The Power (And Risks) Of Therapy On Reality TV

The first time Kelly Mi Li ever tried therapy, she invited the world to watch.   

It was Season 1 of Netflix’s Bling Empire, a reality show that Li stars in and executive produces, and cameras had filmed the BTS of her fraught relationship with then-boyfriend Andrew Gray. “At that time, I was just really kind of desperate to try anything to save the relationship,” Li tells Refinery29, so when production suggested taping a couples therapy session, she agreed. Sliced between storylines about friendly feuds, fertility treatments, photoshoots, and designer outfits, viewers were given a glimpse into one of Li and Gray’s most intimate moments: their sitdown with a psychoanalyst and a conversation that dug into family trauma and issues of abandonment — all in less than three minutes. 

Prior to her time on Bling Empire and her session with Gray, therapy was an “unknown” for Li. “Growing up with Asian culture, therapy or mental health was never discussed,” Li says. “There's this stigma that if you go to therapy, something's ‘wrong’ with you…When in reality, therapy benefits everybody.” This personal unfamiliarity became one of the primary reasons she decided to film her session. “I didn’t know what to expect….there was no clinical boundary, I just trusted the process,” she says. The therapy scene, which was filmed over multiple sessions and several hours, wasn’t enough to keep Li and Gray together, but it did spark a new relationship between Li and mental health — a relationship that is still going strong today.

In general, therapy is meant to be a safe space, a place where we are free to be honest about our deepest feelings and fears, past or present, without judgment. Put plainly: “Therapy sessions are not entertainment,” says Indiana State associate professor Malynnda Johnson, whose research focuses on the intersection between health and pop culture. Filming these scenes on our fave shows raises questions of confidentiality, and in some instances, portrays therapy as a quick and simple solution (trust, while it is extremely worth it, there is nothing simple or quick about cracking your pain open). Yet these scenes, seen on shows from MTV’s Couples Therapy to Bravo’s Vanderpump Rules, Real Housewives, and even Married At First Sight, can also help normalise therapy for viewers off-screen. So, is there a way for therapy to be a meaningful safe session and reality TV gold? The answer, it turns out, is not a simple yes or no. 

Unlike scripted television, reality shows have the particular power of being able to show viewers what therapy entails in a way that feels, well, real. While there are reality shows like My Strange Addiction, LA Shrinks, and Couples Therapy specifically focused on mental health and wellbeing, therapy sessions have also been integrated in programs that are simply about the everyday lives of cast members, like Dr. Kerrie Mohr’s appearances on Summer House. 

“The fact that we're even having reality shows where they're bringing in therapists for a regular show, and not just shows like Intervention and Hoarders, is encouraging because it is giving that opportunity to have that more normalised conversation of, hey, everybody should do this,” Johnson says. Even with editing, Johnson adds that showing therapy sessions on reality TV demonstrates “that it's not someone laying on a couch being psychoanalysed, it's just a conversation between two people with one person giving good questions.” Only in this case, there’s better lighting and a bit more glam. 

Dismantling stereotypes around therapy is one of the main reasons Elizabeth Winkler, a licensed marriage and family therapist, agreed to go on Vanderpump Rules as resident bad boy Jax Taylor’s first therapist, thinking it might help introduce therapy to an entirely new audience. “The gift of being able to witness it on television is that it gives you permission to maybe try it yourself,” she says, adding that given the level of drama and toxicity on these shows, therapy scenes can offer a place to pause and reflect on that behaviour, and consider the underlying cause — for cast members and viewers.  

Nearly everyone I spoke with reiterated the same phrase: everyone can benefit from therapy — and, in a surprising way, reality TV can set that example. “If we're seeing these real characters, engaging in healthy behaviours, then it can be wonderful,” Johnson adds. “The downfall and the scarier part of it is how it’s being portrayed.” Or, what it’s being used for. Because at the end of the day, this is a reality show, meaning that these therapy scenes are often used to drive the storyline forward, such as addressing Li and Gray’s fight from an earlier Bling Empire episode or Taylor’s infidelity and seemingly compulsive lying that drove the plot of VPR Season 1. As Leah Prinzivalli pointed out in The Atlantic, Bethany Frankel’s therapy sessions on Real Housewives of New York were used to soften her image. 

The same can be said for Vanderpump Rules’ Taylor who went to multiple therapists over the seasons, in addition to Winkler, during his time on the show. In many cases, there’s still an element of performance with these on-screen sessions, whether from the star themselves or by virtue of the editing process, which can condense growth and leave out important information. What ended up making the cut — Taylor opening up about his history of lying and cheating while simultaneously lying about his most recent cheating scandal — was not what Winkler considered to be the major breakthroughs. “What the world sees … may not be what really is the full situation. And that is the risk of doing anything on television,” she says. 

This “what you see isn’t always what you get” extends to the people giving out advice, too. Some shows like the Real Housewives franchises are inconsistent with the types of mental health providers they have on, frequently featuring a mix of  therapists as well as life coaches. Other series feature alternative healers, like Taylor’s reiki master in Season 6. Viewers rarely, if ever, really get a sense of someone’s qualifications as they sit opposite our favourite cast member. Winkler herself was credited in Season 1 of VPR as “Dr. Winkler,” when in reality, she doesn’t hold a doctorate. When she flagged it to production, they corrected the issue in future airings, but Winkler says that it’s particularly important for reality shows to accurately identify someone’s credentials for these scenes. “It is a responsibility that benefits the client, the viewers, and the show,” she says. “Most importantly, the client needs to be given that info as a therapeutic process is built on understanding the expertise or limits of their practitioner.”

And of course, there’s the time restraint of it all. Winkler notes that though they shot hours of footage with VPR’s Taylor, as did Li on Bling Empire, mere minutes made the cut. Finding time to unpack generational trauma *and* fit in cheating scandals and feuds means that, often, these therapy sessions — and the painful and extremely personal trauma TV stars unpack in them — are quickly addressed and then wrapped by the next commercial break; but the impact of those conversations can last well after the cameras stop rolling. “You get it on camera, and then you move on. And then you've got this person that's just a raw open wound, says Melody Murray, a former reality TV producer and director turned therapist. “It's so not okay at all. It's dangerous.” After more than 12 years working in reality TV before becoming a therapist, Murray considers therapy on reality TV to be “very necessary,” particularly since the genre takes such a mental toll on contestants.

Looking back, Murray says certain forms of therapy are more suited to TV, such as cognitive behavioural therapy, which focuses on problem solving, because it’s visual and can be implemented quickly, compared to say psychodynamic therapy, which takes a slower, more long-term approach. Great for the person, not for the camera. And, there are certain forms of therapy that cross the line entirely. For instance, several experts I spoke with disagreed with reality shows filming hypnotherapy sessions. This type of therapy, shown in shows like TLC’s I am Jazz and later episodes of Bling Empire, involves individuals being hypnotised, putting them into a more relaxed and calmed state. While health organisations clarify that this form of therapy cannot be used to control a patient (despite what Ben Affleck’s upcoming flick may have us believe), it can make individuals more open to suggestions or behaviour changes — a process that, when filmed, raises a red flag for Johnson. “That is a level of consent that I really strongly question,” she says.

Which is why it’s so refreshing to see some shows handle their stars — and their on-screen mental health — as more than another storyline. In Season 3 of Family Karma, star Vishal Parvani and his partner Richa Sadana allowed cameras into a couples therapy session. Parvani has long been vocal about how much therapy has helped him in the hopes of reducing mental health stigma, and seeing how their experience was handled made it clear that not all therapy scenes are created equal. Some shows do take the need for a safe space more seriously than others. 

Beyond checking credentials, this can mean showcasing a more representative range of therapists. “People need to see themselves reflected in the people that are helping them,” Murray says. The therapist Parvani and Sadana saw in Family Karma was a person of colour, though that wasn’t one of their requirements. (For what it’s worth, the majority of reality TV therapists I’ve seen have been white women.) The couple met with multiple therapists and selected a provider they connected with, rather than relying on production to choose for them. 

“The reason why we connected with her actually was because she didn't want to be filmed. … We really appreciated that fact about her,” Parvani tells Refinery29. Stationary cameras were set up so the therapist was never fully seen, audiences were not given her full name, and there was no crew in the room for the standard one-hour session. “It was handled differently [than other Family Karma scenes],” Sadana says. While the couple discussed amongst themselves what topics they wanted to steer away from in advance, such as details of their sex life, the therapist did bring up the topic during their on-screen session. Sadana was visibly uncomfortable. “Obviously in our sessions afterwards we’re completely open,” she says.  

As someone who is a fan of reality TV of all kinds and has had multiple therapists over several years, in settings ranging from a home office to a more clinical space, I felt like this scene in Family Karma was different, in part, because we weren’t right up in Parvani and Sadana’s faces. The way the session was shot communicated a level of privacy, while still bringing audiences into the room with the stars, toeing the line between therapy for reality TV and therapy for real. Considering this was her first ever therapy session (she tells Refinery29 she was nervous and aware they were being filmed), “I wasn't going to do a therapy session that was just for the show,” Sadana says.

Since their therapy episode first aired, Sadana and Parvani have heard from fans who said their scene helped break the stigma and normalise therapy, particularly among South Asians. And despite some initial trepidations, the Family Karma couple both say they wouldn’t be opposed to follow-up sessions. “I know there’s always risks involved,” Parvani says, but luckily, he says, “it's only been beneficial for us” — and in many ways, their viewers. 

Similarly, after filming her couples therapy scene in Bling Empire, Li received “hundreds if not thousands” of messages from people who said that scene helped encourage them to try therapy. She estimates that more than half of those messages came from Asian women. 

While Li says her scenes on Bling Empire “barely scratched the surface,” the show opened a door to actively work on her mental health. She started asking herself: How can I break my patterns? What can I do to better myself? Questions she is still exploring off camera in individual therapy. While each reality show and cast member is different, she says for her, filming that Season 1 therapy scene on Bling Empire, “changed the course of my life and has helped me tremendously.” 

I guess that’s the thing; therapy scenes on reality TV come with a lot of risk but can deliver meaningful rewards for cast members and viewers alike. And — like some of our fave reality stars — they’re still a work in progress.