Dr Martin Rundkvist is a Swedish archaeologist, journal editor, public speaker, skeptic, atheist, lefty liberal, bookworm, and father of two. This is the world's #1 archaeology blog according to 
[More blog entries about psychology, psychiatry, psychotherapy, anxiety, depression, parenting; psykologi, psykiatri, psykoterapi, ångest, depression, föräldraskap.]
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 depression and anxiety symptoms. She had seen Valium befuddle her sister and would have none of that: instead she ended up spending almost two decades in 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 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
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 pre-CBT 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 licenced 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.
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Comments
"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.
Unfortunately, it seems that for many people it is an eye-opener. Much of the prevailing thought seems to be that you should train children like dogs...
Posted by: Dunc | May 10, 2007 09:43 AM
I'm afraid such people are not very likely to find that information buried in a book like that.
Posted by: Martin R | May 10, 2007 09:52 AM
It's entirely possible that above and beyond the real (yet carefully contextualized) benefits of psychiatric drugs, humans could need some sort of support and guidance we could call "therapy" which, unfortunately, is either unable to be made truly scientific or must await some discoveries into human mind and consciousness which are so far unforeseen.
It's also possible that a great mistake has been made into trying to make 'psychotherapy' a science, whereas at best (in my experience) it has represented aid to people seeking help or to find further 'growth' lent by insightful & experienced individuals who are *informed* by what scientific studies and general standards of care we have.
Posted by: El Cid | May 10, 2007 11:32 AM
Talking to a sympathetic chef or seamstress will do you as much good as Freudian psychoanalysis.
If the chef or seamstress has a good take on what makes people tick. As a veteran of therapy and Better Living through Chemistry, I agree that psychotherapy is useless. The best therapists I have had have been licensed clinical social workers or nurse practitioners. Instead of "tell me about your mother" fluff, they focus on ways to change the behaviors and thoughts that we use to make ourselves miserable.
Posted by: Rugosa | May 10, 2007 12:30 PM
El Cid, how would we know if such a non-scientific therapist were good or bad if their interventions couldn't be evaluated by scientific methods? Your description fits religion better in my view.
Rugosa, yes, I also believe that personal characteristics and life experience play a part in making such a chef conversation fruitful.
Posted by: Martin R | May 10, 2007 12:39 PM
It is placebo and a lot of it is woo.
Your view is based on a 70s view of psychotherapy and ignores the recent scientific studies of effectiveness and developments in psychological treatment.
There are now thousands of well run randomised controlled trials, the majority of which show that psychotherapy is more effective than placebo in treating mental illness.
The more recent developments in psychotherapy, such as cognitive behavioural therapy (CBT), are significantly different from the therapies you describe.
CBT in particular is widely researched and has been subject to a large number of RCTs, although the extent of evidence depends on the disorder. Some are better researched than others.
Its effectiveness over drug therapy depends on the disorder. It tends to be more effective than drug therapy for anxiety disorders, as effective as drug therapy but better in preventing relapse for depression, and used as an effective adjunct to drug therapy with psychotic disorders.
Models of CBT therapy are generally based on cognitive models of the disorders in question, although they tend to lag behind the most current models from cognitive science.
Dismissing psychotherapy as 'woo' based on your own experience and a limited view of the literature seems a little harsh I think, especially considering its proven effectiveness and safety.
Posted by: Vaughan | May 10, 2007 01:15 PM
Vaughan, please read the entry before you comment on it. I wrote, "And no psychotherapy or conversation with chefs is as efficacious as cognitive behaviour therapy, which focuses on your symptoms and disregards any childhood ordeals entirely."
Posted by: Martin R | May 10, 2007 01:25 PM
I saw that, but afterwards you say:
Yet there are well-tested ways to cope with or alleviate all these issues. And psychotherapy is not one of them.
CBT is a type of psychotherapy, which kind of threw me.
Posted by: Vaughan | May 10, 2007 01:43 PM
OK, then please advise me so I can clarify the text. Is there a blanket term in English for pre-CBT psychotherapy? There is a Swedish term, samtalsterapi, which literally means "conversation therapy".
Posted by: Martin R | May 10, 2007 01:51 PM
This post is talking to me. The uniformly accepted psychotherapy I grew up with was a troubling idea for me, but I didn't know how little support it had.
My problem would have been that while I can be a good conformist when it suits me I am much too independent to accept authoritarian environments outside an educational context. I could envision the outcome of such a treatment - 'we must first work with your problems of accepting my authority'. Indeed.
So I had the same feelings as you when psychotherapy was dethroned. Reading that article I can but hope that the swedish resources now will be directed towards more successful methods.
It seems KBT can be remarkably efficient in some cases, for example. But current practice has kept much resources with the old method as well, probably by inertia and old fellows networking. As you note, it is woofully good at protecting itself.
Posted by: Torbjörn Larsson, OM | May 10, 2007 02:20 PM
Uuups. I read "psychotherapy" as (freudian) "psychoanalysis", so I'm glad you threw me. Please read my previous comment with those two terms exchanged.
Posted by: Torbjörn Larsson, OM | May 10, 2007 02:29 PM
I suppose until very recently, psychotherapy has basically been where medicine was before microbes was discovered. Various schools of thought, all pre-scientific woo, fought for dominance of a market were there was a real need for methods that worked. And in the absence of such methods...
Posted by: Martin R | May 10, 2007 02:32 PM
Between the eras of Freud and CBT lies later-20th century "humanistic psychology". Which, I contend, offered only placebo.
Posted by: Martin R | May 10, 2007 02:35 PM
I see - I have never heard of it before. I sloppily assumed it was a rebranding ā la "creation science" to "intelligent design", but I will check your reference.
Posted by: Torbjörn Larsson, OM | May 10, 2007 02:43 PM
Ahh yes, the wonders of the modern, science based, save-us-all-from-our-foolishness CBT.
Hmm.
CBT is as not as powerful, well characterised, or scientifically solid as some would like us to believe. Nor, in many instances, I would dare suggest, is it particularly ethical either.
Far too many untested and untestable subjective assumptions, inferences and interpretations in these theories and models, and their applications. CBT studies and their underlying theories often have a certain mirage-like quality to them; the closer you look at them the more they tend to vanish into thin air.
And, yes, I am very well acquainted with the peer-reviewed literature and its clinical application on at least one major aspect of this subject, and (obviously) take a far more skeptical line than some here have.
I also have serious doubts about the general cognitive model of behaviour, and think that conscious cognition has far less importance in determining behaviour than many believe.
Some forms of CBT have their place, but overall it is a modest and often abused one at best, and I think an awful lot of money, time, and patient's lives are being wasted on this stuff.
Posted by: Ardem | May 10, 2007 10:26 PM
I'm currently learning some "Psychology of the Workplace" woo under duress.
It seems to consist of taking such vague-but-useful notions as "not acing like an complete ass", "knowing what you're doing", "listening to people" and "being careful", putting them through a blender and resynthesising them into equally vague but completely useless notions like "thinking outside tbe box", "being a team player", "assertiveness" and "conscious competence".
As for CBT, it's been flavour-of-the-months for around five years, and seems to be still working out its basic principles. Certainly we're not dealing with a proven method - more likely a cluster of nebulous partial insights cobbled together in response to the collapse of mainstream psychoanalysis.
For my money, it takes far too much from the pseudoscience of NLP (itself a mishmash of EST, Freud and, er, Scientology) to be credible.
Posted by: Kapitano | May 10, 2007 11:24 PM
Maybe it's like this: there is no therapist-based treatment against depression and anxiety with a strong and reliable effect. Yet maybe CBT is the currently known therapist-based treatment whose effect is least like placebo.
I'm watching the whole thing from outside, as I have an innately buoyant spirit and rarely suffer from anxiety.
BTW, let me also suggest that the concepts of "personal development" and "growing as a person", as used in psycholingo, are woo.
Posted by: Martin R | May 11, 2007 03:04 AM
Allow me to comment on that one, Martin.
I presume that psycholingo means the kind of language psychotherapists use when they talk about the mental state of their clients.
It may be that personal growth and development in that specific context is not exactly objective, neutral terms, yet they might still describe something real.
If the crazy shit that goes on inside teenagers' heads, and which, eventually, leads them to becoming 'grown ups', is not personal (i.e. mental, spiritual) growth in a very real sense, then what is it?
And, by consequence: If there is such a thing as personal growth, who says it cannot be furthered by guidance and advice from someone older and more experienced? Is it woo?
Posted by: Henrik | May 11, 2007 05:25 AM
I should have qualified that suggestion: I mean "personal development" in mature adults. Of course, as you point out, a person grows and develops hugely until about age 20/25. Either that, or they end up dead or in jail.
On my commute train, there are huge ads for a full-year course in "personal development" offered by a newage therapy centre. The slogan is "Become Who You Are", and the people in the ad pix are attractive greying 50-year-olds smiling stoned smiles. That's what I mean by woo.
I believe that a healthy adult who suffers neither from depression nor anxiety needs no "personal development". The whole concept is a typical artefact of post-war Boomer self-centredness. Of course nobody's radiantly happy every day, but that's just life in my opinion. If someone's really bored or unhappy or lonely, then they probably need to change jobs or spouses or find some new friends.
Posted by: Martin R | May 11, 2007 05:59 AM
I wish you wouldn't use the term 'axioms'! Please reserve that term for mathematics and logic.
Posted by: Alex Leibowitz | May 11, 2007 01:52 PM
Any other good words for basic assumptions that must be accepted on faith?
Dogma perhaps.
Posted by: Martin R | May 11, 2007 03:57 PM
Funny. I took Martin's use of 'axioms' to be a mocking of the fact that those who wrote about, and practiced 1970s and 1980s psychotherapy often behaved as if they believed their pronouncements were the foundation and the result of great works of impeccable logic.
Posted by: lllewelly | May 11, 2007 07:39 PM
"Dogma" would underline the religious character of the whole thing. Pretty apt, actually.
Posted by: Martin R | May 12, 2007 02:48 AM