Monday, September 30, 2013

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.


Sam L. said...

I don't know how I feel about that, Stuart, but I'm suspecting that I don't care.

Anonymous said...

The famous American psychologist, William James, published a book called The Varieties of Religious Experience. He said a private Saint has two basic capacities: exalted emotional sensibility and a superior intellect.

Does the phrase "The cat's in the cradle" have meaning devoid of the feelings the phrase elicits?

Feelings are information that must be integrated to make improved judgements. They are not to be dispensed with altoghether or life would be meaningless. There would be no "good" or "evil," no ethical philosophy, if humans do not feel first and evaluate the content of thoughts and feelings to arrive at personal judgments. If you are not conscious of how feelings determine your thoughts, then you are unconscious of the fact that feelings are enmeshed with your thoughts and ethical judgments!

Dennis said...

I believe Carl Jung said it best. "The word "Happiness" would lose its meaning if it were not balanced by sadness."
We have a brain where both feelings and logic reside. To remain human we have to have balance with neither one being more important that the other. Any philosophy that place more emphasis on feeling is going to lead to disaster. Remember that most "feelings" are not good.
Balance is a key concept in dealing with almost any human endeavor and that requires an open mind.

Dennis said...

One might consider James' lectures contained in "Pragmatism." He was after all a philosopher as well. I believe he moved to philosophy to better explain his approach to psychology, but it has been a while since I read James.