Episode 375: Anxiety About Nose Job & Privacy In Telehealth Therapy

Hello friends!

In today’s insightful episode, we tackle two profound listener questions that delve into personal struggles and the complexities of therapy in the modern world.

Our first discussion revolves around a listener’s internal conflict about undergoing a nose job. They share their long-standing desire for this procedure, influenced by cultural norms and compounded by severe anxiety. We explore the importance of understanding the underlying reasons for wanting cosmetic surgery, the impact of cultural pressures, and strategies for managing anxiety related to such a significant decision.

The second question opens a window into the world of telehealth therapy and the challenges of maintaining privacy in less traditional settings. A listener shares their experience of feeling uneasy about the lack of privacy during their online therapy sessions. This concern leads us to discuss the crucial aspects of privacy in therapy, the legal and clinical implications, and the importance of addressing and resolving such concerns with your therapist.

As always, you can send me questions at duffthepsych@gmail.com and find the full show notes for this episode at http://duffthepsych.com/episode375.

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Question 1:

Hello, Firstly, I want to say that I love your podcast and it has helped me a lot.

And also I would like to talk about my problem with indecisiveness about getting a nose job. I have severe anxiety and i’m currently in therapy. I was born in a country where basically anyone gets a nose job, and I also wanted to get one from when I was a teenager. Meanwhile, I overthink so much that I cancelled my surgery 3 times, but I really cannot get over this idea. I really don’t know how to decide on this matter. I am scared that I may turn out ugly or something.


The listener’s background is important here. They come from a culture where nose jobs are common, a fact that undoubtedly plays a role in their desire for the procedure. However, it’s crucial to understand that cultural norms vary greatly, and my perspective, shaped by a different cultural background, might not fully grasp the nuances of their experience.

Their long-standing desire for a nose job isn’t an impulsive whim; it’s a deeply rooted wish. This distinction is vital, especially when comparing such a permanent and significant change to something like an impulsive tattoo, which, despite its permanence, doesn’t carry the same weight or potential for regret.

While some might argue against the need for cosmetic surgery, emphasizing the importance of self-acceptance, I believe the decision lies solely with the individual. If this is a change you’ve consistently wanted and can afford, then it’s your right to pursue it. However, understanding the “why” behind this decision is crucial. Is it purely about aesthetics, or is there an underlying issue with self-esteem or self-concept? If it’s the latter, a cosmetic procedure might not address the deeper issue.

Anxiety complicates this decision. It can magnify fears and doubts, especially when the stakes are high, as they are with cosmetic surgery. A certain level of anxiety is natural and even beneficial, pushing you to thoroughly research and choose the right surgeon. But when anxiety starts to override reason and preparation, it becomes a barrier.

Having a support system is essential. Trusted loved ones or advisors can provide perspective and help identify any potential blind spots in your decision-making. Taking time to make this decision is not only wise but also indicates a thoughtful approach to a life-changing choice.

Regarding the anxiety component, since you’re already in therapy, additional strategies might help. An accountability partner can provide support and gentle encouragement. Exposure to the procedure, through visiting the facility or watching informative videos, can help familiarize you with the process and reduce anxiety. Visualization techniques, imagining a positive outcome and its impact on your life, can also be beneficial.

Remember, it’s okay to feel anxious. Once the procedure starts, the anxiety will fade, and the decision will be in motion. It’s about managing your anxiety and continuing to work towards your goal, even if the path there is challenging.

In summary, if the desire for a nose job is a true reflection of your wishes and not solely a result of cultural pressure, focus on managing the anxiety around it. Use the tools at your disposal, lean on your support system, and trust in the preparation you’ve done. Your journey to making this decision is as important as the decision itself. Best of luck!

Question 2:

Hi Duff! I have been listening a few years and you have really helped me. I was in a bad place for a while; bad marriage, a child who was transitioning due to gender dysphoria, etc. I started therapy again because I was leaning on my kids and others who had their own problems and I didn’t want to cause more problems for them.

So my question is this: I was doing zoom appointments with my therapist at the time. She was working from a “we work” type of space that was not very private. This became apparent to me when I heard a big group of people talking while we having our appointment. She said there was a coffee shop in this space. I wanted to continue with our session so I didn’t mention it at that time. I thought a lot about this and how it bothered me that my session didn’t seem to be private. I decided to confront her about this. In the next session I said I wanted to discuss this outside of our therapy session. I asked her to tell me more about the situation (maybe I misunderstood something) Her response was “how did you feel when you asked me about this?” I felt this was a deflection designed to take away any responsibility on her part that she had done something wrong. I was using a company that assigns therapists so I was able to get someone new that I really like. Problem solved except I was never able to get any validation that my confronting her about the situation and her response was not valid. New therapist was understanding about the privacy part but did not address that I tried to address the issue and the therapist turned it into part of my therapy and nothing to do with her. It isn’t a huge deal because I solved my own problem.

This has been a year ago. I know you are looking for new questions so I thought I would throw this one in there to possibly get an answer to something that has bothered me. Thank you so much for your help. Your podcast has been very helpful.


The listener’s concern about the lack of privacy during their therapy session in a co-working space is completely valid. Privacy is a cornerstone of therapy, both for clinical effectiveness and legal compliance. When sharing deeply personal experiences, a secure and private environment is essential. This is where online therapy, while convenient, can present challenges. The listener’s discomfort upon hearing background noise during their session is understandable, as it can disrupt the therapeutic process and raise concerns about confidentiality.

The response of the therapist to the listener’s concern, however, seems to have missed the mark. When the listener courageously confronted the issue, hoping for clarity or reassurance, the therapist’s response felt more like a deflection, a common frustration in therapeutic relationships. A more effective approach would have been to acknowledge and validate the listener’s concern first, and then, if appropriate, explore the emotional impact of bringing up such an issue.

In my practice, I prioritize my clients’ privacy and comfort, ensuring a conducive environment for open communication. If conducting therapy from a home office or a co-working space, it’s crucial to manage background noise and maintain confidentiality. Clients should never hesitate to address any concerns about privacy or the therapy setting.

The listener’s decision to switch therapists demonstrates self-advocacy and a commitment to their mental well-being. It’s important for both therapists and clients to engage in open dialogue about the therapeutic environment, especially in the context of telehealth. As therapists, we should be responsive to our clients’ needs and preferences, ensuring they feel heard and respected.

For those attending telehealth sessions, consider the privacy of your own environment as well. If you’re joining from a less private space like your workplace, discuss this with your therapist to find the best approach for your sessions. It’s all about creating a space where deep, meaningful work can be done without the fear of being overheard or interrupted.

Thank you for sharing this experience. It highlights an important aspect of modern therapy in the age of telehealth and serves as a reminder of the importance of privacy and open communication in therapeutic relationships. Keep taking care of yourself, and know that it’s always okay to advocate for your needs in therapy.

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