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The Value of Psychotherapy
I’ve noticed that some people on Ricochet harbor a suspicion of psychotherapy (which I will call therapy hereafter). The issues seem to fall into three categories:
- Therapy is bunk;
- Therapy is part of the leftist movement;
- Therapy is only for people who are “sick.”
1. I cannot really address item 1, and it seems to be rarely expressed anyway. If someone thinks therapy is all bunk, no study I link too, nor argument I make, is going to change his or her mind. Still, this has come up recently with therapists called charlatans who prey on the sick and confused. Also, I have seen more than once the implication that we keep people ill so they will keep coming to see us and pay us money. I will say this: Every therapist I know would love to live in a world that did not need therapist.
2. Many therapists are democrats. It stands to reason, as more therapists are women than men, and women are more likely to be democrats. Further, the whole “I care for people” message tends to attract touchy-feel types, who, let’s face it, like the liberal-lefty language of caring and feelings.
And therapists, as a whole, are a whole lot more accepting of peoples “alternative” lifestyles. We make a point of meeting people where they are to help them without judging them, whether that be because they sleep with the same sex or they killed 16 people. (There are therapist who work in prisons).
Of course, what therapists are doing is looking at human beings as unique individuals, each with their own rights and responsibilities. And despite what you think, most therapists are not trying to get criminals off with excuses, get people out of jail on technicalities, or blessing “bad” behavior. As therapists, our goals are to help people live the fullest, most productive, satisfying lives they can lead. What that is varies from person to person.
Now, if you want to say that is a leftist message, you can. But that is like saying all expressions of patriotism come from the right. While the left seems to have made flag-waving a GOP province, I don’t think we should just concede therapy to the left.
Besides, there are lots of conservative therapists. Like me. Y’all know me. I am to the right of Attila the Hun on foreign policy. There are more like me.
3. The idea that therapy is only for the sick is the most important criticism. But therapy is not just for people who are “crazy” or “insane.” Anyone can benefit from talking to a counselor or therapist. All of us have our “pockets of crazy,” as a colleague of mine says. None of us are as rational as we would like to think. There is always something we could work on to live more actualized lives. Now, most people do okay without it, but we all could do better with it. It is like a massage: Most of us don’t need them, but man, do they help.
Mental illness in general gets a bad rap. It has a high stigma. People look at someone who’s depressed and say, “Just snap out of it.” As it were easy. There are arguments over the use of medications. Certainly, Hollywood doesn’t help, either with its portrayal of illness or therapists.
Still, anyone can benefit from a therapist. In fact, higher-functioning people get more out of it. There are more skills they can learn and more techniques they can work with. You have to have the right fit, of course. Not every therapist is for everyone. If you try one and he or she doesn’t fit, seek out another. That not all therapists are created equal is no different from any other profession.
I’d be happy to answer any specific questions people have.
Published in General
It’s alright, Bryan. At least you’re not a lawyer.
I think you’ve left off one on your list of objections. That is what I would call a conflict of worldviews or a conflict of models of human nature. Psychotherapy was seen as an intruder into the proper territory of dealing with the human soul (psyche), which was religion.
Also, the popular depiction of psychotherapy is still often psychoanalysis, and I think that turns a lot of people away, without realizing that psychology developed a better and better clinical track record the more it moved away from Freud.
You might straighten out the difference between the titles and levels of licensing etc between “psychotherapist” “psychologist” “psychiatrist” and “psychoanalyst”.
Good suggestions.
I am not sure it would make that much of a difference lol.
I would not wish this job on anyone. People are complex and truly believe some “strange” things. From their perspective it is rational. Some of us have wise friends who are our therapists . It does bother me that there can be an over reliance on drugs to reduce symptoms. They can be powerful but must be used wisely.
Good luck with your work, Bryan!
It’s worth a try. Back to my first comment, one of the things about lawyers is that most lawyers don’t like and respect most lawyers. They have their friends and some direct colleagues whom they respect, but many others? The same is true of management consultants. Sure, there are some good ones. And then there are a whole lot who are the blind leading the blind or outright con men.
Is it that way among psychologists and psychiatrists? Or is there generally mutual respect in the profession? If mutual respect, at least you aren’t a lawyer or management consultant.
My experience as a therapist is that we tend to respect one another, much like doctors or nurses. Always a bad apple or two, of course, but for the most part we respect the professional.
Thanks.
For the people we work with, the meds are much needed.
I’ve seen it from both sides. I was the “identified patient” in my family from age 5, and didn’t find out until I was 15 that it wasn’t me. I thank from the bottom of my heart the psychiatrist who sat down with me and explained why it wasn’t me. Made me decide to be a therapist when I grew up. Got undergrad degree in Psychology, MA in Counseling. Never used it. It turned out that I was really bad at it! The professional associations of mental-health professionals are the worst kind of libs today, but we know here at Ricochet that there are individual therapists who are not. Kudos to them.
Totally agree. Bryan, I semi-applaud the effort, but I think you are arguing with straw-men, here, as with your other post.
I hope I did not give the impression that meds were not needed.
How often do people come off the meds? I hear it is dangerous at times when people seem to be doing better so stop their meds on their own. It is not as simple as all that.
Ryan M, I disagree. I don’t think he is arguing as just trying to clarify. There is a difference. At least he is not a lawyer. ;-)
Sigh.
People stop taking meds when they feel better. Just like with hypertension.
If you have one major depressive episode, your chance of a 2nd is 50%. If you have 2, your chance of a 3rd is around 70%. If you have 3, your chance of a 4th is over 90%.
Therefore, if you have a 2nd episode, keep taking the meds. Each episode is an injury to the brain.
Most of our clients end up in the hospital because they stopped taking their meds. Like 80% of the time.
I’d call it moving the goalposts.
Now that is saying I am acting in bad faith. I thought you said in the other thread you liked me.
Clearly, you fall into the people in group 1: Therapy is Bunk.
I cannot change your mind, because it is made up.
No, I didn’t mean that as a jab quite as you’re taking it, Bryan. I should’ve made it a longer sentence. I’m saying the same thing I said in the other thread about straw men. I don’t think, by any stretch of the imagination, that you’re acting in bad faith. Sorry for coming across so rudely, as that is not my intent.
Bryan, How do you know therapy is working? As a patient? As a therapist? What are the measures or benchmarks, if you will? Do you ever “fire” a patient because you feel you’re not a good match?
Have you ever listened to Dennis Prager when he talks with Dr. Steven Marmer of the UCLA faculty? What do you think of Marmer’s assertion that, eventually, a good therapist explains the role the patient plays in his own misery?
I’ve had some experience with my kiddos and I’ve felt most satisfied with the help provided by a social worker, whose approach was very practical, using tools both to assess personality traits and to help develop coping strategies for OCD, for instance. I’ve had less luck with talk therapy and psycho-pharmacology (not that it didn’t alleviate symptoms, but the side-effects were … undesirable).
Also, a clarification on my own position, here. I have no problem with “therapy.” I disagree with particular worldviews, and I think the profession of psychiatry tends toward overmedication. That is worlds different from being “anti-therapy.”
I think people in general trend towards over-medication. Everyone wants something easy to make the problems go away. I would probably be that way, if it weren’t for the fact that every time I try some new medication, it’s a game of Russian roulette. I don’t think it is just psychiatry that has that problem.
I have been one of those who has voiced a distrust of therapy and I don’t think my reason was listed.
Like any other profession, I don’t think many are all that good. And they have a lot of power to do a lot of harm. As a consumer, if one is in the market for therapy, one should shop long and hard. But it appears to me once the patient feels validated (your husband is the problem, your mother is the problem, it’s all chemical, here’s a prescription …) the shopping stops.
Parents I know are rattling off acronyms of whatever their kid is suffering from, and cramming drugs into their kids. As my husband says: ever notice no one has a kid who’s just an (expletive) any more?
And I have had friends pushing anti-depressants on me with more enthusiasm than peers pushing cocaine in the 80s.
And is a prescription now automatic during a time of grief?
I’ve gone to well over a dozen therapists over the past couple of decades. Results have been mixed; I’d say I cured roughly a third of them.
My take is that therapy is a guided reflection on oneself, and therefore can be beneficial to just about everyone. However — and this is a huge however — there are two problems. The first is that the most therapists aren’t all that good. As in all professions, you have good and bad, but certain professions (teachers, lawyers, therapists) skew pretty heavily bad. The second problem is that compatibility is key, so even if you find an otherwise good therapist, they might not be able to help much. I’d guess I’ve met with close to 20 therapists. A handful of them were awful, most were so so, one was good, and another was very good. It’s really hit and miss, so while there are some real benefits to be had, I’m not sure it’s worth the money and the bother unless you have no other options.
Admirable Evasions: How Psychology Undermines Morality by Theodore Dalrymple
Psychotherapy and the Pursuit of Happiness Ronald W. Dworkin
Psychology and psychiatry are respectable professions. But the fields have acquired bad reputations for the reasons already mentioned: overuse, ideological corruption, and bad science. In that way, they are no different than medical fields in general.
It’s not all the fault of practicioners. Many patients have unrealistic expectations. Media and other cheerleaders have exaggerated the field’s precision and its applicability.
Also, psychology has arguably suffered from the inordinate influence of licensing organizations like the APA. Consensus should not be required.
A person can be both a good psychologist and a good Christian. But there has indeed been a trend for centuries of misguided people wishing to supplant religion with the sciences even in the handling of personal and social issues. Psychologists have indeed moved into roles historically performed by priests, pastors, rabbis… and even friends and neighbors.
Has the rise in prominence of psychology changed how our society perceives the roles of friendship and family?
First, kudos to Bryan, excellent post!
Second,
Unfortunately, the latest diagnostic manual has excluded grief as a rule out for major depression. This means that many people who are grieving can appear to meet criteria for major depression now.
Another reason that people often receive prescriptions “for grief” is that they are seeing a medical doctor–not a therapist, psychologist or psychiatrist. But, rather their PCP, or other specialist. Medication is the easiest tool these MDs have. Yes, they could provide referrals, but often that is not what patients want. Also, if a patient reports sadness or something that could be construed as depression, quality standards require that it be documented and addressed.
When I did therapy in private practice, I tried to educate clients on the nature of therapy and change. One of the ways I did this was talking about agreeing to three sessions, that gave us time to get to know each other’s style, clearly define the problem and set-up a treatment plan…in some cases, change could also occur. Then, if things weren’t working we could move on, no harm, no foul. The most common responses I received were:
1. This might take more than three sessions?!
2. I just needed someone to listen.
However, what generally happened is that people realize there is a cost to the situation that prompted them to seek therapy, but realizing the costs associated with change was not something they had realized–even when they change was what they wanted and a wise decision.
The most poignant examples were when I worked with patients before and after gastric bypass surgery. Often some of the most successful patients wound up losing long-time family and friend relationships, despite accomplishing what all these people had begged them to do-lose weight and get healthy. Costs on both sides of the equation.
*I should note, I didn’t deal with serious mental illness, more depression/anx and medical problems.
The reputation of psychiatry also suffers due to its inevitable limitations.
My extended family is full of nuts. Bipolar, depression, schizophrenic, OCD, sociopath… we’ve got it all. Some rely on lifelong medication. When their treatments began, a variety of medicines were tried with often disastrous effects.
The sad reality is that body chemistry and personalities (which affect chemical balances through factors like stress and motivation) vary too much between individuals for any medication to be suitable for all. And it is not yet possible to identify how each individual patient will respond to each medicine or psychotherapeutic treatment.
Even if it was possible, will the patient exercise and eat well to maintain his or her current chemistry? Will some surprise experience cause unexpected stress to the body?
When I was diagnosed many years ago with Asperger’s, comorbid with depression and other issues, the psychiatrist was straight with me. He said he could prescribe me something which might help but also might send me into psychosis. Thankfully, I was only there for the diagnosis.
Thanks, Brian. You make several good points.
I think that the apparent hostility toward therapy in a number of Ricochet posts has more to do with the context, which lately has been SSM and transgender issues. As I understand it, the therapy “establishment” did a politically-motivated about-face on the homosexuality question in the 1970s. Earlier, homosexuality had been classified as some type of mental disorder. That opinion was reversed, and my impression is that now the “establishment” considers it inappropriate to treat homosexuality, even if the individual wants treatment.
That looks like a political decision, and it also looks as if it were based not on science, but on ideology. I don’t think that psychology or psychiatry has much, if anything, to contribute to the question of morality. Don’t take that the wrong way — I don’t think that the law or medicine has much to contribute, either. Moral issues are a different question.
For my part, I have the strong impression that the therapy “establishment” has taken a moral stand on the Leftist side on the issues of homosexuality and transgenderism. Maybe I’m wrong on this. But I think that it is the source of much of the distrust that you perceive.
PscyhLynn: regarding #26.
While that makes sense, I am talking about people being offered meds without a request even being made. I am not talking about people who lose a loved one, have trouble dealing with life and seek help months later.
I am talking about people who lose a loved one and are automatically handed a prescription. I have seen it happen several times here in the states, Canada and Britain.
(I am NO expert, just sharing my observations) A prescription seemed to blunt the grief and help them get through the initial shock. But in a couple of cases years later the wound is still open. Makes me wonder if that initial grief has to be suffered to get through to the other side.
That made me laugh out loud. The old joke about psychology majors was that they just wanted to find out what was wrong with them.