Clinically Weird

Monday, May 20, 2024

Clinically Weird

Psychology: is it all bunk? I don’t think so, but I’ll ask my therapist.

These thoughts—or should I say “thoughts”?—were inspired by reading the first few pages of Abigail Shrier’s new book Bad Therapy: Why the Kids Aren’t Growing Up.

With another couple books open and on the slow-boat-to-China of my reading to-do list…uh, to-read list?…it’s going to be a while before I endeavor to finish Shrier’s. Nevertheless, I like direction she takes from the outset.

In her introduction and first chapter, she doesn’t go quite so far as to claim psychotherapy is completely worthless, but she does scrutinize its value to children, teens, and young adults. At the same time, she admits to undergoing adult psychotherapy of her own, which I take as indicating she is not hostile to or suspicious of the field.

The problems with psychotherapy applied to kids are multiple, as she describes. First, treating every bit of childhood upset as a psychological problem blows every even mildly unhappy episode way out of proportion. As she says, it’s like subjecting a kid to the hospital emergency department’s surgical trauma unit for a simple knee scrape. This criticism assumes that psychotherapy is in fact a powerful medical intervention.

Second, it subjects kids to the views of an adult outside the home who is not a parent or guardian, and thus does not have as direct a stake in the child’s welfare. Yet the therapist who will most certainly begin by calling on the child to question motives and “deeper” feelings about closest family. More perniciously, by professional standards, the therapist is meant to be a disinterested party governed by confidentiality, putting therapist and adult guardian in oppositional roles. This creates a discrepancy between the parents as a child’s guardians and the therapist, aiming to tease out subtle signs of conflict without necessarily any regard for the child’s primary social setting.

Shrier further questions the therapeutic approach at its most fundamental: Is there any real value to psychotherapy generally? It has been found to harm patients as much as help them. Shrier reports from academic sources that find a lot of unintended harm and failure within the field—even applied to adults. This is true especially in situations where every unpleasant life event is treated as a potential source of deep psychological trauma. Wallowing in each of life’s mental discomforts is as often as not likely to cause lasting mental scars rather than to heal them.

For instance, as the psychoanalytic industry has expanded and become mainstream over decades, there has been a tendency to rate every episode of unhappiness in a person’s life as a “trauma.” The trauma label has been applied increasingly to every bit of unhappiness in childhood indiscriminately. Among adults, it has become commonplace for any upset to signify trauma; post-traumatic stress disorder (PTSD) diagnosis is available to anyone who wants it and is willing to seek out a complicit therapist. Meanwhile, research has shown that real traumatic events in a person’s life are more often a source of individual strength and resilience in the underreported non-disorder of post-traumatic growth, a more common phenomenon that PTSD.

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To be fair, as a consumer of news and information, I am a fan of the distilled conclusions of psychological research that appear in the news and pop science. Yet I think many findings reach too far. The research is often tentative and flimsy, to put it bluntly—and for a whole host of reasons. Most of it isn’t robust because it reflected the researcher’s desire to find what he or she already believed to be true. The field is among the most plagued by the so-called academic replication crisis. There is no money or career advancement to be had by repeating other’s experiments with an eye to disproving their findings. For a scientific hypothesis to be validated, it has to be capable of surviving attempts to prove it wrong. Very few such attempts are undertaken in the field of psychological research.

The field isn’t robust enough to subject children and young adults to its dubious promises. Client-patient confidentiality is meant to permit an adult patient to speak “openly”—which in the case of children may mean trying to make the adult therapist happy by imagining things. It has been shown that false memories of imagined past life events can be created in healthy adults, intentionally or not. Impressionable youngsters may be asked to question the adults they rely on in their own families. The potential for harm as the therapist undermines the child’s sense of security at home should be obvious. You’d have to be crazy not to think something a little fishy could happen there.