Talk therapy isn’t rocket science

Roughly one in four American adults is in therapy. Maybe, like me, you’re one of them. In fact, you could be in a “virtual” therapy session right now, while you’re reading this. Maybe, like 3 million other Americans, you were “matched” with today’s therapist on an app, and maybe after you tell them about your day you won’t like how they respond and you’ll ask for someone different next time. There’s an online therapy app literally called “Doctor on Demand.”

Cringeworthy apps notwithstanding, most Americans believe the therapy they’re receiving is scientifically informed. “Evidence-based” is a term that gets thrown around a lot. In reality, it was Dr. John Watson, an early 20th century psychologist, who coined the term “behavioral science” to describe his field. A century later, there remains a general consensus that today’s psychotherapy is as scientifically legitimate and rigorous as the field of medicine.

But is it?

To be sure, the 20th century saw incredible leaps in our understanding of mental health and illness. Thanks to pioneers like Watson and others, we now have helpful language to describe many common (and some rare) distressing mental or emotional experiences, and built bodies of evidence showing certain therapies can really improve them.

But by the late 1970s, problems were brewing. In 1977, Christian psychologist Paul C. Vitz wrote Psychology as Religion: The Cult of Self-Worship, a book that remains eerily relevant. Vitz, who converted to Christianity while a professor of psychology at New York University, saw his profession descending from an honest scientific endeavor into an exercise in bad philosophy parading as science.

In those days, psychotherapists were obsessed with the concept of “self-actualization;” a somewhat nonsense term that Vitz began to see as not so much the product of following-the-data than of following-the-Freud.

Actually, it went back further than Freud: Vitz saw that modern “behavioral science” had been infected by the utterly unscientific theory of philosopher Jean-Jacques Rousseau that human beings are born intrinsically good, and that it’s “society” that corrupts us.

Given today’s “talk therapy” culture, I’d say we’re still infected with that idea.

If we’re shopping for therapists online, who exactly are we treating as the “expert” here, if not ourselves? If our therapists are scientists—just the same as medical doctors—why does therapy culture position the patient in the driver’s seat? It defies logic: If someone seeks therapy because they feel their mind is disordered, or at least unhealthy, why would we expect their therapist to implicitly believe everything that mind tells them—about their life, their coworkers, their mother?

All this brings to mind a prescient gag on Tina Fey’s early-2000s sitcom 30 Rock: A fictional NBC executive develops a lucrative TV “show” in which women can pay for canned footage of good-looking men periodically saying encouraging things into the camera, like “wow, that’s such an interesting story,” and “honey he doesn’t know what he’s missing.” They’re canned responses playing on a loop. It’s meaningless—just like a therapist who’s literally never met a single other person in your life telling you they bet you’re tired from always having to be the bigger person.

To be clear, much mental suffering is real, and there is such a thing as evidence-based psychotherapy. Vitz describes therapy that “works”—according to the data—as therapy that allows the therapist “gently to challenge the client’s distorted thinking and to facilitate positive changes.” 

In other words, therapy that “works” is the opposite of so much modern talk therapy. Rather than meaninglessly affirming every patient’s self-perception, it encourages them to consider they might be wrong about themselves, or their fears, or their mom. To those suffering from terrible anxiety or sadness, that should be welcome news.

I know this kind of therapy personally. For two years, I received therapy for obsessive-compulsive behavior. The treatment radically changed my life for the better, but I can’t say it ever made me feel “self-actualized.” The evidence-based therapy for OCD is called Exposure and Response Prevention. My therapist spent our sessions dreaming of ways to “trigger” my irrational fear(s), and then helped me practice refraining from compulsive behaviors to assuage my anxiety. Basically, I paid her to scare me. It worked.

Not all therapy has to look exactly like that. But unlike the “online” therapists we “match” with, scientifically informed therapists should be able to tell us what they believe “good mental health” looks like, and have a well-researched plan to help get us there.

Otherwise, we risk paying a stranger to pretend to be a scientist while doing for us what our friends, pastors, and loved ones are much better equipped (and called) to do: to have compassion for us, to challenge us to see life a little more clearly, and to really know and love us.