In Defense of the Long, Painful Grind of Therapy

I’m not familiar with Masson’s book but “The Myth of Emotional Healing” is an absurd subtitle. Just because much of what passes for “therapy” isn’t up to snuff does not mean good therapy doesn’t exist and emotional healing is a myth. Emotional healing is a very real, very vital and desperately needed ability we all have inside us. The trick is just finding the people who can really help us achieve it. (In my experience, Alice Miller is the best – highest quality therapy for the price of a few paperbacks.) Real therapy is life-saving, liberating, enlivening. I appreciate Masson’s work on Freud, but, what is he doing with that subtitle… He’d probably benefit (as would most people) from reading Alice Miller, who explains why much of psychological and medical “help” is manipulative, repressive, and counter-productive — but she also provides the opportunity for a truly emotionally therapeutic experience, so you can really feel the difference.

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The research I’m familiar with suggests that it is not “ineffective methods” but rather lack of emotional preparation and appropriateness that undermines success. Therapy success appears to be associated more with therapist characteristics than by method or school of therapy employed.

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Would you mind explaining to us what constitutes ethical and legal behavior in psychotherapy?
To cite just one glaring example, is it really ethical and should it be legal to foist Ritalin and other demonstrably harmful stimulants upon millions of children who supposedly suffer from the hypothetical ADHD syndrome? Yes, federal and state laws do permit the use of neurotoxins,” but I have no doubt that Big Pharma lobbyists, the self-serving psychiatric guild, and the acquiescent FDA play a major role in crafting toothless legislation that perpetuates chemical lobotomies and other brain-disabling treatments.
Is it ethical and should it be legal to practice a so-called profession whose entire raison d’etre is based not on legitimate, verifiable medical and scientific findings, but on the multitude of fictitious disorders concocted by DSM panels (the majority of whose members derive financial benefit from their association with pharmaceutical companies and ECT device manufacturers)?
Given the widespread corruption and lack of credibility inherent in the intellectually shoddy and morally bankrupt mental health industry, I see no valid reason for its continued existence and acceptance.

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Reading Epstein and others demonstrates that these confident statements about the efficacy of therapy are unfounded and mostly locate the issues within an individual devoid of the persons context and resources, the very things that are the keys to any chance of healing – rather than a few hours with a therapist administering what David Smail refers to as a ‘hodge podge of half baked theory and techniques’. Laughable things like EMDR and its entirely fictitious Accelerated Information Processing model and its empty stage management techniques that can be handy for enhanced placebo via ‘bilateral stimulation’

If the odds of harm are low why have I heard from literally thousands of people over my years in the field that say they were harmed in therapy and in myriad ways? Just silly anecdote I guess.

Despite that fact that in most cases the therapist is in complete and utter ignorance regarding the clients actual life out side the comforts of the therapy room door – beyond the mood and mayhem of distorted stories they have presented to you.

In order to get at this information requires a genuine interest in understanding past experience in therapy warts and all – many people feels embarrassed, shamed and unable to tell this truth especially to another so called therapist.

How many drop out convinced they have also failed at therapy as well as feeling a failure just generally. How many therapists chide their clients to do the homework and put the work in, so its really all about YOU not the therapy or the therapist at fault, just look at all of our evidence, a hill of beans really.

How much does it cost to bring a malpractice suit? Who has the time and resources for this especially when they are suffering? And especially when the harms of psychotherapy ‘ are well known but under researched’

In the UK Taking Therapies service the drop out rate is enormous yet ZERO are followed up.

Here are some useful summaries from William M. Epstein critiques from his books, The Illusion of Psychotherapy, Psychotherapy as Religion: The Civil Divine in America, and Psychotherapy and the Social Clinic in the United States.
1. Lack of Scientific Foundation
Epstein argues that psychotherapy lacks a solid scientific basis. He critiques the field for relying on anecdotal evidence and subjective experiences rather than rigorous, empirical research. He contends that many of the claims made by psychotherapists cannot be scientifically validated, making psychotherapy more of a pseudoscience than a legitimate scientific discipline.
2. Ineffectiveness
In his work, Epstein questions the effectiveness of psychotherapy. He asserts that the evidence supporting its efficacy is weak and that any perceived benefits are often due to placebo effects, the natural course of recovery, or other non-specific factors unrelated to the therapeutic process itself.

3. Psychotherapy as a Form of Religion
Epstein likens psychotherapy to a form of secular religion, where therapists act as priests, offering moral and emotional guidance rather than real, evidence-based solutions. He suggests that psychotherapy fulfills a cultural need for meaning and comfort, similar to religious practices, but without delivering concrete, measurable benefits.

4. Commercialization and Professionalization
He critiques the commercialization and professionalization of psychotherapy, arguing that it has become more about maintaining a lucrative industry than genuinely helping people. He is particularly critical of how the field has expanded its influence by medicalizing normal human experiences, turning everyday struggles into mental health issues that require professional intervention.

5. Impact on Social Policy
Epstein is concerned about the influence of psychotherapy on social policy. He argues that it diverts attention and resources away from addressing structural issues like poverty, inequality, and social injustice, focusing instead on individual psychological problems. He believes that this shift reinforces a neoliberal agenda that blames individuals for their circumstances rather than addressing broader societal issues.

6. Ethical Concerns
He raises ethical concerns about the power dynamics in the therapist-client relationship. Epstein is critical of the authority that therapists wield over their clients, often without sufficient accountability or transparency. He questions the ethical implications of this dynamic, especially when combined with the lack of solid evidence for the effectiveness of therapeutic interventions.
7. Critique of Social Work and the Social Sciences
Beyond psychotherapy, Epstein extends his critique to the broader fields of social work and the social sciences. He argues that these fields often suffer from the same lack of scientific rigor and are influenced by ideological and cultural biases that undermine their objectivity and effectiveness.

1. Questionable Efficacy
Weak Evidence for Effectiveness: Epstein argues that the evidence supporting the effectiveness of psychotherapy is weak and inconsistent. He contends that many studies that claim to demonstrate the benefits of psychotherapy are methodologically flawed, often relying on small sample sizes, biased reporting, and subjective measures of improvement. According to Epstein, much of the research fails to establish causality, meaning it cannot definitively prove that psychotherapy itself is responsible for any observed improvements in clients.

Placebo and Non-specific Effects: He suggests that any benefits reported by clients of psychotherapy can often be attributed to placebo effects, the therapeutic relationship (often called the “therapeutic alliance”), or other non-specific factors such as the passage of time, rather than the specific techniques or interventions used in therapy. Epstein argues that these factors would provide similar benefits even in the absence of formal therapy, thereby calling into question the necessity of psychotherapy itself.
Regression to the Mean: Epstein also points to the statistical concept of “regression to the mean” as an explanation for why people often report feeling better after therapy. Since many clients seek therapy during periods of acute distress, their symptoms may naturally decrease over time regardless of the therapy they receive. This natural improvement is often mistaken for the effect of the therapy, leading to an overestimation of its efficacy.

2. Harms of Psychotherapy
Pathologization of Normal Life: Epstein argues that psychotherapy can cause harm by pathologizing normal human experiences. By labeling everyday challenges and emotional responses as symptoms of mental disorders, psychotherapy may encourage individuals to see themselves as ill or deficient, which can lead to unnecessary treatment and a sense of dependency on mental health professionals.
False Sense of Control: He is critical of the way psychotherapy promotes the idea that individuals can exert control over their mental health through therapy. Epstein argues that this belief can be harmful because it ignores or downplays the significant impact of external, structural factors—such as poverty, discrimination, and social inequality—on mental well-being. As a result, individuals may feel responsible or blame themselves for their struggles, leading to increased feelings of inadequacy or failure if therapy does not lead to the desired outcomes.

Reinforcement of Social Conformity: Epstein contends that psychotherapy can reinforce social conformity by encouraging clients to adjust their thoughts, feelings, and behaviors to fit societal norms, rather than challenging those norms or addressing the underlying social conditions that may contribute to their distress. This can be particularly harmful for individuals who may be experiencing distress as a result of oppression, marginalization, or other social injustices.
Dependence on Therapy: Another harm that Epstein identifies is the potential for clients to become dependent on therapy. He argues that psychotherapy can foster a reliance on the therapist, creating a dynamic where the client feels unable to cope with life’s challenges without the ongoing support of therapy. This dependence can undermine an individual’s autonomy and self-efficacy, potentially leading to long-term reliance on mental health services.
Lack of Accountability: Epstein also critiques the lack of accountability in the psychotherapy profession. He argues that because the outcomes of therapy are difficult to measure objectively, therapists are rarely held accountable for ineffective or harmful practices. This lack of oversight, combined with the subjective nature of therapy, can lead to situations where clients are harmed without recourse.

3. Broader Social and Ethical Concerns
Distraction from Structural Issues: Epstein argues that the focus on individual psychotherapy distracts from addressing broader social and structural issues that contribute to mental distress. By framing psychological problems as individual issues to be solved through therapy, society may neglect the need for systemic change to address social determinants of mental health, such as poverty, inequality, and discrimination.

Reinforcement of the Status Quo: He further contends that psychotherapy often reinforces the status quo by encouraging clients to adapt to existing social conditions rather than challenging or changing them. This can perpetuate social inequalities and injustice, as therapy becomes a tool for maintaining social order rather than promoting meaningful change.

William M. Epstein is also critical of the Diagnostic and Statistical Manual of Mental Disorders and for obvious reasons.

1. Medicalization of Normal Behavior
Epstein argues that the DSM contributes to the medicalization of normal human behavior. He believes that the manual pathologizes a wide range of everyday experiences and emotions, transforming them into mental disorders that require treatment. This, he contends, is a way to expand the reach of psychiatry and psychotherapy, turning ordinary life challenges into medical issues.

2. Lack of Scientific Validity
Similar to his critique of psychotherapy, Epstein questions the scientific validity of the DSM. He argues that many of the disorders listed in the DSM are not based on objective, scientific criteria but rather on subjective judgments made by committees of mental health professionals. He suggests that these categories lack clear, empirical definitions and are often created or modified based on cultural, social, or economic factors rather than scientific evidence.

3. Influence of the Pharmaceutical Industry
Epstein criticizes the DSM for being influenced by the pharmaceutical industry. He argues that the expansion of diagnostic categories serves the interests of pharmaceutical companies by increasing the market for psychotropic medications. This relationship, he suggests, undermines the integrity of the DSM and raises ethical concerns about its role in promoting the use of drugs to treat conditions that may not require medical intervention.

4. Reinforcement of a Neoliberal Agenda
He believes that the DSM reinforces a neoliberal agenda by individualizing social problems. By framing issues like anxiety, depression, and stress as personal mental health disorders, the DSM shifts focus away from structural factors such as poverty, inequality, and social injustice. Epstein argues that this approach absolves society of responsibility for these issues and places the burden on individuals to manage their problems through therapy or medication.

5. Arbitrariness and Over-Diagnosis
Epstein also critiques the DSM for its arbitrariness in defining and categorizing mental disorders. He points out that the boundaries between different diagnoses are often vague and that the criteria for inclusion in the DSM are not always consistent or based on solid evidence. This, he argues, leads to over-diagnosis and the potential for harm, as more people are labeled with mental disorders and subjected to unnecessary treatment.

6. Ethical and Social Implications
Finally, Epstein is concerned about the ethical and social implications of the DSM’s widespread use. He argues that the manual’s influence extends beyond psychiatry into broader social and legal contexts, where DSM diagnoses can affect individuals’ rights, responsibilities, and social standing. He questions the ethics of relying on a document with such significant power when its scientific and moral foundations are, in his view, deeply flawed.

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You have made certain assumptions about the supposed virtues of psychotherapy without substantiating your arguments. Sweeping assertions (“therapy is very real, very vital…[and] “liberating”) put forward without verifiable findings derived from rigorous testing and other procedures necessary in a legitimate field of medical science, and appeals to authority (Alice Miller in this instance) carry much less weight than the harrowing, real-life stories of the many MIA contributors who have been physically harmed and/or emotionally scarred by the sundry “treatments” offered by this would-be profession. Furthermore, your use of the word “symptoms” to characterize the thoughts, feelings, and conduct of people in various states of emotional distress is yet another example of the unwarranted appropriation of medical language. Given the fallacious premises and intellectual shoddiness of the cult masquerading as psychiatric science, I find Masson’s subtitlte “The Myth of Emotional Healing” entirely fitting and accurate. For there can be no literal healing of non-corporeal entities such as emotions and patterns of behavior unless they originate in demonstrable–not hypothetical–pathology of the brain and nervous system.
Lastly, if the DSM–the current guide for the diagnosis and treatment of hundreds of putative disorders created out of whole cloth by panels whose members generally have ties with the pharmaceutical industry–is not based on legitimate science, I fail to understand what can endow any kind of therapist with the authority to pass judgment on the mental “health” of his or her client. In the absence of verifiable, universally valid criteria, why should one give more credence to the ideas of Alice Miller rather than the hypotheses put forward by Freud, Jung, Reich, Lowen, Skinner, Hubbard, Pierrakos, Janov, and other self-styled experts?

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Forgive me but this made me laugh – i’ve worked in the industry for decades and can attest that those of us labelled as ‘therapists’ are just human beings and just as messed up and lost as everyone else is. Where are these people floating on air with everything sorted? those that have been in therapy for years are often more crackers.

Harms can be done in many ways, not least due to direct abuse but often more subtly. Therapists hold a position of power and are believed to be in possession of curative powers that simply do not exist beyond marketing, advertising panglossian self belief that is probably responsible for stimulating a little placebo effect.

Many trauma therapies EMDR, CBT etc are getting people to connect, often with devastatingly, overwhelming experiences and all that comes with this – many people simply drop out when it gets too much and very few if any are followed up – i’ve had many a client tell me this was like having their trauma drug up and left by the side of the road.

As soon as we get people to think about things we are shifting our sensory complexity often in a disturbing and painful direction. Most therapists have no clue as to what life is really like for anyone beyond the therapy room door and so we can easily do much more harm than good operating as we do in near complete ignorance. Not just in trauma work either, relational work, all of it can harm.

The therapy industry evidence base is consistently and criminally oversold so the image of professionalism and healing power is pure illusion. Yet the culture colludes with this marketing hype and suffering people step into a dangerous, misleading one sided power imbalanced situation.

If any of this worked perhaps we would expect to see suffering decreasing but it increases year in years out – it is however useful to power and profit to have millions of people psychologised into believing the fault lies in personal disorder not in myriad cultural disorders and so the status quo is maintained.

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The only thing that bugs me more is how (most?) therapists (seem?) to have the attitude that their insights and opinions carry more weight.

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