Fellow Daisy Alpert Florin on when therapy scenes work in a novel, and why they often don’t—yet are still invaluable to the writing process.

In an early draft of Sheena Cook’s novel, A Tender Hate, Scottish detective Iris Larkin is ordered to go to therapy when her personal issues threaten her ability to do her job. If therapy was a way for Iris to work out her issues, it was also a way for Sheena to discover what those issues were.

“I was trying to work out on the page the secrets Iris wasn’t telling anybody, the secrets I didn’t even know,” Sheena, a BookEnds fellow, said.

There were seven therapy scenes in the draft Sheena submitted to her mentor, Meg Wolitzer, at the end of 2018. At Meg’s suggestion, she cut them down to three. But when the book went on submission, one editor suggested cutting the scenes altogether.

“She told me the scenes did not move the plot forward,” Sheena said. “It was a surprise, and I was sad to take them out.”

When I heard Sheena’s story, I was well into a revision of my own novel, which included scenes where my main character, Isabel, goes to therapy in the aftermath of a sexual assault. At the time, I considered whether or not to cut the scenes but, in the end, decided to keep them.

The scenes remained in my draft throughout my BookEnds year and were still there when the book went on submission. It was only when my editor, Caroline Zancan at Henry Holt, did a close edit that she suggested I remove the scenes. 

“I think you needed to write those scenes to get insight into Isabel’s character and motivations,” Caroline wrote, “but you don’t need to spell out those motivations so neatly for us.”

Like Sheena, I was surprised, but when I looked closely at the scenes, I could see the novel didn’t need them. Aside from a few exchanges, which I reassigned to other characters, I scrapped the scenes entirely.

All of which got me thinking: do scenes of therapy in novels ever work? 

“Therapists work well in fiction when they are used to move the action along,” said Sandra Leong, a BookEnds fellow and practicing psychotherapist. “They work less well as a form of exposition about a character.”

Therapy is central to the plot of BookEnds fellow Jennifer Solheim’s novel Interstitial, about a rock band on the rise. When Nate, the band’s lead singer, passes out on stage during a performance, he goes to therapy to understand what is happening to him. His therapist, Kathleen, is a former musician and working with Nate brings up issues for her about her lost music career. Therapy works in Interstitial because it is crucial to the central question of the novel: it defines Kathleen as a person after she leaves music. She plays a pivotal role in the band’s story, but—as Sandra explained as crucial to the role of therapists in novels—she also has a fully developed storyline of her own.

Therapy can also work in fiction if it leads to an explosive revelation that causes change in the novel. In Pat Conroy’s 1986 bestseller The Prince of Tides, for example, what is revealed in therapy is a secret so dark and long buried, it clarifies what has happened to the characters up to that point.

But, Leong points out, those kinds of breakthroughs are rare in therapy and can feel contrived in fiction. “More often than not, therapy is a slow drip of information,” she said.

While sending your character to therapy can be a useful exercise, those scenes don’t always need to appear in the final work. When considering whether or not to use therapy in a piece of fiction, Caroline says it’s important to distinguish what you as the writer need to know about your character and what needs to be on the page.

“The things that often come up in therapy,” she said, “are often more powerful as the subtext rather than the text of the novel. It’s important for you to know these things, but let us see them at work in the characters’ actions and interactions.”

In the end, Sheena removed the therapy scenes from her novel, keeping only the most essential points, which she lets Iris muse on throughout the novel. But even though the scenes didn’t stay, she doesn’t regret writing them. 

“I learned so much about Iris by writing those scenes,” she said. “And besides, I love eavesdropping on other people’s secrets.”

Daisy Alpert Florin was a BookEnds fellow in 2019-2020. Her novel My Last Innocent Year will be published by Holt in 2023.