Wednesday, September 19, 2007

Therapy

We recently experienced some trauma at the hands of an old friend. I'm not sharing details. We haven't resolved this yet, and we're still a bit hurt by the explosion. A little after the fact, it occurred to me that our friend couched all of his complaining in therapy language. It's easy to recognize; it's not the way normal humans talk. And it was packed with superficially-persuasive bad logic and flawed reasoning. I'm thinking his therapist hasn't been doing him any favors.

This is a shame; done well, I think therapy (or "counseling", or whatever name it travels under) gives people a chance to have an outside opinion on their problems. Many of our problems seem intractable to us, but the solutions may be blazingly obvious to someone who isn't stuck looking at them through the lens of our own experiences. And just talking through problems with someone is a huge help; we often don't feel we can share problems honestly with friends or family, especially if the problems concern them. We can be completely truthful with a therapist and have no fear of repercussions, and we can benefit from their unbiased opinions.

On the other hand, you never really get an unbiased opinion. Your therapist is only human, and is operating from their own set of prejudices and personality quirks. If your therapist believes that all trauma stems from childhood sexual assaults, you might end up with therapist-induced false memory syndrome. If your therapist believes that trauma stems from past-life experiences, you'll experience regression therapy. These are fringe (though very real) examples, but it's a lot easier to imagine a therapist who believes, for instance, that marital problems are generally the husband's fault, or that all problems stem from laziness, or from insecurity, or from repressed guilt. And your therapist's neuroses are never clearly labeled. You don't know when you choose a therapist if he has beliefs incompatible with yours; you may never find out. Everything he says may sound reasonable, but you never know if it's based on fundamental, unspoken beliefs that you don't agree with.

The reason why this is such a problem is that in therapy, there are no standards; that is, the therapy you get is entirely determined by your therapist's world view. Even widely discredited practices are still in use by some therapists. So much of therapy has been so divorced from research-based science for so long, it is truly more of a philosophy than a science. Different therapists may have totally different approaches to a particular patient's problem, and there's quite literally no way to tell which approach is better, or if either is good at all. And there is no standard training for therapists. Much of the licensing can be regarded as a joke; there's a housecat in Philly with four professional certifications, including one from the American Psychotherapy Association.

Many therapists tend to hop on new trends faster than a 'tween at a mall. This is market-driven, to some extent; many patients are looking for the philosophy espoused by this year's bestselling self-help book or mouthpiece on Oprah. Therapy methodologies are as likely to reflect this year's cool therapy concept and/or bestselling book as they are to reflect sound, well-researched practices. And you never know if today's coolest possible therapeutic practice will turn out to be tomorrow's embarrassment to the profession.

Another problem I have with the general practice of therapy: it contains an inherent conflict of interest for the therapist. The patient wants their problems resolved, and as quickly as possible. The therapist, on the other hand, has a strong financial interest in maintaining the therapeutic relationship for as long as possible. At $100 a week, a therapist has a real incentive to make problems last longer than would strictly be necessary. He's also got a strong incentive to not say anything, no matter how badly you need to hear it, that will drive you away. It's like asking a window installer if you need new windows; sure, he's an expert. But he's also got a vested interest in a certain answer. With window salesmen (and plumbers and mechanics, et cetera) it's a matter of trust. With therapists, it's about trust too, but worrying about finances is a shallow level of trust, compared to sharing one's feelings and secrets. If you're trusting your therapist enough to share openly with him (which is, after all, required for therapy to work), it would probably never occur to you to question if he's milking your course of counseling for more cash.

Again, I think that for some people, with the right therapist, counseling can be a huge help. But it can also be destructive and toxic, and you never know in advance what you're going to get. This is one of the reasons I've never seriously considered therapy myself. The other reason is that I'm not a good therapy candidate: all of my problems are either so insignificant that they don't require therapy, or so chthonic and enormous that therapy wouldn't help. And the enormous ones, I talk to the cats about. And I can always rely on Laura to condense months of counseling into a few short, easily understood words.

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