I've had good therapy and bad therapy. Good therapy ends on such a positive note. Bad therapy had me wondering if there was something so wrong with me, I couldn't be helped. Our gender confused daughter had 6 months of horrible gender affirming therapy that worsened her mental health. With good therapy for 4 years now, which has vastly improved her emotional well being, and which we know will one day serve her so well that she won't need it anymore, I'm confident that she will be in a better place. And I'm grateful for the "good" therapist!
Ok, so suppose there a still a few "good therapists" out there. How would a potential patient tell whether the therapist he was considering was one of the good ones? How would he be able to find one of these good therapists from among the sea of bad ones?
Unfortunately, the only tried-and-true way of knowing for sure is trial-and-error -- "shopping around," as it were. Therapists have different personalities, habits, and styles that work better for some people than others.
There are a couple of tells for therapists who are truly awful, though -- the one I can think of off the top of my head is if they interrupt you when you're talking.
The best thing a therapist can tell a man who wants to be a woman is that "transition" is impossible. Therefore, "detransition" does not occur either. There is no such thing as a "gender identity."
This is mainly driven by autogynephilia and perversion, as it was mentioned that boys are disgusted with their impulses which are largely affected nowadays by ubiquitous internet pornography. That has to be addressed.
Their lack of emotion won't be solved with estrogen. That is nonsense. They need to deal with their childhood and daddy issues. And why do they need to manipulate their biology if "gender" is totally social? (Hint: "gender" has no application to humans because it applies to words only.)
Fundamentally, therapy should focus on reality, not lies. And telling males that their irrational feelings are valid does not do that. Being a woman isn't a feeling, costume, or essence, and women's spaces aren't rehab centers for delusional or failed men. Being a woman is a biological reality which males cannot and never will have.
That is why the only response in therapy, and medicine in general, must be NO. This whole thing is a fraud.
Wonderful!!! I, too, am a therapist who believes that the relationship with the client is the most important part of therapy. I care deeply about my clients and about their lives, and they know it. It makes all the difference. Thank you for expressing it so clearly.
So you and many of the commenters love therapy. You make it sound like the therapist is the clients friend. You’re a pretty expensive friend. Was Abigail wrong with here statistics about the explosion of children diagnosed with ‘disorders’ happened to coincide with the explosion of children in therapy? Helicopter parents want to make little Johnny or Janey feel safe and think therapy is the answer. If the only friend they have is the therapist then gif help them.
"Was Abigail wrong with here statistics about the explosion of children diagnosed with ‘disorders’ happened to coincide with the explosion of children in therapy? "
This is a good question, to which there is an answer: The fact that two or more things increase at approximately the same time does not tell us anything about whether one causes the other, or whether there are other causes that might be causing both. Or, maybe it is just a chance occurrence that these two things increased at the same time. Or, maybe the true answer is a mixture of the above situations.
It is very difficult to determine what causes mental disorders without conducting long term studies in which the researchers are lucky enough to identify and measure the things that cause the mental disorder. These also have to be studies with a lot of people in them, so that the results are less likely to be a product of chance and more likely to reflect the true state of affairs in the general population. An example: The U.S. Army studies the occurrence of PTSD symptoms in soldiers as a function of combat exposure. The Army does a lot of testing of incoming enlistees, including measures of PTSD symptoms. The Army also has records of what kind and level of combat soldiers exposed to during their service. They can then take post-service measurements of PTSD symptoms and find whether the symptoms developed during the time period the soldier was in the Army, and can also look at the relationships between level of combat exposure and symptoms. Most researchers do not have the resources the Army has to conduct this kind of study, however. Besides, it is unethical to subject children to adverse experiences to study whether those experiences cause psychiatric conditions.
When families take children to therapy, it is almost always because the child has developed symptoms or complaints, or been referred by a doctor or school official, FIRST. So it is unlikely that psychotherapy caused the child's problems, although it may or may not address them in a helpful way subsequently.
I do see that a pop therapy culture has developed outside of professional psychology and psychiatry, not for the first time. What is different currently, is that the internet has enabled current pop therapy fads to spread widely and rapidly, and teenagers are major consumers of this kind of information. Pop versions of trauma theory have also spread into public school systems via "Social and Emotional Learning" curricula. These topics are very popular among teenage girls and young women especially, and there are many social media influencers who coach them in how to get diagnosed as "trans," "autistic," "traumatized," etc. These kids do have issues, or they wouldn't try so hard to look like they are mentally ill, but the issues they really have are obviously not that they are "nonbinary," because that is not a real thing. The real issues are more likely to involve low self-esteem, eating disorders, interpersonal problem, and/or difficult family situations.
Inexperienced or poorly trained therapists can be fooled by their clients, if the latter are in fact trying to do that. Indoctrinated therapists also push the usual woke critical theory approaches in their work with clients, which is not evidence based therapy and is likely to be ineffective at best, and more likely harmful. There is an extreme shortage of experienced, well qualified mental health professionals who specialize in adolescent care, relative to the sharp rise in the number of cases.
The idea being promoted by Schrier and others that psychotherapy causes mental illness in general or the current adolescent mental health crisis in particular is probably wrong and potentially very destructive. At the same time, it is true that professional training has been taken over by woke cultists, and the future of real psychotherapy is uncertain at best.
I have to agree here. I think the Greek actress Melina Mercouri said “In Greece we are poor. We don’t have psychologists. We have friends.” For me I needed friends to get me into therapy and prop me up during. Amazing! They are still here. What a blessing.
I used to work at a community college and, following the COVID lockdowns, I saw many young people who no longer had IRL friends and struggled to interact with others. Additionally, it took quite awhile for social organizations to reopen, so even when they wanted to meet people, there were few avenues to do so. Furthermore, it was very hard to develop relationships in class when everyone had a mask on.
When someone comes to me and doesn’t have any close friends, my job is to help them identify & challenges the cognitive distortions that are feeding their anxious and/or depressed mood as well as encourage them to push themselves out of their comfort zone.
And then there are times people come to me because they have shared their struggles with friends and family and it’s getting them nowhere. Sometimes, it takes seeing someone outside one’s circle to get the perspective needed to get unstuck.
I can concur, being a mentor for university students during the pandemic, in a country that had the longest lockdowns on earth (bar maybe China), the youth I encounter portrayed very bizarre social behaviour. They weren’t very interested in making friends, would inappropriately latch onto me as a kind of social crutch, and broadly speaking seem deeply depressed and uncomfortable and distressed about the future.
Now seeing some of these young people move into the workplace their behaviour has somewhat improved, however they are now being faced with hybrid work situations where the norm is to be isolated from their colleagues and work through digital mediums rather than in person. It’s about time society did something to moderate young people’s exposure to digital and social media. It’s inhibiting their development in very fundamental ways.
It’s rare for me to have clients for more than a year. Usually 8-12 sessions is sufficient. Long-term clients often have multiple serious issues that take more time to work through. Insurance doesn’t pay for you to be someone’s sounding board.
Therapy is not friendship, nor is it supposed to be friendship. Therapy by necessity is very personal in nature, and so there needs to be a lot of empathy, rapport-building, etc. -- unfortunately, that leads too many people mistake all that for what goes on in a friendship. It also has (or at least is supposed to have) specific goals in mind, whereas friendship works best when it's not so transactional.
I would definitely agree that a.) if someone doesn't have (a lot of) friends, therapy is a poor substitute and just takes a space away from someone who may need it more, and b.) it isn't for everyone. Therapy does get pushed way too hard in some respects, and it's led too many to believe it's a panacea for the normal ups and downs of life. If "lift heavy stone make sad head voice go away," then you probably don't need therapy. I worry, though, that the growing backlash against therapy as a whole will only lead us to throw the proverbial baby out with the proverbial bathwater.
The YouTube channel Psychology with Dr. Ana did a long form video critique of Abigail Shrier a couple months back. She agrees with Shrier on some points but largely considers many of Shrier’s points lacking. I think Shrier is a case of people following her because she points out a few major problems that haven’t been getting attention so people wholesale buy in to Shrier’s viewpoints. I suppose I’ll take the positive that she has brought certain criticisms to a more mainstream audience.
Therapy has been immense for me and that includes seeing the right therapist. I have seen a bad therapist and unfortunately didn’t realize they were bad until I saw a great therapist who really helped me in a short period. Sadly “shopping” for therapists needs to be a thing.
This is a beautiful article and expresses what I’ve learned over many years and from a variety of therapists. It is rapport and relationship that heals. Even as a coach, the ability to be curious, kind, respectful and tuned-in allows us to walk with another on their path for however short the time. The blank screen approach I found dehumanizing and arrogant.
Therapy is no better than astrology, actually. Especially psychoanalysis. Why bother with wild speculation about the origin of problems? It’s unhealthy to chalk up problems to certain variables that might have no causal effect.
Your comment is interesting because it's very much in line with how CBT works (or at the very least, how I understand it's supposed to work). It's kind of like the anti-psychoanalysis -- focusing on specific goals, learning healthier coping strategies and ways of thinking to replace ones that aren't working so well, and not spending any more time than you need to.
All mainstream psychotherapeutic approaches have been tested and found to be at least moderately effective in reducing symptoms and distress across most client populations and diagnosis. Average improvement is about 75%. No mainstream therapy has been found to be significantly more effective than any other, except for a few specific diagnoses, e.g., simple phobias. CBT is not anti-psychoanalysis. I practice a combination of both.
What does that mean? Like what is being numerically measured and how meaningful is that measurement? Is it just that 75% say "I feel better than I did before therapy", or is there some more objective measure of benefit involved?
The amount and kind of pre- and post- treatment testing varies with the study. Research in the past 20 years or so has tested specific "brand name" therapies against treatment as usual (general therapies in common use), and sometimes against waiting list groups. These studies usually are targeting specific symptoms, such as PTSD, depression or anxiety. The researchers use batteries of tests that measure these symptoms. Older studies more commonly used comprehensive pre- and post-tests, and used control groups of people who received "supportive therapy." Interestingly, the supportive therapies also resulted in some change, even though it wasn't intended to happen.
CBT was initially researched pretty extensively, because it was developed within academic settings and also had easily objectified strategies. (Such as having people count how many times per day they did an unwanted behavior as a function of how many times they used a cognitive-behavioral tool for reducing the behavior). As a result, CBT was touted as superior to psychoanalysis and ever other school of therapy used during the 20th century. CBT is in fact very helpful for most commonly presented problems, and more helpful than most therapies for a few specific ones, such as simple phobias, smoking cessation, and some PTSD symptoms.
When other kinds of therapies get more research attention, however, they also yield good results for the general problems, and can be better than CBT for things like relationship issues and long term effects of child abuse and neglect. In addition, approaches based on psychoanalytic theory and strategies are used to resolve technical problems that arise in CBT type treatments. CBT therapists originally just gave clients tools, assigned practices and monitored outcomes. As it turned out, many clients don't do exactly what the therapist tells them to do in a sustained way, and the CBT therapists had no idea how to address this issue. Psychoanalytic theory and training has always focused on the phenomenon of "resistance to treatment," and offers a wide array of approaches to resolve it. CBT therapists also did not initially focus at all on the clients' emotional experience: the focus was on thinking and behavior entirely. That is no longer the case, because CBT therapists have imported tools from various other therapies that enable them to work more skillfully with feelings.
Generally, however, the psychotherapy outcome research has shown repeatedly that positive client outcomes correlate more with what the various therapies have in common than with what distinguishes them. This is called the "common factors theory." Not everyone agrees with it, but superiority of any particular approach tends to wash out whenever a new brand name therapy is repeatedly compared to established ways of working.
Everyone needs a friend. Sometimes (though really not that often), a lonely person can buy a sort of 1-sided, transactional friendship by paying a therapist they click with. This transactional friendship can even be mutually beneficial.
You still haven’t convinced me it’s a science, an evidence-based medical practice or even particularly more effective than building a relationship with the parish priest. But I’ll agree it’s not always harmful.
I'm just going to copy and paste what I wrote above:
"Therapy is not friendship, nor is it supposed to be friendship. Therapy by necessity is very personal in nature, and so there needs to be a lot of empathy, rapport-building, etc. -- unfortunately, that leads too many people mistake all that for what goes on in a friendship. It also has (or at least is supposed to have) specific goals in mind, whereas friendship works best when it's not so transactional.
"I would definitely agree that a.) if someone doesn't have (a lot of) friends, therapy is a poor substitute and just takes a space away from someone who may need it more, and b.) it isn't for everyone. Therapy does get pushed way too hard in some respects, and it's led too many to believe it's a panacea for the normal ups and downs of life. If "lift heavy stone make sad head voice go away," then you probably don't need therapy. I worry, though, that the growing backlash against therapy as a whole will only lead us to throw the proverbial baby out with the proverbial bathwater."
I am aware that real friendship should not be so transactional, which is why I described it as “a sort of 1-sided, transactional friendship.” But having a goal doesn’t negate what I said, nor does it make it different from that relationship with the parish priest (or, frankly, many free relationships). It certainly doesn’t make it a science.
This doesn't negate my point as well, which is that although friendships *take* work to maintain, therapy *is* work -- or at least, it's supposed to be. Therapy can look like a "real" friendship from the outside if you don't actually know what you're looking at, but it's not.
Besides, it's not as though "real" friends can't be detrimental to one's mental health. They can easily give bad advice, show a lack of empathy when you may need it, push you into things that aren't good for you (e.g. drugs, gender ideology, etc.), be superficial, take advantage of your time and generosity, etc. And cutting oneself off from unhealthy relationships and finding better ones is much easier said than done. Of course therapy has its own failure modes, they're just very different.
"Sometimes (though really not that often), a lonely person can buy a sort of 1-sided, transactional friendship by paying a therapist they click with. This transactional friendship can even be mutually beneficial." Replace "therapist" with an "escort" and it actually still sort of works. (Sorry, I like your comment but my "like" button is broken)
Lovely article. Reminded me that when I made an off-hand remark to the Safeguarding lead in one of the schools I worked in to the effect that, ' loneliness is one of the most common causes of distress in the young people who are really struggling here' his peremptory retort was, 'it's much more than just loneliness' ...but, in fact, he came to understand that all the other factors: effect of parental dysfunction, addiction, violent behaviour etc were all distinctly improved when the hopelessness of psychic isolation was addressed via therapy.
When I underwent (psychoanalytic) psychotherapy in my twenties, I once asked my therapist when we would be “done.” His answer I have remembered all my life, it opened up a new and wonderful way of understanding the world. He said: What you are doing here is telling yourself the story of yourself; you are “done” when you realize what you have composed is a work of fiction.
What you said about boys taking estrogen to open up their emotional lives interests me. I just finished Max Wolf Valerio's book The Testosterone Files (written before transing became 'cool') and he describes at length what T did to him. It was fascinating to read his descriptions about how his emotions, assertiveness, aggressiveness, sex drive, et al changed. Some for the good, some for the bad, and he briefly talked about transwomen who reported suddenly being emotional and more compassionate on estrogen. Which leads me to ask what I've been wondering for years, mostly about taking T, but now I wonder about E: Is it possible for men and women who *don't* want to change sex *microdose* T or E to get those assertiveness/emotional benefits without putting one's health at risk? Or risk becoming more opposite-sex in appearance when you're quite happy with the sex you are, you'd just like a little hormonal tweak to boost what seem to be deficiencies in your birth sex?
The most common use is during menopause to improve mood, sex drive, and bone density.
There’s also a school of thought that younger women have messed up their hormones with hormonal birth control and no longer produce the low levels of testosterone that are natural in women. So you can replace it to recreate a more natural hormonal profile.
Both are off label I think and we are talking about tiny amounts of testosterone. Micrograms not milligrams.
Thank you. Interesting. I think I remember now reading something many years ago about T in low levels for women. As for birth control, has The Pill changed much? I was on it for a few years when I was younger and it had already morphed from its original incarnation in 1960 to deliver only the right amount of hormones to keep a woman from getting pregnant, unlike the early ones that made women so sick and caused cancer. I was also on Depo-Provera for about a year and it stopped my periods but also my sex drive…not quite what I was looking for! (Although a somewhat sexually problematic partner might have had something to do with it too…but…I remember losing interest completely).
I've had good therapy and bad therapy. Good therapy ends on such a positive note. Bad therapy had me wondering if there was something so wrong with me, I couldn't be helped. Our gender confused daughter had 6 months of horrible gender affirming therapy that worsened her mental health. With good therapy for 4 years now, which has vastly improved her emotional well being, and which we know will one day serve her so well that she won't need it anymore, I'm confident that she will be in a better place. And I'm grateful for the "good" therapist!
Ok, so suppose there a still a few "good therapists" out there. How would a potential patient tell whether the therapist he was considering was one of the good ones? How would he be able to find one of these good therapists from among the sea of bad ones?
Unfortunately, the only tried-and-true way of knowing for sure is trial-and-error -- "shopping around," as it were. Therapists have different personalities, habits, and styles that work better for some people than others.
There are a couple of tells for therapists who are truly awful, though -- the one I can think of off the top of my head is if they interrupt you when you're talking.
Enjoyed this read from beginning to end.
The best thing a therapist can tell a man who wants to be a woman is that "transition" is impossible. Therefore, "detransition" does not occur either. There is no such thing as a "gender identity."
This is mainly driven by autogynephilia and perversion, as it was mentioned that boys are disgusted with their impulses which are largely affected nowadays by ubiquitous internet pornography. That has to be addressed.
Their lack of emotion won't be solved with estrogen. That is nonsense. They need to deal with their childhood and daddy issues. And why do they need to manipulate their biology if "gender" is totally social? (Hint: "gender" has no application to humans because it applies to words only.)
Fundamentally, therapy should focus on reality, not lies. And telling males that their irrational feelings are valid does not do that. Being a woman isn't a feeling, costume, or essence, and women's spaces aren't rehab centers for delusional or failed men. Being a woman is a biological reality which males cannot and never will have.
That is why the only response in therapy, and medicine in general, must be NO. This whole thing is a fraud.
Wonderful!!! I, too, am a therapist who believes that the relationship with the client is the most important part of therapy. I care deeply about my clients and about their lives, and they know it. It makes all the difference. Thank you for expressing it so clearly.
So you and many of the commenters love therapy. You make it sound like the therapist is the clients friend. You’re a pretty expensive friend. Was Abigail wrong with here statistics about the explosion of children diagnosed with ‘disorders’ happened to coincide with the explosion of children in therapy? Helicopter parents want to make little Johnny or Janey feel safe and think therapy is the answer. If the only friend they have is the therapist then gif help them.
"Was Abigail wrong with here statistics about the explosion of children diagnosed with ‘disorders’ happened to coincide with the explosion of children in therapy? "
This is a good question, to which there is an answer: The fact that two or more things increase at approximately the same time does not tell us anything about whether one causes the other, or whether there are other causes that might be causing both. Or, maybe it is just a chance occurrence that these two things increased at the same time. Or, maybe the true answer is a mixture of the above situations.
It is very difficult to determine what causes mental disorders without conducting long term studies in which the researchers are lucky enough to identify and measure the things that cause the mental disorder. These also have to be studies with a lot of people in them, so that the results are less likely to be a product of chance and more likely to reflect the true state of affairs in the general population. An example: The U.S. Army studies the occurrence of PTSD symptoms in soldiers as a function of combat exposure. The Army does a lot of testing of incoming enlistees, including measures of PTSD symptoms. The Army also has records of what kind and level of combat soldiers exposed to during their service. They can then take post-service measurements of PTSD symptoms and find whether the symptoms developed during the time period the soldier was in the Army, and can also look at the relationships between level of combat exposure and symptoms. Most researchers do not have the resources the Army has to conduct this kind of study, however. Besides, it is unethical to subject children to adverse experiences to study whether those experiences cause psychiatric conditions.
When families take children to therapy, it is almost always because the child has developed symptoms or complaints, or been referred by a doctor or school official, FIRST. So it is unlikely that psychotherapy caused the child's problems, although it may or may not address them in a helpful way subsequently.
I do see that a pop therapy culture has developed outside of professional psychology and psychiatry, not for the first time. What is different currently, is that the internet has enabled current pop therapy fads to spread widely and rapidly, and teenagers are major consumers of this kind of information. Pop versions of trauma theory have also spread into public school systems via "Social and Emotional Learning" curricula. These topics are very popular among teenage girls and young women especially, and there are many social media influencers who coach them in how to get diagnosed as "trans," "autistic," "traumatized," etc. These kids do have issues, or they wouldn't try so hard to look like they are mentally ill, but the issues they really have are obviously not that they are "nonbinary," because that is not a real thing. The real issues are more likely to involve low self-esteem, eating disorders, interpersonal problem, and/or difficult family situations.
Inexperienced or poorly trained therapists can be fooled by their clients, if the latter are in fact trying to do that. Indoctrinated therapists also push the usual woke critical theory approaches in their work with clients, which is not evidence based therapy and is likely to be ineffective at best, and more likely harmful. There is an extreme shortage of experienced, well qualified mental health professionals who specialize in adolescent care, relative to the sharp rise in the number of cases.
The idea being promoted by Schrier and others that psychotherapy causes mental illness in general or the current adolescent mental health crisis in particular is probably wrong and potentially very destructive. At the same time, it is true that professional training has been taken over by woke cultists, and the future of real psychotherapy is uncertain at best.
I have to agree here. I think the Greek actress Melina Mercouri said “In Greece we are poor. We don’t have psychologists. We have friends.” For me I needed friends to get me into therapy and prop me up during. Amazing! They are still here. What a blessing.
I used to work at a community college and, following the COVID lockdowns, I saw many young people who no longer had IRL friends and struggled to interact with others. Additionally, it took quite awhile for social organizations to reopen, so even when they wanted to meet people, there were few avenues to do so. Furthermore, it was very hard to develop relationships in class when everyone had a mask on.
When someone comes to me and doesn’t have any close friends, my job is to help them identify & challenges the cognitive distortions that are feeding their anxious and/or depressed mood as well as encourage them to push themselves out of their comfort zone.
And then there are times people come to me because they have shared their struggles with friends and family and it’s getting them nowhere. Sometimes, it takes seeing someone outside one’s circle to get the perspective needed to get unstuck.
I can concur, being a mentor for university students during the pandemic, in a country that had the longest lockdowns on earth (bar maybe China), the youth I encounter portrayed very bizarre social behaviour. They weren’t very interested in making friends, would inappropriately latch onto me as a kind of social crutch, and broadly speaking seem deeply depressed and uncomfortable and distressed about the future.
Now seeing some of these young people move into the workplace their behaviour has somewhat improved, however they are now being faced with hybrid work situations where the norm is to be isolated from their colleagues and work through digital mediums rather than in person. It’s about time society did something to moderate young people’s exposure to digital and social media. It’s inhibiting their development in very fundamental ways.
Of course, but if they are with you for years, doesn't it mean you are not helping them get unstuck / solve their problems?
It’s rare for me to have clients for more than a year. Usually 8-12 sessions is sufficient. Long-term clients often have multiple serious issues that take more time to work through. Insurance doesn’t pay for you to be someone’s sounding board.
Therapy is not friendship, nor is it supposed to be friendship. Therapy by necessity is very personal in nature, and so there needs to be a lot of empathy, rapport-building, etc. -- unfortunately, that leads too many people mistake all that for what goes on in a friendship. It also has (or at least is supposed to have) specific goals in mind, whereas friendship works best when it's not so transactional.
I would definitely agree that a.) if someone doesn't have (a lot of) friends, therapy is a poor substitute and just takes a space away from someone who may need it more, and b.) it isn't for everyone. Therapy does get pushed way too hard in some respects, and it's led too many to believe it's a panacea for the normal ups and downs of life. If "lift heavy stone make sad head voice go away," then you probably don't need therapy. I worry, though, that the growing backlash against therapy as a whole will only lead us to throw the proverbial baby out with the proverbial bathwater.
The YouTube channel Psychology with Dr. Ana did a long form video critique of Abigail Shrier a couple months back. She agrees with Shrier on some points but largely considers many of Shrier’s points lacking. I think Shrier is a case of people following her because she points out a few major problems that haven’t been getting attention so people wholesale buy in to Shrier’s viewpoints. I suppose I’ll take the positive that she has brought certain criticisms to a more mainstream audience.
Therapy has been immense for me and that includes seeing the right therapist. I have seen a bad therapist and unfortunately didn’t realize they were bad until I saw a great therapist who really helped me in a short period. Sadly “shopping” for therapists needs to be a thing.
This is a beautiful article and expresses what I’ve learned over many years and from a variety of therapists. It is rapport and relationship that heals. Even as a coach, the ability to be curious, kind, respectful and tuned-in allows us to walk with another on their path for however short the time. The blank screen approach I found dehumanizing and arrogant.
Therapy is no better than astrology, actually. Especially psychoanalysis. Why bother with wild speculation about the origin of problems? It’s unhealthy to chalk up problems to certain variables that might have no causal effect.
Your comment is interesting because it's very much in line with how CBT works (or at the very least, how I understand it's supposed to work). It's kind of like the anti-psychoanalysis -- focusing on specific goals, learning healthier coping strategies and ways of thinking to replace ones that aren't working so well, and not spending any more time than you need to.
All mainstream psychotherapeutic approaches have been tested and found to be at least moderately effective in reducing symptoms and distress across most client populations and diagnosis. Average improvement is about 75%. No mainstream therapy has been found to be significantly more effective than any other, except for a few specific diagnoses, e.g., simple phobias. CBT is not anti-psychoanalysis. I practice a combination of both.
> Average improvement is about 75%
What does that mean? Like what is being numerically measured and how meaningful is that measurement? Is it just that 75% say "I feel better than I did before therapy", or is there some more objective measure of benefit involved?
The amount and kind of pre- and post- treatment testing varies with the study. Research in the past 20 years or so has tested specific "brand name" therapies against treatment as usual (general therapies in common use), and sometimes against waiting list groups. These studies usually are targeting specific symptoms, such as PTSD, depression or anxiety. The researchers use batteries of tests that measure these symptoms. Older studies more commonly used comprehensive pre- and post-tests, and used control groups of people who received "supportive therapy." Interestingly, the supportive therapies also resulted in some change, even though it wasn't intended to happen.
CBT was initially researched pretty extensively, because it was developed within academic settings and also had easily objectified strategies. (Such as having people count how many times per day they did an unwanted behavior as a function of how many times they used a cognitive-behavioral tool for reducing the behavior). As a result, CBT was touted as superior to psychoanalysis and ever other school of therapy used during the 20th century. CBT is in fact very helpful for most commonly presented problems, and more helpful than most therapies for a few specific ones, such as simple phobias, smoking cessation, and some PTSD symptoms.
When other kinds of therapies get more research attention, however, they also yield good results for the general problems, and can be better than CBT for things like relationship issues and long term effects of child abuse and neglect. In addition, approaches based on psychoanalytic theory and strategies are used to resolve technical problems that arise in CBT type treatments. CBT therapists originally just gave clients tools, assigned practices and monitored outcomes. As it turned out, many clients don't do exactly what the therapist tells them to do in a sustained way, and the CBT therapists had no idea how to address this issue. Psychoanalytic theory and training has always focused on the phenomenon of "resistance to treatment," and offers a wide array of approaches to resolve it. CBT therapists also did not initially focus at all on the clients' emotional experience: the focus was on thinking and behavior entirely. That is no longer the case, because CBT therapists have imported tools from various other therapies that enable them to work more skillfully with feelings.
Generally, however, the psychotherapy outcome research has shown repeatedly that positive client outcomes correlate more with what the various therapies have in common than with what distinguishes them. This is called the "common factors theory." Not everyone agrees with it, but superiority of any particular approach tends to wash out whenever a new brand name therapy is repeatedly compared to established ways of working.
Thanks for this excellent piece. Every parent of a gender confused kid dreams of a therapist like this!
This is an excellent piece. Thank you for writing it.
Everyone needs a friend. Sometimes (though really not that often), a lonely person can buy a sort of 1-sided, transactional friendship by paying a therapist they click with. This transactional friendship can even be mutually beneficial.
You still haven’t convinced me it’s a science, an evidence-based medical practice or even particularly more effective than building a relationship with the parish priest. But I’ll agree it’s not always harmful.
I'm just going to copy and paste what I wrote above:
"Therapy is not friendship, nor is it supposed to be friendship. Therapy by necessity is very personal in nature, and so there needs to be a lot of empathy, rapport-building, etc. -- unfortunately, that leads too many people mistake all that for what goes on in a friendship. It also has (or at least is supposed to have) specific goals in mind, whereas friendship works best when it's not so transactional.
"I would definitely agree that a.) if someone doesn't have (a lot of) friends, therapy is a poor substitute and just takes a space away from someone who may need it more, and b.) it isn't for everyone. Therapy does get pushed way too hard in some respects, and it's led too many to believe it's a panacea for the normal ups and downs of life. If "lift heavy stone make sad head voice go away," then you probably don't need therapy. I worry, though, that the growing backlash against therapy as a whole will only lead us to throw the proverbial baby out with the proverbial bathwater."
(That said, I would also agree that therapy is perhaps not quite as evidence-based as we're often led to believe.)
I am aware that real friendship should not be so transactional, which is why I described it as “a sort of 1-sided, transactional friendship.” But having a goal doesn’t negate what I said, nor does it make it different from that relationship with the parish priest (or, frankly, many free relationships). It certainly doesn’t make it a science.
This doesn't negate my point as well, which is that although friendships *take* work to maintain, therapy *is* work -- or at least, it's supposed to be. Therapy can look like a "real" friendship from the outside if you don't actually know what you're looking at, but it's not.
Besides, it's not as though "real" friends can't be detrimental to one's mental health. They can easily give bad advice, show a lack of empathy when you may need it, push you into things that aren't good for you (e.g. drugs, gender ideology, etc.), be superficial, take advantage of your time and generosity, etc. And cutting oneself off from unhealthy relationships and finding better ones is much easier said than done. Of course therapy has its own failure modes, they're just very different.
I never said it was a *real* friendship. Are you this bad at listening in therapy?
Sounds like you're engaging in transference right now.
"Sometimes (though really not that often), a lonely person can buy a sort of 1-sided, transactional friendship by paying a therapist they click with. This transactional friendship can even be mutually beneficial." Replace "therapist" with an "escort" and it actually still sort of works. (Sorry, I like your comment but my "like" button is broken)
Lovely article. Reminded me that when I made an off-hand remark to the Safeguarding lead in one of the schools I worked in to the effect that, ' loneliness is one of the most common causes of distress in the young people who are really struggling here' his peremptory retort was, 'it's much more than just loneliness' ...but, in fact, he came to understand that all the other factors: effect of parental dysfunction, addiction, violent behaviour etc were all distinctly improved when the hopelessness of psychic isolation was addressed via therapy.
When I underwent (psychoanalytic) psychotherapy in my twenties, I once asked my therapist when we would be “done.” His answer I have remembered all my life, it opened up a new and wonderful way of understanding the world. He said: What you are doing here is telling yourself the story of yourself; you are “done” when you realize what you have composed is a work of fiction.
That sounds oddly like brainwashing.
"We will be done here when you have lost your previous identity and assumed the one deemed suitable for you by the cult."
Stephen Levine's talk is now a paper, maybe someone mentioned this below?
https://www.tandfonline.com/doi/pdf/10.1080/0092623X.2024.2362774
What you said about boys taking estrogen to open up their emotional lives interests me. I just finished Max Wolf Valerio's book The Testosterone Files (written before transing became 'cool') and he describes at length what T did to him. It was fascinating to read his descriptions about how his emotions, assertiveness, aggressiveness, sex drive, et al changed. Some for the good, some for the bad, and he briefly talked about transwomen who reported suddenly being emotional and more compassionate on estrogen. Which leads me to ask what I've been wondering for years, mostly about taking T, but now I wonder about E: Is it possible for men and women who *don't* want to change sex *microdose* T or E to get those assertiveness/emotional benefits without putting one's health at risk? Or risk becoming more opposite-sex in appearance when you're quite happy with the sex you are, you'd just like a little hormonal tweak to boost what seem to be deficiencies in your birth sex?
Yes, at least for women. Low dose testosterone is available if not commonly prescribed.
For what reason? Are they being treated for something other than 'gender dysphoria'?
The most common use is during menopause to improve mood, sex drive, and bone density.
There’s also a school of thought that younger women have messed up their hormones with hormonal birth control and no longer produce the low levels of testosterone that are natural in women. So you can replace it to recreate a more natural hormonal profile.
Both are off label I think and we are talking about tiny amounts of testosterone. Micrograms not milligrams.
Thank you. Interesting. I think I remember now reading something many years ago about T in low levels for women. As for birth control, has The Pill changed much? I was on it for a few years when I was younger and it had already morphed from its original incarnation in 1960 to deliver only the right amount of hormones to keep a woman from getting pregnant, unlike the early ones that made women so sick and caused cancer. I was also on Depo-Provera for about a year and it stopped my periods but also my sex drive…not quite what I was looking for! (Although a somewhat sexually problematic partner might have had something to do with it too…but…I remember losing interest completely).