Good and Bad Therapy

It feels like vindication. Or better, you take your vindication where you can get it.

The topic is therapy, the ostensible subject of my blog. For more than a decade and a half I have been writing about the uses and abuses of therapy.

I have expressed some serious doubts about psychoanalysis, a therapy I practiced for many years, but have not spared other forms of therapy-- from assertiveness training to self-esteem boosting to recollecting past traumas. I have generally praised cognitive and behavioral treatments, even though they are not widely available.

My efforts notwithstanding, therapy has become ubiquitous in America. It is not unfair to call ours a therapy culture.

Thus, I wholeheartedly praise journalist Steve Salerno’s long Quillette piece about the bad and the good of therapy. Much of the time therapy provides only scant benefit, but more often, even when it does work, as Salerno’s analysis makes clear, the results are often less than salutary.

As long as therapy infests the culture, defines our cultural values and shows us how to conduct our relationships, we are within our rights to judge its effectiveness by the state of the culture at large. On that score, things do not look very good.

Salerno writes:

Just as clearly, though, in a more prophylactic sense, the ubiquity of therapy hasn’t exactly made America an emotional Canaan. Suicides continue to spike. Illicit drug use is a national emergency. Self-reported anxiety and depression are at an all-time high. As is social polarization. Even the divorce rate, after decades of moderating, is ticking mildly back up again.

Jaundiced perceptions aside, therapy’s role in modern life is no joke. America is a nation increasingly surrendering itself to the therapist’s couch. Forty-one million American adults sought therapy in 2020–21 alone, which was peak-COVID. 

Nevertheless, that figure reflects a therapy juggernaut not out of line with trends before or since. Nearly a quarter of America has been in therapy in the past 12 months, according to Gallup polling. It is nigh impossible to consume any form of media without being bombarded with PSAs that herd people into overcrowded therapy waiting rooms the way Japan’s oshiya herd people into jam-packed subway cars.

So, examine therapies that supposedly work. Salerno addresses the question of self-expression treatment, where patients are encouraged to let loose, to express their feelings… openly, honestly and shamelessly.

He quotes an article from Aeon:

A clear example is “cathartic interventions” that promise relief by directing people to express difficult emotions in a purge-like manner, such as punching pillows when angry and yelling as loudly as possible when distressed. Such practices ... lend themselves to the rising popularity of “smash rooms” in which people pay to “therapeutically” destroy items such as televisions and toasters with a hammer. ... [C]opious research indicates that, as a means of dealing with difficult emotions, these approaches have the opposite of the intended therapeutic effect, actually increasing anger and distress. Simply put, teaching people to punch when angered leads to more anger and punching.

Someone might have noticed that encouraging people to throw tantrums requires therapists to validate anti-social infantile behavior. 

Moreover, if your therapist wants you to understand the bad things that you suffered in the past, he is giving you the impression that those traumas and misfortunes define who you are. Try ridding yourself of them then.

As Linden also explains, a psychotherapist “starts asking you how you feel about your mother and your father and your spouse, and so on and so forth. And just by talking about all the negative events which you experienced in your life ... you get the feeling your life has been possibly a whole mess.” And while group therapy has been hailed for its ability to provide patients with the comfort of knowing they’re not alone in their struggles, patients who hear a room full of similar complaints may grow overwhelmed and demoralized. “There is a kind of infection risk,” according to Linden.

In addition, many therapists swear by the effectiveness of assertiveness training, aka, leaning in. Again, if a patient learns how to do it and applies it to his life outside of the therapist’s office he will quickly lose friends and alienate people:

In the 1990s, when assertiveness training was all the rage, a joke circulated about how you could tell if total strangers were alumni of such programs. They were the ones in restaurants who demanded a different table from the one the hostess selected and then sent back their food at least once. The training “worked” for them in tight focus—but how the people in their orbit felt about it was another matter. Graduates of such training were bracketed as rude, difficult, demanding, opinionated, and aggressive.

It should be fairly obvious that therapists who fetishize feelings have nothing to say when patients rationalize their emotional incontinence by saying: That’s how I really feel.

Besides, therapy tends to want patients to liberate themselves from social constraints, from repressive rules and responsibilities. The result, a rash of broken homes:

So, suppose both your aging wife and rote engineering job are part and parcel of those “recurring patterns that keep you tethered to behaviors that no longer serve you in the present moment,” and you “remove” them  in order to move to Sedona to paint still life with lizards. Your children thus become the collateral damage of your epiphanies. Linden’s book Risks and Side Effects of Psychotherapy describes patients who became so focused on unburdening themselves of blocks that they began to struggle with “coping at work and at home.” They did indeed separate from partners, resign from jobs and/or break off contact with family and friends.

The contemporary trend to see life as an ideological struggle against patriarchy, white supremacy and bigotry has made its way into therapists’ offices. Such therapists insist that their patients are suffering from societal ills and that they need to become politically active, the better to join the vanguard of the revolution:

The most eyebrow-raising trend in modern counseling might be termed ideological therapy, wherein social justice bleeds into psychology (as it seems to bleed into everything these days). Members of this counseling camp vow to help members of this or that identity group cope with racism, sexism, or other grievance-based identitarian concerns. This, of course, presupposes that society is patriarchal, racist, and/or otherwise riven, and that the need for change resides structurally in society and not in the mind of the patient.

Consider this post a brief excursion through Salerno’s article. You can do yourself a big favor by reading the whole thing.

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