Many skilled and competent therapists are out there. (I use term "therapist" to describe psychologists, psychiatrists and clinical social workers - professionally trained and licensed practitioners.) Moreover, research shows that psychotherapy can be very effective. Either alone, or sometimes in combination with the judicious use of medication.

Yet so often practitioners don't help people very much. Some struggle for years in therapy with one practitioner after another, and never seem to make any progress. Others resolve some conflicts, but then are hit with others that hadn't been addressed.

I see three reasons for this situation. One is rooted in the kind of people therapists tend to be today. Their personal values, social attitudes and how they relate to conventional norms and behavior contrast in several ways with those of the "pioneers" from Freud's era. That contrast impedes effective help.

Then there are the kinds of problems that people experience. They've evolved over the decades, but especially since 9-11 and the near-depression that began in the fall of 2008. But many therapists aren't in synch with the impact of that shift. They fail to understand how 21st Century conditions impact emotional lives and conflicts. Many are clueless about how life in today's world interweaves with the dysfunctions or family conflicts that patients bring with them into their adult lives.

The third reason is the therapists' vision of the goals of treatment; what a healthy outcome or resolution of conflicts should look like, and how to get there. Many remain stuck within an older model - helping patients better manage, cope with or adjust to change and traumas; build resilience and restore equilibrium. But that's no longer possible: Our new environment is one of "non-equilibrium" and unpredictability. That creates new emotional and life challenges across the board -- for intimate relationships, careers and for engaging with a changing society - the "remix" that America is now becoming.

The Psychotherapist - Past and Present

The early analysts were pioneers, adventurous explores of uncharted terrain. They were trying to uncover how human personality and unconscious passions evolve within people to create symptoms and dysfunctions. They courageously risked their careers when they called attention to the impact of repressed sexuality. Aside from the accuracy of early theories about the causes of emotional disturbance, the practitioners' aim was to reduce suffering. They wanted to help people develop more love, reason and independence - albeit within the context of the norms of their era that they, themselves, accepted.

Moreover, most were well-read in literature, history and culture, more so than today's practitioners. That gave them a broad outlook and perspective on life. For example, Freud's writings are filled with references from Shakespeare, Goethe and other great works of literature, drama and mythology. He drew on their themes, plots and character portrayals to help illuminate and understand the motives and moral dilemmas underlying his patients' emotional problems.

Most contemporaries and followers of Freud possessed a radical spirit. They wanted to uncover the truth beneath patient's symptoms; see beneath the surface. They shared the view that successful treatment was based on a love of the truth; that is, emotional reality. And that it must preclude any kind of sham, deception or illusion.

Of course, Freud and his contemporaries interpreted their patients' problems in many ways that were flawed. They made assumptions about psychological health that were part of the prevailing values and norms of post-Victorian, early-20th Century society - a largely patriarchal culture. For example, most assumed that a normal, successful life derived from being well-adjusted to those norms.

Nevertheless, their spirit of truth-seeking, rooted in broad understanding of human culture, literature and history, has become lost. Today's practitioners tend to be technicians, looking for the right technique that will treat the patient's symptoms. Many tend to be cautious, often disengaged and detached people in their manner and interactions with patients. They are largely ignorant of philosophical, religious, cultural and socio-economic forces that shape people's psychological development, especially those in non-Western societies. And yet, all of those forces in all parts of the globe profoundly impact how and why we learn to think and behave as we do. Much current world conflict reflects those differences that define what we think in "normal" or "disturbed."

Many therapists today simply assume that adjusting to prevailing values and norms reflects psychological health. Now that's desirable for those whose conflicts have disabled them from minimally successful functioning. But it misses the mark for those whose conflicts are linked with their successful adaptation to begin with. The therapist then fails to explore their patients' definition of "success" - how it's shaped their career and life goals, their conflicts and disappointments.

Some therapists will spend inordinate time ferreting out tiny truths about the patient's family and childhood, without figuring out which have relevance to the person's conflicts today, and which don't. They may ignore the impact of trade-offs and compromises patients made as they created their sexual and intimate relationship patterns

Overall, today's practitioners tend to share in, rather than critique and examine, the social norms, values and anxieties of today's world. Too often, they uncritically accept good functioning per se, and conventional values like power-seeking, as psychologically healthy. This blinds them from recognizing that "normal" adjustment can mask repressed feelings of self-betrayal, self-criticism, and the desire to be freer, more alive. All of those longings can conflict with or oppose parental expectations or the pressures from social class membership.

Emotional Conflicts In Today's World

People's problems have evolved. Up through World War II and into the 1950s-early 60s symptoms that were more typical of Freud's time -- hysteria or specific phobias, for example - diminished. People wanted help for fitting in with the apparent paths to success and happiness and for dealing with conflicts that interfered with or limited it. Therapy often addressed things like guilt, inhibition, the need for approval, and dealing with the conflicts generated by defined, rigid roles for men and women. Desires or longings that deviated too much from the prevailing norms were troublesome and created conflicts, often unconscious.

The popular TV show "Mad Men" is a good portrayal of conflicts of that era, especially issues of identity, longing for an authentic self and gender roles. At the same time, the men enjoyed the surface appearance of power and control. And women chafed against the limits imposed by gender roles, as the women's movement began to arise.