Is Therapy Dying Out?

Call me prescient.

When I began this blog four and a half years ago I named it “Had Enough Therapy?”

It didn’t make me a lot of friends in the therapy world.

Yet I could see around me that traditional psychotherapy, the kind that peddled insight and understanding had outlived its usefulness. If, indeed, it ever had any.

Patients no longer wanted it. Insurance companies were refusing to pay for it.

It had lost out in free market competition. Patients preferred medication and cognitive-behavioral treatments.

They had also discovered that four hours a week on the treadmill will improve your mood while four hours on the couch would disprove it. Come to think of it, the choice was obvious.

Psychotherapy was losing customers because it did not provide what it was supposed to provide. When a product does not offer value, consumers they look elsewhere.  

So said I in a post four years ago.

By now the therapy profession has caught up. Within limits, of course. It doesn’t really understand why it no longer attracts patients, but it knows that the party is over.

Lori Gottlieb sums it up today in a long article in the New York Times Magazine.

In her words:

What nobody taught me in grad school was that psychotherapy, a practice that had sustained itself for more than a century, is losing its customers. If this came as a shock to me, the American Psychological Association tried to send out warnings in a 2010 paper titled, “Where Has all the Psychotherapy Gone?” According to the author, 30 percent fewer patients received psychological interventions in 2008 than they did 11 years earlier; since the 1990s, managed care has increasingly limited visits and reimbursements for talk therapy but not for drug treatment; and in 2005 alone, pharmaceutical companies spent $4.2 billion on direct-to-consumer advertising and $7.2 billion on promotion to physicians, nearly twice what they spent on research and development.

According to the A.P.A., therapists had to start paying attention to what the marketplace demanded or we risked our livelihoods. It wasn’t long before I learned that an entirely new specialized industry had cropped up: branding consultants for therapists.

So far so good.

Therapists lost out because they have no sense of reality. They are all about image and feeling. Seeing their business crash they have decided that the profession needs to be rebranded. That is, it needs an image make-over.

Since Gottlieb is not a very clear thinker, she spends much of her article explaining that she, as a trained therapist, is not just rebranding herself. She has begun to offer an entirely different service: she has started working as a life coach.

When they know what they are doing, coaches are not doing therapy. They are helping people to solve real problems and real dilemmas in the real world.

When Gottlieb consults with Casey Truffo, a former therapist become branding consultant, she hears this:

“Nobody wants to buy therapy anymore,” Truffo told me. “They want to buy a solution to a problem.” This is something Truffo discovered in her own former private practice of 18 years, during which she saw a shift from people who were unhappy and wanted to understand themselves better to people who would come in “because they wanted someone else or something else to change,” she said. “I’d see fewer and fewer people coming in and saying, ‘I want to change.’ ”

People no longer want the ephemeral change that comes from self-understanding.

Of course, no one asks whether change is change for the better or the worst. 

Gottlieb wants to show us that her six years of graduate training were not for nothing, so she follows the time-honored therapeutically-correct path and blames everyone but herself and her training for the problem.

Why has the marketplace cast such a negative judgment on therapy?

First, therapeutically correct self-awareness encourages patients to withdraw from their lives, the better to transform them into new stories.

It’s better to live your life than to narrate it.

Second, the therapy that Gottlieb spend years learning offers patients little more than a warm bath of empathy.

Since therapy is now a woman’s profession, it teaches aspiring therapists, both male and female, how best to mother their patients.

Many years ago young women therapists claimed they could offer something that male therapists could not: that experience of being mothered with empathy.

It was inevitable that clients would wake up to the fact that you do not need six years of graduate training to learn how to mother or to empathize.

Once patients decided that they would rather solve their problems than share the pain, they decamped from the offices of these mother therapists.

If are now seeking out coaches who will help them to solve their problems, we should applaud, not whine.

Unfortunately, Gottlieb and her team of consultants seem to prefer whining about the current state of affairs.

Significantly, Gottlieb’s fails to acknowledge the importance of cognitive and behavioral therapy.

Since cognitive treatment is notably more effective than empathy baths and emotional insights patients increasingly prefer it.

In much of Gottlieb’s drawn out article she shares her feelings about changing from therapy to coaching. She does not understand that sharing feelings is not very interesting or very useful activity.

Finally, she blames the world because it is not interested in something that she spent six years learning.

In her words:

It’s precisely this double bind in which many of my colleagues and I feel caught. If we give modern consumers the efficiency and convenience they want, we also have to silence our nagging sense that we may be pandering to our patients rather than helping them. Will we do therapy in 140 characters or less, or will we stick to our beliefs but get a second job to put food on the table? It’s one thing to be more than a blank slate and even to focus on finding solutions, but will we throw away so many doctrines of our training that we cease being therapists entirely? The more we continue in this direction of fast-food therapy — something that feels good but isn’t as good for you; something palatable without a lot of substance — the more tempted many of us will be to indulge.

After explaining that her coaching practice has produce more beneficial results than her therapy work Gottlieb begins to flagellate herself for “pandering.”

Inadvertently, Gottlieb tells you all you need to know about why no one wants to do therapy any more. For all of their graduate training therapists cannot even think straight; they are stuck in a world of image and feeling. They whine about reality and fail to develop clear concepts.

Why would anyone pay for such an intellectually inferior product?