You Don't Need Therapy

The bloom seems to have come off the therapy mystique. Now that Abigail Shrier’s new book, Bad Therapy, has been riding the top of the Amazon best seller list, other therapists are stepping forth to explain that therapy is not all that it is knocked up to be.

Considering that I have been beating on this particular drum for well over ten years, I am happy to welcome Shrier and the other therapists who have now discovered that encouraging people to have therapy is something of a con.

Now, Illinois therapist Emily Edlynn explains when you do and do not need therapy. From the pages of the Washington Post:

Psychological suffering can signal a time for reflection and change, but it does not always require therapy. There are many resources that can help alleviate stress, anxiety and loneliness without turning to the limited resource of a therapist.

She is, however, overly optimistic about what therapy can and cannot do. 

Therapy is a science-backed treatment addressing mental health symptoms that cause significant problems in daily functioning. For instance, mindfulness-based stress reduction for anxiety or cognitive processing therapy for post-traumatic stress disorder. 

Sessions focus on setting goals for change, developing and practicing skills that improve psychological health, and an ongoing evaluation of progress toward goals and continued treatment needs.

Saying that therapy is science-based is simply wrong. Mindfulness meditation comes to us from religion, as do 12 Step programs. Most therapy involves psychodrama. Therapists want you to understand that you are living out a family drama. They want to teach you to play your role better, and with more feeling. Beginning with Freud, therapy comes to us from the theatre.

Some cognitive therapy has a scientific basis, but Edlynn’s notion, which is commonplace in the therapy world, that treatment involves developing relationship rapport, is not science:

Therapy involves developing trust and rapport because the therapist-patient relationship is proven as the most essential predictor of positive change. 

Of course, the therapeutic rapport is largely one-sided. As Edlynn points out, therapists do not share personal details but expect their patients to overshare. In truth, it is difficult to develop relationship rapport when one person is exposing himself and the other does not reciprocate.

Edlynn suggests that you need therapy when you cease to function effectively in your everyday life. True enough,  For some reason she does not mention that medication can often be an essential part of therapy or its adjunct. 

She suggests that therapists can help people who cannot manage their symptoms:

People need therapy when their mental health symptoms are causing serious impairments in their daily functioning — in close relationships, work performance, sleep or social activities. For instance, if a person’s work stress overwhelms them to the point that they miss work and are subsequently at risk of losing their job.

Among the new techniques that people use to get a handle on their lives-- is coaching. Considering that I stopped doing psychoanalytic therapy and replaced it with coaching several years ago, I find this to be persuasive. 

Edlynn explains it clearly:

Consider a coach who specializes in the area where you want to make change, such as your career or parenting. Therapists can coach, but coaches don’t need to be therapists. There are important differences between coaching and therapy.

Coaching is not about insight and awareness. It evaluates the game, teaches the rules, identifies the players and considers any one of a number of possible moves. The patient is not sick, literally or metaphorically. Through coaching the patient learns how better to play the game.

Coaching, like improving your skills at playing a game, is not about the drama. Life is not theatre, the past is not playing itself out in the present, like a bad play.  

And your life does not follow a script. Even if your therapist teaches you to emote, therapy will still make you a character in a play, following a script.

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