For Hoarders and Addicts, Drama is Trauma — Not Therapy

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Good drama relies on conflict and confrontation — but that is not true of good therapy. In fact, if you are trying to change human behavior, kindness, empathy and support are far more effective than tough love and quick fixes.

Unfortunately, this means that the “psychotherapies” that get spotlighted on reality TV shows that aim to change people’s disordered behavior — the extensive clutter clear-outs in Hoarders, the theatrical interventions on Intervention, the rough detoxes in Celebrity Rehab — are often counterproductive and can even be harmful. This week, with the premiere of a new season of Hoarders, it’s worth remembering that reality and reality TV are not the same.

As TIME’s Kayla Webley put it recently in “Hoarders Purge With Help From Community Groups“:

[H]oarding experts say that quick forced cleanouts often do more harm than good to the resident’s mental state. Effective treatment for hoarding takes a year on average, says Gail Steketee, a hoarding expert and the dean of Boston University’s School of Social Work.

The same is true in terms of addiction. Leading expert William Miller, emeritus professor of psychology at the University of New Mexico, summarized the available data this way: the more the counselor confronts, the more the client drinks (or takes other drugs).

Attacking people and tearing away their defenses abruptly is harmful for numerous reasons. First, people engage in compulsive behaviors like hoarding and addiction because they are suffering. So increasing their pain will consequently support further compulsion. Second, most people don’t like to be told what to do: putting them in a humiliating “one down” position is likely to provoke rebellion. Finally, like Grandma said, you simply attract more flies with honey than with vinegar. Sadly, being nice makes boring TV.

The bottom line is that TV shows don’t spotlight the most effective treatments. Rather, they publicize the most dramatic. What doesn’t appear on TV is the sometimes disastrous aftermath of get-tough interventions — such as the risk of suicide. Most notoriously, Nirvana frontman and drug addict Kurt Cobain committed suicide days after an intervention.

When it comes to mental health, drama is not what you want.

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