Ray,

Your points are well-taken. Your critique of psychotherapy was certainly
intelligent. I have some agreements and some bones to pick.

1. You mentioned that most therapists are biomedical in their beliefs. I don't
know if this is actually the case. It's certainly true within psychiatry, but I
know many therapists who are more psychosocially oriented. However, there can
be no doubt that therapists of all sorts (counselors, social workers,
psychologists, an the like) are all becoming more biologically oriented. This
is indeed troubling given that advances in psychiatric medication have been
meager at best over the past 50 years.

2. You stated that therapy generally operates in a pro-status quo fashion; that
is, therapists support the current social structure. I bet that most therapists
are nominally liberal (they vote Democrat or whatever the so-called “liberal”
party where they vote), but not to the point where they would support any plans
for radical social change. I would thus agree that most therapists are not very
concerned with social forces when they engage in performing therapy. There are
certainly exceptions to this rule; many feminist therapists (or derivatives
thereof) frequently discuss social structure.

2b. My take is that social forces are important, but they are not a big issue
for many clients. In America, for example, many clients are filling their
socially endorsed roles as consumers, parents, and employees who don’t question
authority. If these roles are not themselves part of the problem, it seems
strange to try to correct them.

2c. If a client is not conforming, then that may not at all be a sign of
individual “pathology,” so to speak. Gandhi, MLK, etc. – not conformists. We
need more people to not conform if true social change is to be enacted. But a
therapist should point out the consequences that are likely to ensue from
nonconformity. Just because a client is operating from the moral high ground in
an unjust system does not mean that therapists should resort to cheerleading.

3. Yes, therapists often view client’s problems on an individual level. It is
pretty hard to help anyone outside the client make changes, so it makes the most
sense to focus on the client.

4. Some therapists do indeed claim a lot of expertise in areas well outside of
their competence. Shame on them for doing so. I’m not a fan of claiming a lot
of expertise in areas that I don’t know anything about.

5. The evidence is fairly clear that psychotherapy alleviates emotional
distress. Meds often do the same, but the long-term outcome (at least for
depression and anxiety) is better with psychotherapy. That being said, many
people are not helped substantially or at all by treatment. Psychotherapy is
well short of a cure-all. Indeed, not a lot of progress has really been made in
improving psychotherapy outcomes for quite some time. Chasing ambulances and
giving psychological “help” to people who don’t want it is a different matter –
it shouldn’t be done. But providing individual or group therapy to people who
seek services is often a reasonable solution. I’d love to see the social
changes you alluded to, but I’m sticking with supporting psychotherapy (noting
the above caveats) in the meantime.



CP



Clinical Psychology & Psychiatry: A Closer Look
http://clinpsyc.blogspot.com
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