Thursday, December 30, 2010

Talk Therapy with a Forked Tongue

Therapy's Delusions: The Myth of the Unconscious and the Exploitation of Today's Walking Worried
by Ethan Watters and Richard Ofshe

The Goodread review:

In this clearheaded and courageous book, Ethan Watters and Richard Ofshe expose the pseudoscience behind the twentieth century's most enduring myth - Freud's theory of the psychodynamic mind. Despite the lack of credible evidence for a powerful unconscious that controls our behavior, a huge number of therapists continue to base their practice on the idea that only they can uncover their patients' unconscious motivations, luring thousands of Americans, from the mildly demoralized to the seriously ill, down dangerous and arbitrary paths of treatment. . . . This book is a call to action for reforming the poorly regulated mental health profession, so that no more patients are misled by a myth that has held sway over American minds for far too long
Finally someone is willing to come out and say it.  Much of what passes as psychotherapy is not based in empirical science and is quite often unhelpful or even worse.  This book is a wry yet disturbing romp through the cultural history of psychoanalysis from its birth out of the forehead of Freud, through it’s explosive captivation of the American pop psyche, and finally up to the present day accumulation of psychotherapy methods (the intellectual grandchildren of Freud’s) that are trademarked, patented and hocked to practitioners at carnival-like trade shows.  It is a must read for anyone who has questioned the Great Oz of the Ego/Id/Superego Trinity and wants to know who the man behind the curtain is.

While there has been a virtual Gatling Gun of  criticism of the biomedical model from psychosocial adherents, there has been very little in recent memory in the way of criticism of psychotherapy.  In that sense, Therapy’s Delusions is a breath of fresh air.  My only gripe with Watters and Ofshe is their implicit assumption that the biomedical model is more objective and has more to offer consumers of mental health.  While both theoretical arenas contain elements of empirical knowledge, they are also both driven by ideology and consumer-capitalism.  It is quite well known now that the pharmaceutical industry drives bio-psychiatry forward as a commercial enterprise.  The authors fail the test of objectivity by ignoring this plain fact.  However, they have done us a service by highlighting the equally disturbing but lesser known fact that psychosocial based therapy is also a capitalist endeavor made up of many entrepreneurs and businesses both large and small.  Every peddler of treatment models and every practitioner of psychotherapy has a profit motive hidden, undeclared, under the surface of their brand.

What’s wrong with that, you ask, it’s the American Way, is it not?  Yes, it is.  And it is not so wrong except that it is denied and hidden.  It is lurking in the id of the mental health industry, you might say.  Hidden from view, who can say when and how often the profit motive trumps the best interest of consumers of mental health care?  Don’t expect a straight answer from your therapist, especially if their house is underwater, as we say these days.


  1. Interesting book - I'll need to take a look at it. See also Ethan Watters' latest book Crazy Like Us, about the globalization of the DSM-IV model of mental illness and how it's unhelpful for mental health professionals in other countries (and, by implication, in the US as well). Which I reviewed here, briefly, it's amazing.

    In Crazy Like Us Watters doesn't heap all the blame on either biopsychiatry or psychotherapy - which is a nice change. As you point out, biological psychiatry tends to take all the flak, and yes it deserves a lot, but that doesn't mean therapy is spotless...

  2. Yes, I have to agree that Crazy Like Us is a great book and I highly recommend it without reservations. Isn't it interesting that it takes a journalist to say the things that psychologists, anthropologists and traumatologists should have been sensitive to all along.

  3. I'm only at the beginning of my studies, but I ultimately aim to become a counselling psychologist, or a psychotherapist. Even in my preliminary reading, it has been pointed out multiple times that it is not the approach/school/method of therapy which helps the client, but it is the therapeutic relationship or working alliance.

    Is it really that harmful to "peddle" pseudoscientific theories, when they don't even matter in the grand scheme of client healing? Perhaps they give the client a framework for understanding their own mind and actions, and that of others, giving them comfort and the ability to rationalise and cope with what would be otherwise overwhelming relationship issues.

    Also, I find it hard to believe that any therapists go into this line of work to "exploit" people. Surely the type of person drawn to this profession would not have such capitalist motivations? I certainly don't, but perhaps I will see people like this in time.

    I actually have a BSc (genetics) and I believe strongly in the scientific method. Even so, clearly I also have a pro-therapy mindset. I think I shall have to buy this book, to remind me to assess the treatment methods I'm studying objectively!

    Thanks for the thought provoking post!

  4. Just came across this article today, it's a nice counter-argument!

  5. Thanks for your thoughtful response Kate (and sorry for my untimely response to your response). I have a bad habit of ranting and tend to exaggerate in response to what I see as a lack of real dialogue and critical thought in the field.

    I would not necessarily discourage your career choice and therapists can do a lot of good, of course. The argument that non-empirical methods are harmless placebos is common wisdom for some and I think there is some general truth to it.

    The point I really want to make though, is when the therapist buys their own advertising, truly believes the sugar pill is medicine, if you will, then there is a danger of doing harm, and I do think that I have seen it happen. When working with someone who is emotionally vulnerable and who puts a lot of trust in you, you can lead them down a very wrong path in their life. Overwrought methodological theory serves to blind the therapist to what is really happening because what happens with the client in session is distorted by that lens.

    My view is somewhat biased because I work in public mental health, mostly with the “severe and persistently mentally ill,” so I see cases that go very very badly sometimes. I think for private therapists there is a greater proportion of clients who are likely to get back up on their feet with a little support from the therapist, maybe regardless of method or theoretical bent.

    I don’t think that therapists are bad and want to exploit their clients any more than pharmaceutical researchers are out to get people, but in the real world people are motivated by success and money. Therapists are just as vulnerable to this as auto mechanics or any other profession. Therapists, however, are much better at fooling themselves. That’s my cynical observation from years of dealing with them and trying to supervise them.


  6. Kat -
    I do wish you well in becoming a psychotherapist. My experiences have not been that many go into this field for $, but that many DO go into this field because of needs they have, many of which are unconscious.
    for instance, WHY would a therapist scream at her/his client??? Belittle them? Act superior to them? Literally bark orders at them, in telling them HOW to solve a problem? I have had therapists who have done the following: one spoke about her hatred of men, because her husband had cheated on her; A man told me, in a very ugly voice, that his wife was a JAP (Jewish American Princess), even tho I was Jewish; my first therapist exhibited all the symptoms of borderline personality disorder, and actually 'accused' me of 'hogging' all the therapy time for telling her MY problems (she told me that she needed time to tell me HER problems - btw - I was paying HER); another told me, very belligerantly that of course men didn't like me because of the way I 'acted' - never explaining what that was, and never trying to help me 'change', etc.; several said NOTHING during entire sessions - when I asked one why she wouldn't say anything she told me that I and my boyfriend (we had sought couples counseling) had 'too many things' going on - I told her that in my next life I would become a therapist & do exactly what she was doing - get paid big bucks for doing NOTHING; when I told a new therapist what I was coming to see her for, she responded 'And THAT bothers you?!' like I was nuts or something-she never helped me, and should have told me that from the start that she couldn't. I am really sick & tired of this profession - I think many therapists are in it because: 1) they have a 'belief' that they MUST announce to everyone, like 'men are all jerks",; 2)Many are angry people who can take their anger out on their clients easily - clients are vulnerable, and desperately want help, and won't fight back. 3) Many have mental problems themselves, and in a very bizarre way, think they can 'work them out' by doing therapy - a variant of this is they feel badly, but when doing therapy on others, are no longer focused on their problems, and so feel much better; 4) Many just want power, and go 'nuts' if challenged; 5) Many can't get intimate with others, they are too scared, etc., BUT as we all have intimacy needs, they fulfill these needs by getting 'intimate' with their clients - after all, when we listen to someone's deep feelings, we do feel closer to them. THis way the therapist gets intimacy without having to be vulnerable.
    Well, that's about it. I think therapist's sessions should be randomly 'listened in on' by supervisors. Otherwise, there is no way that anyone else really knows what's going on - and can call them on it.

    1. Kat, I think most therapists well-intentioned. In retrospect, I wish I'd never gone to therapy and wish I could purge their vocabulary and worldview from my brain.

      Like everyone, I have my flaws, much more my younger self seeking treatment. However, the therapy relationship was so contrived my counselors lacked the slightest notion what hindered me in the real world. The consulting room was a bell jar.

      I had highly unrealistic expectations what therapy could accomplish, and the therapists collaborated this. I expected some sort of change--maybe I'd become someone else. I expected the inevitable pain of living would somehow be lessened. And so I surrendered myself to the therapists' imagined wisdom, and complying with all the exercises and rituals they requested. I thought all these placebo motions accomplished something.

      One therapy team indeed was unethical and mean-spirited. Another "ethical" therapist was a mother figure, rescuing, sometimes prescribing action and stoking my self-pity. An analytic treatment led me--or encouraged me to lead myself--to such an introspective frenzy life heightened like an acid trip.

      All of this damaged my functions in the real world. I lost friends during my foolish excursions. Now I see others delighting in their delusional transformation and wonder if they're under the influence of some therapist.

      In retrospect, I feel completely duped. But this wasn't being gullible to a street fortune teller or a slick human potential huckster hawking his books. This was submitting to treatment from credentialed accredited practitioners.

      All these people preempted my own self-narrative with their interpretations. They left me feeling MORE childlike and dependent. And they taught me a mindset that reduces complex relationships to categories and labels.

      I can't provide answers. I doubt the juggernaut is going anywhere. But I'd urge students and clinicians remove themselves from the theoretical pseudo-world and see the cruel manipulation of psychotherapy through realistic