The Difference Between a Therapist and a Friend

"Apart from payment, what is the difference between a therapist and a friend?"

This question came up in a conversation recently. In some respects, a therapist feels rather like a paid friend who has some training. Friends listen to your problems, they offer advice, etc. And if you include making lunch or buying a few beers as a sort of payment, then even the money difference seems not to be particularly germane.

Of course there are a few good answers to the question, depending on context. One answer is that there are legal implications to being a therapist that don't really apply to friends. If you tell a friend your troubles and decide to bone afterward, there's no risk of your friend losing his license. Or at least, there shouldn't be.

The answer we settled on, for our purposes, is that you don't need your friends to be right, but you do need your therapist to be right, or at least to be moving generally in the correct direction. They have a responsibility to do so, in fact.

Friends really only need to be there for you. They are supportive and encouraging, hopefully, but sometimes the advice they give is lousy. That's fine, whatever. I've had close friends give me what was actually pretty bad advice, and I am still close friends with those people. They have lots of other good traits to recommend them. Hiding bodies or such.

Unlike a friend, a therapist's job is to help you work through your problems, if not to fix them then at least to manage them. When a therapist accepts your money, they are accepting responsibility for helping you, i.e. providing actual help. They don't need to come up with all the answers or fix every problem, but they need to be able to move toward real solutions.

This distinction does a few things. For some people, it reminds them to take friendly advice with a grain or two of salt. For example, when I sometimes grumble about friction with my family back in the old town, the guy who hasn't spoken with his mother for 10 years sometimes chimes in about how to deal with the situation. And I listen, but I don't exactly give his advice a lot of weight.

The distinction also reminds us that we, as friends, are not therapists. We can try to help our friends figure out their troubles, just like we can try to help them find the answer to legal questions, or identify the noise coming from the engine of their car. But there is, for most of us, a serious gap between our abilities, and the abilities of a trained psychologist, lawyer, or car mechanic. We ignore that gap at our peril, and at the peril of our friends.(1)

Finally, the distinction reminds us that therapists have a very real responsibility. And this may sound harsh, but if you're seeing someone who's not doing their job, see someone else. William Styron, in his book Darkness Visible, talks about seeing someone who had been trained at Yale and who came very highly recommended. Based on those recommendations, and the name "Yale," Styron continued to see him in spite of serious misgivings. The results were less than positive, and Styron is pretty candid about the fact that he'd have been better off firing the guy.

Granted, it can sometimes be hard to tell the difference between moving slowly toward a solution because it's difficult, versus someone who is just not really competent. That's fine. But I know more than one person, including teenaged me, who had a session with a trained professional who was at the very least a bad fit. Don't be afraid to say "This here is a really bad fit. I can find someone else."

My own story may be helpful. As a teen, I was the unpopular kid at school, with all the attendant unhappiness. My parents wanted to help however they could, and decided that maybe having someone professional for me to see would be a good idea.

The first lady I talked with asked me a pile of questions. One of the questions she asked was whether I heard voices. Even then, I had a pretty robust internal dialogue, so I said yes. That's just how I understood the question, at the age of 14 or whatever.

She promptly recommended to my parents that I go on a course of anti-psychotic medications. That would have been very bad. Thankfully my parents knew it, and they demurred, both with respect to the medication and to her continued services.

The second lady I talked with also asked a pile of questions, but I don't recall anything about voices. Afterward, she told my parents basically that there was nothing really wrong with their son. That I was reacting the way healthy kids react to really unhappy environments, which is to be really unhappy. She said she could be an outlet for some of that unhappiness, to give me some tools to help deal better with the situation, and to let my parents know if anything seemed to get really bad all of a sudden. And that approach was a pretty good way to go.

Notes:

(1) I'm leaving aside the question of whether you would want a good friend who is also a trained psychologist, attorney, or car mechanic to do their respective work for you. In order I would say no, no, and it depends how expensive the car is.