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 most never return after the first appointment (Guadiano & Miller, 2012; 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. Nowadays, it is often said, people are looking for a quick fix. Big Pharma has obliged, using their deep pockets to be market “progress in a pill” effectively. 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!
While certain to cause controversy, we strongly suggest the field has much to learn from and gain by joining the larger community of healers outside of our field. For limited time, the publisher is providing free access to the article. Click here to read now.
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
My son once watched some therapists leaving a consultation group, and said of the male therapists, who were much larger than him, “I could roll them for their lunch money.” And they did indeed project a kind of “I’m not here” colorlessness. Not a good vibe for a healer!
As an engineer and hypnotist, I see a lot of possible ways to construct a healing experience with the materials at hand, even though the science — like chemistry before the discovery of oxygen in the 1770s — is not yet contributing enough to increase therapeutic effectiveness year by year, or even generation by generation.
Talk therapy works, but we don’t know why. To an engineer (or hypnotist) “It works but we don’t know why” is a very good space to be in. It would be better to know why, but it’s the “it works” part that’s all-important.
As you point out, the wide variety of alternative approaches gives clients an opportunity to select something that resonates with them already, which is nothing to be sneezed at. This alone means that the selected practitioner is likely to have a worldview and a process that are acceptable to the client, even if the practitioner isn’t all that good at “meeting the client in his model of the world” by any absolute standard.
Alternative approaches tend to be more experiential, more vivid, as well. Compare a Tarot reading to a Rorschach test, for example.
Given the embryonic state of the science, which has learned many valuable things, but these things haven’t budged the therapeutic effectiveness needle in two generations, I think it’s wise for practitioners to recognize that, for the moment, they need to look elsewhere for ways to increase their effectiveness.
In the old days, physicians put a lot of store in their bedside manner, because their drugs didn’t work, but bedside manner did. The standard bedside manner for physicians was to be gravely attentive, but also certain of the patient’s recovery. And also to give medicines that were so foul in taste, color, and texture that the patient knew they were receiving a powerful treatment!
I don’t think these exact techniques are the right ones for talk therapy, but your article reminds me that, since we know that talk therapy works, we might as well project this confidence so our clients know, too!
Robert
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
Wow… thanks for this… I certainly was not expecting it. You nicely described the gap I straddle between my job as a professional working for a government and my lived experience. I also like that you didn’t wrap it up nicely into a set of steps from here… it think this is a huge “can of worms” for helpers. I’m not really even sure what to do with this.
thanks all the same… the truth doesn’t need to be tidy or convenient.
Phil
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.
Hello,
Fantastic read. It is truly fascinating to hear of some of the reasons why people are reluctant to come in for therapy. I guess a piece of it makes sense because at least one aspect of our culture has become DIY. We also, unfortunately, all look for the easiest path to the solution. We have been groomed by the ever advancing technology to have little to no patience for the things that may take time, like “working through” our issues.
I wonder if there is a middle ground. I wonder if there is a way to combine some of these “forms of healing that are a better fit with their beliefs, that ‘sing to their souls.'”
I am a relatively “new” therapist (in the field for 3/4 years now) who just sat for the licensure exam. In my little experience I have discovered an alarming amount of people who are in the field and who do not enjoy this work. It is not for everyone and requires a lot of training even after school. I think there can be a tendency for people in any field who have been doing it for a long time to feel like those coming in will work as hard.
I hope to be the exception to that rule, because I am willing to and currently am putting all my efforts into becoming the best therapist I can be.
Thanks for such a good read!
Kelley
Great article, Scott. Research shows that 40% of client success in counseling is outside factors, right? And 30% is relationship with the therapist. For too long psychologists and professional mental health counselors have ignored spirituality in the therapy session. Counseling professionals as a whole are much less spiritual than the average person they treat, and they frequently refuse to discuss or are too uncomfortable to discuss spirituality in the session. Recently a gentleman inquiring about an appointment told our intake person that he and his wife had been to see another counselor locally. He asked at the beginning of the session how much they would be discussing their religious and spiritual views regarding marriage. She told them that religion had nothing to do with their problems and they would not be discussing it at all. They got up, asked for a refund, and left. While a counselor may not say it this directly, because I client may not ask it this directly, if the counselor doesn’t initiate the conversation, clients know the counselor is uncomfortable talking about it. Many counselors are more comfortable talking about sexual acts than about spirituality!
The ACA considers spirituality an important part of treatment and you can’t separate the mind, body and spirit. We treat the mind and body, but ignore the spirit. While counselors may not think they are doing it, they are judging and looking down on their clients who are hungry for spiritual answers to their problems.
Shame on us as a field for not truly showing unconditional positive regard like a psychic does! For looking down on people and not accessing the outside factors in therapy. For not forming healing relationships with clients who are wounded and looking to us for help.
This is a very thought provoking and challenging article and I plan to share it with everyone in my practice. Thank you!
Hi Scott,
How co-incidental
Here is something I wrote a few dos ago!
Science is the ability to deal with facts, rather than what someone says about people, situations or things. Yes I know this is a rather simplistic way of defining science but from a perspective of emotional wellness, it by and large suffices. And pray why do I wish to talk about science when it comes to emotional/mental well-being? In the olden days Greek philosophers like Plato said ‘psychology is the science of the soul!’ So where did facts fit in? And then Woodworth came in and added, “first psychology lost its soul, then it lost its mind, then lost its consciousness. It still has behavior of a sort.”
So since the 20th century, psychology has mostly been defined as the science of human behavior. And since science is a branch of study concerned with observation of facts and establishment of verifiable general laws and since it employs certain objective methods for the collection of data because its objective is of understanding, explaining, predicting and control of facts, we can comfortably say, that to understand our behavior all we need to do is to become good scientists.
But look at what’s going on around us? From gazing at balls, to pulling out tarot cards, to wearing of stones on ones fingers, to trying to decipher which direction your bed should be placed – all of this mumbo jumbo – is being lapped up at a frenetic pace as though if one didn’t do any of this the world would conspire to make life even more miserable and unbearable than it already is!
These pseudo sciences – yes pseudo – because another aspect of science is to form hypothesis and then to test them. And there aren’t many carefully designed and controlled experiments that have been conducted with tarot, palmistry, and the like to prove any cause and effect – that the cause of emotional troubles lies in our ‘horror scopes’ or in ‘positions’ in and of our beds! In fact, these ‘experts’ make more and more unverifiable claims. Pull out a tarot and we guarantee that your husband is having an affair! Wear these stones of different hues and this will ensure that you get that coveted promotion. Turn the direction of your bed and lots of money will flow into your empty coffers! Blah, blah, blah! But the amazing thing! A large majority of the populace believes and practices this gibberish. Why? Because as Thomas Edison said: there is no expedient to which a man will not go to avoid the real labor of thinking.
Shakespeare’s words make a case for scientific attitude – ‘the fault dear Brutus is not in our stars but in ourselves, that we are underlings’. Of course in psychotherapeutic language underlings are humans who have not had the courage to notice how they contribute to their own troubles. The more you believe in the arrangement of things, the stones that you wear, the extra letter in your name, the less you will be inclined to look for the ‘real’ reasons for your difficulties. As Dr. Albert Ellis said: ‘dear person, if you find yourself in a problem, be sure you are part of that problem’! To escape and not take responsibility for setbacks and to attribute reasons that are unsubstantiated makes for temporary appeasement. Choices due to poor attitude, unquestioned ideologies, and questionable points of view are not examined closely enough. Yes, thinking is hard. To look for data to support our interpretations and evaluations is tough. It’s so much easier to develop beliefs that are unscrutinized and superstitious. Ideologies become ‘truths’ by sheer reiteration. Commonality of beliefs is offered as reasons for validity. Fallacies abound because rational thinking is difficult. Strangely the very tool needed for emotional wellness – the ability to think – becomes compromised at the door of these pseudo sciences.
If you really want to start living the good life I suggest you step back, get rid of all the paraphernalia that adorns your fingers, toes and what have you and put on that thinking cap. Reviewing your life lived thus far; assessing the questionable ideologies that you have lived by will bring in far more ‘luck’. Cheers to thinking!
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.