Is Psychotherapy Worth It?

A debate

Posted Mar 04, 2016

Bob Cooke, YouTube, CC
Source: Bob Cooke, YouTube, CC

It's difficult to conduct valid research on whether psychotherapy is worth the time and money. Indeed, an excellent Psychology Today article is entitled, Why Psychotherapy Efficacy Studies are Nearly Impossible. 

And a recent Nature article finds that more than half of all positive findings in social science research fails the replicability test!

So it's worth taking a logic-based look at psychotherapy's pros and cons. To that end, here is a mock debate between an eclectically oriented psychotherapist and a person who's very anti-psychotherapy.

THERAPIST: Thank you for coming in.

CLIENT: I didn't have a choice. The judge said I either see you or I go to jail. Psychotherapy is worse than useless. For all that money and time, you may get insight into yourself but your life is no better. In fact, your life is usually worse because you become self-absorbed, a boring, navel-gazing narcissist.

T: There's actually quite a bit of data supporting the benefits of psychotherapy including for addressing anger issues. It might help keep you from losing your temper again

C: Those studies are done by psychologists, who have a vested interest in finding  psychotherapy to be effective. Besides, there are too many different kinds of patients and therapists, with too many different levels and kinds of talent and experience to validly say that psychotherapy is effective.

T:  Right  It's an art and depends on the therapist and patient. Since you're stuck here for 10 sessions, shouldn't we at least give it a try to see if I can be helpful to you?

C: No. It could make me worse. First, as I said, it could turn me into one of those people who became self-absorbed because of therapy. Next, psychotherapy opens old wounds for no good reason. So what if my mother was overprotective and my father slapped me around? It will do no good to replay that again.

I've forgiven him and I just don't think about it--You don't scratch where it doesn't itch.  Plus, blaming my parents just gives me an excuse for my current behavior. I need to keep suppressing those bad memories--That's worked a lot better for me than "processing" them.

And none of that is what really causes my temper. I just have a big adrenal gland--I inherited that from my father. So when someone does something that offends me, I go from 0 to 60 in one second.

The best advice is to just to be aware when I'm starting to get angry, take deep breaths and make myself walk out of the room. Also, the fear of going to jail will keep me from losing it.

T:: Might it help for you to understand what made you overreact with that co-worker, so maybe you won't trigger that adrenal gland so intensely?

C:  I know exactly why I overreacted to him. He's lazy and stupid but thinks he's smart. Then one day, he tried to lecture me on why I was wrong. He was dead wrong. It was the last straw and talking to him does not good, so I got furious and slugged him. Therapy isn't going to help me.

T:  It's true that if you don't think therapy will help, it's less likely to. I just want you to know that I care and I often can help people with anger problems, with a wide range of problems.

C: I'd rather just sit here in silence than talk about my childhood traumas.

T:: I don't know you but for many people, suppressing childhood trauma and just behaviorally dealing with the issue, is insufficient. Their core trauma comes out in other ways.

C: That's standard shrink talk. I just don't buy it. Suppression and practical baby steps. That's what's worked best for me and will continue to.

T: Would you let me share an idea?

C: Do I have a choice? If I say no, you'll just report that I was an uncooperative patient and I'll have to go to jail. So say what you want.

T: You don't want to talk about childhood trauma. That's okay. Really. Often, the client knows best. So how about we focus on the here-and-now: What you're feeling now, what you're motivated to work on now? What's keeping you from being the person you want to be? Often, changing the way you're thinking about an issue can be very helpful.

C: Yeah, CBT. If I need help with a practical problem, I can Google it and read a world-class expert's practical advice. Actually, that's what I want to do now--read some articles on my phone--That's likely to be much more useful than talking with some psychotherapist, whose training and life experience is so theoretical, whose methodologies have iffy efficacy, who spends her life in the bubble of her nice little office rather than in the real world, who probably chose to be a therapist at least in part to try to solve her own psychological problems. I'll just sit here and read, thanks.

T:: I can understand why you feel that way.

C: There you go again with the standard shrink phrases.

T: Yes, feeling legitimate empathy is something we're taught and believe in. You can always just sit there and read for the rest of the ten sessions but would you give me a shot at least for the rest of this session to see if you find our talking at least a useful adjunct to bibliotherapy, reading the articles?

C: Okay, but after this session, I reserve the right to sit here and read articles during the other nine hours. When you report back to the court, you can call it bibliotherapy.

T:  I promise to try my best to be helpful and I'd love it if you'll try to be as open and honest with me as you can. That can make all the difference. At the end of the session, we can reassess. Are you willing to trust me that much?

C: I dunno.

His new book, his 8th, is The Best of Marty Nemko.