Is the Gym the Place for Psychotherapy?

I was on the treadmill when the battery for my noise-canceling headphones died. As I took them off and hung them on the railing of the machine, I heard a personal trainer talking with some urgency to the woman walking on the machine next to me. She was in her late forties, more or less, and about forty pounds overweight. He questioned whether she had planned to cancel the training session because she had not lost any weight, and when she nodded in the affirmative, he went on for some minutes, describing her emotional problems and what she should do about them. The noise of the treadmills was not loud enough to block his voice. The trainee, a woman, was a little out of breath which may be why she did not respond to his lecture.

What to do?  “I really should not be hearing this,” I told myself.  As someone who has done weight counseling and clinical research, I know how important it is to protect the privacy of everyone with whom I have contact.  Having a therapeutic conversation with a client would be done in an office, and the information in my notes was protected against an invasion of privacy. And yet, this trainer was conversing in a sufficiently loud voice so that I, and perhaps someone on a nearby machine, could hear what he was saying. Should I have been hearing about her problems with her mother? Did I want to know what she eats when she is upset? I suppose we all would benefit from his advice to take better care of ourselves, but it was not necessary for me to hear that as a bystander.

Combining exercise and talk therapy is certainly a good idea, as it may amplify the benefits of both. Presumably both therapist and client are better off engaging in physical activity; we all sit more than we should.  And as a friend told me, you, the patient, know that your therapist isn’t sleeping while you are talking if you are walking together. Sometimes simply walking side by side with someone who is an empathetic listener makes it easier to talk about problems than sitting face to face. How many of us have taken a walk with a friend or family member to discuss a problem?

But the personal trainer is neither a friend nor a family member, much less a licensed therapist. Yet because his advice was being given in a professional capacity as a paid trainer, it is reasonable to assume it would be taken more seriously than if the advice came from a friend or another gym member on an adjacent treadmill.

It is very tempting to give advice even when it is outside the area of one’s expertise. I go to the gym; shouldn’t I be able to help a weight loss client plan a program of physical activity?  For example, when I see a client for a weight-loss consultation, I ask about the level of physical activity and usually suggest exercise as part of a weight-loss plan. Certainly I should be able to suggest even more: how much weight lifting should be done along with cardiovascular activity.  But I am not a certified personnel trainer and I would never give advice as to the kind of exercise that should be followed, beyond the obvious recommendation to walk. Instead, I recommend a consultation with a personal trainer or physical therapist to make sure that the physical activity is compatible with the client’s health, stamina and age.  Would I take the client to a gym to show her how to use the machines? Of course not.  I do spend time with clients helping them figure out when their schedules will permit them to exercise.  And once I discussed with a client what she could wear in the gym that would flatter her shape. (It is hard to find workout clothes in large sizes.)

However, I have overheard many trainers who have relatively little nutritional expertise giving advice about diets or nutritional supplements; sometimes their information is erroneous or based on little evidence that a particular supplement, for example, is safe and effective.  Too many times, I have been told that a friend is following the latest diet fad because his or her trainer recommended it.

Would we be taking financial advice from our trainer or listening to her about how to decorate our living room, buy a car, or deal with a troublesome teenager? Unlikely.  Would we take marital advice or suggestions on how to deal with an aging parent from the person who helps prepare our income tax?  Probably not. But as I kept glancing at the woman on the treadmill beside me, I wondered why she was allowing her trainer (and not a therapist) tell her how to handle the demands of her mother, or problems with her marriage. (I obviously heard too much.) Was it because she was a captive on the treadmill? Or maybe she believed that someone who is overseeing how your muscles are working is competent to advise her on her emotional state.

The trainer’s advice to exercise faithfully, eat frugally, and give her some time for herself are within the bounds of common sense; they are suggestions that any of us could give and receive.  But if he plans on continuing his gym psychotherapy, let him go through professional training and receive the credentials to do so. And then he should he want provide therapeutic consultations in the gym, go to a place where only the client is listening.

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