The stimulus for Greenberg’s piece appears to have been his attendance at the annual Evolution of Psychotherapy Conference in Anaheim earlier this year. He seems to take a pretty dyspeptic view of the whole event: “Wandering the conference, I am acquainted, or reacquainted, with Cognitive Behavioral Therapy, Ericksonian Hypnosis, Emotionally Focused Therapy, Focusing, Buddhist Psychology, Therapist Sculpting, Facilitating Gene Expression, and Meditative methods.” A forty-year veteran of the California personal-growth/therapy scene, myself, it’s easy to develop a jaundiced eye over time as a panoply of approaches come and go. Yet, I have to say my own view, as a result of over 300 podcast interviews with psychologists across a broad spectrum of orientations, is there is more of a developing consensus and that the differences between many approaches are relatively minor.

By contrast, Greenberg seems to go into despair.

As I say, it took two readings of Greenberg’s article to really get the overall sweep. On first reading, it seems to be a bit of a meander, beginning with some slighting anecdotes about Freud. Then we’re on to the Anaheim conference and some handwringing about the seeming tower of Babel created by the profusion of therapeutic approaches. This segues into a discussion of Rozenzwig’s 1936 “Dodo Bird Effect” which asserts that therapeutic orientation doesn’t matter because all orientations work. As the Dodo pronounces in Alice in Wonderland, “Everyone has won and all must have prizes.” According to Greenberg, the Dodo Bird Effect has been borne out in subsequent studies and the requisite common ingredient for therapeutic success is faith, both the client’s and the therapist’s.

Greenberg goes on to describe several of the presentations, most notably by Otto Kernberg, Scott D. Miller, David Burns, and Martin Seligman. Part of what put me off about this article on my first reading is that I have conducted in-depth interviews with the first three of these gentlemen and I would not have recognized them from Greenberg’s somewhat muddled account.

Otto Kernberg, MD, one of the grand old men of psychoanalysis, is characterized as intoning “the old mumbo jumbo about the Almost Untreatable Narcissistic Patient…” In my opinion, this really slights his lifetime commitment to research, his many contributions to object relations theory, and his role as Director of The Institute for Personality Disorders at the Cornell Medical Center.  In my interview with Dr. Kernberg, I was struck by the flexibility of this octogenerian to incorporate the findings of neuroscience, genetics, and even cognitive behavioral therapy in this thinking.

Greenberg seems to use Dr. Scott D. Miller’s research as supporting the Dodo Bird effect. I attended a daylong workshop with Scott Miller a few years ago and it was one of the best presentations I’ve ever seen. I also interviewed him for one of my podcasts. The key takeaway for me from Scott Miller’s work is that the Dodo Bird effect shows up only when therapeutic effectiveness is averaged across therapists. That is, on average, all psychotherapies are moderately effective. However, Miller reports that not all therapists are equally effective and that, if you look at therapists who are consistently rated as effective by their clients vs. therapists who are consistently rated as ineffective, then therapy emerges as a highly worthwhile enterprise.

As Miller said in my interview with him, “If the consumer is able to feed back information to the system about their progress, whether or not progress is being made, those two things together can improve outcomes by as much as 65%.”

As I say, I had difficulty recognizing Miller in Greenberg’s account. Evidently, Greenberg is critical of Miller having developed a standardized set of rating scales for clients to provide feedback to their therapists. Greenberg sees these scales as playing into the hands of managed care and the trend towards “manualized” therapies. However, in my interview with Miller, he is very clearly critical of managed care, at least in terms of their emphasis on particular treatments for particular diagnostic categories. As Miller said in his interview with me, “If there were inter-rater reliability that would be one thing; the major problem with the DSM is that is lacks validity, however. That these groupings of symptoms actually mean anything… and that data is completely lacking… We are clustering symptoms together much the way medicine did in the medieval period: this is the way we treated people and thought about people when we talked about them being phlegmatic for example; or the humors that they had. Essentially they were categorizing illnesses based on clusters of symptoms.”

I also had difficulty recognizing Stanford psychiatry professor, David Burns, from Greenberg’s summary of the session he attended with Burns.  In short, Greenberg portrays Burns, who has developed a Therapist’s Toolkit inventory as wishing to replace “open-ended conversation with a five-item test… to take an X-ray of our inner lives.” This runs counter to my experience of Burns who, for example, in my interview with Dr. Burns about his cognitive therapy approach to couples work said, “…cognitive therapy has become probably the most widely practiced and researched form of psychotherapy in the world. But I really don’t consider myself a cognitive therapist or any other school of therapy; I’m in favor of tools, not schools of therapy. I think all the schools of therapy have had important discoveries and important angles, but the problem is they are headed up by gurus who push too hard trying to say cognitive therapy is the answer to everything, or rational emotive therapy is the answer to everything, or psychoanalysis is the answer to everything. And that is reductionism, and kind of foolish thinking to my point of view.” This hardly sounds like someone who thinks he’s invented a paper-and-pencil test that will be the end-all of psychotherapy.

And then Greenberg goes on to skewer positive psychology, which is what drew me to his article in the first place. After all, the title “The War on Unhappiness” seems to promise that. Like Ehrenreich, however, Greenberg’s critique is largely an ad hominem attack on Seligman. For example, referring to his earlier work subjecting dogs to electric shock boxes to study learned helplessness, Greenberg characterizes Seligman as, “More curious about dogs than about the people who tortured them…” He goes on to recount Seligman’s presentation to the CIA on learned helplessness which became the basis for enhanced “interrogation” techniques in Iraq. Now, we are told Seligman is working with the U.S. Army to teach resilience to our troops. In Greenberg’s view, Seligman would have us going his dogs one better by “thriving on the shocks that come our way rather than merely learning to escape them.”