Is Therapy Broken?
Here’s the world’s shortest rant about problems in modern psychotherapy practice.
The training is inadequate and totally misguided because the discipline is still in its infancy.
Training to be a psychotherapist is structured like college and university instead of more like an apprenticeship, which is to say that it’s focused on declarative knowledge about theory, rather than actual practice. You learn about history, a few theoretical models, and very little application of those models. The result is therapists who can tell you about theories but have no idea what they really mean and how to put them to use. While there is a practicum requirement, it’s meager and the quality is not only variable but also unchecked.
Training should be focused on wisdom, which I casually define as the combined ability to see problems clearly, get to the root of them, visualize an end goal and formulate a plan to get there that’s tailored to the client. The topic of wisdom is almost never discussed, which is a testament to how immature the field and/or the education currently is.
Part of the reason wisdom isn’t methodically developed (if it can be) or even given priority is because the discipline has yet to decide what real psychological wellbeing is outside of superficial surveys that rely on self-reporting. To move forward, the entire discipline must undergo a scientific-spiritual evolution that challenges basic assumptions about self, ego, and the role of discursive thinking in deep contentment. While mindfulness has slowly crept into a few areas of therapy, it’s a long way from truly breaching the theoretical foundation of happiness. Absent that knowledge, wisdom, which is premised on a solid understanding of deep contentment and its relationship to identity, will remain a pariah in mainstream psychology and psychotherapy.
Therapeutic culture, transmitted from supervisor to trainee/intern, suffers from other serious concerns and doesn’t fill the gaps imposed by educations.
Therapists learn how to be therapize through school, from media, from watching others, from role models, etc. An important piece of that training happens in supervision, beginning in the last year of school and extending through the next 3 years, typically. While supervision isn’t uniform or standardized, many supervisors are older and themselves were trained by the previous generation of therapists. In that way, the culture of therapeutic practice is passed on from generation to generation. Despite its mutations, the culture of practice shares a few important and in my opinion harmful features.
First, therapists are not adequately informed about the power of their role. A therapist’s suggestions and narratives have tremendous gravity. Clients are pressured into adopting the therapist’s interpretations by virtue of their expert role alone. Rather than approaching interpretations delicately and as scientific theories, open to falsification, they treat them as truths that the client must be sold on for therapy to work.
Second, therapists can spend an inordinate amount of time talking about past traumas without a defined goal or useful application. In therapeutic culture, the value of these expeditions is taken for granted, but it shouldn’t be.
A lack of proper training does damage to clients in need.
While some therapists can develop wisdom on their own and correct the deficits in their education and training, many do not, and are prematurely thrust into roles where they’re charged with guiding others through complicated psychological issues, a role they’re wholly unprepared for. The result is often wasted time and resources, at best.
At worst, unqualified therapists can lead clients astray, reaffirm their maladaptive narratives about themselves of others, worsen situations and relationships, and lead clients to make poor decisions for their long-term wellbeing. Unqualified therapists can also lead clients to more self-involved, more psychologically sensitive instead of resilient, and more lost in their thoughts than engaged with their moment-to-moment experience. The result is paradoxically a loss of empathy, an increase in anxiety and neuroticism, and poor outcomes.
Final Thoughts and Recommendations
Therapy isn’t broken, but it needs help. To move forward, leaders in the field must move past Western psychology’s myopic and technical approach to studying wellbeing and begin to incorporate Eastern philosophy, perhaps operationalized in traditional scientific terms.
Education in therapy should always be accompanied with robust real-wold application. The application need not be limited to students doing therapy themselves: students could watch other therapists, including their teachers, offering therapy. But these therapists need to be vetted carefully to ensure that the therapists are truly helping, in line with the updated understanding of wellbeing mentioned above.
Expecting that therapeutic culture will change quickly is impractical. But a new generation of therapists and supervisors could emerge and gain popularity if it delivers superior outcomes. To do this, the style of therapy discussed would need to be branded and a mainstream (accredited) curriculum developed.