The facts are startling. Despite being on the scene for close to 150 years, the field of mental health–and psychotherapy in particular–does not, and never has had mass appeal. Epidemiological studies consistently show, for example, the majority of people who could benefit from seeing a therapist, do not go. And nowadays, fewer and fewer are turning to psychotherapy—33% less than did 20 years ago—and a staggering 56% either don’t follow through after making contact or drop out after a single visit with a therapist (Guadiano & Miller, 2012; Marshall, Quinn, & Child, 2016; Swift & Greenberg, 2014).
For those on the front line, conventional wisdom holds, the real problems lie outside the profession. Insurance companies, in the best of circumstances, make access to and payment for psychotherapy an ordeal. Another common refrain is nowadays people are looking for a quick fix. Big Pharma has obliged, using their deep pockets to market “progress in a pill.” No work required beyond opening wide and swallowing. And finally, beyond instant gratification or corporate greed, many point to social disapproval or stigma as a continuing barrier to people getting the help they need.
For all that, were psychotherapy held in high regard, widely respected as the way to a better life, people would overcome their hesitancy, put up with any inconvenience, and choose it over any alternative. They don’t.
WHY? Mountains of research published over the last four decades document the effectiveness of the “talk therapies.” With truly stunning results, and a minimal side effect profile compared to drugs, why do most never make it into a therapist’s office?
For the last two years, my longtime colleague, Mark Hubble and I, have explored this question. We reviewed the research, consulted experts, and interviewed scores of potential consumers.
Our conclusion? The secular constructions, reductionistic explanations, and pedestrian techniques that so characterize modern clinical practice fall flat, failing to offer people the kinds of experiences, depth of meaning, and sense of connection they want in their lives.
In sum, most cho
ose not to go to psychotherapy because they are busy doing something else–consulting psychics, mediums, and other spiritual advisers–forms of healing that are a better fit with their beliefs, that “sing to their souls.”
Actually, reports show more people attend and pay out of pocket for such services than see mental health practitioners!
More, as I noted in my plenary address at the last Evolution of Psychotherapy conference, our own, large-Consumer Reports style survey, found people actually rated psychics and other “spiritual advisers” more helpful than therapists, physicians and friends. While certain to cause controversy, I strongly suggested the field could learn from and gain by joining the larger community of healers outside of our field.
Below — thanks to the Erickson Foundation — you can see that speech, as well as learn exactly what people felt these alternative healers provided that made a difference. An even deeper dive is available in our article, “How Psychotherapy Lost its Magic.” Thanks to the gracious folks at the Psychotherapy Networker for making it available for all to read, regardless of whether they subscribe to the magazine or not.
Until next time,
Scott
Scott D. Miller, Ph.D.
Director, International Center for Clinical Excellence
Beautiful and respectful: “a better fit with their beliefs, that “sing to their souls.”
Wow, I loved reading it!
Fascinating! I’m sure some will decry this as a return to being “witch doctors,” but better to know what one is rather than strive to put modern clothes on and pretend it’s better and more civilized.
I will say that there’s a difference between magic and magick, and that the latter deals with (in the literature) a change or shift in consciousness (whether through ritual, prayer, or potion) and the former, sleight-of-hand tricks. So to say that psychotherapy is a magickal practice–I heartily agree!
Thanks to you and Hubble for this article!
Hi Scott!
Long time no see…I work among other things with education issues in psychiatry nowdays. Must say i agree so much in what say above. Gregory Bateson would have say that we missunderstand/mix them up, the different logical types…….!
Personally I follow the development of the self compassion therapy and have some Contact whith prof Kristin Neff in Texas…….
Take care!
All the best from Bo Kalmar Sweden
Many therapists practice with marginal competence or no competence, having completed graduate school with no training other than classroom and practicums, or completion of training in “cognitive behavioral” therapy, proven to be ineffective with anything other than superficial problems.. In many years of supervising newly minted psychologists, I can attest that many rationalize that they have no time or don’t need training. With that arrogance, it is no wonder that people see psychics. At least they feel better about themselves after a psychic session. I worked in 4 hospital psychology departments. At best it was myself and perhaps 1 or 2 others per department who had sought training outside of graduate school
Hahahahahahahahaha,
Sometimes my hand doesn’t seem to do what i want it to do – why don’t i just chop it off!
Seriously Scott, ‘look at me, look at me!’ doesn’t make a good argument.
Simply there are good therapist and bad therapists, people get to choose and if they choose a charlatan instead then that is their right. Part of what therapists do is try to help people uncover their inner mental machinery and understand it, and work with it, encouraging or accepting engagement with chiropractors or mystics does them no favours in the end – if you wish to support and entertain this argument then you need to understand your moral base is not yet complete but is striving for attention.
The problem with psychotherapy is that it has yet to understand itself; i.e., the experience of the client. I was fortunate to have a client ask for multiple-hour sessions for a few days a week in hopes of igniting a breakthrough, which it did, and which I wrote a book about. I quickly found myself not worrying about the time. The result was that I listened to this person for a longer time than in the standard “hour.” I say “listened” on purpose because the only assumptions I make are that clients seek therapy because they’ve been hurt in the past and that there exists a natural healing process for those events. The activation of that process, which I call therapeutic catharsis (and have written about), is the therapist providing sufficient support for the client’s experiencing; i.e., the explicit and implicit dimensions. That degree of support allows the client’s emotional experiencing to arise in an unforced way; i.e., coincident with that support. Unforced activation is not retraumatizing, even though it may appear that way as the client gains deeper access to the past experience. In that phase, the client’s emotional experiencing is a delayed fight or flight reaction. If the therapist doesn’t “freak out” and continues with that support, the client’s emotional experiencing reaches a peak of intensity and spontaneously transitions to the healing phase, characterized by crying, indignation (preferred over anger) for objectively unfair/unjust treatment, and a self-generated insight into how that person was affected and which is more profound than any I could offer. The forced activation of emotional experiencing is not therapeutic as it forces up more unresolved stuff than the ANS can process. The classical example is a client talking about a very recent upsetting event. All the therapist can do is to listen patiently and let the overly activated sympathetic mode to return to normal.
Supporting the client’s experiencing is the hard part. The key, and which took me many years to recognize, is to not distract clients from their experiencing, and their implicit experiencing in particular. The other hard part is what the therapist doesn’t do; i.e., act in any way that interferes with the client following their own experiencing.
Thank you for this description, Jeffrey! That’s what it’s all about! I like your term ‘Unforced activation’ and the accompanying emotional catharsis which can accompany it. I have experienced this many times as client during Gestalt therapy, with I suspect, Ericksonian elements. Theses sessions sometimes led to some immediate disorientation, which I interpret is being thrown off the track of your habitual thinking, feeling. The client needs to be trained to live with the discomfort of this for a while, if necessary. But for me it was nearly always followed at some point by a sense of joyful clarity and the possible greater choices in behaviour. What more can we ask for? I was very lucky to have a couple of very skilled and accepting therapists for some years.
The essential point you mention is that the therapist must accept this depth of cathartic behaviour and not freak out. To achieve this, they must of course have accepted their own issues and that’s where the problem lies for many of them. The other point is that is that the therapy cannot have specific goals, as the end of the process is unpredictable because it works as a system.
Best wishes for your continuing success.
Thank you Scott Miller, PhD, for your research. I remember your presentation at the Evolution of Psychotherapy Conference 2017. I greatly appreciated your demonstration on Tarot cards.
As an LPC I was enlivened to use my Clairvoyant skills, medium skills, and Psychic skills on a daily basis along with emdr, dbt, hypnosis, net, nlp, cbt.
My clients appreciate these skills.
Thank you!
We always practiced the supernatural dimensions of Christianity healing just as Jesus did and so much of Christianity has stopped doing as they became more secularized. Since most Americans and others believe in God and or the supernatural they desperately want someone to speak to their souls.
When I teach in Scandinavia and Europe with an interpreter they always translate “Counseling and Psychology” as seelsorge or “Soul Care”. Every major religion practiced Soul Care as a primary focus. Then the sceptics abandoned the soul for medications and William James was ignored as was Jerome Frank and Rev. Boisen.
I just returned from Norway where the Ministers there have implemented our Whole Person Model with great success and heard about the incredible miraculous changes in the emotional, relational and physical lives of many people. If a nation with a secularized state church can do it everyone can.
I was in a group with Dr. Rogers in 1969 when a young woman sobbingly shared her deep guilt and shame. Dr. Rogers listened carefully and the asked, “How do you most successfully deal with the pain?” (Paraphrase) She replied, “I pray”.
At that point Dr. Rogers became upset and angrily said something like, “That is Bull S___.”
They cut that from the film.
My perception: “Dr. Rogers had never fully resolved his own religious issues and was unable to be “Non-Judgmental”.
He was asked about that event later by my colleague at U Cincinnati and he said he confirmed my perception.
The Core Conditions must come from within a clean heart. Bitterness will always interfere with our skills.
Another atypical Rogers example. Here he states (in 1966), ‘If I sense that I am feeling bored by a client and if this feeling persists, I think that I owe it to him and our relationship to share my feelings with him’ (p. 185). Rogers, C. R. (1966). Client-centered therapy. In S. Arieti (Ed.), American handbook of psychiatry (Vol. 3, pp. 183–200). New York, NY: Basic Books). My favorite comment after I bring this to someone’s attention is to say that if any employee of mine ever says such to a client he/she is automatically fired! I couldn’t believe this when a first read it a few years.
hello, can you please write the reference for the information with the percents? thank you