Psychotherapy — a system of gimmicks!

We see unacceptable rates of suicide, depression, and anxiety among children, adolescents, and young adults. Narcissism has risen. Empathy has decreased. In our relationships, child neglect in the United States is up while contact time with children has declined as a result of labor policies that place the market and profit over family. Institutionally, in tandem with the implementation of neoliberal policies in the 1980s, a shift began in the U.S. educational system. By adopting neoliberal policies and practices, the U.S. educational system has begun to function as a business rather than an educational institution driven by a human-centered purpose. In the same way the cultural components of neoliberalism have influenced our relationships, families, workplaces, and educational system, so too have they influenced entire disciplines and fields of thought and practice, including psychology and psychotherapy.

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Traditional, mainstream psychotherapy has adopted a hyper-individualistic ethos by focusing primarily on the individual, and addressing pervasive, systemic problems as individual problems. I recently spent a year providing individual and group psychotherapy to a primarily adult, outpatient population at a local community mental health organization. I discovered that despite the uniqueness of each client and their conceptualization of and experience with a variety of symptoms, I really only ever heard and helped treat a handful symptoms and disorders. It became obvious to me that the prevalence and pattern of depression, anxiety, social phobia, panic, and substance abuse in the United States constitutes a larger and more systemic social problem. Nearly 50% of the U.S. population will experience a mental health disorder at some point in their lifetime, and we have higher prevalence rates of mental health disorders than any other country in the world. And yet, though millions and millions of individuals are experiencing the same afflictions, we continue to conceptualize, diagnose and treat these disorders as disorders of individual functioning.

Cognitive Behavioral Therapy is the most widely studied and utilized evidence-based treatment for a number of common disorders including depression, anxiety, PTSD and OCD. It, along with several other similar treatments, has proven effective at symptom reduction. Despite its evidence base and widespread use, others and I view this therapy as a technique that treats little more than symptoms, and as ill equipped to elicit deep and substantive change.

Rollo May, refers to this type of therapy as gimmick:
“Psychotherapy is facing a very profound crisis. I think the teachings of the fathers Freud, Jung, Rank and Adler has been, in this crisis, almost completely lost. The problem is that psychotherapy has become more and more a system of gimmicks.

The gimmick approach leads to a general boredom. And the reason so many new systems in psychotherapy spring up is that therapists are bored. They are bored because they deal with the minor problems of life. They patch a person up and send them out again. I don’t regard that as real therapy at all. The therapy that is important as I see it is the therapy that enlarges the person, makes the unconscious conscious, enlarges our view. It enlarges our experience, makes us more sensitive, and enlarges our intellectual capacities as well as other capacities. This is what Freud was setting out to do. It’s what Jung, Adler and Rank tried to do. These people didn’t talk about gimmicks. It just didn’t interest them. What did interest them was making a new person.”

Allen Francis is the chair of the DSM-IV Task force and part of the leadership group for DSM III and DSM-III-R is Professor Emeritus and former chair of the Department of Psychiatry at Duke University School of Medicine. In his latest book, Saving Normal, he discusses how commercial interests have hijacked the medical enterprise, putting profits before patients and creating a culture of over-diagnosis, over-testing, and over-treatment. He blames diagnostic inflation for the fact that an excessive proportion of the population relies on psychiatric medication and the myriad of subsequent problems.

  • 1 in 5 adults in the United States uses at least one psychiatric drug while roughly 4% of our children are on a stimulant.
  • Psychiatric meds are now the star producers for the drug companies in 2011, over $18 billion for antipsychotics (6% of all drug sales), $11 billion on antidepressants, $8 billion on ADHD medications. Antidepressant use nearly quadrupled from 1988 to 2008.
  • Primary care physicians, who have little training in psychiatric illnesses and medication and are under significant pressure from pharmaceutical companies and representatives, prescribe 80% of these.
  • The misuse of legal drugs has now become a bigger public health problem than street drugs, with more emergency room visits and deaths due to legal prescription drugs than to illegal street drugs and 7 percent of our population is addicted to prescription drugs.

Let us not forget that until 1973, our best psychiatrists and psychologists believed homosexuality was a psychiatric disorder. At any given moment, we seem to think we have the best answers from the most exhaustive information, and we have far too much confidence in what we think we know.

As a result of viewing the world through the cultural framework of neoliberalism, which places efficiency, effectiveness, and profit top priorities in all affairs, we have packaged psychotherapy as an evidence-based and manualized program, effective and able to produce short term change. But we have avoided the most profound and cathartic answers our patients seek.

We must restore the art of psychotherapy. We must be willing to face uncertainty and the precarious nature of therapy and life along side those we aim to help. And we must always think critically about the extent to which the treatments and interventions we chose may or may not be an extension of a system whose goal is not the growth of our client but rather a bottom line.

— Melissa M. Racho, Spent six years in an American Psychological Association accredited program that left her disillusioned about the ever shallowing nature of what has been an incredibly rich field psychotherapy.

From issue #134