Saving Psychotherapy

Eric Maisel, PhD
23
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Psychotherapy is not quite a dying profession. But it is certainly a limping profession. Statistics indicate that over the past two decades fewer and fewer clients have gone in for “the talking cure.” What’s going on?

The typical reasons given for this decline are the following four. First, the pill-popping mental disorder paradigm has made meds more attractive than talk. Second, life coaching has grabbed a significant portion of psychotherapists’ clientele. Third, psychotherapists have done a poor job of branding themselves (compounded by legal restrictions against certain kinds of promising). And fourth, there is some basic passé quality to the whole enterprise, with its long-ago early nineteenth century flavor.

On top of these, there are other reasons, too—reasons that were always there. For one, it was never really clear what a psychotherapist was supposed to be an expert “at.” Interpreting a dream? Diagnosing a mental disorder? Being a paid listener? Picking a single thing (like a client’s cognitions) as the most important thing or even the only thing to look at? Making wise suggestions? Never making any suggestions? What exactly was this sort of talk supposed to accomplish or even be “about”?

Second, it was only attractive to a certain sort of person: basically, to an educated, psychologically-minded person who was willing to talk and willing to reveal. The client had to buy into the basic idea that sitting, chatting with someone, and telling him or her about what was bothersome was something that made sense to do and was worth doing once a week for fifty minutes (for three hours, really, if you included the commute and the waiting time). So, right from the beginning, there was always a limited pool of prospective clients.

Third, the staggering range of psychotherapist types, personalities, styles, and basic competences made landing on a therapist who might really serve you quite a crapshoot. Here was a person you were supposed to trust and open up to—and you might get someone wet behind the ears, or trapped on a single note (“And how did that make you feel?”), or not very wise, or icy cold, or downright cruel.

This same variety and eclecticism that made every psychotherapist his or her own gunslinger, one using unsubstantiated Freudian language, another still poring over dreams, a third looking only at cognitions, a fourth rebranding psychological conflicts as spiritual crises, and so on, meant that it was rather hard to believe that there was actually any there there. Didn’t it rather seem like each psychotherapist was just making it up?

Of course, psychotherapy always had one thing going for it: talking to another person can help. That person need not have been a psychotherapist—it could be your brother, aunt, pastor, or best friend—but by and large psychotherapists were good at listening, empathizing, reflecting back, and so on; qualities in short supply among people not paid to exhibit them. That was always what psychotherapy had going for it. But it also had all the negatives I just described; and so, the chickens were really bound to come home to roost.

So, what might now save psychotherapy? Shifting its feet. Rather than promoting itself as expert talk of one sort—expert at “diagnosing and treating mental disorders” or expert at “reducing mental and emotional distress” or expert at “solving problems of living”—it could, and really ought to, promote itself as the best investigative tool around. One that uses the scientific method (by floating hypotheses and checking them out) rather than pretending to be a pseudo-medical enterprise or a medical sub-specialty (which it is not).

If psychotherapy shifted in the direction of promoting itself as the premier investigative tool for understanding emotional health and problems in living, and lived up to that promotion, that would change its footing, putting it on much more solid ground. It would also help therapists better know what they were actually doing in session, in addition to listening: they would be investigating. A great body of knowledge around what constituted smart investigating could grow, all therapists could be trained in something really useful and actionable (ways of investigating), and, insofar as human nature is amenable to being investigated, finally some smart investigating could commence.

I’m calling this reframed, redefined and rebranded version of psychotherapy multi-lens therapy, to put the emphasis on where it ought to have been put all along: not on diagnosing, not on problem-solving, not even on relating (which is a good and lovely thing), but on investigating. A multi-lens therapist would be trained to look at human affairs through twenty-five specific lenses (among them the lenses of original personality, formed personality, trauma, development, family, circumstance, social connection, and life purpose and meaning) rather than reducing the enterprise to the reductionist tactic of “treating the symptoms of mental disorders.” A multi-lens therapist would be trained to accept the largeness of human reality and, as a result, would work more deeply, more powerfully—and more truthfully—with clients.

The enterprise of helping another person through talking is worth saving. It always has been worthwhile and it will always continue to be worthwhile for one person to unburden himself or herself to another person, for one person to seek advice from another person, for one person to use another person as a sensible sounding board. For psychotherapy to distinguish itself from all that, for it to represent a real body of knowledge, and for it to be useful in its own right, it needs to grow and change. It needs to become the home of smart investigating and the place where you come when something human needs figuring out. It is not that yet—but it could become that.

23 COMMENTS

  1. “Investigating”? Investigating what? “Troubles”? You use the word “pseudo-medical”. Psychotherapy is on Wikipedia’s ‘List of topics characterized as pseudo-science’, and for good reason.

    https://en.wikipedia.org/wiki/List_of_topics_characterized_as_pseudoscience

    “That person need not have been a psychotherapist—it could be your brother, aunt, pastor, or best friend—but by and large psychotherapists were good at listening, empathizing, reflecting back, and so on; qualities in short supply among people not paid to exhibit them.”

    Emboldened, with emphasis added.

    I would have definite questions about the short supply matter, and you didn’t say anything about business associates. Psychotherapy is a business. People without friends, or caring family members, can pay a psychotherapist for this type of functional relationship. Still, I don’t think it beats friends and family.

  2. I just don’t think psychotherapy is safe. Some people have no issue with this, and I’d call them lucky, because it can so easily go the other way. The training lends itself heavily to projecting, which is what ultimately leads to othering, marginalizing, and blatant stigma.

    It’s not necessarily about the DSM, one can reject that and still be doing this level of projecting, unconsciously, because that is how humanity is perceived through the psychological lens, in divisive “us and them” terms, and based on what, exactly? That’s what this programming inspires and creates, social division based on arbitrary terms. That is inherently abuse of power, because it is a betrayal of trust. It can all be unconscious, but it is still the result of this programming, which is why I call it unsafe.

    This is how programming works, which is what the education and training of this is all about, from what I recall, and my memory of it is quite clear. It’s a filter which is divisive to humanity, and it can stick and do a lot of harm in the most insidious ways, hard to identify but it can be felt. People graduate from their training programmed, not awakened. That’s very unsafe for future clients.

    The first thing a “psychotherapist” (or anyone who desires to help people this way) would have to learn is what it means to have a “healing dialogue.” That has a specific intention, energy, and flow to it, and I’ve never encountered anyone traditionally trained to have this awareness.

    Another thing is to understand how cording works, which is how subtle communications transpire, and how to separate from this after a client, so it is not carried forward to the next client. Everyone is healing and growing in a healing dialogue, not just the client.

    This should be a professional service with appropriate boundaries, not a takeover of someone’s life and beliefs, and ultimately, in worst case scenarios (and they do exist significantly, I believe), their mind and spirit. The issue of boundaries is usually a big problem with therapists, I have found, in that they can be terribly invasive with their own conscious or unconscious judgments.

    A lot of therapists have control and power issues, too, and can play all sorts of mind games, but that’s in all healing vocations. One MUST be careful and trust their intuition when seeking help and support in any healing way. We’re ALL vulnerable as we heal and grow. Otherwise, we don’t.

    • “I just don’t think psychotherapy is safe.” That was my experience, “downright cruel” could describe her, too. Pathological liar is another good description, as is “terribly invasive.” Not to mention she quickly defamed me with a fake “lifelong, incurable, genetic” disease, which I did not have.

      I’ll never trust another psychologist ever again, personally. I think the psychologists are really nothing but people who “bait and switch,” in other words pretend they’re there to do talk therapy, but then defame you with a DSM disorder, and demand you be poisoned by psychiatrists.

      As to being investigators, since it’s us non-“mental health” people who did bother to investigate, do our research, and find the iatrogenic etiology of both “bipolar” and “schizophrenia.” I’d say the psychologists aren’t very good investigators.

      • “As to being investigators, since it’s us non-“mental health” people who did bother to investigate, do our research, and find the iatrogenic etiology of both “bipolar” and “schizophrenia.” I’d say the psychologists aren’t very good investigators.”

        That is so true!!! At this point, I believe many of us know way, way more than they do. We got our info through first hand experience, and that is what is most reliable, without a doubt.

        And they’re not very good listeners, either, they don’t hear a word we’re saying. And it seems as though when they do hear, it gets translated into something else by the time it reaches their brains. It really is like we’re in two different worlds speaking two different languages. It’s weird. That is not my experience with the world, only with mh-related clinical or social service people. That is a world unto itself.

        • “they’re not very good listeners, either, they don’t hear a word we’re saying. And it seems as though when they do hear, it gets translated into something else by the time it reaches their brains.” Absolutely true, my psychiatrist was required to declare my entire life to be a “credible fictional story,” once I confronted him with all his delusions about me, written in his medical records. That’s pretty pathetic.

          “It really is like we’re in two different worlds speaking two different languages. It’s weird. That is not my experience with the world, only with mh-related clinical or social service people.” Same here, I’ve never met dumber, more disingenuous, more delusional, and more ungodly disrespectful people in my entire life, than the “mental health” workers.

          I think they’re actually brainwashed in school to ‘keep a professional distance’ or something. But this prevents them from treating their clients in a mutually respectful manner. And, of course, you’re not actually going to help your clients, if you are not interacting with them in a mutually respectful manner, are you? No, you’ll render yourself “irrelevant to reality.” And your clients will walk away.

          As one who has worked in sales, I have had lots of repeat customers. Because I know enough to treat my clients in a mutually respectful manner, and I refuse to sell anything but beneficial services and products.

          The “mental health” workers have neither beneficial services (how is defaming people with “invalid” and stigmatizing diseases beneficial to one’s clients?), nor beneficial products (let’s be real, the psych drugs are all neurotoxins). But the “mental health” workers are apparently too stupid or unethical to stop trying to force these harmful services and products onto other people. Forced “treatment” should be illegal in a so called “free market economy.”

          • Wow, SE, I feel and hear you, my thoughts are exactly the same. It is MADdening (which I guess is the point?).

            I was in customer service retail for 17 years and my experience is as yours, mutual respect as well as integrity of the products we’re selling is vital. I had very loyal and appreciative customers for years–AND a grateful staff (I was manager) because we were all in it together. To me, power meant responsbility, not getting away with abusing or demeaning or thinking negatively about my staff, that would have tanked us.

            I was recognized for having the lowest turnover rate in the company because I knew how to promote people to where they most belonged (and to where they preferred), where their skills and talents would shine, and my departments thrived. Members of the staff I supervised felt good about themselves, their jobs, and we had fun! And everyone felt valued, that was the most important thing for good functioning.

            Again, to mh clincians and staff–what’s the problem here? Can’t you see what we’re saying? When are you all going to wake up, own this crap you’ve been dishing out, and come out of denial and avoidance? C’mon folks, get real. We’re speaking the truth here, no doubt about it. Lift your heads up–out of the sand. For everyone’s sake. You’ll feel better to surrender here, because the truth shall set you free. It will set ALL of us free!

          • I worked in retail management for a while as well, Alex. Apparently, or at least I got the impression, from a psychiatrist who was partners-in-crime with this now arrested and convicted criminal doctor.

            https://www.justice.gov/usao-ndil/pr/oak-brook-doctor-convicted-kickback-scheme-sacred-heart-hospital

            A psychiatrist who was pissed because she was unable to medically unnecessarily institutionalize me forever for profit and to cover up her crimes, that the psychiatrists do despise those of us who work in retail management. As that psychiatrist was being held back, by other doctors due to her fury, her defamatory departing comment to me was “I’ll see you in the malls.”

            Although that psychiatrist didn’t know I do a lot more than just retail management. Apparently the psychiatrists believe they can illegally look at one’s finances and judge a person’s worth, or lack of worth, to society as a whole, without knowing anything other than that person’s short run income being generated at one point in time.

            I was a mom of two young children at the time, plus a very active volunteer. Including being a village planning commissioner, co-chair of a 250+ member strong creative arts program, charter rep of a Boy Scout pack, as well as doing many, many other volunteer activities. While also working on my art portfolio, since I’m also an artist. And, of course, I became a psychopharmacology researcher who found the medical proof that the “schizophrenia treatments” do, in fact, create both the negative and positive symptoms of “schizophrenia.”

            https://en.wikipedia.org/wiki/Neuroleptic-induced_deficit_syndrome
            https://en.wikipedia.org/wiki/Toxidrome

            Someone should educate the “mental health professionals” that you can’t judge people merely by illegally looking at their short run financials. I’ve now got a huge art portfolio poignantly visually describing America’s completely iatrogenic “bipolar epidemic,” that is terrifying to the “mental health” workers, due to it’s “truthfulness.” Not to mention, terrifying to the child rape covering up religions, for whom the psychiatrists drug people.

            https://books.google.com/books?id=xI01AlxH1uAC&printsec=frontcover&source=gbs_ge_summary_r&cad=0#v=onepage&q&f=false

            I’ve noticed lots of contemporary artists’ work is about the mass drugging of the American public, as well. I would imagine our art history books will some day include, not just the sick “Spirit cooking” and pedophilia artwork that is all the rage with today’s so called “elite.” But also the artwork of the Spirit led, anti-child abuse, anti-mass drugging of the population artists.

            Those who claim to be experts on the brain, who only bothered to develop the left side of their brains, should be educated to the fact that those who bothered to develop both the left and right side of our brains, will be the more “insightful” and able to see the big picture.

            Murdering all those of us who are actually creating works and documenting reality, rather than merely creating “mental illnesses” in other people, is not going to be beneficial to our society. So let’s hope the “mental health” workers do some day get out of the “mental illness” creation business.

          • “…that the psychiatrists do despise those of us who work in retail management. As that psychiatrist was being held back, by other doctors due to her fury, her defamatory departing comment to me was ‘I’ll see you in the malls.'”

            Omg, they had to physically hold her back while she was angrily yelling defamatory things at you? That sounds like some kind of assault to me, or attempted assault. Insanity.

            During the years I was working in retail, in the 80s/mid 90s, I was living in the ‘burbs and at the time, I was not having problems with therapists or psychiatrists (ah, the good ol’ days). That all began in the late 90s when I began grad school in San Francisco, and then after that when I got off the drugs, went into the system as, first, client, and then as professional.

            My first strike was during grad school, that I had a “diagnosis,” that was enough to elicit stigma, projection, and power abuse from one professor who was more full of himself than anyone I’d ever met up to that time (until my last psychiatrist, who was quite a piece of narcissistic work–sinister, mean and just the biggest asshole ever, couldn’t get away fast enough from this jerk, and ALL of psychiatry once and for all).

            When I was in a social services group, my crimes were that I was 1) a psychotherapist and 2) withdrawing from psych drugs, and 3) intelligent and competent. The last one was true of everyone in the group, I think. The therapists/facilitators really resented intelligence and independent thinking in their clients, I’m sure you and others have picked up on this, too.

            One thing about mh clincians–they are extremely competetive, and at the same time, they cannot stand competition. As a group, I find most therapists to be terribly insecure, despite outward appearances, which is why they can easily resort to gaslighting. Go figure. More insanity.

            “Those who claim to be experts on the brain, who only bothered to develop the left side of their brains, should be educated to the fact that those who bothered to develop both the left and right side of our brains, will be the more “insightful” and able to see the big picture.”

            First thing I noticed when I began grad school was, in general, the lack of appreciation for art and theater (one of the reasons I moved to SF in the first place, aside from The Beats). I found the mh academic culture to be incredibly dry, analytical, and extremely unimaginative–to the point of stale and overwrought thinking. Anything but creative and innovative.

            Developing one’s creative side and “right brain” consciousness is, indeed, vital to deep thinking, gaining truthful insights, and assessing the big picture. That won’t happen in “menal health, inc.” I’m sure of it at this point, I don’t see how with the way they are programmed.

            “So let’s hope the “mental health” workers do some day get out of the “mental illness” creation business.”

            Yes, beautiful vision, SE. The world needs free thinkers, artists, creators, heartfelt humanitarians, as well as true blue systems busters, whistleblowers, and truth-speakers. NOT more drones from the cookie cutter mh industry. No thanks.

          • “I’ll see you at the malls!” While the others held her back from physically assaulting a “patient.” Sounds like one emotionally stable woman with great interpersonal skills. The epitome of reason and a bastion of sanity. 😀

            Bwahahaha!

          • She was an absolute loon, Rachel. She fraudulently listed me as her “outpatient” for years afterwards, according to health insurance companies.

            After I learned about this, I called and asked her to stop fraudulently listing me as her outpatient at a hospital I’d never been to before, according to me and that hospital. So she switched to fraudulently listing me as her outpatient at the hospital I’d had the misfortune of meeting her.

            Her lackeys called me and asked why I’d missed an appointment. I told them they were going to make themselves all look like fools, since I’d moved out of state, so obviously I was NOT making appointments with that insane psychiatrist.

            But since that psychiatrist was the psychiatric “snowing” partner in crime, for this now convicted doctor, she no doubt wanted to cover up her prior malpractice and crimes.

            https://www.justice.gov/usao-ndil/pr/oak-brook-doctor-convicted-kickback-scheme-sacred-heart-hospital

            She belongs in jail, along with her partner. And absolutely, “the inmates are running the asylums.”

          • Fatal Attraction meets One Flew Over the Cuckoo’s Nest.

            My dad frequently remarked on how nutty everyone running the System was. The “crazy’s” were too drugged up to think straight. The real nuts were the sanists running the thing. 😛

            The woman who got me diagnosed BPDS actually fits the “symptoms” better than me. But because she slept with a different guy every month or so and never bonded with any she thought she was emotionally sound. 😛

          • It’s medically called projection. And, yes, most my former doctors projected their own “mental illnesses” onto me. My PCP who, by lying to me claiming psych drugs were “safe … meds,” started me on psych drugs, was a dangerous paranoid “schizophrenic.” She was paranoid of a non-existent malpractice suit because her husband was the “attending physician” at a “bad fix” on a broken bone of mine, I later learned from picking up medical records.

            My outside my insurance group, second opinion doctor, was a manic lunatic, because she was hell bent on profiteering off of covering up the rape of my child for her pastor and some pedophile friends of hers, so I was mislabeled as “manic.” Medical evidence of the child abuse was eventually handed over by some decent and disgusted nurses in my PCP’s office.

            Yes, doctors do have projection problems.

  3. Psychology might be thought of as more effective if the practitioners didn’t waste a lot of time trying to do great therapeutic things with individuals so delirious they barely know where they are, and are incapable of absorbing ordinary ideas, much less therapeutic ones.

  4. real religions, not lucrative pseudoscientific cults masquerading as “treatment,” etc., are great for discovering the meaning of life or at least…providing some guidance. philosophy, sociology, connecting with others, creative pursuits…

    these are good ways to move forward in life, at least for me (and people I know). Psychotherapy, counseling, self-help, etc. are worse than useless.

  5. We don’t need psychotherapy or psychiatry. We need to disprove apollonian fundamentalism (apollonian ego in the center of the psyche). Psyche need phenomenology empathy and respect, not pity. And psyche does not exists for stupid apollonic perception. We will have a material culture without psyche, as long as apollonian ego will dictate the way we should perceive psyche.

    To understand what psyche is, we need to perceive it’s real image, first.

    “Re-Visioning psychology” James Hillman.

  6. The big problem with psychology is its association with corrupt drug dealing/brain mutilating psychiatry. If a psychologist or counselor wants to help people they have to start their own practice. Work at the mental illness center and you have to tell folks to remember they’ll always be “bipolar” or “schizophrenic” and promote the drugs the shrink prescribed. Then yell at the “client” for not trying harder or skipping “meds” on the sly (though you lack proof) when they deteriorate on the 3-6 mind altering drugs Dr. Frankenstein has them on.

    Btw, Eric Maisel, I know you reject the bio model and work independently. Probably for the reason I describe. Please don’t take this personally. 🙂

  7. That’s why I will only see a social worker for therapy. Their entire focus is different than psychologists, and of course, psychiatrists. Social justice, systemic thinking, client-centered, non-medical model, etc… No hocus pocus. Of course, there are fools and charlatans in every single profession, but my experience is that clinical social workers are trained to see a person in their environment, and the intersection of all the domains of the individual’s life and how it impacts them.

  8. Eric,

    I’m honestly not sure what you mean by ‘investigating.’ The most beneficial thing I’ve ever discovered is attachment theory. Thanks to John Bowlby and those who followed, it gave me the keys to help unlock my wife from her traumatic childhood. No therapist could possibly do what I have done. What our son has done. But a therapist could have been a great facilitator and taught us the ropes instead of me having to figure it out on my own while I was also dealing with my own issues that hindered my ability to help my wife.

    A paid therapist lacks the credibility that most people need: trauma victim or otherwise. We need to know that person is ‘in it’ for more than just the money, and when all hell breaks loose and the money dries up, his/her help won’t vanish.

    Respectfully, you can never do what the SO’s, family and friends can do: and that’s ok. It’s not your place. But the breadth of knowledge an ‘expert’ can have is something I simply don’t have time or energy to replicate, and that is a place that I feel can be served by those in your position to help those of us in our position.

    Wishing you well.
    Sam

  9. Hi Eric, thanks for this article, I think it makes a lot of sense! I think this role of “investigator” is already being taken on by those who are shifting to developing a formulation rather than a diagnosis: a formulation is a map of what’s going on and of possible routes to something different. Therapists can collaborate with people in developing such maps and in going through the process of change. But “investigating” sounds more understandable, less like jargon, than “developing a formulation.”

  10. Thanks for this article Dr. Maisel. I took “investigator” to mean getting to the bottom of the story and finding out what happened to someone instead of what is wrong with them. In that context it makes great sense to me. I think it is about finding a good, honest psychologist and the RIGHT one for you. There are good ones but others are tied to the DSM and function more like psychiatry and can do a lot of harm instead.

  11. One of the best therapists I have ever seen I saw over Skype. After I told her what happened to me she looked at me and said, “You don’t need a therapist. You need a lawyer.”

    What we need are people, degreed or not, who can point out exactly why and how “therapy” violates people rights. We need people to steer others, by example, away from therapy. We need role models who can illustrate that “problems” can be solved without aid of the mental health profession.

    Some of us need validation, just someone to listen and agree, “Yes, that therapist broke the law and broke all ethics to which they were bound as therapists.”

    Decades ago, say, in the 1960s, therapy was not very popular. Why? Because rigorous self-examination was not popular. People did not worry about every little thing that was wrong with them.

    As soon as you point out a person’s intrinsic deficiencies, or what you see are deficiencies, it sets a person down a very bad rabbit hole that’s hard to get out of. Sadly, all you need to do is to suggest a deficiency for the person to go into a tailspin.

    Yesterday I was on the phone with a guy, a free “business coach” session. I told him I’d like to have a more meaningful job, but I can’t seem to get hired at one. This guy knew nothing of my background and I didn’t tell him I spent 35 years as “disabled, severely mentally ill.” Knowing nothing about how far I have come (including currently dealing with a terminal illness), he ended up telling me I was “pessimistic” which, sadly, got me started on thinking I had a deficiency. Good thing I know better than to dwell on it or worry about it. If I was that flawed, I’d be miserable, and I’m certainly not.

    • As an example of the above, I have known people to read articles about “highly sensitive people.” This is a pseudodiagnosis, and it has harmed many people. As soon as they latch onto the self-diagnosis of this deficiency, “highly sensitive,” suddenly, the looping effect takes hold and they will become the diagnosis. This is a terrible trap. I know people who latched onto that diagnosis and now have social problems, difficulty maintaining friendships, and even have trouble keeping a job. I have no clue how to tell a person to stop this self-diagnosis, that the very idea of that something is terribly wrong with them is poisoning their minds.

      There is no such thing as “highly sensitive.” Some people are more prone to be observant of certain details. Others observe and remember totally different details. I notice workplace unfairness a lot sooner than others. I am the first to complain, often the only one who dares to say anything.

      Understandably, I am bothered when I have to take a call at work and I hear the caller being prompted by another person in the room. One time, I took a call from a guy who was clearly being abused by his girlfriend. He told me his girlfriend found out that he had purchased our product and now, he said, she was making him close the account with us. He said he regretted it. Knowing she could not hear me, I told him, “You can always sign up again, don’t worry.” Meanwhile, she continued to yell at him and cuss him out in the background.

      Afterward, I approached my supervisor and really, I wish now that I hadn’t. I was shocked at her lack of human compassion and lack of understanding of the significance of the event. She was condescending and told me to “get back to work.”