Is Psychotherapy Superstition?

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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. The occasion was that my parents had marriage problems and sought guidance: they came into contact with a newly accredited Gestalt therapist who put them through some really hard-core confrontative sessions, leading to my mom's collapse. [Stuff about other people's Valium use deleted.] To repair that damage, and pretty incongruously in my view, she ended up spending almost two decades in the Gestalt therapy movement. 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 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 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.


More like this

"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...

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.

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.

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.

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.

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."

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.

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".

Since joining the skeptic movement, I have come to question a lot of axioms, including those of psychotherapy. It's been liberating.

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.

By Torbjörn Larsson, OM (not verified) on 10 May 2007 #permalink

CBT is a type of psychotherapy, which kind of threw me.

Uuups. I read "psychotherapy" as (freudian) "psychoanalysis", so I'm glad you threw me. Please read my previous comment with those two terms exchanged.

By Torbjörn Larsson, OM (not verified) on 10 May 2007 #permalink

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...

Between the eras of Freud and CBT lies later-20th century "humanistic psychology". Which, I contend, offered only placebo.

Between the eras of Freud and CBT lies later-20th century "humanistic psychology".

I see - I have never heard of it before. I sloppily assumed it was a rebranding à la "creation science" to "intelligent design", but I will check your reference.

By Torbjörn Larsson, OM (not verified) on 10 May 2007 #permalink

Ahh yes, the wonders of the modern, science based, save-us-all-from-our-foolishness CBT.


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.

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.

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.

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?

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.

I wish you wouldn't use the term 'axioms'! Please reserve that term for mathematics and logic.

By Alex Leibowitz (not verified) on 11 May 2007 #permalink

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.

By lllewelly (not verified) on 11 May 2007 #permalink

t'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"

Entirely possible? Yes, we call that "interpersonal interaction", or "having friends and loved ones".

Quite frankly, I think you're also misrepresenting the nature of psychiatric drugs.

By Caledonian (not verified) on 12 May 2007 #permalink

I am a psychotherapist & practice pre-CBT therapy. Strangely enough I have some sympathy for your skepticism. Going to a therapist, as your parents did looks pretty grim, however I have a hunch that even this rather horrific stuff may well have been better than say, suicide. Could it be that those courses & groups prevented that or some other catastrophe? For some people it may have (for some it may have exacerbated the situation, it is hard to tell, but don't underestimate people, they have some idea of what they need.)

One thing I offer that say, most chefs, do not is confidentiality, time, a place and extensive skills and experience with people, and I also have my own supervision to attend to my functioning (all ethical practitioners have that.) In this private & personal space, not invaded by research from the outside, there is a form of internal research. "How are you doing?" "What has been helpful in this session?" With 20 plus years of working with people I have a certainty that the work is OK. People get better, I see it, they tell me, they are not stupid.

That is the sort of knowing that does not register easily in research. A lot of research I have seen into psychotherapy is very superficial, some of it is pure nonsense. What are they measuring & what is the control group? How is confidentiality maintained, and how are underlying shifts measured as opposed to outcomes related usually superficial presenting problems? A scientific nightmare. CBT is a form of therapy (lets leave psyche out of it, as they don't get that) that is OK for some things, I use it often, but it is only a small aspect of my work. It is designed to show up positively in the research, it is tautologically effective. Be skeptical about psychotherapy research.

Ask people how their therapy helped & they will usually tell you something quite sensible. But there is some strange psychobable that is for sure. What we experience in dreams & in our minds is very fluid & subjective so it is not easily grasped in language; Id, ego, superego, flat, growth, high, sad, depressed, moody are metaphors and as a psychotherapist I can work with the language the client brings, be it Buddhist, Christian or skeptic! A lot of this new age stuff is in the culture, that is the language clients use, even when they talk about rape, murder, death or trauma about financial transitions. Talking about pain helps, but it is "inner pain" - how can you research that "scientifically"? With great difficulty, but easily in an ordinary conversation.

Nothing wrong with taking to a friend. It will help. What if you don't have any or if you don't trust them? Or you have done that & you need something more?

Yes it is risky, some therapists charge too much, some are sexual predators, some are simply full of their own problems. How to avoid that?

Ask friends (if you have them).
Check out credentials. Modalities. Training. Do their words mesh with your own understanding of what it is to be human?
Google them & read up on them.
Are they kind.
Don't trust too easily, be prepared to try a second one if the first seems wrong. Don't assume you are the problem.
Do they have current practising certificates. Research who with, do they seem like ok organisations?
Most sessions should leave you feeling a bit more hopeful, enlivened.

This sort of learning is not scientific research by standards set for the physical sciences, but it will work for a lot of people. And it may go against some research. Who are you going to trust when you need some help?

Martin, I'm right with you on humanistic psychotherapy and its many incarnations (Gestalt therapy, existential psychotherapy, and so on). It's all bunk, and there's plenty of evidence to that effect. But it's a mistake to lump other forms of psychotherapy -- including the modern incarnations of psychotherapy in the Freudian tradition -- in with humanistic psychotherapy, and call them all woo. There is, in fact, plenty of empirical evidence that for many mental disorders, psychodynamic therapies are as effective as CBT and drug treatments, if not more effective (the relative effectiveness depends on the disorder).

Well, as a "sufferer" from AS & ADHD, I would say that we need therapy and not only drugs! It seems as if some here wants to say that therapy is B-S and drugs are the way!
If that is the path of "scientific" psychiatric treatment, save us from that.
The consumation of drugs against mental problem INCREASES year from year. Still KBT (or CBT) have helped many AS persons to handle their life better, without the use of drugs. And if you do not have to spend money on expensive drugs and get helped, what is the problem? AS persons certainly do not complain.

It is important to recognize that all therapies does not work for all kind of disorders. But KBT seems to work very good for AS persons.

And I bet an old noaithi shaman would have made a great counsellor with his or her metods, who where based on long expirience and traditions. In the end, it comes down to learning to know how people tick and you do not need science to learn that. But neither do you need old Freud and Oidipus complexes to do so...

There are to few true shamans in the world anyway, and to many western self-made copycats be they aroma therapists or Freudian psychologists.

By Mattias Niord (not verified) on 14 May 2007 #permalink

Except, umm... there are all sorts of disorders for which talk therapies(including psychodynamic therapies) show better results than control groups or placebos. If you do a little PsychInfo research on metanalyses of different treatment programs for different disorders (from personality disorders to PTSD and depression), you'll find several statistically significant results, with varying effect sizes depending on the disorder, length of treatment, type of treatment, and so on. It's disingenuous, if not lazy, to lump all non-CBT talk therapy together. Psychodynamic therapy and humanistic therapy are fundamentally at odds with each other theoretically and practically (psychodynamic therapy is, at base, anti-humanistic, e.g.), and their empirically demonstrable treatment outcomes are very different as well.

The advice in Walter's post about questions is good stuff, and not just for talk therapists but any sort of professional dealing with mental health stuff - if you're not comfortable with a psychiatrist then you're not going to tell them the things they need to know to make appropriate treatment decisions.

Also, having done a little counselling skills work, really listening to someone's problems and letting them talk things through is a lot more difficult than it sounds. Listening is an undervalued skill!

What if your distaste for psychotherapy is actually just residual anger for what you believe caused your mother's collapse, and using your voice on the net to rail against it is your best current method to express it?

You're obviously entitled to your opinion on this, and I think that there are many angles to take in criticizing psychotherapy, but equating it to "superstition" and thinking it literally is just "talking to someone about your issue" is pretty simplistic no? Come on, we're all smarter than that.

I find it more likely that I carry residual anger against my mother for not letting me go into Gestalt therapy, and for not being allowed to act upon my adolescent urge to have sex with my mother's therapist's wife, who was kind of hot, nor with any other of my mother's female friends, which was at its root really just about my longing to earn the respect and love of my dad. I wonder if my dad is secretly a cross-dresser?

This is a great quote from the pre-scientific era of clinical and counselling psychology. Unfortunately, it applies rather too well to unsepcified psychotherapy. "Psychotherapy is an undefined technique applied to unspecified cases with unpredictable results. For this technique, rigorous training is required." (Raimy, 1950)

I find it atrocious that psychotherapy is one of only two lines of treatment for a lot of long term depressed people. There are nearly hundred medical cause conditions that have "depression" as a part of that disease process. These causes are not even looked for. Patients who put two and two together and try to look for the root biological cause of their illness are brushed aside by their GP's... Thyroid doctors who try to treat thyroid condtions properly are run out of the business.

But you *are* welcome to spend through the nose to look for some non-existent "childhood" cause of depression, based on a theory founded on the professional fraud of narcissist, drug-abusing, sexually harassing, lying, misogynist Sigmund Freud.

" it's a mistake to lump other forms of psychotherapy -- including the modern incarnations of psychotherapy in the Freudian tradition -- in with humanistic psychotherapy, and call them all woo."

Wrong. It's woo and always has been. Freud fabricated each one of his case history "successes". The psychoanalysis industry pressured and financially induced "Wolfman" not to go to America, where the reality of Freud's miserable failure would have destroyed Wolfman's status as a living legend.

More recently Eysenck discovered the same proportion of people waiting for psychotherapy get better on their own (2/3) as psychotherapists "cure". Coincidence? Don't think so.

Therapy is a relationship between two people, and if your therapist is abusive, untrained, self-serving, unethical or immature the result will be unhealthy and potentially damaging. Despite agreeing that there are many "crackpots" presenting as therapists, therapy with a mature and competent practitioner should help a client recover from trauma, depression or anxiety. Too many people fail to recognise the need to receive treatment or modify their behaviour to improve the quality of their lives as well as their daily interactions with other people, including their own partners or children. A direct link occurs between victims of violence becoming violent, aggressive or abusive themselves or excusing and accepting abusive treatment.

In other words, psychotherapy IS scientifically based on logical conclusions drawn from facts. The mind is affected by trauma or chemical imbalances. However, the brain is plastic and can be changed; behavioural patterns and reactions can also be reprogrammed by changing core beliefs or brain chemistry. This may sound simplistic, but it forms the basis of why clients will improve if they receive appropriate help and follow the guidelines offered by a skilled practitioner. The problem does not lie with therapy, per se, but with finding a competent therapist who can assist you. Bottom line, ask yourself if you would trust or like this person if you chanced to meet them in the street. If not, listen to your gut and go elsewhere for help. Too many psychiatrists, in particular, act as mini-gods and thrive on reducing patients to a position of infantile dependence instead of building them up and encouraging them to function better and be responsible for their own lives. Perhaps these psychiatrists lack the insight to recognise that they lack therapeutic skills and are condoning and implementing abusive and exploitative practices in their offices. Unfortunately, those in positions of authority can abuse their power or use their knowledge to hurt or exploit others. More stringent guidelines need to be imposed to ensure that violation of clients' trust is not abused by those in their care. A bad therapist will damage clients and taint the therapeutic community. Without respect, skill and genuine concern, therapy, like any relationship, cannot succeed or promote better health and personal improvement.

"Staff psychologist's" comment is a clear demonstration of what happens in therapy. A supercilious "authority figure," defines reality and attempts to shame us back into line if we challenge his expertise.

The pills-cure-our-woes camp also disregards its skeptics and the ample testimonies from those who've been harmed by medications.…

It's interesting how mental health workers process criticism in a defensive crouch instead of listening to what their critics have to say. They advertise to be professional listeners, after all.

By missbelle (not verified) on 16 Feb 2013 #permalink

CBT is NOT really proven to be effective. Only if you are gullible.

There have never been any real control groups with that kind of stuff. Therapy itself is a placebo.

How do you study this if the control group is not getting a placebo?

There haven been attempts to do this. With proper control groups it's mostly ineffective just like most of the other therapies. In depression the effect is very small.

CBT highly effective? Only if you're dreaming.

There is no such thing as an effective science-based psychotherapy today.

Not surprsing as we discover more and more neurological abnormalilities in patients with these disorders.

Depression is actually a brain disease.

also the founder of talk therapy freud. was a proven fraud and lied about all of his "cures".

He never cured anyone and i doubt any of his successors did.