The Trouble With Therapy Today

Freud Museum, London, England

Source: Zde/Wikimedia Commons/CC BY-SA 4.0

This is the first post in a series.

In recent years, there have been a number of books published that are highly critical of how psychotherapy is being practiced today, and, in some cases, directly blame our current cultural stresses on such therapy itself. For instance, consider the recently released Therapy Nation: How America Got Hooked on Therapy and Why It's Left Us More Anxious and Divided by therapist Jonathan Alpert (2026, Hanover Square Press), in which he generally argues that "too much therapy, or the wrong kind, can have painful effects on individuals, families, communities and our nation."

Alpert views Americans today as being "overtherapized" and accuses so-called "therapy culture" of contributing to the "anxieties dividing America today." Fascinatingly, he personally adheres to and sings the praises of cognitive behavioral therapy (CBT), despite the fact that CBT has for decades been and continues to be the predominant therapeutic approach in this country, refusing to recognize that this is a significant part of the problem with what he calls "bad" therapy today.

Another scathing critique of 21st-century psychotherapy titled One Nation Under Therapy: How the Helping Culture Is Eroding Self-Reliance (2005, St. Martin's Press) was written by non-clinician and social critic Christina Hoff Sommers and psychiatrist Sally Satel and suggests that in recent decades, "we have seen the rise of a therapeutic ethic that views Americans as emotionally underdeveloped, psychically frail, and requiring the ministrations of mental health professionals to cope with life's vicissitudes." And then there is an earlier precursor of this genre by Jungian analyst James Hillman and writer Michael Ventura titled We've Had a Hundred Years of Psychotherapy—And the World's Getting Worse (1993, HarperOne), which focuses on the presumed impotence and failure of psychotherapy to impact the world for the better.

Now, I will not be specifically reviewing these books here but rather want to consider and carefully analyze their shared generic premise that psychotherapy has somehow gone astray in our day in terms of its therapeutic efficacy and that it has instead become part of the problem, both individually and collectively. Have we truly become "overtherapized" in this country and succumbed to a culture of "therapism" as some of these authors suggest? Are there too many "bad" therapists around, as Mr. Alpert claims? Have Americans really had too much psychotherapy for their (and the nation's) own good? Or, could the exact opposite be true? Or might both sides of this debate have some merit, but for different reasons? I would argue that the answer is mainly in the eye of the beholder.

Psychotherapy—the therapeutic treatment of mental disorders, existential suffering, and human misery utilizing psychological methods and, perhaps surprisingly to some, more literally defined as healing of the soul or mind —has, in some form or another, been practiced now for more than a century by medical and mental health professionals around the world. Ever since famed Viennese physician Sigmund Freud—the undisputed father of modern psychotherapy—first introduced the revolutionary “talking cure” and controversial treatment method he called “psychoanalysis,” generations of psychotherapy patients have been privy to a rich and varied collection of psychological, philosophical, and spiritual wisdom aimed at alleviating, or at least mitigating, their suffering and setting them on the path toward healing and wholeness.

To be sure, the theory and practice of psychotherapy have dramatically evolved since Freud's day—for instance, most (but certainly not all) psychotherapists today no longer use the iconic couch or see patients four to five times per week for years or decades. Indeed, depending upon whom you ask, the current definition and description of psychotherapy can vary wildly, which all contributes to the swirling cloud of mystery, confusion, and controversy still surrounding psychotherapy more than a century since its birth. Incredibly, there are an estimated 400 to 500 different types of psychotherapy currently being practiced. But despite these discrepancies, psychotherapy has, according to some recent studies, been proven to be effective and helpful for approximately 80 percent of those who try it.

Over the past decade, and particularly during and since the COVID-19 pandemic, the prevalence and availability of psychotherapy have grown significantly. And as regards how psychotherapy is now provided, in 2025, the global use of online video therapy—a relatively recent development in the delivery of psychotherapy services popularized during the pandemic—will likely exceed $65 billion annually. Psychotherapy has become big business these days. And, despite falling out of favor with the public around the late 20th- and early pre-pandemic 21st-century due in large part to the psychopharmacological revolution, it is now more popular and pervasive, not only in America but around the world, than ever before, spurred primarily by the existential crisis posed by the global pandemic. But is this a bad thing? Well, it all depends upon how one defines and conceptualizes psychotherapy, its particular explicit and implicit methods and goals, what one considers to be "good therapy" versus "bad therapy," and how influential psychotherapy is seen to be on society and vice versa—topics that I will address in future posts.

Dr. Diamond is the author of the soon-to-be-published Secrets of Psychotherapy: Quintessential Clinical Wisdom for a Crazy World.