The Decline of Therapy

Does psychotherapy have an image problem?

Fewer and fewer people are signing up for therapy these days, so therapists like Brandon Gaudiano are trying to understand why. After all, the new therapies, especially the cognitive-behavioral kinds, have been shown empirically to produce good outcomes. When it comes to depression and anxiety they are at least as effective as medication. Why has the message not gotten out?

It sounds like a plausible premise until Gaudiano tells us that not many therapists are using these new and effective techniques:

But psychotherapy’s problems come as much from within as from without. Many therapists are contributing to the problem by failing to recognize and use evidence-based psychotherapies (and by sometimes proffering patently outlandish ideas). There has been a disappointing reluctance among psychotherapists to make the hard choices about which therapies are effective and which — like some old-fashioned Freudian therapies — should be abandoned.

Why limit ourselves to Freudian therapies? How many therapists are involved in touchy-feely work, teaching empathy and asking how it feels to feel as you feel?

Face it, if the word feeling suddenly vanished from the language more than half the nation’s therapists would be struck dumb.

I am confident that there are more feeling-based therapists than there are cognitive-behavioral therapists.

Therapy has been around for quite some time now. Psychoanalysis did lead the way but it has now been eclipsed by other forms of therapy. Unfortunately, most of the new therapies are more fluff than substance. They seem to derive less from scientific research than from a caring instinct.

Also, many therapists spend a lot of time handing out bad advice. I am, of course, not against counselors who give advice. Unfortunately, most therapy programs do not teach anyone in doing it well so most therapists, especially the young and inexperienced do it poorly.

Nary a day passes when you do not have the chance to see a therapist handing out insights on television. Some are real therapists; some are the fictional equivalent.

Would anyone’s experience of watching these people persuade him to undergo therapy? How many of these TV stars are doling out anything more than shopworn platitudes and psychobabble? How often has anyone watched one of these therapists and come away thinking that the therapist might really understand or help me with my problems?

By saying that it’s just an image problem Gaudiano ignores the fact that many people have had a direct experience of therapy. If they have abandoned therapy they might be making a rational judgment based on their own personal experience.

When Gaudiano says that the problem is image he is disrespecting the population that has simply had enough therapy.

If therapy is declining as a profession perhaps it just the market’s way of saying that therapists have not been doing a very good job. You are not going to spend money to see someone who essentially is trying to mother you. If that’s what you want you can get it for free from someone who is probably better at it.

To avoid misunderstanding, the tendency to mother patients is not limited to female therapists. Male therapists also indulge this unfortunate habit. As might be expected it isn’t something that you want to witness first hand.

It’s true that cognitive-behavioral therapies, among others, provide a clear benefit for many patients. But, then again, so do aerobic exercise and yoga. More and more people have come to recognize their value.They cost less than therapy and you do not have to listen to someone say:

“How did that make you feel?”

By now, I suspect that many prospective therapy patients would pay good money not to have to hear that again.