By Joe Borders

Marriage and Family Therapist

In Roseville

August 6, 2022

The Rehearsal:
A Therapist’s Dream And Nightmare

***Update on 8/13/22. I feel like I should give a content/trigger warning about this show. Especially to parents. At the time of writing this article I had seen episodes 1,2, and 3. (spoiler the following sentence) The show continually hits on issues that might be really emotional for parents and in episode 4 includes a depiction of a teenager overdosing on opiates.***

Recently, after finishing the most recent seasons of Stranger Things and Star Trek, wife and I found ourselves looking for something to watch at night after we put the kids to bed. We stumbled across this treasure that I need to share with you. Especially if you too are a therapist or mental health professional in any capacity.

The Rehearsal is an ongoing semi-reality tv show found on HBO that currently has 4 episodes released. I say “semi-reality tv” because when I looked up the definition of reality tv, the word “unscripted” was in there, and this show is oddly…scripted and not.

The Rehearsal follows comedian, Nathan Fielder, as he helps people who are struggling with confronting core issues in their lives. The key concept and selling issue of this show is the way he does this. In each episode, Nathan helps a person confront whatever issue is plaguing them by creating extremely elaborate and detailed simulations of the scenarios in question.

In episode one he helps a man build up the courage to disclose to his trivia team mate that he does not have a masters degree after saying he did several years prior out of fear that the team would reject him. To do this, Nathan creates a life size replica of the bar the man plays trivia in with his friends. He recreates the bar down to the smallest details, and then hires an actor to play the friend. The majority of the episode is spent with Nathan coaching the man through different potential scenarios, interruptions, unexpected events, and outcomes, and ends with the feared event taking place.

Episode 2 sees Nathan helping a woman decide if she wants to have a child by creating her ideal homestead and hiring a couple dozen child actors to play her child over several weeks, with a child of a slightly older age being swapped in every day……I can’t capture this one in words here…you’d have to just see it.

Episode 3 continues the rehearsal of the the woman in episode 2, but also includes a rehearsal for a man who’s grandfather recently died. This man was included in his grandfather’s will and has an inheritance that his brother (the executor of the estate) is keeping from him. Much of the episode is spent rehearsing how this man might talk with his brother about this.

I can’t tell you how much I enjoy this show.

There is a piece of me that is amazed and in awe of the incredible extent to which Nathan and his production team go to recreate and simulate scenarios. But there is another piece of me that is occasionally slightly horrified.

I think all of this is probably a normal and expected reaction to this show, but I want to talk about this from the perspective of a therapist. As a therapist, I found myself watching the Rehearsal with my wife and on multiple occasions telling her that some of it resembles the work I do, some of it is stuff I would wish to be able to do in my wildest dreams, and some of it really touches on some of the pains and unique struggles of being a therapist in ways that I’ve not seen captured anywhere else.

Rehearsing

In therapy, we often do various forms of rehearsing, imagining how a situation might go, or role playing to help people sort out their emotions surrounding a situation, work on coping skills, plan out what they can, and accept the things they can’t. I LOVE the aspect of The Rehearsal where Nathan is able to construct elaborate proxies of the scenarios people fear or are stuck on. I would love to do something like this myself as a therapist and I think in an ideal world, this kind of thing could be immensely powerful and helpful to a good number of people.

I can’t tell you how often I get someone in therapy who is afraid of an upcoming event, something they have to do, being honest and open with someone, or just having healthy boundaries. We work through these things in therapy, but having an actual in vivo exposure type of scenario as seen in The Rehearsal would be amazing. At the very least, there is an argument to be made for state dependent learning. We know the brain picks up on small cues like scents, sights, and sounds, and pairs all of those things with memory recall, hormone levels, etc. Rehearsing events like they do in this show could definitely be beneficial to some people.

But!

Worst Case Scenario

There are times in The Rehearsal where the ethics are questionable and they find themselves in difficult places where an interaction could clearly be painful or cause suffering. To date I can’t recall seeing anything where things turned out for the worst in the end, but it can definitely get uncomfortable and you really feel for the subject (I think it’s accurate to call the person the subject in this context?). In episode one for example, the subject spends the whole episode rehearsing coming clean to his friend, but when the time comes you can see him struggle and there is a period of time where, as a therapist, I can see him actually physically trying to disappear, and it hurts my heart.

Everything so far has seemed to work out in the end in these rehearsals, but I question the ethics of all of this. It reminds me of a story I heard on NPR one time: Dark Thoughts. A lot of people don’t know this, but OCD primarily revolves around ruminating thoughts and the presence of compulsions is not required for the diagnosis. Some people call this “pure O OCD”. Many people with OCD fear that having negative thoughts means they’re likely to act on them. In this NPR story, a psychologist specializing in OCD talked about working with a client who was afraid that they would stab someone with a knife because they had imagined it, tagged the thought as negative, tried to suppress it, and then ruminated over it for years. The psychologist gave the client a knife in session and invited the client to attack him with it. The client was then able to see that, given the opportunity to enact their fear, they chose not to, thereby opening a window to regaining a sense of choice, self-efficacy and control.

There is an argument to be had for the benefit and efficacy of approaches like this, but they are definitely not without risk. In therapy we need to be sensitive to our clients’ comfort levels, resiliency, and distress tolerance. Through building a therapeutic relationship we are better able to gauge when we might have gone too far and pull back. I don’t see that happening in this show. There was one time in the first episode where they essentially had the subject play out a version of the worst case scenario, where the actor playing the friend got angry and offended. It again seems like this worked out ok in the end, but I could see that interaction be difficult and damaging for some people.

The Struggle of being a therapist

This is the part I really want to talk about.

There have been a couple of times in the Rehearsal where I have seen Nathan experience things that I myself have experienced many times as a therapist, and these times were touching and meaningful to me in a way that might be different from the way a regular viewer would see them.

To me, as a therapist, one of the best parts about this show is that Nathan provides intermittent narrative of his experience, what he is learning, and how the rehearsals are for him. This gives us some insight into the experience of being a helper and trying to guide someone through their healing process.

Letting Go

An important part of Nathan’s narrative that we’re introduced to again and again is his uncertainty and sometimes confusion. As a therapist, I often struggle with feeling like there is more I can do, something better, more helpful, or more “right”. I think all therapists go through this struggle at some point or another and we all have to work on being able to accept being “good enough”. You can never be the perfect therapist, deliver all the best interventions at exactly the right time, and perfectly mechanically guide your client to success. In many ways, Nathan tries to do this in his show.

Many new therapists struggle with the idea that you can’t save or “fix” your clients. The role of the therapist is much more along the lines of walking with clients, helping them along the way, coaching sometimes, and being there with them when they’re struggling. It’s much more about warmth, connection, and empathy. Nathan often internalizes this inability to “fix” or perfectly solve problems as him failing to fully understand the human condition and an indication that he must do better next time, but I think a big part of the beauty of The Rehearsal is that you can do EVERYTHING to help a person grow and heal, but at the end of the day people don’t work that way.

We all need to grow towards and create our own well-being. People can help, for sure, but no one can make someone “fixed”, healthy, “better”, or self- actualized. In this way, sometimes its hard to be a therapist, to care for your clients, want the best for them, but ultimately have to let go when they leave session and hope for the best till you see them again.

People Leave

There have been a couple of moments in The Rehearsal that have really captured some unique therapist experiences. To avoid spoiling too much, I won’t say exactly when, but at some point one of the subjects no-shows and never comes back. This is a brief moment in the episode, but the way Nathan talks about it was touching.

One day, after making a seemingly significant break through the day before, the subject no-shows. Everyone on staff is waiting for him. Eventually at some point Nathan calls him and he says that he just decided to go to the fair with his girlfriend instead. The subject invites Nathan to join them, but when Nathan gets there the subject’s phone had died, Nathan couldn’t find him, and then he never heard from him again.

This kind of experience happens to therapists all the time. I get really invested in my clients. I truly deeply care about them and wish them well in life. Sometimes we make breakthroughs and they pull away. Sometimes they no-show for reasons that just feel bad. Sometimes they even just go away.

Being open and vulnerable is hard for many of us. It’s really not uncommon for people to just stop coming to therapy, not say anything about it, and just disappear. Over the 10+ years I’ve been doing this I’ve had this happen dozens of times and I’m always left wondering what happened to those people. Where they went, how they’re doing…..It’s a unique experience that I don’t think many other people have in their lives.

Can’t Do It Myself

Another touching moment occurred at the end of episode one. *slight spoiler warning*. After spending the whole episode guiding the subject through confronting his fears and coming clean to his friend, Nathan ends the episode with confronting this same fear and coming clean himself to the subject about something he did earlier in the episode without the subject’s consent/knowledge. Nathan articulates himself fairly well in this interaction and apologizes to the subject. This scene ends with it being revealed that he was talking to an actor he hired to play the subject, not the subject himself.

This was a touching moment for me.

Sometimes as a therapist I help clients through difficulties that I struggle through myself or that I know I would not be able to handle any better than they are. There’s a very unique, specific experience occurring here, where you find yourself lifting someone else up, helping other people, but struggling in some ways yourself at the same time. Sometimes there’s a feeling of almost being left behind…or like you should be working on yourself more, or wish you had the time to, or something along those lines. This has been more palpable and present over the last 3 years with the Covid-19 pandemic. Like never before, I’m almost always struggling with my own stuff in some way while simultaneously helping others with theirs.

Sometimes I see my clients thrive and grow in ways I cannot. At the end of the day this is usually because I’m not ready to confront something, I’m really busy, something crazy is going on in life, or my children and work are taking up all my time. We all have our own lives to live and our own paths. This does not mean that another person’s growth is highlighting your shortcomings.

I feel compersion for my clients: happiness for the happiness of others….and maybe its not even about me….just seeing this scene in The Rehearsal made me feel sad for Nathan….and then sad for myself like I should be thriving to better myself in the ways my clients are…..and I know in some ways I am.

These are the conflicted thoughts and feelings that can come up while watching The Rehearsal. Check it out! :-p

An update on August 13, 2022.

After seeing episodes 4 and 5, the show has continued to be really good, emotional, and complicated. In continuing to view this show from the perspective of a therapist, I am appreciating more and more the way the focus seems to be shifting away from the personal growth of the subjects to Nathan’s personal growth…or that of his character. As with so many other aspects of this show, this hits home as a therapist. I go to work everyday, help people with their issues, but there is always a part of me in the room too. Sometimes there is a part of me working through or touching on my own issues in some of the things I work on with my clients. At the end of the day, I am a wounded healer. I help others, but I also have my own issues, and like everyone else, I’m just trying to figure things out and pursue my own version of happiness.

I’m also struck by how Nathan is so deeply trying to understand the experience of his subjects. This week I found myself talking with my wife about how this is part of the idea behind therapists having their own therapists. True, part of the function of this is for the therapist to process their own issues, but also, its generally understood and expected that having the experience of being a client gives therapists insights into how the experience feels for their clients. The struggles, emotions, awkward interactions, vulnerability, all of it. Sometimes as therapists we get into the role and can forget what its actually like to be on the couch. Sometimes you truly have to walk the walk to talk the talk.

About the Author

Joe Borders is a marriage and family therapist located in Roseville and Sacramento. He is primarily a sex positive gender therapist, but also specializes in working with couples, teens, addiction, and the LGBTQ community. Joe is also the owner and founder of SacWellness. You can find out more about him by visiting his sacwellness listing or by visiting his website: therapy and counseling in Roseville and Sacramento