Set Up for the Con


Many years ago, when I first opened my private practice, I saw a husband and wife, separately, for individual therapy. Many times, if I hadn’t known they were married, I’d not have figured out that they were talking about the same event, so different were their accounts.

I sent them to a colleague, far more experienced than I, for couples counseling. When I conferred with him, his stories of their sessions frequently bore little relation to how they each described to me their marriage.

Over the years, I’ve learned a couple of very troubling things that this situation exemplifies.

The first is obvious: a therapist cannot reasonably assume a client’s reports to be accurate.

The second is a bit more subtle: “supporting” a client’s perceptions can easily wreck lives. In this instance, supporting the husband’s understanding probably wouldn’t have worked out well for the wife, and vice versa.

In the twenty-five-plus years I’ve been in practice, I’ve often had therapists refer the spouse of one of their clients to me. Almost invariably, they’ve given me an account of what they understand the spouse’s issues to be—based entirely on conversations with their own client. I’ve learned just not to expect these accounts to be accurate. These accounts aren’t always terrible (though sometimes they are), but they’re often enough off in significant ways.

I’ve also occasionally had the parents, siblings, or significant others of my own clients come in for consultation. In almost every case, I’ve had to revise my surmises about those people—sometimes in a more positive direction, but sometimes in a negative one. One case in particular stands out in memory. A client brought in her older sister, whom she’d generally portrayed as a stalwart supporter. I was stunned to watch the sister systematically undermine, contradict, and control my client, while my client willingly submitted to being demeaned.

I remain puzzled that therapists, all of whom have some sort of graduate degree, think they can understand someone they’ve never met, based on the pained accounts of suffering clients. I’m excruciatingly vexed that therapists are routinely willing to support, encourage, or exhort their clients to actions based on such questionable views.

Even the most by-the-book, “correct” therapy can be dangerous: the client’s changes impact people outside the therapy room, who have no say in shaping the therapy. A therapy that makes a client very happy can easily wreck the lives of those he or she influences.

The direct relevance of these observations to “Mad in America” is this: The psychotherapy and counseling industries have themselves played a significant role in our culture’s willingness to embrace biological psychiatry. We will not win back the hearts and minds of the public if we keep repeating the mistakes that made people willing to leap into the arms of the pharmaceutical companies.

Many people, both people who need help and their significant others, quite rightly fear therapy. The possibility of getting relief without falling prey to the influence of therapists offers those people hope.

Two major historical phenomena illustrate the problem: NAMI, and the False Memory Syndrome.

While NAMI is sometimes portrayed as a front for the pharmaceutical companies, that’s not how it started. It started with families of the seriously mentally ill who were sick to death of being portrayed as causing the problems of beloved family members. While we can, and should, decry the perfidy of the pharmaceutical companies for many things, we can hardly blame them for supporting an organization that needed an alternative to therapists who blamed them for their own heartbreak.

And the False memory Syndrome, which was almost entirely manufactured by the therapy industries, simply disgraced talk therapy and proved that even the most highly trained therapists, at prestigious institutions, could not be trusted to abide by basic principles of logic and evidence.

While we are rightly aghast at the machinations of psychiatrists and pharmaceutical companies, we do not often enough ask why our culture has been so ready to embrace biological psychiatry. After all, “drugs” face a generally negative bias in our culture, and we have historically tended to see “facing your problems” as a moral imperative. As the most religious culture in the industrialized West, America is not naturally inclined to embrace materialist explanations of human suffering.

If biological psychiatrists have lied to us, we need to ask why, as a culture, we have been so willing to embrace those lies. Generally, we’re most apt to be conned when the con men appeal to our hopes and fears. We know that people in pain hope for relief, and the people in their lives hope that for them. What we don’t like to admit is that they fear the influence of therapy, and often rightly so. If we want to defeat biological psychiatry, we can’t just show its lack of integrity. We have to offer alternatives that deserve trust.



Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.


  1. I am still mind boggled over your belief that talk therapy can “wreck lives.”

    If your theory is true then perhaps our government should begin banning all forms of influential human contact, since that’s really all that talk therapy is. Perhaps we should ban self-help books as well since those are practically the same thing if you just imagine the book as a therapist.

  2. You are right that we were conned, but can you blame us? When doctors like Dr. Drew, talk show hosts and a plethora of other people we put trust in (rightly or wrongly) constantly tell us everything is a disease, what are we supposed to believe? “Your addiction isn’t your fault, it is a disease”. “You are not feeling depressed because you live in an unhealthy environment, but rather your neurotransmitters are misfiring”. If Prominent medical professionals tell you this enough, why wouldn’t we believe it? Now we know better but is it that crazy we once believed DOCTORS. This, on top of the incessant advertising by pharma constantly telling us we are all sick in the head. America is only one of two countries that allow pharma dtc advertising. Furthermore, who says we need alternatives to bio. psychiatry to defeat it? Isn’t the first tenet of medicine to “do no harm” when that is pretty much all bio. psychiatry does and has done (insulin coma therapy, lobotomy, electroshock, insert drug name here). Given bio. psychiatry’s outcomes, it looks more like a eugenics operation than a medical model. It seems as though you have written another veiled apologist article for biological psychiatry.

  3. Regarding “we need to ask why, as a culture, we have been so willing to embrace those lies.”
    You have to be kidding me, its all about drugs. Consume the RIGHT drugs to be happy.

    Regarding “to defeat biological psychiatry, we can’t just show its lack of integrity.”
    I think you missed the con. The psychiatrist predicts the future. The prescribed drugs change the brain and then make the prediction come true ( emotionally unstable due to a brain chemical imbalance). Those psychiatrists making the error (predicting the future) can not admit to making an error , do not believe they are wrong, and no one can prove they are wrong. The Dunning–Kruger effect.

  4. And how to you propose therapists bring integrity back to the work they do? Most therapy practiced in the US is not at all supported by evidence, and as you previously noted, incidences of adverse effects are not well studied. Paying lots of money, investing lots of time, and putting a lot of trust in someone during a time of distress is what is often asked of clients, all with little evidence of why doing so would be helpful, if it actually would be likely even to be helpful, or if it is, the extent it is likely to be helpful, or the risks of being harmed beyond the trust, time, and money spent.

    For all of the poor science done by biopsychiatry and the lack of translation of science to actual practice, many talk therapists are hostile to scientific or systematic approaches to studying effects of therapy, I believe to the detriment of patients.

    • When we are dealing with mental health we are taking shots in the dark. So when we do have good evidence, doctors should use this as a starting point. And one of those starting points would be, in most cases, not to start a patient on a drug regimen right off the bat. We might not know the best solutions, but we should at least try to limit the harm done.

  5. I’m neither a counsellor, or a psychiatrist, I am someone who in the past has had a significant number of hospital admissions, received both drug and talking therapies, and over the last 10 years has worked professionally in mental health. This blog doesn’t offer anything substantially new, what it does do is touch on areas we are uncomfortable in going to. I have learnt over many years of tribunal representatation that their is more than one accurate version of the truth, and sometimes these bear no resemblance to each other.

    Family accounts can be very different sometimes what is described as supportive could in fact be seen as destructive. Peer support can be of real value to recovery, but I have seen many occasions when this has removed a person’s abilities and therefore created disability, because people regardless of whether or not they have struggles managing their mental health can be dangerous, psychiatrists, therapists, brothers, parents and friends all included.

    I often joke that “influential human contact” is bad for our mental health and well-being, most of the problems had had to deal with were caused by people, including myself, so I might not have a problem with banning social engagement.

    If only that would work, I’d be happy, the truth is isolation doesn’t work either. In the 19080’s the UK began importing U.S. media therapy shows, Ricky Lake, Oprey etc. At first it might have been fun to watch Americans open their souls for our entertainment, but then we started creating our own shows.

    The problem is people aren’t perfect, relationships are all fundamentally flawed, and these shows tug at the cracks and rip them right open. I have concerns about the therapy culture and its growth in the UK. You know what most of us are unhappy about something, most of us feel we could do better if only this hadn’t happened. Those thoughts are human, they generally don’t mean we need fixing. My house has lots of cracks on the stairs, its not going to fall down, I don’t need a builder, I can patch it up myself.

    The same is true of my soul, it has cracks, the rise in therapy for sale has caused us to believe we need fixing, just as it has been the case in drug treatments, we have been mis-sold the need for therapy. I am often approach American evidence critically, doctors and insurance companies make profit from drugs and therapy, lawyers make profits from compensation claims and T.V companies make profit from selling the cracks in our souls.

    Meanwhile those who are truly struggling to can be left stranded on the side walk watching the traffic.

  6. Thanks for a terrific article. I am not at all a fan of NAMI, but this organization would not have been so successful, as you point out, had parents been encouraged to be the solution, and not seen as the problem. I am also very skeptical of therapists who claim they “know” what is really going on amongst family members, and of course, their opinion is usually critical towards the family and congratulatory towards themselves. For that reason, I have as little to do with therapy as possible. On the other hand, I continue to ask myself, in the case of NAMI, why would parents prefer to believe that their child has a chronic brain disease? That is a hopeless view of their relative and extremely damaging to them. Yet many parents prefer to believe that their child is mentally defective in some way than to actually see if there is something in the family environment that can be changed.

  7. Wow! So, we can’t believe a word a client who comes to us in pain says… That’s exactly what biopsychiatry does, when it labels the client in pain “insane” = not to be taken seriously, not to be listened to at all.

    IMO, it’s not about either “blaming” others — to blame in fact doesn’t mean anything other than to hold responsible, and I think, we all have a responsibility for our re-/actions, and may be held responsible for them; essentially, that’s how we learn how to navigate the world, interact with others; no responsibility = no learning process –, or blaming the individual in pain (for lying). If somebody is in pain it’s because they’re hurt. That doesn’t mean they were intentionally hurt. “With rare exceptions, I think parents do their best. They try. But there are a lot of ways in which they can go astray.” I think, this applies to everybody. Nobody is perfect. We all can go astray, people in pain included. Nevertheless, something inside of us doesn’t go astray: the self. Knowing this, I never dismiss of anything somebody tells me as untrue. If I’d been met by my own therapist with the attitude that my words were not to be trusted, I’d walked out the door of her office, and never went back in. The same I’ve observed with people I myself have worked with since. Not that they left the office. On the contrary, they stayed, and they returned, time and again. Because I did not doubt the truth of what they told me.

    If I want to really help someone, I think, I have to believe that whatever they tell me is true for them. Otherwise, I can’t really help them.

  8. I found the premise of this piece – that people coming for therapy essentially should not be believed, and that this somehow promotes biological reductionist psychiatry – as distrurbing as I find it illogical. Over the past 25 years, the literature has shown again and again that the vast majority of people who get psychiatric diagnoses are trauma survivors. If therapists don’t believe reports of abuse, which is more often perpetrated by family members or authority figures than by strangers, how can people possibly build trusting relationships with therapists? Why do you assume thta many of those NAMI members did not abuse their relative, or at least did not make them the family scapegoat?

  9. Bob,

    I find it hard to believe that therapists should be given credit for the unrivaled success of the most cynical and dishonest business plan ever conceived and executed by an American industry.

    The pharmaceutical industry had much more loyal surrogates to insure it’s enormous market share of national health care dollars.

    • Which is why anybody who wants to actually get over their “mental illness” should take recovery into their own hands and damn what anybody else tells them. Nobody else can do it for you. Should an individual listen to therapists? Yes and no. Therapists spend a lot of time shooting down the relatives or arguing amongst themselves as to which therapy is superior. Yet, there are some excellent helfpul therapies, especially the ones where one must suspend disbelief.

  10. I think what Mr. Fancher was saying, is that those practitioners who believe in the value of talk therapy/ human to human therapy should try a lot harder to make at least some general ground rules to the various approaches, so that Big Pharma cannot point the finger at “talk therapy” with ridicule saying in essence, you see this group of quacks doesn’t even apply basic scientific rigor in their therapy. Our special pill works so much better and at Fixed cost and we have the “data” to back up our claim. Our scientifically “validated” pill versus their subjective notions of therapy. The fact that the pills are mostly poison doesn’t matter because they were able to put the old “science” label on it. I agree with Mr. Fancher talk therapy practitioners as a group should immediately implement basic protocols that would quickly elevate and show the real effectivenss of talk therapy versus these mostly bogus medicines that merely mask and confuse both the patient and therapist and reduce to almost zero the chance for real progress. The idea that talk therapy Should hold itself to a very high standard is a starting point to dismantling the big pharma lies. This truth still holds, the best medicine for a troubled human being is another less troubled human that cares. NOw it’s time to execute what we already know and bury the real “con” once and for all. Bob Fancher Rocks!!!!

  11. Hi there, Bob!

    I’ve long been an admirer of your perceptive analyses and reflections in “Cultures of Healing”, and was very pleased to find you blogging here…

    I’d like to note that when you state “I remain puzzled that therapists, all of whom have some sort of graduate degree, think they can understand someone they’ve never met, based on the pained accounts of suffering clients”, this provokes a counter-reflection on my part…

    Why do therapists and clinicians who have never met those making claims of atrocious behavior on the part of their clients… ofttimes clients placed under their care on an involuntary basis… when they have never met them? Or assessed the validity of these claims with the circumspection and caution which might be considered appropriate, in cases regarding serious accusations of criminal behaviors?

    I think the part of my experience which has me feeling truly disillusioned is that I believed that the average clinician, being of above average intelligence and with long years of higher education, would be capable of rational reflection on my actual circumstances, life history, and real-world symptomatology when presented with evidence that conflicted with the fables and hyper-dramatic narratives that had been built up around me…

    Well, it appears it just doesn’t work that way. I tend to think that Nicholas Nassim Taleb makes very telling points when he emphasizes that we frame our experiences into narratives, narratives influenced in ways both subtle and dramatic by cognitive bias and our desire to build a “just-so story”, and that these narratives can overwhelm our ability to engage in rational behaviors unless we are continually on our guard against what I am tempted to call “seduction by signage”… at the risk of sounding more like a fan of postmodernist theory than a punning comedienne?

    As Korzybski wrote, “The map is not the territory”. Likewise, client histories – as presented either by the client, or by their lovers, friends, enemies, or clinicians – may bear little or no relationship to reality.

    bonze anne blayk