Psychotherapy is about the relationship. This point is of such importance, that in Germany (where psychotherapy is covered by the mandatory health insurance) patients are allowed to have a couple of test sessions with several different therapists and then choose to continue with the one they feel best.

Also - as already pointed out - there’s a multitude of schools or types of psychotherapy (CBT, Psychodynamic, etc.) with statistically significant benefits. Of course, some are more suited for some cases than others. The OP treats psychotherapy as a monolith.

One way to look at it, is, that many people weren’t raised with competent-enough parenting (or mentoring) to acquire the skills to cope with some issues on their own - i.e.: the “just deal with it”. And this is the role of the therapist: not to become a parent, but to play the prosthetic role of a very competent parent, or mentor. So that the patient can increase self-awareness, self-reflection, and emotionally grow into being able to better deal with the situation at hand.

However, perhaps the biggest takeaway message here is that we need to educate Society - as we educate kids to learn to recycle - on how to choose a good therapist, what good therapy feels like, the importance of accredited and evidence-based methods (so people don’t rely on astrology and other quacks for - and therefore avoid properly dealing with - their emotional health needs), as well as, what should NOT happen in therapy sessions.

PS: And also educate about what is black & white thinking ;)

Which is not to say psychotherapists don't do anything right. Maybe they do something right. But it may be almost by accident, or maybe much is not needed for you to feel someone's got your back.

These trends, of solving a given problem a given way, are largely cultural. I wouldn't be surprised if one day we see present day psychotherapy as flawed as we see alchemy today.

Let me start out by saying that although I am not a psychotherapist, I do have a masters in psychology, and two years graduate clinical training, plus experience in the field. I also have some experience helping conduct psychotherapy research studies.

Back in the 60, a well-known psychological researcher named Hans Eysenk published a claim that, based on an analysis of many psychotherapy outcome studies, psychotherapy does not work. This sparked a great debate.

I was puzzled by this claim, since it seemed clear to me that psychotherapy could be helpful. But then years later I read an article in the Handbook of Psychotherapy and Behavior Change, I think it was the 1979 edition.

It was written by Truax and Carkhuff, and it summarize a number of studies that looked at outcome by psychotherapist. What they found was that about 1/3 of psychotherapists were helpful with most of their clients, 1/3 had little impact, and 1/3 were on the whole harmful.

Based on a good deal of experience in the field, including a whole summer observing psychotherapists practicing group psychotherapy in a mental health clinic, this seemed to me about right.

I think the problem started with Freud. He was a brilliant man in many ways, but I think it is clear he was not very good at actually curing people of their personal problems. In the decades that followed, I think there was a pattern that developed where some training institutes, Freudian and non-Freudian, were run by therapists who are poor at the craft and so don't know how to teach it to others, and furthermore don't know how to select students who would be good therapists, while at other institutes the overall pattern was neutral or positive.

I have been out of the field for many decades, and had hoped things had improved. Alas, it seems that is not the case.

"You have to be willing to help yourself" is perilously close to "psychotherapy only works on people who are capable of changing of their own volition", which calls into question the entire purpose of psychotherapy. If I could change my way of thinking through sheer force of will, why would I pay a professional $100 an hour to sit and listen while I do it? It evokes the classic defence of the quack - the spoon only bends if you truly believe in the power of the mind.

If that problem is framed as "some patients are too sick to treat", then at least it shifts the burden of responsibility onto the therapist; it's not the patient's fault that the psychotherapist lacks the neccesary tools to facilitate change. Blaming the patient for having a bad attitude just makes the profession of psychotherapy look ineffectual.

There is such a thing as "lay psychoanalysis", not involving a professional. I wouldn't dismiss it.

What I would definitely dismiss, as someone who has spent time in a psychiatric hospital as a patient, is the bad faith pseudoscience of psychiatry. Individual doctors may be doing their best, but the profession is very much as described in this article.

That's why you can have multitudes of wildly conflicting theories and schools of psychotherapy, where most of them work to achieve the goal of wellbeing, but none of which achieve understanding of how human brain works. (of course, some pretend they do, and try to portray this to the patients - as if the ideology the school of therpay holds is the truth about the human brain)

There's nice discussion of this in the book "Health & Suffering in America by R. T. Fancher"

1) A prospect of looking for a person I can trust is quite daunting if it necessarily involves sharing sensitive things with those I wouldn’t trust once I get to know them. If you have the money and the confidence required to share very personal things with four different psychiatrists, it may work for you—it doesn’t seem likely to for me.

2) Knowing my own dislike for pseudo- or cargo cult science, I foresee how we would have to spend a lot of time diving into the “why” underlying every point, and I know from experience how it’s awkward (not to mention a waste of money and time) when you have done your own research and start noticing that a professional, in fact, (A) doesn’t know something and (B) unable to admit it and do more research (made worse if that person (C) charges by the hour).

Really, I can get on board with the idea of someone telling me that I’m in denial and me snapping out of it, but assuming I can’t acknowledge that when my friends say so why would I suddenly believe a person who knows me much less and, no offence, for all I know may well be making a living doing something not very far removed from fortune telling?

Long story short, it’s likely a Bad Idea(tm) to take these matters into your own hands[0], but I instead try to educate myself on the fundamentals by reading books. Among my recent findings on this topic is Iain McGilchrist’s The Master and His Emissary, if the above resonates with you may like it too (though I’ve only recently started it, not yet halfway through). Iain is, no surprise, a psychiatrist, but with a huge lean towards neuroscience, which is a good combination that to me makes for an interesting/palatable read. Being more or less the opposite of a self-help book, it builds on analysis of fairly hardcore well-sourced research and so far I feel enabled to make my own conclusions as to how it may (or may not, yet to be seen) apply to my psychological balance (slash lack thereof).

[0] Of course, this should go with a big red warning label that *I have not tried therapy* (yet?). Don’t listen to me, probably.

The trouble with a social intervention like therapy is the fundamental attribution error in sociology. Which character is the problem and which is the solution played out in a battle of the minds in an enclosed space. The government employed brainwashing therapist seeking to downplay any eccentricity that destabilises a social norm, or the poorly functioning client who blames others for their problems.

Therapists have a habit of dumping the responsibility for generally unsolved philosophical questions about social interaction onto the client. Where is the line between internal and external social stimuli? Who do you attribute your problems to? What is the value in a diagnosis label? Answer these questions for yourself and you’ll cure many different ailments. Fail to find the answer and remain pathologized?

Therapists routinely underserve the amount of education and philosophy required to heal. The diagnostic categories are a descriptive mess that are used as tools, yet people use them as definitions far too often.

I recommend anyone interested in therapy and ideas to see Jordan peterson’s YouTube video Self-Deception in Psychopathology (from before his fame) where he gives a quick rundown of a view above the current running mill of therapy. It tackles briefly some philosophical problems with therapy.

this is esp true for individuals who end up needing therapy b/c they think in ways that are not aligned with society.

so most therapists teach coping mechanisms to fit in more w/ society so that it becomes a source of support vs judgement. it's a nice and controlled "lobotomy" of the parts that "should" be excised.

vs the "integrate the shadow/subconscious" stance which believes that these parts cannot truly be excised and instead are suppressed instead of integrated.

If one complains over the internet that therapy works like astrology, instead of actually talking to their therapist about this topic, then therapy is for them a waste of money, as it's clear that they have no participation and trust. Changing therapist - like I suggested - misses entirely the point, now I see.

Complaining that patient X went to therapy and didn't work and therefore therapy doesn't work is like complaining that a computer science degree is useless because developer X doesn't find a good job.

People is complex and treatment is complex as well. It's perfectly possible that even an unqualified person (e.g. the so-called "coaches") can improve a case, that qualified people didn't, for legitimate reasons. I actually do know at least one unqualified person who practices therapy, and I think they're able to help some cases, but that doesn't detract from qualified therapists.

On the other hand, there is a structure to human mind, and people who systematically studied it for years have tools that unqualified people generally don't have. One may not subscribe, say, to Freudian theories, but the relation with the parents is extremely relevant to one's development, and without knowledge and tools, the practicioner will likely stumble.

Misdiagnosis was the worst part of my experience, but not the beginning or the end. Diagnoses are naturally a double edged sword and some therapists avoid them altogether, but it seems a clear mistake to focus on this conflict.

Bureaucracy notwithstanding, a lot of the reason for diagnoses is that the suffering seek closure. I declare however that a lot of the reason for the mental health field is that the citizens of a suffering society seek closure. The therapist delivers that closure in the form of: “It’s you.” Whether this contributes something wholly productive to that person’s mental health is surely circumstantial. For me, it was a disaster.

I’m not comfortable making similarly broad assertions about therapy itself, but in my experience, it was just me opening up to someone who didn’t open up to me. Having a 3rd party to resolve disputes is not any new invention so couple therapy and similar should probably be considered separately. As for individual therapy, I have been inable to map the process by which what we call therapy today evolved from what was psychoanalysis. My fear is that it was painfully basic and painfully stupid. Can someone fill me in?

Some of my friends are in the mental health field and a couple of them are very open minded, willing to discuss these things. Our conversations led me to make a vow that I will never visit another mental health professional for as long as I live. Being no stranger to the history and other less contempory criticisms of psychology, the experience motivated me to learn more about the industry of psychology in America. I think the issues are strikingly congruent with contextual issues in the structures that empower it. In the US, this would be law enforcement, healthcare, academia, public education, the economy. In a sum, I concluded that capitalism is simply not as fit to address mental health problems as it is to create them.

I myself have tried going down that route several times and come away disgusted by how bad it was. At best… at best it was emotional intelligence and self care at a grade school level. Talking to the provider was like talking to a robot or someone reading a script in a call center. The providers consistently effected a tone not unlike how one patronizes an unruly toddler. It was impossible, literally impossible to get them to switch to speaking to you like a person.

I have known several people who went into to psychology mostly to serve their own navel gazing. Have heard several explicitly say the opportunity of manipulation (yes using that word) excited them.

I’ve studied the history and present level of knowledge, the quality of the science backing it, and come away more concerned the more I know.

Folks generally need people to talk to about the difficulties of life.

The medical profession on that topic is… not that great. You don’t have to be a political whackjob to have serious concerns.