Psychotherapy Isn't Nonsense

In an article published in Aeon magazine, Niklas Serning, a psychotherapist and writer, used anecdotes and the popularized findings of behavioral genetics to discredit the merits of psychotherapy. While I appreciated the article on the whole, which made several good points, I found it to be uncharitable and skewed, using a straw-man argument as the author lumped all forms of psychotherapy into one that perceives personality as (a) largely malleable and (b) developed almost entirely by one's environment.

He argued that denying his cold, hard facts was akin to religious fundamentalism yet seemed to miss much of the overall data on theory and practice. With respect to theory, being "trauma-informed," which seems to mean that trauma is the sole foundation of all mental illness, isn't part of any graduate school curriculum; the tenets of this philosophy are usually learned outside of any official institution. In our universities, we learn the biopsychosocial model of treatment, which takes into account all of the underpinnings of mental health: the genetic predispositions to certain ailments (based on family history), one's normal manner of perceiving the world (how cynical or charitable, pessimistic or optimistic one tends to be), and socio-economic factors that may influence the expression of the former two.

Let's begin with genes. Your genes are not your destiny. Biologist Bill Sullivan wrote, "There’s no escaping which genes we are born with, but what truly governs destiny is which genes are activated and by how much—variables that are influenced by the environment through epigenetics." Sullivan made the case that the environment acts as a dimmer switch affecting gene expression, meaning that environments make it more or less likely that you'll exhibit certain personality traits.

Serning rightly noted that people respond to trauma differently, meaning that some are able to more instantaneously reinterpret a difficult event in a manner that serves their well-being, yet he failed to account for the changes that occur in the brains of individuals who have experienced severe hardship, which isn’t rare. As Sullivan explained, "If you look at the brains of, unfortunately, children exposed to ACEs (adverse childhood experiences)...if you look at those brains postmortem, you can find epigenetic changes that took place at stress response genes. So, what that is telling us is that children exposed to ACEs are being epigenetically reprogrammed to expect stress and trauma all the time, and they don't seem to be able to grow out of that."

So, it appears that this isn't just about how we innately tend to interpret events. Trauma can make us more cynical, even if we're genetically predisposed to depression and anxiety. Consider that with something like borderline personality disorder, trauma is considered to be an etiological factor.

This leads us to the social aspect. Serning argued that clinical psychology blames one's environment for everything, which is far from the model normally used, outlined above. While it's true that some people are much more sensitive than others, if we use pediatrician Thomas Boyce's analogy of the orchid and the dandelion, doing so doesn't negate the fact that orchid personalities benefit significantly from a positive social environment. Author David Dobbs, in covering several experiments related to gene expression and behavior, noted, "...these bad genes can create dysfunction in unfavorable contexts—but they can also enhance function in favorable contexts. The genetic sensitivities to negative experience that the vulnerability hypothesis has identified, it follows, are just the downside of a bigger phenomenon: a heightened genetic sensitivity to all experience." This means that environmental influence doesn't alter one's sensitivity, only influences its direction. This is a much more hopeful view than the one presented in Serning's article, and much less fatalistic.

Finally, the psychological part, which is the one I'm most familiar with. Serning argued, "...suffering stems from how we now, at this time, relate to the world and what our current circumstances are." This is the foundation of all psychotherapy. We deal with the past because it infects the present and future if left unchecked. I agree that obsessing over it is unhelpful, as Serning noted while citing Abigail Shrier, but denying it is equally harmful. In treatment, we consider the past in order to better understand our fears, hopes, and overall perspectives. Even cognitive behavioral therapy, which focuses much more on the present than psychoanalysis tends to, attempts to understand the past as it explores the evidence for and against core beliefs about self and others, which are influenced as much by one's past as one's present. Fundamentally, Serning misses a significant point: Your beliefs and emotions affect your choices, even if they remain unconscious. You can't become resilient if you avoid what disturbs you. You tend to become much more anxious instead.

At bottom, psychotherapy doesn't aim to change personality in a dramatic manner. It offers the tools needed to reinterpret the world and even one's past while developing a deeper understanding of one's potential. Patients don't seek therapy for profound change; instead, they aim to tweak certain parts of themselves that they dislike. Therapy helps them become less reactive and more prudent. While the initial reactions to stressors don't improve by much, their reactions to their reactions can. They become better able to accept their mental illness as part and parcel of their general cynicism, thus becoming more motivated to hold themselves back from lashing out. Psychotherapy is a delicate balance between authenticity and change, rigidity and humility. Acceptance and change work hand in hand.

In his best argument, Serning noted, "The therapeutic space shouldn’t insulate real external relationships from the dark messy internal relationships of ourselves—it should serve to occasionally incubate, prepare and clarify difficulties only with the express intention of sending the client back out to real relating." And this is exactly what treatment aims to be. Serning spends most of the time attacking a caricature of therapy. Offering "no cures" or "promises," most therapists would agree with Serning's take on therapy. The rest of us offer no such thing, only the tools needed to tolerate opposing perspectives, take them less personally, and account for as many of the possible outcomes of our decisions as possible, as well as recognize the need for some to be more empathic. Letting go of resentment is a worthy cause (again, we agree), but, as with anything else, it depends. Some are better off not forgiving and just letting go; you can do both. While Serning appears to be open-minded in this piece, as with any other clinician, he certainly seems to believe what curative change ought to be. In the end, he offers his own brand of psychotherapy.