Tuesday, September 16, 2008

The Case Against Traditional Psychotherapy

Research finds that psychotherapy helps more patients than it hurts, but I'm skeptical of that because:
  • Those studies are often biased because they're almost always conducted by psychology PhDs.  Consciously or unconsciously, they want to show that psychotherapy works; otherwise it invalidates all their years of training and work in their field. 
  • Not all therapy is alike. The major metaevaluations lump-together traditional psychotherapy that focuses on the childhood roots of one's unhappiness with the more effective cognitive-behavioral therapy, which corrects the irrational beliefs that keep a person stuck.
Most of my skepticism about traditional psychotherapy comes from having been career coach to and acquaintances of so many people who have spent months or even years exploring their childhood with a therapist. I've found that:
  • Traditional psychotherapy too often keeps people stuck in their past. I've found, again and again, that all that analysis of their childhood actually makes people more inert: analysis paralysis.  They seem less able to move forward than equally troubled people who have not been in therapy.  One former therapy junkie told me, "Therapy gives you insight into yourself, but your life is no better."
My guess is that spending a lot of time examining one's bad past strengthens the brain's neural pathways associated with those negative thoughts. That makes those thoughts top-of-mind and thus continue to drag a person down. 
I've found that people are more likely to have career and life success if, when a negative thought from their past intrudes, to simply say to themselves, "Stop! What baby step I can take right now to improve my life."
Therapists who advocate delving into your childhood argue that the above advice is simplistic. They'd say, "Before you can move forward,  you need to understand where the fears and anxiety originated."  But I'm convinced that, for the reason stated above, most people would be wise to simply push themselves harder to take action than to undergo childhood-analyzing psychotherapy. And doing that has none of these side effects:
  • Psychotherapy too often discourages self-efficacy. Many therapists who see clients for more than a few sessions consciously or unconsciously make patients feel dependent on them. That's the opposite of what therapy should be doing: building self-efficacy.
  • Psychotherapy too often encourages narcissism. I've noticed that many clients and friends who have had extensive psychotherapy are self-absorbed in conversation and less likely to care for others.  The word narcissistic comes to mind.
  • The cost.  
I do think that brief cognitive-behavioral therapy is often worth it, but before trying that, make all efforts to push yourself forward and if that won't work, journal about it: For example, ask yourself: What's the pros and cons of taking that baby step? If the worst occurred, am I better or worse for having tried? Usually, low-risk baby steps are, indeed, worth it.


Grace said...

Therapy can be of benefit when you have some more serious mental health issues or traumatic events in your life (past or present) that need to be addressed.

But if you are just going through a difficult time, find a mentor. Ask someone that you know and respect - someone who is successful in the area you are struggling in - and ask if they would meet with you over the next 3-6 months to discuss your specific issues. Sometimes I think that therapy is effective just because it gets us to look at our issues on a regular basis, allowing us to maintain momentum. You can meet regularly with a mentor. Just be sure to set boundaries (make each visit no more than one hour in duration) to discourage meddling or dependency.

If you don't know anyone who fits the bill, ask people in your church or service organization, or ask people you know for referrals.

Another suggestion:
Find a respectable self-help book in your "growing area" and start a book club with friends. Encourage one another along the journey. Sometimes, just knowing that you will be held accountable by someone else is all you need to keep moving.

You can also do what I do - develop supportive, brutally-honest relationships with loving friends. Whatever you do, be open to the fact that you probably need to change in some area. So many people look to therapy to validate their own feelings and justify their own behaviours, and when they are challenged on it, they change therapists.

Marty Nemko said...

Another good post, Grace.

I agree that for people who have a serious mental illness or can't get past a trauma by forcing themselves into action, journaling, or talking with a good friend, cognitive-behavioral therapy may be helpful.

My strongest caution is against traditional psychotherapy that involves looking to the childhood roots of one's malaise, especially if it takes more than a few sessions.

Grace said...

My caution regarding therapy stems from a time years ago when my husband and I tried going for counselling. When the therapist kept trying to draw the focus back to the fact that my mother was sick a lot when I was a child and that I must have resented it, well,... we were not in therapy for long. (By the way, I had a very happy childhood.)

Another thing about therapy is that the therapist only works with what you tell him/her. Many people don't tell or understand the whole story and so the therapist's guidance may not be based on reality. But you can't get a lot of B.S. past a good friend.

Dave said...


I would put more stock into marriage counseling. I think pre-marital counseling is also an excellent idea. Unfortunately, most couples think they don't need it. There are times when couples need someone to push the right buttons.


Anonymous said...

Marty makes excellent points describing the weaknesses of traditional therapy and the strengths of cognitive-behavior therapy (CBT).

To add to the latter, a good CBT therapist teaches you how to be your own therapist. No need to rely on expensive, time-consuming therapy sessions for years.

In my own CBT practice, the average duration of therapy involves 8-10 sessions. If you doubt this, I will offer you a ten-session, money-back guarantee.

Dr. Michael R. Edelstein

Grace said...

I'm not saying all marriage counseling is ineffective, or that analyzing your family of origin is a waste of time. I know people who have had relationship breakthroughs while in therapy. I'm just saying that it can be difficult to find an effective counselor who can give each issue the appropriate amount of consideration.

Counselors can ask probing questions to gain understanding and get people to explore their lives more deeply, but some just go digging for dirt, sensationalizing irrelevant events, and creating problems where there were no problems before.

The patient-counselor relationship is very intimate and too often we enter into that trusted relationship without doing our research. When going for counseling, make sure that the counselor is properly trained and has relevant experience. See if you know anyone who has used their services. Ask them some questions. Just because they call themselves qualified professionals, that doesn't mean they are.