The Case Against 'Psychotherapy'

Why we need less therapists not more

Full disclosure... I'm a therapist. I provide Cognitive and Dialectical Behavior Therapy for a range of anxiety, mood, and eating related problems. Heck, I even own and operate an outpatient center.

So why on earth would I be dunking on my own profession? Am I trying to put myself out of a job or something?

Nah, it's actually the opposite. I'm trying to save my profession.

Don't get me wrong - I believe certain types of therapy can be crucial, even life-saving, when they're done ethically and for the right person at the right time.

But what does that actually look like?

Some conditions come to mind. Obsessive Compulsive Disorder can be quite debilitating and there are widely studied and effective therapies available for this condition. Eating Disorders like anorexia and bulimia can be life threatening if left untreated. There are effective therapies for Post-traumatic Stress, severe depression, and when fear & anxiety create significant impairment. Some people can struggle to regulate intense emotions and enter into self destructive behavioral patterns that can include self injury and substance abuse.

By no means am I suggesting that individuals struggling with these conditions should avoid seeking help. Quite the opposite. I believe they require the right type of help.

Upon examining the literature on effective psychological therapies (psychotherapies) for these conditions, a consistent pattern emerges. The most efficacious interventions share several key characteristics:

1. Active engagement: These therapies are notably proactive, requiring direct participation from both clinician and client.

2. Behavioral focus: They emphasize changing specific behaviors that perpetuate unhealthy cycles and maintain psychological distress.

3. Skill development: A core component involves building new, adaptive skills to navigate life's challenges more effectively.

4. Specialist implementation: These therapies are typically delivered by professionals with a high degree of expertise in treating specific conditions. Dedicating their professional life to studying these conditions, what works and developing clinical expertise.

This is NOT what the overwhelming amount of people are receiving. Mental health industry is churning out therapists like they're on an assembly line. And what's their main skill? Basically, just being good listeners and keeping a conversation going.

Now, don't get me wrong, that's a useful skill. But here's the problem: this general counseling or "talk therapy" is being slapped on everyone, no matter what their issue is or how bad it's gotten. It's like a one-size-fits-all approach, and we know that doesn't work for shoes, let alone mental health.

Most of these therapists have a master's in counseling or social work. That's great, but it doesn't exactly prepare them with a science based education and expertise to intervene really severe and debilitating conditions. They're generalists, talk therapists. And while that's fine for some things, there is way too many of them, and not enough of people who can help where we need the help.

The online educational landscape for aspiring therapists has also fallen prey to the trend of dilution and oversimplification. Many online programs, prioritizing convenience and rapid completion over depth and rigor, fail to adequately prepare students for the complex realities of clinical work.

These accelerated, often asynchronous formats often lack the crucial elements of in-person supervision, intensive role-playing, and hands-on clinical experience that are essential for developing robust therapeutic skills. Instead, they tend to focus on theoretical knowledge and standardized approaches, leaving graduates ill-equipped to handle the nuanced, often messy realities of real-world client interactions.

The explosion of therapists is real. Since COVID hit, it's like they've been multiplying like rabbits. Just think about this - I did a quick search on Psychology Today for my local zip code, and guess what? A whopping 160 therapists popped up! Remember, this count only includes therapists who've chosen to advertise on Psychology Today. It doesn't even scratch the surface of all the other practitioners out there who aren't listed on this platform.

What's particularly striking is the content of these profiles. Many of these therapists claim a remarkably broad range of expertise. They list everything from severe conditions like bipolar disorder to more common issues like relationship problems, and even venture into areas like spirituality.

And then we've got this whole other animal - the therapy mill app industry. I'm talking about platforms like Talk Space and Better Help. These guys are pumping out therapy sessions like they're running a fast-food joint. They're selling this idea that 'therapy' is the magic bullet for all mental health issues. Got anxiety? Therapy. Feeling blue? Therapy. Stubbed your toe? Well, you might need some therapy for that emotional trauma.

And the way they present it, you'd think finding the right therapist is as easy as swiping right on a dating app. Just keep shopping around until you find your perfect match, right?

What is Psychotherapy?

The general public's understanding of psychotherapy is often shaped by media portrayals, popular culture, and varying degrees of mental health literacy. Psychotherapy is typically seen as a process where a person talks about their problems, feelings, and experiences with a trained professional. Many people imagine it involves discussing childhood memories, dreams, and personal relationships to gain insights into one's behavior and emotions.

This general perception often doesn't fully capture the diversity of therapeutic approaches, the active nature of many evidence-based treatments, or the specific techniques used for different conditions. It tends to be more aligned with traditional psychoanalytic or humanistic approaches, rather than more modern, targeted interventions like cognitive-behavioral therapy or dialectical behavior therapy.

"Psychotherapy is the informed and intentional application of clinical methods and interpersonal stances derived from established psychological principles for the purpose of assisting people to modify their behaviors, cognitions, emotions, and/or other personal characteristics in directions that the participants deem desirable"

- John Norcross, PhD

Currently, therapy has devolved into a diluted version of its psychoanalytic and humanistic roots. What we often see now is a therapist passively steering the client through a meandering stream of consciousness, occasionally tossing in a reflection or a bit of feedback.

This watered-down approach bears little resemblance to the rigorous, theory-driven practices within depth psychology or the deeply introspective work of humanistic pioneers. It most certainly is not the targeted behavioral treatments for severe clinical disorders. Instead, it's become a sort of weekly review, where the therapeutic value is assumed to lie in the mere act of talking things out.

The therapist, in this model, functions more as a sounding board than an active agent of change. They might offer the occasional insight or validation, but there's often a lack of structured intervention or targeted skill-building. This passive approach can create an illusion of progress without necessarily addressing the core issues or equipping clients with the tools they need to navigate their challenges effectively.

This trend reflects a broader simplification of therapy in the public consciousness, where the complexity and diversity of therapeutic approaches have been reduced to a one-size-fits-all model of 'talk it out and feel better.'

TikTok Therapists and Telehealth

The landscape of mental health care has undergone a significant transformation, evolving into a booming industry driven by artificially generated demand and unrealistic promises. This shift has been fueled by a potent mix of pop psychology, social media trends, and oversimplified narratives about mental health and well-being.

The proliferation of "pop culture therapists" has contributed to this phenomenon. Many of these practitioners, while well-intentioned, derive their understanding of psychological disorders and interventions more from viral TikTok videos and YouTube self-help gurus than from rigorous scientific research or deep philosophical foundations. This trend has led to a dilution of the therapy "product," with complex psychological concepts often reduced to catchy soundbites and quick-fix solutions.

The dilution of therapeutic training has led to a troubling trend where many therapists' approaches and advice are increasingly shaped by pop culture rather than scientific rigor or philosophical wisdom. In this social media-driven landscape, complex psychological concepts are often reduced to simplistic memes, catchy hashtags, and viral TikTok trends.

Therapists, particularly those with inadequate training, may find themselves gravitating towards these easily digestible, popular ideas rather than engaging with peer-reviewed research or time-tested philosophical insights. This results in a brand of therapy that's more akin to regurgitating self-help soundbites than providing evidence-based interventions.

Clients may receive advice that's trendy and relatable but lacks the depth and efficacy of approaches grounded in serious academic study and clinical experience. Consequently, the therapeutic process risks becoming a shallow exercise in validation and pop psychology platitudes, rather than a transformative journey guided by well-founded psychological principles and thoughtful, individualized care.

In my professional experience, I've witnessed an alarming trend of inappropriate hospitalization and overprescription of pharmaceuticals. Rather than implementing safe and effective interventions tailored to individual needs, many practitioners resort to standardized advice and protocols without careful consideration of the potential consequences. This cookie-cutter approach can lead to unnecessary hospitalizations, which may traumatize patients and disrupt their lives, or to the hasty prescription of powerful psychotropic medications without adequate exploration of alternative treatments or underlying issues

The rise of telehealth has further accelerated this trend. The ability to provide therapy from home, without the overhead of renting commercial space, has lowered the barrier to entry for many aspiring therapists.

This combination of factors – artificially inflated demand, simplified approaches, and reduced operational costs – has created a perfect storm for the commercialization of therapy. The result is a marketplace where quantity often overshadows quality, and where the nuanced, evidence-based approaches required for treating serious mental health conditions are at risk of being drowned out by a sea of generalized, one-size-fits-all interventions.

In this environment, it's become increasingly challenging for individuals to distinguish between substantive, effective therapeutic approaches and those that merely scratch the surface. The promise of quick fixes and universal solutions has created a cycle where demand for therapy continues to grow, often outpacing the development of skilled, specialized practitioners capable of addressing complex mental health needs.

Psychotherapy Can Create Harm

Last October, I presented a comprehensive analysis of the potential harms associated with psychotherapy. For those interested, the full article is available by clicking here.

It's crucial to understand that the negative impacts of psychotherapy extend far beyond the egregious ethical violations that occasionally make headlines, such as a therapist losing their license for engaging in sexual relations with a client. The spectrum of potential harm is much broader and often more subtle.

These less obvious, but equally significant, harms can include:

1. Administering inappropriate therapeutic approaches

2. Over-pathologizing normal human reactions and experiences

3. Accepting clients' narratives as unequivocal truth without critical examination

4. Imposing the therapist's personal values and biases onto the client

5. Inadvertently creating or exacerbating psychological issues

6. Fostering an unhealthy dependence on therapy or the therapist

7. Misrepresenting or misapplying psychological concepts

Each of these issues can have profound and lasting effects on clients, potentially hindering their progress or even exacerbating their initial concerns. This underscores the importance of not only ethical practice but also of ensuring that therapy is appropriately targeted, evidence-based, and delivered by well-trained professionals who are aware of these potential pitfalls.

We Need Less Therapists Not More

As we reflect on the current state of mental health care, it becomes clear that a paradigm shift is necessary. Contrary to popular belief, we need fewer therapists and less general talk therapy, with fewer people accessing the system overall. Instead, we should focus on providing more targeted psychological interventions from genuine experts in their respective fields.

The increased awareness of "mental health" in recent years, while well-intentioned, has led to unintended consequences. More people are now seeking help for problems they might have previously considered a normal part of life. This heightened awareness can result in over-interpretation and the pathologizing of normal human experiences. We must be cautious not to medicalize every aspect of the human condition.

What we truly need is a cadre of highly trained clinicians with deep expertise, focusing on treating severe clinical problems. Simultaneously, we should resist the urge to push people towards therapy for typical life challenges. By doing so, we risk undermining individuals' innate coping capacities and fostering unnecessary dependence on professional intervention.

The current flood of people seeking therapy has, paradoxically, made it more difficult for those with serious mental health issues to receive the help they urgently need. Wait times have increased, and resources are spread thin. By reducing the overall number of therapists in the market and significantly increasing the rigor of training programs, we can ensure that those providing care are truly equipped to handle complex psychological issues.

The mental health industrial complex, in its current form, risks doing more harm than good. By pathologizing normal human experiences and promoting dependency on therapy for everyday challenges, it's creating a society of individuals less equipped to handle life's inevitable stresses and setbacks.

This system, driven by profit and fueled by oversimplified notions of mental health, is inadvertently weakening our collective resilience. It's not just failing to help those who truly need it; it's actively making people worse by undermining their natural coping mechanisms, fostering a culture of victimhood, and diluting the quality of care available. The proliferation of undertrained therapists and quick-fix solutions is not just ineffective – it's potentially dangerous. We're facing a crisis of our own making, where the very system designed to improve mental health is, in many cases, exacerbating the problems it claims to solve.

Don’t even get me started on School Based Mental Health Clinics. That’s an article for another day.

RESIST