The Politics of Therapy

Obviously, this story is too good to miss. At least, for this blog, it is. One Katie Heaney has quit therapy. Nothing strange or bizarre about that. Her reasoning draws our attention: she is quitting therapy because therapy has failed her. OK, she doesn’t quite put it in those terms-- because she is a good person-- but she finds that therapy is tedious, monotonous and incapable of dealing with the real problems-- which are political and social and biomedical.

She writing this in New York Magazine, and if, perchance, her therapist practices according to the principles adumbrated by that magazine’s highly challenged advice columnist, Dear Polly, she has taught Heaney to feel her feelings, to learn why she feels or does not feel her feelings and to express her feelings.

Without indulging too many theoretical contortions, you will notice that the approach involves introspection, looking within, blocking out the external world and wallowing in self-pity. 

Why anyone would ever imagine that that might be therapeutic is beyond me.

It also means that her therapist, to her discredit, has no ability to discuss anything that is going on in the real world, in the world outside the muck and mire of personal feelings. It is one thing not to know how to solve the world’s problems. It is quite another to be incapable of discussing them-- as an objective reality. 

Haven’t cognitive therapists explained in intricate detail that depression comes about from feelings of helplessness-- as though we cannot do anything to influence the state of the world or even our current condition.

Strange to say, in a culture where women are empowered to make their marks in the workplace and the marketplace, where they are more than ever involved in business and the professions, therapy does not help them to make their way in the world. It distracts them from reality and invites them to withdraw into the snug cocoons of their feelings.

I would also mention the work of an Israeli social worker, by name of Moshe Farchi. Working with the Israeli Defense Forces Farchi developed a new way to treat trauma. When a traumatized individual feels totally hopeless when dealing with the pain of a trauma, the solution is-- ruffles and flourishes-- to do something. It does not need to be large. It does not need to be grandiose. But a trauma victim who learns to function in the world, to undertake real world responsibilities, to perform real world actions is more likely to be able to exit the traumatic haze than someone who hunkers down with the thought that there is nothing he can do.

And if your therapist says that you should get in touch with your feelings, she-- in this case-- is feeding your depression because she is telling you that there is nothing you can do.

Feeling and doing are not the same thing.

And yet, Heaney’s therapist seems not to have known anything about these ways to treat depression. But, you will notice that Heaney does not blame her therapist. She defends her therapist by blaming the world. I emphasize the fact that she does not have the minimal gumption to hold her therapist accountable. After all, there are good and bad therapists. Some therapists fail. To ignore the fact is a moral failing-- one that would lead a patient to blame herself or the world or the stars.

Heaney opens thusly:

Last month, I quit therapy. I had been seeing my therapist for a year: in person for the first six months and then remotely. I found it harder to connect over Skype (I was always too aware of the clock), and the longer I kept it up, the more futile my weekly sessions seemed. In my normal life, I had enough to say to a therapist to fill an hour a week, no problem. Now, it’s just the same thing over and over: The world is falling apart, and I am depressed.

As it happens, Heaney is still employed. She is writing for New York Magazine. Nothing about her description of her current destitute state says that she cannot function as a contributing member of society. Besides, as she says, she is now living with family and saving money. Isn't thrift a sign of good character?

Two months into the pandemic, my wife lost her job, and two months after that, we moved cross-country to live temporarily with family to save money and try to figure out what the hell to do next. I don’t know how to articulate the way I’ve felt virtually every day since mid-March, but I assume you understand because you’ve felt it too. It’s bad. It sucks. I am acutely anxious and depressed all the time, and to me it seems there is very little I can do about it. I know what you’re thinking: I sound like I need therapy.

She goes on to describe her therapy. Frankly-- and we always want to be frank-- we ought to ask ourselves why her therapist-- presumably a credentialed professional-- could not steer the conversation in more productive directions. And could not help her to situate herself in the real world.

As you will see, she does not blame her therapist-- though she should-- and she doesn’t blame herself-- though she might. She blames the world. Nothing is quite so useless as railing against the world:

Therapy has helped me when I have felt ambiently bad without totally understanding why, or when I have known there’s something I need to do but can’t bring myself to do it. Throughout the months I kept seeing my therapist — because it was, I thought, the smart, self-protective thing to do — I heard myself as a broken record: I’m bored, I’m lonely, I’m cynical. But because I know the reasons (respectively: I’m doing the same thing every day, I’m seeing only two people, the government keeps proving it doesn’t care about us), my therapist couldn’t offer me much in the way of insight. I don’t think this is her fault, and I don’t think it’s mine. Our problems are just too big, and too external.

Since she seems to want to make herself feel bad, she conjures the single counselor who believes that therapy works. If therapy really works and if it does not work for her, the fault lies with-- the world. Seriously?

If he were talking about cognitive treatments, I would happily agree. Since he seems to be talking about all talk therapy, his is obviously an outlying view. No one really believes that any more:

Bruce Wampold, an emeritus professor of counseling psychology at the University of Wisconsin—Madison, has studied the impact and efficacy of psychotherapy throughout his career and wants to emphasize that, generally speaking, psychotherapy works. 

What impresses about those who defend therapy is their gross incapacity to accept that therapy can fail. They are masters at rationalization-- a skill that, frankly speaking, is positively useless when navigating real life situations.

Consider England, says Wampold. “England has put billions of pounds into making psychological treatments accessible, but the rates of depression in England are going up,” he says. “That doesn’t mean that the treatment isn’t effective, but psychotherapy isn’t meant to address ills of society.” Unemployment, poverty, discrimination, and social isolation all cause massive distress, and therapy can’t fix any of them. Stronger social services, better-paying jobs, and rigorous anti-racist policies would address these issues more directly, but these things are much more expensive, time consuming, and community oriented than individual therapy. These are also things a second stimulus relief package might address, but our elected representatives have dragged their heels for months, rushing instead to confirm a Supreme Court justice before the election.

It’s all the fault of our politicians, especially our Republican politicians. This becomes a screed against Republicans. It suggests that once we elect Democrats the world and everyone’s mental health will magically improve. Someone ought to explain that these people are so in touch with their inner children that they are acting like children who cannot accept not having got their way. 

In truth, those who live their lives for politics, who are incapable of taking any responsibility for their situations, who blame it all on a certain president, are suffering abject misery. Think about it. They would feel so much better if we had elected that incompetent fraud named Hillary Clinton. And we would feel so much better-- we have it on the authority of Tom Friedman-- if our current president could sing Amazing Grace, as our last president did. Doesn't this really mean that Tom Friedman should retire?

You remember our last president, someone who spent twenty years singing Amazing Grace in the church of a notable bigot named Rev. Jeremiah Wright, a bigot who hated white people, who hated America and who hated Jews. And who, by the way was a close friend and associate of Rev. Louis Farrakhan.

So, the armies of the left are raising havoc on America’s streets. They are burning and looting and pillaging and even murdering. And we are supposed to think that it is all the fault of the current president, but not of those who are committing the crime. Nor of those like Jeremiah Wright whose rhetoric incites to riot.

I suspect that more than a few people are so discombobulated by the Trump presidency, so detached from their rational faculties, that more than a few non-Democrats will vote for the Democrat-- in order to cure the mental distress of their fellow citizens-- the ones who could not accept the results of a fair election. 

In short, Heaney is making the case for Biden. She is exhorting her readers to heal her by voting for Democrats. Otherwise, she will stay depressed, and we do not want her to stay depressed. It’s an election tactic like another.