The Great Therapy Con

Strangely enough, some people take exception to my posts about therapy. A glance at the title of this blog should have told them that one of its purposes is to critique both therapy and the culture it has spawned. Since the therapy culture has largely replaced religion as a source of moral precepts it seems worthwhile that someone somewhere calls it to account.

Very few people are doing so. Thus, I soldier on… despite the criticism.

At times, I critique the so-called advice offered by Ask Polly. At times I express admiration for the advice offered by therapist Lori Gottlieb. At times I write about other advice columnists, like Carolyn Hax, because, they generally offer better advice than therapists.

Anyway, a man recently wrote to therapist Lori Gottlieb. He is engaged to marry a psychiatrist who is apparently undergoing therapy herself. For all I know, she might be undergoing psychoanalysis and might even be training to be an analyst. Naturally, she wants to share all of the goodness with him. Or else, she has become a cult follower and wants him to belong to the cult. This is commonplace among psychoanalysts… though Gottlieb does not seem to recognize it.

The letter writer, calling himself Needs Clarity, is questioning the therapeutic process and perhaps, with any luck, is questioning whether he really wants to marry a woman who is about to join a cult that often feels like scientology for people with triple-digit IQs.

He writes:

My fiancée and I recently started going to couples therapy. It wasn’t my idea, I will admit, but she’s a psychiatrist, so I expected it to happen at some point. She goes to her own therapist at least twice a week, independent of our session. Prior to this, I have never seen a therapist of any kind. Our relationship is good, and while we have the occasional spat, it’s nothing out of the ordinary. She feels we don’t communicate as well as we could, and I don’t disagree. Although therapy wasn’t my idea, I was open to the idea, and I happily get out of bed at the crack of dawn so we can see the doc before work. The benefit so far is that it generally makes her happy that we’re doing it. And therefore, I’m happier.

While I’m finding our sessions to be helpful, I think it’s proving something I’ve long suspected about therapy. That is, it’s a forum for a person (or couple) to just talk out loud. The feedback is minimal, and it comes off as pretty well rehearsed. I like our doctor, but I get the feeling his jokes, patter, and advice aren’t from coming from great insights into how I behave — or how we behave as a couple — and that it’s more or less canned answers and advice.

As long as you understand that this couples therapy is more about recruiting him to the cause than about solving any of their mutual problems, you will be able to understand this. As it happens, he finds therapy to be rather vapid and unprepossessing. He finds that it’s all canned answers, psychobabble and clichés. Now, I ask you, how could anyone take exception? The man has exceptionally good judgment. That should be the end of the story. 

When I read Gottlieb’s response, I feel a deep sense of gratitude. She has succeeded in showing us how therapists con their patients. You know that Oxford biologist and Nobel Laureate Peter Medawar declared psychoanalysis to be a con. And you know that famed Freudian Jacques Lacan called it a scam. Most therapists believe that they have gone beyond Freud, but, thanks to Gottlieb, we see that they are still conning people.

The first part of the con is to convince the man that if he thinks that therapy is a waste of time, that it is stupid and inconsequential… this means that he has a problem. Freudians call it resistance. We note that Gottlieb never really considers that the man might be right. She glosses over the possibility that it mitht be a waste of time. He is being played by his fiancée and the therapist. Now Gottlieb tries to do more of the same:

In order for you to gain more clarity about your therapy experience, NC, it will help you to consider your feelings around being taken care of. How comfortable are you with dependency, vulnerability, and acknowledging the need for help? I wonder if it might be easier for you to assign these traits to someone else (like, say, your fiancée). You minimize your “spats” as “nothing out of the ordinary,” though they’re out-of-the-ordinary enough for your fiancée to notice a communication problem. Even when you agree with her, you do so from a place of remove. Instead of simply saying that you two have difficulty with communication, you tell me that she feels there’s a communication problem, and that you “don’t disagree” (which sounds different from the affirmative, “I think there’s a communication problem” or, simply, “I agree”).

It’s natural to want to feel in control, and it’s also true that some people have early experiences that make being in control not just desirable, but necessary for their very survival. A person who perceives himself to be cool, calm, and collected might protect himself from any underlying emotional stirrings by distancing himself from the need for help, while also devaluing those who see people at their most vulnerable: therapists.

It is not a classical Freudian con, but con it is. The man has been told that he is uncomfortable because he has not gotten in touch with his feminine side… blah, blah, blah.

Gottlieb pays lip service to his concerns and turns them back on him:

It’s possible, of course, that your therapist is a frustrated stand-up comedian, presenting you with “patter” and “jokes” that are “well-rehearsed.” It’s possible that he tosses out “canned answers” and “advice” like candy. I have no way of knowing, NC, if that’s what goes on in your sessions or if you’re distorting the experience by projecting your preexisting beliefs onto him. I do wonder, though, how you came to suspect, before experiencing therapy yourself, that therapy is “just a forum for people to talk out loud.” If that were so, wouldn’t a friend or a wall or a mirror do? And if you truly believed this prior to meeting your fiancée, why did you choose a partner whose work you have so little respect for?

In the second part of the con Gottlieb tells him that he should bring all of these thoughts and feelings to therapy. Thus, she is telling him to get more involved in the treatment. Considering that she has already dismissed his opinions by declaring them symptoms of his own emotional problems, you would have expected nothing less:

If you’re going to therapy to improve communication, why not start now? Share your concerns with your fiancée and ask what her experience of your couples therapy has been like so far. But don’t do this at home. Do this in your next session, in front of the therapist, so that he, too, can hear about your questions and doubts. Tell both of them that you don’t feel paid attention to in these sessions; that you don’t feel truly heard or understood as deeply as you’d like. Share with both of them that you don’t see the value in the therapy you’re getting, other than as a means to make your fiancée happier. Share your impression that you’re getting patter and stock advice.  Ask your fiancée to share with you why couples therapy is making her happier when you’re finding it so empty and superficial. And ask yourself why you wrote “I like our doctor” if you feel like an audience member in a bad comedy show for which you’re paying three figures an hour. Bring all of this into the therapy, and see how both your fiancée and your therapist respond.

Gottlieb believes that the man should learn how to be a better couples therapy patient and thus how to be a better husband. She does not understand that couples therapy counts among the forms of therapy that has been the least successful. But, at least she is doing her part to keep the con going.