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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
Let me try an analogy:
Michael Jordan could get more out of coaching for basketball than someone with a lot of challenges.
Regardless of therapy’s Feynman-validity as a science, we may use science to examine the results of therapy, which I would presume optimistically are positive. It gets difficult because controls are challenging, so statistics leap to the fore as a tool to attack the problem. I am becoming more comfortable with statistics (in college I wanted nothing to do with such a contrived “science” in which the answers were all fuzzy), but I am seeing the light these days. The problem is that statistics *as practiced* in much of professional literature these days may well be poorly done.
If anybody would like to know why serious people who really do care about mental health issues have such disdain for what we see, the following may help:
I do not contend that this is common, just that it happens. But what of the thousands of cases in its wake? Whence the horde of eager specialists in “multiple personality disorder”? Frauds, or dupes?
From my practical experience with a very limited sample size, and with no offense meant:
4. A not entirely groundless suspicion that most therapists have no idea what they’re talking about.
5. A not entirely groundless suspicion (with couples therapy) that no matter what the facts on the ground, ultimately it’s the man’s fault and he’s the one that has to change.
I’ll try a little levity here, just so see if there is some common ground. A wise baseball man once clarified Yankee hatred for me. It went something like this ” you say you hate the Yankees. Really? You hate Joe DiMaggio? Mickey Mantel just wasn’t your kind of player? You think Jeter is some SOB and Joe Torre is the antithesis of what the game is meant to be? Really? No, of course not. What you hate is Yankee FANS. People that appropriate, misconstrue, or celebrate as their own the achievements of these men. Which is perfectly reasonable.”
Bryan, I think what a lot of people react to are Therapy Fans (not the people who have posted already about specific negative experiences)- but the journalists, the academics, the bureaucrats, the school administrators- who are very much NOT therapists, but who love to swim in the language of therapy, psychology, treatment, etc without the faintest ideas of the individual in question or the actual process required.
Keep up the good work- based on some of your prior posts I have no doubt you are providing an invaluable service to your patients.
Sure, the Sybil case is just one, right? Sure, we already stipulated that there are bad apples in every field.
But MPD was unassailable. Two generations of psychotherapists bought into this nonsense, and so did two generations of patients. Now we are asked to lay down our critical faculties and accept that some women are men and so forth, and I just don’t buy it. To the man whose only hammer is a therapist, every nail sounds deeply in need of therapy. There can be few examples of a field more prone to self-serving explanations than one which purports to explain and treat the shortcomings of others in terms of profitable intangibles.
I’m not calling anybody dishonest. Just pointing out that the motivations for therapy to see things as other than treatable through therapy are too large to overcome.
I’m not opposed to psychotherapy or even plain old jawbone therapy. But I think it is like the Ritalin gang, a bunch of self-licking ice cream cones.
I don’t know about computer programmer because they are dregs of the earth but most people can benefit from talking to a wise person. Their gift for analyst and knowledge in different areas could give them the tools to get out of their ruts. Of course finding someone who is wise is the problem. The appearance of wisdom is not enough.
Can you cite any example of Hollywood actually being helpful? I think they are entertainers interested only in the bottom line (as is appropriate), not moralists. I just wish the average consumer would recognize that fact and stop taking ‘lessons’ from entertainment.
Of course, wisdom is orthogonal to credentials, so that’s not really illuminating the question.
Interesting take.
I think a lot of what I have seen people responding too in various threads are “fans” of this or that.
28 Days
Not sure about wisdom.
The older I get, the less I know for sure, but the more sure I am of the few things I know.
Bryan’s point about more intelligent, less troubled patients being likely to get more out of each therapy session makes perfect sense.
An intelligent person can follow the psychologist’s explanations and suggestions.
An educated person is probably familiar with the basic concepts and knows how to research after the therapy session.
A kind and patient person can be humble enough to listen fully and to give uncomfortable claims fair consideration.
A generally untroubled person can have the clarity of mind to carefully consider everything.
And a rich person can afford more sessions. ;) Seriously though, affluent people (who earn their wealth) tend to have more self-discipline than welfare babies.
And do their homework!
There’s a good movie called Mumford that basically objects to the need for credentials in psychology.
It should be necessary for therapists to identify their level of training. But we have all known persons with an instinct for understanding and helping people. I think it might still be possible in some states to treat people as an unlicensed therapist, though not as a “psychologist”.
Like in any field, there are different schools of thought (Freudian, behavioral, positive, etc) which are often too stubborn to admit the bits of truth in the others. Psychologists should advertise by school, since each patient will respond more positively to one or another.
I think one of the key issues here is “psychotherapy” is often used casually as a catch-all for general forms of talking with a mental health professional, which does genuinely include whole subfields which are bunk, such as Freudian psychoanalysis
My main issue with therapy today , aside from the very large number of not very competent people in the field is the automatic triggering of therapy or lesser forms (Grief Counselors, the new ambulance chasers of the 21st century) for everyone.
The trade off is individual growth by coping with a difficult situation. We seem to be trying to avoid pain and grief which makes us adults in mentality and maturity.
I lost my father when I was 12. The six months that followed were painful and difficult but I was left alone to deal with it. I ‘grew up in a hurry’ and acquired a competitive maturity that was very beneficial to me.
Today, in similar situations I see an immediate turn to ‘therapists’.
Sometimes the demons inside are meant to be overcome by ourselves. That is part of becoming an adult.
I do allow that some people cannot handle the load alone, but bearing that load is necessary for maturity.
I recently ran into this. Two people asserted what initially appeared to be opposing positions. A third person took a public position in favor of the first person’s position, and in opposition to the position of the second person. The third person was a therapist. Can you imagine the second person trusting the therapist to give a fair judgment?
There are schools of thought regarding psychotherapy. Since the therapist might have a brief for one philosophy of psychotherapy as opposed to another, how does one tell if the therapist thinks the “right” way?
I don’t see the dichotomy. A Therapist helps you manage a situation like the death of a parent, not by avoiding pain, but by growth.
Growth is uncomfortable, even painful. The goal of therapy when there is a traumatic event is to avoid the trauma, not pain. Trauma is much worse than pain.
Donald, I am not sure there is enough information here for me to make sense of it.
If person A votes Democrat, and Person B votes Republican, and the therapist is a Democrat, so what? Politics is not therapy.
I have no problem working with someone of a different faith than I have (or no faith at all). You would with what the person brings.
Though, as I said, I might be totally misunderstanding what you posted
Yes, really. Your analogy is false because therapy isn’t a service delivered to someone; it’s more like a teacher-student relationship.
It should come as no surprise to hear that higher-functioning students get more from a teacher than lower-functioning ones.
A good way to put it. Therapy works better with someone that tends to have healthier relationship because it works out of the relationship. When your therapy relationship is your only healthy one, that makes it harder.
Agreed. Unfortunately, since people no longer go to church, they need to satisfy their psychological urge to receive “lessons” somewhere … so we’re probably stuck with Hollywood as the new moral nurse.
Yuck!
I have extended family members who have been treated for depression. I have also had two children under the care of mental health professionals. My personal experience has made me generally leery of the profession. One of our daughters was diagnosed as depressive at age 7, went to a LCSW for sessions and was put on medication. We were told that anything she said in therapy was privileged and that the therapist could only give us general hints. He was a great guy, BTW, but the situation made us uncomfortable and after a year or so we quit. Recently, a high school daughter was “suicidal” because of something she had written on a notebook along the lines of “my life is wasted, everyone would be better off if I weren’t around.” She had to have several sessions with the school counselor, a very nice lady who my daughter really liked. But while I’m glad the school took things seriously, I think my daughter was just having one of those days (weeks?) when life sucks and you consider checking out. Going to weekly sessions with the counselor just reinforced, for her, that SHE HAD A PROBLEM. Again, nothing stated in the sessions could be divulged to the parents.
Limited experience, admittedly. But these situations happened over 20 years apart and they were so similar that I’d have a hard time sending a kid of mine to therapy.
Reinforcing that going for treatment means “You have a problem” is part of the stigma.
And someone else here was unhappy the therapist shared things with his parents.
Kinda puts therapists in a catch 22, don’t you think?
Bryan, what does the law say about sharing info with the parents? Is the therapist required to share what was said? Forbidden from sharing what was said? Or does each therapist make his own rules?
Well, yes, most professions have their catch 22 moments. And my daughter wasn’t feeling a stigma about seeing the therapist, just wondering why the therapist thought she still needed the help. Is there a point at which the patient feels ok, but the therapist insists more work needs to be done?
Also, what’s the deal with minors? Is it okay to spill to the parents or not? Or is it only up to the therapist?
The laws depend on the treatment. For Substance Abuse treatment, a 13 year old can seek and keep treatment confidential. For Mental Health, the parent/guardian has to be involved.
The parent/guardian is the client as much as the child in the mental health cases or Substance Abuse, so they have a right to the record. However, many child and adolescent therapists tell the parents they will not get all the information shared. (And no records request can get you something not written down). The accepted practice is to only tell the parents general things, or things that put the child in danger. The ethical thing would be to help the child/teen tell his or her parent(s) with the support of the therapist.
To get help, the client has to feel that what she is saying if confidential. No teen is going to really open up if mom and dad are going to hear about it, anymore than a person would if their spouse was going to get to hear it all.
There is some gray area in there that differs by therapist.
Good question, by the way
I agree, that would be a good outcome. However, it has been my observation that few therapists are skilled enough to navigate this and most mediocre ones move to avoiding the pain.
Unlike doctors, or engineers, therapists can get degreed and then practice with little trail of competence to control professional quality.