shows use the conventions of TV filming and editing to create emotional drama and intensity, such as cutting between speakers, close ups on eye movements and facial expressions, editing out less emotionally charged material, self-disclosing monologues and use of music to heighten emotion. Aristotle9 identified catharsis as a process of emotional purging experienced by the audiences of Greek tragedies. RTVT programmes almost invariably seem to follow the stages of therapy recognised by both Rogers10 and Snyder:11 an initial stage of catharsis (through emotional disclosure, often via monologues to camera); a phase of insight (provided by both the helper and participant), followed by ‘positive choice and action’10 as we watch the participant embark on a change process.

The viewer may identify with participants and feel they have shared in their emotional journey. They may experience emotions associated with the therapeutic process, or tap into or release emotions around their own issues, as in group therapy where significant issues can be prompted by others, raising clients’ self-awareness and offering ‘...the invaluable healing factor of simply knowing that you are not alone with your issue’.12

In another de-mystifying convention of the RTVT genre, the on-screen helper engages in periodic confessional monologues to camera, discussing their own concerns, frustrations and feelings in relation to the participant and offering unique insights into the therapist’s experience that are usually confined to the privacy of the therapist-supervisor relationship.

Bohart and Tallman13 propose that ‘all therapy is ultimately self-help and it is the client who is the therapist’, highlighting that self-help has proven to be as helpful as contact with a therapist and can suit some clients better.14–18 They argue that ‘ultimately clients must manufacture solutions from their own experience...’ and that therapists need to be ‘open to any unique solution that might fit the client’s life space’.13 RTVT may be a therapeutic avenue available to the client within their own ‘life space’.

Rogers19 identified that a common healing element of all therapy is an accepting, genuine and empathetic therapeutic relationship. This raises the question: can RTVT provide an adequate substitute for the therapeutic relationship? This is difficult to answer without extensive audience research, but viewers may feel as if they are in a helping relationship with the RTVT show therapist; they may engage with others through website support forums or watch as a communal activity with peers or family, which may replicate some of the therapeutic elements of the helping relationship or group therapy.

Ethical issues and limitations

It is important to acknowledge that watching RTVT may be an inadequate substitute for working directly with a qualified therapist. The genre also presents ethical challenges. It is potentially exploitative of participants – they sign away their rights to confidentially at a time when they may be vulnerable or unable to afford services. There is a degree of potential commercial exploitation of audiences – the programmes are funded not only by overt advertising during commercial breaks but also often by more covert techniques such as branding and product placement within programmes, as the shows’ ‘experts’ recommend products and even promote their own brands and associated products. Other ethical issues echo those raised by ‘the Gloria tapes’ in which Rogers, Perls and Ellis were filmed conducting therapy with a real client to produce a training video for counsellors. West20 questions whether Gloria could really have given ‘informed consent’: could she have been fully aware of the extent to which the tapes would be viewed and how that would feel or affect her life? Similarly, alongside the ubiquity of television repeats, the expansion of the world-wide web gives anyone around the world access to footage of RTVT shows; do we know the full effects of this on participants? Indeed, a common criticism of the RTVT genre has been its ‘hit and run’ effect: participants are encouraged to visit deep emotional places but may then be left without follow-up or aftercare. (Although programme makers have responded with more follow-up support for participants.)

Despite these ethical challenges, RTVT shows may demystify therapy and destigmatise issues such as addiction, compulsive hoarding and obesity through sympathetic portrayal. Even where the shows present issues as pathological, they often link them to traumatic life events, eg accidents, bereavements or abusive experiences. Diamond,21 in his discussion of Celebrity Rehab, comments: ‘… part of what makes such programming so compelling is our compassion for the suffering souls we see struggling literally for their lives. And our... identification with their struggle... These “reality” shows are, at their best, indeed about learning to confront rather than retreat from reality’.21

McMurria22 notes that, while RTVT’s ‘commercially sponsored... corporate benevolence’ can mask underpinning social inequalities, the ‘fan chat’ is ‘filled with empathy’. Similarly Feasey6 sees both socially conservative and progressive possibilities for the show Supernanny, noting its use of surveillance techniques to ‘berate’ beleaguered working-class mothers but pointing to its valuable ‘educational possibilities’.

Implications for practice

While further research is needed, there are many possible implications for practice. Clients may come to therapy because RTVT has de-stigmatised both the idea of therapy and the issues they wish to discuss. RTVT may shape client expectations and increase familiarity with the language and conventions of therapy. The client may have already undertaken therapeutic ‘work on the self’ using RTVT as self-help and the therapist may need to work with the individual’s self-therapy routines. RTVT could become a springboard for therapeutic dialogue. In combination with face-to-face therapy, RTVT may enhance or accelerate the therapeutic process or cause the client to question the therapist or therapeutic approach. If working alongside RTVT, therapists may need to consider the ethical challenges inherent within the genre. Non-directive counsellors may need to consider tensions between the genre’s more directive approach and their own. Critiques of the RTVT phenomenon highlight the need for counsellors to be aware of socio-economic and cultural inequalities and to be willing to engage with these issues within guidelines for anti-oppressive practice.

Jenny Hamilton has recently completed an MA in Humanistic Counselling and currently works as a counsellor in private practice and at a women’s charity in Leicester. 


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