I recently had a book on popular psychology recommended to me and found it absolutely dire. And today’s paper reports that most of Sweden’s university programs for psychotherapists have been found to be substandard and will be closed down unless they improve dramatically. This has inspired me to write something about late 20th century psychotherapy, a.k.a. humanistic psychology, a movement that has been a background presence for much of my life.
When I was a kid in the late 70s my mother had what may be termed a nervous breakdown, followed by severe anxiety symptoms. [Stuff about other people's Valium use deleted.] she ended up spending almost two decades in the Gestalt therapy . Typical 70s stuff: confrontative group therapy, endless costly private sessions, primal screaming, punching pillows. This shaped our home life to such an extent that my kid brother and I (and, I suspect, our dad) would often sigh about mom’s “courses and therapies”. I remember sitting in the rowboat once at our summer house with my brother and our mom on a windy day. She was having a hard time at the oars propelling the boat against the wind, and screaming shrill Gestalt affirmations: “I AM STRONG! I AM STRONG! I AM STRONG!”. Us kids just rolled our eyes.
In high school, for reasons that seem really vague to me now, I actually spent some time myself in Rosen therapy and an Adult Children of Alcoholics support group. I was encouraged in this by my first girlfriend who was older than me and had also adopted some of the 70s “everyone needs therapy” ideology. She had grown up with an alcoholic parent, but I had not: yet I thought of myself as “codependent”. It did me no harm, I suppose, but I can’t see that it did me much good either.
Something that has long bugged me about humanistic psychology is its revealed/authoritarian character. You are expected to believe a lot of axiomatic truths about how emotions and interpersonal relationships work: for instance that a lot of people aren’t “in touch with their feelings” and that this may lead to various psychological and medical problems; and that you need to express anger and fear to “get it out of your system” or you will become “neurotic”. This body of alleged psychological knowledge doesn’t stem from any systematic studies: generally, it originates in oracular pronouncements of visionaries such as Freud, Adler, Maslow and Rogers. Visionaries whose entire models of the human mind have since been recognised as sheer speculation.
Since joining the skeptic movement, I have come to question a lot of axioms, including those of psychotherapy. It’s been liberating. I have learned that research shows that psychotherapy does actually alleviate depression and anxiety symptoms somewhat. But: its efficacy is not dependent on the therapist’s level of training or adherence to either of the various schools of thought in psychotherapy. In fact, what seems to work (a little) is simply to talk to someone about your issues, regardless of what training this person has. Talking to a sympathetic chef or seamstress will do you as much good as Freudian psychoanalysis. And no psychotherapy or conversation with chefs is as efficacious as cognitive behavioural therapy (CBT), which focuses on your symptoms and disregards any childhood ordeals entirely.
Two people whose opinions I value recently recommended me Danish child psychotherapist Jesper Juul’s 1995 book Dit kompetente barn. På vej mod et nyt værdigrundlag for familien (“Your Competent Child: Toward New Basic Values for the Family“). They felt that it had really helped them to become better parents. Well, I’m 3/5 through the book now, and I must say that I simply find it a big mess. To the extent that it offers any concrete advice for parents, it can be summarised in a single sentence: “Treat your children kindly and respectfully and don’t impose your will upon them unnecessarily, because it may give them a low sense of self-worth”. Gee, that’s some eye-opener, Jesper.
Juul shows no awareness of the critical scientific approach where statements of fact and generalisations demand empirical support: he is an evangelist telling us revealed truth about parenthood and childhood. Juul aims at a new paradigm for families, no less, but it is never clear from where his alleged knowledge stems. His case studies are full of ad hoc interpretations, and his models of childhood development are of the unfalsifiable variety: however a child may react to mistreatment, however they may interact with their parents, Juul feels that it confirms his ideas. And the verbiage, oh, the verbiage…
Dear Reader, depression is real. Anxiety is real. Parenthood is often difficult. Childhood is often difficult. Yet there are well-tested ways to cope with or alleviate all these issues. And psychotherapy is not one of them. It is placebo and a lot of it is woo.
So, with the background sketched above, you may imagine that it is with grim satisfaction I read the following in Dagens Nyheter:
“Most of the country’s educational programs for psychotherapists have not received the Ministry of Higher Education’s approval. ‘They do not attain university standards’, is the grim message. The government is also encouraged to re-evaluate the country’s entire system of psychotherapy education.
To become a licensed psychotherapist, you need a specialist education. Such programs are offered by seven Swedish universities and twelve standalone institutes or academies. But most of them do not measure up to university standards, according to the Ministry. PhD teachers are rare and the teaching is not based strongly enough in research.
— Another point we make is that these programs pretty much stand still, they don’t follow the developments in psychiatry, says Irene Häggström, the Ministry’s project manager. She refers to ongoing discoveries in neuroscience and psychopharmacology.”
“Well”, replies Sigmund Freud, “obviously this patient’s hostile reaction to therapy is a clear indication of a deep neurosis that could only be lifted through years of analysis”. Successful woo always aims at making itself impervious to criticism.
Update 12 May: I talked to my mom about this piece and it turned out she remembers things a little differently. To my surprise her version, reflected in the edits above, actually depicts Gestalt therapy in a worse light than I had drawn it. Apparently she didn’t break down and turn to Gestalt for help: she feels that Gestalt broke her down and then slowly helped her rebuild. She even completed a two-year course to become a Gestalt consultant, but I don’t think she has used that knowledge to drive anyone over the brink.
Update 14 May: Op-ed in Expressen/GT on this issue.