526 Comments
Comment deleted
Mar 24, 2022
Comment deleted
Expand full comment

I mistakenly read it as "all therapies are bravery debates" and it felt like a profound truth

Expand full comment
Comment deleted
Mar 24, 2022
Comment deleted
Expand full comment

I think this is on the money. I think it is possible that there are many therapists who justify the existence of their profession by changing dozens of people’s lives for the better. And also that there are the many therapists that cause people to interpret the phrase “go to therapy” as a threat.

I have not met, in person, good therapists, but some of the best advice I have ever received began with the phrase “my therapist said…” so I have to believe they’re out there somewhere.

Expand full comment
Comment deleted
Mar 23, 2022
Comment deleted
Expand full comment

I agree with everything about this post except for the self-doubt in the end. Hey, maybe I should become a therapist!

Expand full comment

I'm sure supportive therapy is useful to more and more people these days. But I have to wonder - if it's basically just talking things through with someone, how sad is it that people aren't already getting that from their lives? Insofar as I have an issue with the rise of "therapy culture", that's why. It seems like a pale, shallow, and *expensive* substitute for something that people should be able to access for free through normal human relationships.

Expand full comment

The people in your life might have their own ideas or agendas that you have a good reason to want to get away from.

Expand full comment

As opposed to therapists, who would never do things like insert political agendas into their practice.

Expand full comment

I don't believe a therapist would go through so much expensive, time-consuming education and make so little money if they had ulterior motives. They don't get self-esteem and a good reputation and referrals from doing their clients wrong.

Expand full comment

There are people in every profession who are bad at their jobs or drunk on power--no doubt therapists are the same.

Expand full comment

Absolutely. Not everyone is good at their profession. When we hire people, we need to choose well. Same as talking to friends, not everyone is a good friend.

Expand full comment

Agreed.

Expand full comment

Not "ulterior motives" per se. There's a genuine desire to do good. But toxic enough misunderstandings can cause harm regardless. And the education you're alluding to is specifically inculcating some of those misunderstandings. See the last part of this article especially:

https://bariweiss.substack.com/p/what-happens-when-doctors-cant-speak?s=r

Expand full comment

This is a large reason why I have not yet tried therapy. I feel like a crazy person for thinking it, but knowing what I do about the politics of the profession, and the way people with relatively ordinary libertarian political beliefs tend to be treated in academia, I have a hard time trusting a therapist not to treat my closely held moral beliefs like some sort of pathology. I know that concern is probably unreasonable, and that I have plenty of actual pathologies I'm sure they would be plenty busy with without judging my politics, but I've just been unjustly called a racist and a nazi too many times to trust someone who is statistically speaking almost certainly strongly affiliated with the Blue Tribe to poke around inside my head.

Expand full comment

If you think it could benefit you, and you have the means, do it. You can always stop if you notice wokeness creeping in in a damaging way. I wouldn’t let this stop me, it’s just the symmetrical counterpoint to “friends/family can have toxic beliefs”.

Expand full comment

Counterpoint: therapists (as a profession) *should* be ready to handle you wherever you are to get what you want out of therapy. If you are worried about it, tell a prospective therapist at an intake session. If they freak out, you know you need to look elsewhere.

Expand full comment

As far as I've understood and experienced, therapists are not there to engage with the object level of your beliefs, unless 1) you bring that up yourself, and/or 2) those beliefs are disconnected from everyday reality enough to prevent you from functioning in the world.

Therapists are trained to help you "integrate" yourself, ie. diminish the amount of internally generated suffering and wasted energy from different unconnected patterns within your (mostly unconscious) mind fighting amongst themselves. That includes patterns left over from past trauma, but not only that.

The sign that therapy could be of help to you is that, when you look at yourself a bit soberly, you notice that your mind (or body) is often *compulsively* drawn to things you wouldn't want it to be doing, which do not feel helpful to your own goals and life.

That's a skilled job btw, not just something that a supportive friend can necessarily do. OTOH, some people are natural born therapists, and statistically, some professional therapists will be bad at their jobs.

Expand full comment

Make so little money? The cheapest therapist in my area charges $125/hour and has no employees to pay. The average therapist in my area charges twice that. Unlike doctors most of them don't have to deal with insurance companies or managing any employees, and don't need to spend as long in school. Being a therapist seems like an attractive proposition if they like talking to people about their problems.

Expand full comment

How so, I would think "long education, hard work and little material profit" is far more compatible with a desire of pushing an ideological agenda than anything else.

Mind you, if you are true believer®, the desire to push ideological agenda rarely feels like pushing it, it feels like helping people to see the light and live good life. Ask any religious missionary.

Expand full comment

I speak from having been a mental health counselor. I went to college and my best grades and most interesting subjects were Psychology. I got out and looked for a job in marketing but with a bad economy, I could only get a counseling job. Then I didn't want to move up to be a supervisor because I wouldn't enjoy it. My parents paid for college, so I didn't have to think only about pay. And, being a woman, I thought if I had kids, my husband might make more money than me, so I continued. So, we may not get into counseling for a political agenda. Though, high morals vs helping a client hopefully would be covered in the studies because this would be a tough one without help. So blame the education if anyone.

Expand full comment

People with political agendas often believe they're doing the right thing

Expand full comment

Perhaps, but its easy to leave a therapist if they aren't doing what they are supposed to do. Friendships are more complicated and fulfill more roles.

Expand full comment

Right. People may feel constrained in what, how, when, where they say things to friends. They want to keep their friends. We may need more of a friend's time than they have available for us. They may also be friends with a person we need to talk about.

Expand full comment

Even if they don't, you may not want to burden them with the details of your problem. I tell people that therapy is the one place you can have a completely selfish conversation. After reading this I suppose your internal monologue is a second place, however it's easy to believe that one's internal monologue may not be as good at it as a therapist.

Expand full comment

I'm not sure I have anyone beyond my wife who I would feel comfortable with/able to discuss my deepest issues with for 45 minutes a week. And people who are mentally unhealthy probably disproportionately have friends who are also mentally unhealthy and might not be able to give consistent calm good advice.

Expand full comment

It’s also not fair to burden your friends with that kind of time and emotional commitment.

Expand full comment

If I'm thinking about what *makes* someone my friend, it's that I'd be willing to take on that burden for them, and I'd expect them to be willing to do the same for me. If I didn't have anyone to turn to in a difficult time, I don't think I'd have friends, just acquaintances.

Expand full comment
Comment deleted
Mar 23, 2022
Comment deleted
Expand full comment

I agree, but do note that when a friend is distressed and need to work through their issues, being 100% honest with them *without emotional filter appropriate to their mental state* is often destructive. That is, emotional support can often be work. Often very hard work that leaves you exhausted. In the past I encouraged a friend to go to therapy because I found myself too stressed out to give them the support and calm advice they needed. That also something friends do, and I'm happy that I live in a society when we have professional help as a legitimate option. Even if it's partly a symptom of people having less close friends, I think it's also a consequence of people understanding it's ok to ask for help, even if their friends can't provide all of it.

Expand full comment

Hmm, I think there's *something* to be thought about with the phrase "in a difficult time".

I've never been or felt the need to go to therapy but it seems like there's a difference between what somewhat would go to therapy for and what someone would call having a difficult time.

I think of therapy as being more for ... chronic (?) ... problems and going to a friend when you're having a difficult time as more of an acute/recent/singular issue.

Expand full comment

Many Americans have no friends, only acquaintances.

Expand full comment

I tried to be that person for my first two in-person friends after my first run at college. I ended up with severe depression and anxiety for a decade, subclinical depression and anxiety for the following decade, and an aversion to offering help to people. The second decade of aftermath was less severe than the first because of a talk-based recovery group I started attending.

Of course, one of them had undiagnosed, untreated bipolar, the other had undiagnosed, untreated Borderline Personality Disorder, and I have autism. My experience may be skewed.

Expand full comment

I would guess so. I've been in a similar situation but was already depressed when I became my friend's "therapist". Honestly, knowing I was helping someone probably helped me stay alive. Although they also ended up seeing a proper therapist for a while.

I think if we're debating "can friends be support therapists?"/"are therapists hired friends" then we should really limit ourselves the normal range most people fall into.

Indeed, if a friend came to me and straight up said they wanted to die and were aleady planning it, or thought their dead father was sending the CIA after them (a delusion I have actually experienced haha), that would set off my outside-normal-range alarm and I would tell them to go to get help.

Expand full comment

Your friends can't know everything that you might need help with.

Expand full comment

If it is a burden to them, they aren't friends in my book. The kind of people you are talking about are acquaintances to me. Friends are something you usually don't have that many.

Friends are those people you can call at 3am to help you and they will. You are lucky, if there is one such person in your life, let alone multiple such people. There are probably not that many people you'd do the same for. But those are friends.

Expand full comment

The fact that they would do it - even happily - does not mean it is not a burden for them.

Expand full comment

Then the fact that it's a burden for them does not mean you shouldn't do it.

Expand full comment

It's a factor for deciding whether you should or shouldn't.

Expand full comment

A "burden" isn't an objective fact, but a subjective description of something. I stand by what I said: if it is a burden to them/or to me, we aren't friends.

Expand full comment

If that's your definition of "friends", then I can't say I disagree. But if that's going to be our definition of "friends", then an awful lot of people don't *have* friends and there's basically no place in our society where you can go and say "I don't have a real friend; can I maybe rent one?" or even "I don't know how to make real friends; can somebody give me lessons?"

Except, to some extent, therapists. And a few other niche cases, but you can't count on those being available in any particular instance whereas therapists are omnipresent.

Expand full comment

Pretty sure this has been a non-trivial source of business for prostitutes over time....

Expand full comment

Loose women yes. Hoes no.

Expand full comment

I had a friend who had been a high class outcall escort. She used to say that her job was 35 minutes of psychotherapy and ten minutes of sex.

Expand full comment

I'd agree, many people don't have friends. Some, because they themselves are too shallow or too selfish. Others, because they simply didn't find a match.

I have two friends in my life. And surprisingly they aren't the two I had imagined would be my friends when I was a kid. Some lessons really hurt to learn.

True friendship only reveals itself when tested. That doesn't imply that one should force this test. Someone who could have been a friend would probably consider this abuse.

Expand full comment

That might be exactly the problem people are describing. It seems increasingly that people can't/won't/don't form friendships, either from lack of ability or lack of place to meet and bond with them, etc. There is likely always going to be a certain percentage for whom therapists are necessary, either because they have persistent problems, or need close friends they can't get (or maybe they need help because their only friend was just caught in bed with their spouse). It is also possible that we are seeing increased therapy demand as people who need a friend go to therapy because they don't have a friend available. My guess is that the increase in demand for therapy is just that substitution effect away from friend to therapist, not driven by an increase in people for whom a close friend or confidant would not be sufficient.

Then again, I would be sympathetic to arguments that something we are doing is screwing people up more, such that they both are less likely to have close friends and more likely to need therapy, friends or not.

Expand full comment

There is an enormous difference between happily helping your otherwise competent friend at 3 am when he is in trouble once a year, and helping someone who does that twice every freaking week.

I have helped a lot of people when they were in trouble and I would gladly do it again.

But there are people out there who are truly broken: if you start supporting them, soon you will notice that you lose 10+ hours per week just treating their emotional baggage, grinding down your own mental state and - worst of all - seeing no permanent improvement on their side.

There is time when you have to stop playing Prince Myshkin and eject.

Expand full comment

It really depends. If any of my best friends called me at 3:00 a.m. really desperately needing to talk, of course I would do it. If they called me even twice or three times in a row at 3:00 a.m., it would start to be a problem. If they called me every single day at 3:00 a.m., it would jeopardize our friendship. At some point I would lay down a boundary that I need my sleep and I would stop answering the phone at night.

If someone has a very chronic issue, then talking about it constantly, especially if they aren't making any progress, is burdensome on their friends. Also, if one person has a chronic depressive issue, that usually means that their friends will try to avoid placing extra burden on them, which means the relationship is no longer reciprocal--we're both carrying each other's burdens--because one person is overburdened and trying to unload their burden on everyone else.

It can get selfish pretty fast.

Expand full comment

I fully agree with what you wrote about friendship. But I feel as if, what you probably perceive as adding nuance, was actually an attempt to steelman what I wrote.

In my post nothing said 3am each and every night. Balance is the key to real friendship. But this balance doesn't need to be achieved instantaneously. Friendship isn't exactly trading either ...

Expand full comment

I think most people think of therapy as treatment for chronic issues, is the thing. The people who need therapists the most are people whose friends can't tolerate their level of emotional neediness.

Expand full comment

In addition to what they said, it's "fair" because you will presumably return the favor.

Expand full comment

I personally see things the opposite way: we are friend because at one point we asked the other person for time and emotional commitment, and we gave it. This is a restrictive definition of friendship but I'm fine with that, there are lots of people that I'm friendly with but that I wouldn't consider "friends".

I also think it's very important that it goes both ways, find some kind of equilibrium. At some point in my life a friend really needed me, and later I really needed them. That's how life goes. I was here for them, they were here for me. That's what friendship is to me. Sharing the good time, helping each others in the bad times, trying to not depend too much on them but also be ready to depend on them a bit if you really need it.

Expand full comment

People are saying that we should be willing to help our friends, and I agree—but I also recognize that I rarely befriend highly dysfunctional people, the ones who need the most support, in the first place. And I suspect I'm not alone in that.

Expand full comment

Right. There are people who are very difficult to tolerate, very difficult to like. Those people probably disproportionately go to therapists/medical doctors/the nice lady st the library, because they need social support and can’t get it otherwise.

Expand full comment

Or even people with great friends might prefer a therapist. I went to therapy to talk about my issues with someone who *was not a friend*. My friends knew my issues, but there was a conflict between how much time I needed to spend working things out verbally and how much of my precious social time time I wanted to spend talking about my mother. I needed that time and those friends free for fun!

My friends also are humans with their own baggage. I couldn’t necessarily talk to the friend with a terrible record for relationships about my boyfriend, or the fatter friend about body image. The friend with a totally deranged mother was wonderfully supportive, but I always felt guilty complaining to her about my only-mildly-crazy mother.

By contrast, I really felt like I could say anything to the therapist. Besides, I was paying him to listen to me! That was incentive for me to be thoughtful and honest, and the whole thing was actually helpful even if it wasn’t life-changing.

Expand full comment

Strong disagree. If it is one sided yes, but if there is reciprocity and two-way interest in the emotional well being of a friend that that justifies - demands even - burdening each other with potentially heavy emotional baggage, and this is one of the things that differentiates friends from "friends" (whatever exists between acquaintance and true friend)

It seems to me if you aren't at least occasionally burdening someone you might never reach that sort of true vulnerability and rapport-building that forges dramatically valuable relationships

Expand full comment

"occasionally burdening" is one thing. Dealing with a chronically depressed person is "consistently burdening," however. And incredibly frustrating because there is usually little or nothing you can do to help. It's a sad fact, but depressed people who needs friends the most are often nearly intolerable to be around.

Expand full comment

I think that's missing, inadvertently, one of the most important parts of most therapy - the therapist generally isn't in the business of giving advice. Calm, good or otherwise. They are paid to listen! Actively, empathically and where possible, encouragingly.

Most people are unable to do this - they can't help giving bloody advice, which is the reason for the splashing out on therapy.

If people don't have friends that can give them a damn good listening to, a therapist may be the only option.

Expand full comment

Therapists shouldn’t give “advice” in the sense of “yeah I think you should take that job” or “leave that relationship” but they SHOULD bring expertise and perspective to their clients that couldn’t be found in the average person. They should be obviously well versed in different theories and the science behind what drives human behaviors. Their job, in my view, is to help you understand your thinking (and subsequent emotions and behaviors) and the reasons behind it more clearly, so that you can decide which actions to take for change. Their job is not to tell you what to do or solve all your problems for you.

therapists should more objective and less biased than friends are. Your therapist shouldn’t have any preconceived notions about what kind of person you are or what your family is like a friend would.

Expand full comment

Different therapists will have different approaches to how to handle this, and some may even give explicit suggestions when solicited, but I think that in a lot of cases if a client asks a therapist "should I take this job?" or "should I leave this relationship?" the therapist will not only have their own opinion, but try to guide the client around to it. This may or may not be a good thing depending on the therapist's judgment, but a good therapist will have experiences with a large client base to draw on in terms of how various life decisions have worked out in different situations, so giving effective advice to a wide range of people could end up being something they have domain expertise in.

Expand full comment

IDK. I would think a good therapist would help the patient to work through the question of "should I take this job?" The therapist shouldn't care about the particular answer. They should care that you are able to make considered decisions for yourself.

Expand full comment

I think different therapists will have different views on what a good therapist should do in a given situation. I think that therapists who most people consider to be good will do their best to guide patients to make decisions that the patients will feel better for having made, rather than prioritizing the therapist's own preferences. But if a therapist thinks for instance, that taking a particular job will probably make you much happier in the long run, but that you consistently struggle with impostor syndrome which makes you feel unqualified for anything you do until you've been doing it for about a year, so you're probably going to be strongly biased in favor of not taking it, then I think a lot of therapists are going to see "guide my patient towards taking the job" as the desired outcome, so if they lead you to carefully consider the matter according to your own judgment, and you decide not to take it, they'll feel they've done a suboptimal job.

If a therapist thinks that some decision is most likely best for your happiness, but you're biased against it due to known habitual flaws in your reasoning, then for them, "guide my patient to what I see as the most favorable outcome" and "guide my patient through their habits of reasoning to uncover if they have biases hampering their judgment and holding them back from what makes them happy" will likely be equivalent.

Some therapists clearly inject their own biases and priorities into their guidance quite a lot. For example, I've heard a lot of people recount stories of devoutly religious therapists pushing their patients to conform to their religious views. Presumably, some therapists are going to be more or less committed to pushing their own viewpoints on their patients. But for some patients, the ideal therapist might not be one who doesn't push their own viewpoints at all, but one who exerts a comfortable amount of pressure pushing them towards decisions that actually make them happy.

Expand full comment

Agreed and understood. But a corollary - when demand for therapy goes up, it likely indicates and is responding to a decrease in close social connections, a decline in healthy marriages, alienation from family... I'm not criticizing people for seeking a substitute. But I wish the *real thing* weren't in short supply, which is what I see as provoking that response. (cf. Bowling Alone.)

Expand full comment

Or potentially a decline of belief in God and absolute moral authority (ETA: priests religion etc)

Expand full comment

Priests also used to provide therapy sessions, with free guaranteed absolute divine forgiveness included!

Expand full comment

I'd argue that if we look at modern specialized professions, then the traditional small parish priest was effectively doing many of these jobs he was effectively the psychotherapist and marriage counsellor, and the traditional rituals of catholic confession IMHO effectively are structured therapy frameworks.

Expand full comment

Seconding this! I think in particular men have trouble forming close friendships, and end up leaning far too heavily on their romantic partners, which makes men who are single (as especially the ones who have just ended a relationship) especially isolated.

Expand full comment

Oh I don't know. I think there were many dysfunctional relationships in the past, people just didn't acknowledge them because it made them uncomfortable or bad relationships were gauche.

I absolutely do not think marriages were healthier in the past, there were just more cultural norms to stay in them no matter what. Etc.

Expand full comment

Good therapy is not about advice though. In fact, if a therapist is giving lots of advice, it’d be fair to say they’re probably not a good therapist.

Also, there are probably things that you (or anyone) wouldn’t feel comfortable telling your wife- and maybe, or especially yourself, that may actually be at the root of your problems. I think people often think of therapy as a means of getting answers or advice, but often it’s the exploratory process of actually figuring out what the issue is that is most illuminating/helpful in therapy.

Expand full comment

If you can't tell yourself how can you tell your therapist? Or are they supposed to be so penetratingly good at their job that they divine these things themselves? That seems like the sort belief that can lead to disillusionment with therapy when you realize that a therapist is just some guy/girl (and not only that but they have 50 other patients and you have spent 1000x more effort modeling yourself than they could possibly ever do)

I've gotten precious little benefit out of a bunch of therapy, but when it was helpful it was never about 'insight' but an external 'professional' agent giving me obvious (but correct) advice which gave it more weight than when I told it to myself. Sort of self-help placebo

Expand full comment

I don’t think it’s that they give you the insight, and certainly not that they divine them. They have no special knowledge per se. They are trained to listen and in a method to help guide you to arrive at the insight on your own and together with you. Ideally you’re the one arriving at the insight b/c that’s when it has the potential of leading to lasting psychological change. Giving you the answer won’t effect change in you. It’s a dynamic exploratory process, and (in the more psychodynamic traditions) helps uncover the Unconscious which can be illuminating and helpful at understanding, and at times changing, patterns of thought and behaviors

Expand full comment

A good therapist can ask the right questions at the right time because they know how to listen. That’s how it’s possible for you to tell them things you don’t really understand about yourself and why you may be doing things that make you unhappy. Then they can explain to you what they heard, and that can make it easier for you to hear and understand yourself. At least that has been my experience.

Expand full comment

That's kind of weird to me, though. The only reason I would go to a therapist would *be* to get advice. I'd see it as like going to the doctor: hey, doc, I have this and that symptom, this pain here and a soreness when I do this -- what does it mean? What should I do about it?

And I'd kind of expect the therapist, like the doc, to say well Carl that seems like a textbook case of Fnord Syndrome, first described by Dr. Whozit in 1899 -- here, let me show you a gruesome plate from my medical textbook -- and I've seen a dozen of these cases in the clinic over the years. Best modern idea is that it's caused by excess hair on your glial cells and the best treatment is gargling twice a day with licorice tea while saying four Hail Marys. Also, stop dating brunettes and give redheads a try.

And I would say thanks! doc and here's $100. I mean, if the guy doesn't know far more than me about how the mind works, and can't give me insight beyond what I can originate myself, then I'm wondering why I'm paying him good money for his education and experience.

I realize this is a caricature, and maybe this is what a good therapist actually does, but by some subtle process of steering me in the right direction in such a clever way that it seems like I stumbled across wisdom on my own, but I would find this tediously circuitous. Why not just shoot straight to the point, tell me what I'm doing wrong and how I could straighten it out? I wouldn't *be* there if I wasn't willing to listen, if I didn't think I'd come to the end of my own abilities to generate insight.

Expand full comment

Being willing to hear someone out is very different from being willing to change. Often, the correct path is obvious and everyone gives the same advice, but actually getting someone to break a bad habit is very hard, and is quite dependant on the presentation of the advice.

Expand full comment

I guess. I've seen others react that way. I mean, I suppose I'm just saying I'm not a good candidate for therapy, but I'm doubtful that would work well with me. I already usually rephrase internally whatever anyone else says to me into my own language -- like a mathematician always rewriting polynomials into standard form. So it would not matter how the advice was presented, since I would always internally reduce it to the same canonical form anyway. And it would annoy me if someone was clearly trying to be elliptical and diplomatic. I far prefer plain speech -- if it's unwelcome news, I prefer to hear that bluntly rather than delicately. But other people aren't like that, I know, so I get the need.

Expand full comment
Comment deleted
Mar 24, 2022
Comment deleted
Expand full comment

The problem here is that what you should do (and the reasons you’re not already doing it) in any given situation is contingent on too many particulars of your interior experience for another person to simply diagnose.

A woman I’m seeing has a fraught relationship with her father. He invited her to go on a trip to Nashville and putz around for a few days. She’s torn about it. Should she go? How many questions need answering here? Why is the relationship fraught? Is it rectifiable? How much does she intrinsically value familial bonds? What is the risk that the trip will be good/unpleasant/emotionally destabilizing for weeks? Who can answer these questions except her?

The utility on offer is having another person help you discover these questions and your own answers to them.

People in technical disciplines do this kind of thing _all the time_ - you get together with Frank and discuss how to design Foo to meet all of the constraints, because having another brain modeling the problem speeds things up substantially.

Unlike in technical disciplines, though, we’ve got a bunch of gremlins in our brain that often want to actively deceive us about what’s happening in our lives (and how we’re playing a causal role). Often our values are misaligned with our behaviors, or we’re acting out some patterns of behavior that are difficult to notice from inside of them, and we’ll react negatively to anyone directly pointing it out. So therapists sidestep those defenses with empathy and questions

Expand full comment

Sure, I understand nobody has the particular to help with some detailed decision or other, but what I would want (if I asked a therapist for help) would be help with *how* to make the decision, and that *should* -- if psychology has any meaning at all -- be something fairly universal, tied to the nature of the human mind.

So in your illustration, presumably the therapist could listen to *how* your inamorata was planning on making that decision, and advise her where her decision procedure was good or bad.

I understand all your last paragraph except the idea that someone could (1) be motivated enough to deal with the gremlins that he decides to go tell a stranger intimate details *and* fork over good amounts of time and money, and yet (2) would "react negatively to anyone directly pointing it out" as you say.

By me that is almost literally insane, violently self-contradictory. You want to get better or not? If you do, and you can't do it alone, then pretty much by definition you're going to have to hear and accept things that are unpleasant and which don't immediately strike *you* as plausible (because if it were either pleasant or plausible to your own ear, you would have already said and accepted it on your own).

That is, the only reason I would go to a therapist is because I thought I needed to hear something unpleasant and strange to my ear, some kind of kick in the ass that would get me out of the rut of my own thinking. So I wouldn't *do* it unless I was fully prepared for that. I mean, if I go to the doc for a funny wart, unless it's meaningless I expect he'll say "dear me, this is going to hurt as we cut it out, but you'll be better afterwards." Why would I expect the head doctor to be any different?

Expand full comment

I mean, it’s not entirely sane, but see e.g. drug addicts who swear they want to get clean and then go do their drug of choice. They’re not a special category, the level of dysfunction is only really special by degree. The reality of the human condition is that we’re not coherent, rational actors. This is what Scott was writing about when he did that exchange with (maybe Caplan?) about mental illness as a revealed preference or whatever.

If you can’t identify places in your own life where you want two things that are mutually in conflict and this has lead you to act out incoherent strategies, odds are you aren’t looking hard enough.

Also, surrendering your judgement to others isn’t a viable or safe path out of dysfunction: this is how people end up joining cults. If your worldview is badly distorted and you can identify that fact, it doesn’t necessarily mean you can just stop it.

You might be interested in “motivational interviewing”, which is a therapy technique for influencing people in the direction you think they should go while still leaving them with autonomy to make their own choices

Expand full comment

I work with a lot of men and many of them do better meeting once a month or on an as-needed basis because they don't have the same volume of material (some do) or the same needs to sort things through relationally. Often men only come to see me because they have run out of other options (mom, wife, girlfriend aren't available or helpful) or because one of those women have asked them to talk to someone because they are worn out from carrying the emotional load of the man in their life not having a wider array of emotional supports. This isn't to say anything about you obviously, just something I notice about the difference between many of my men clients and many of my women clients.

Expand full comment

FWIW the Venn diagram of people I used to frequently drop acid with, and people I'd feel comfortable discussing deep issues with, is a circle.

Discussing them with your romantic partner is perhaps not a great idea, given that a lot of these issues are either relevant to your relationship (so even talking about them changes the situation, in ways hard to predict) or just scary and unwise to inflict on someone who cares about you the way a spouse/long term partner should.

Expand full comment

Personally when I tried therapy, I didn't feel comfortable talking to a stranger about these things and spent the whole time lying / managing the therapists perception of me. Predictably I didn't find therapy helpful

In the end, depending on the problem, I feel more comfortable talking to my family, my spouse, strangers on the internet with similar problems, and close friends. There are occasionally things that are too private even for that, and they go in a private journal instead.

Expand full comment

What about group counseling and "support groups"? It seems like an awful lot of people just need some social contact and a sense that they aren't irredeemably defective. Nothing too fancy or expensive.

Expand full comment

I use therapy like how I hear some sex-work patrons use sex-work services. There was an initial hurdle to overcome, but once I was past that it was kind of nice being able to discuss those deepest issues with someone who didn't have the perfectly normal, healthy desire to have a symetrical relationship with me that a romantic partner or friend would like to have.

Historically, this role has been filled by religious leaders and phylosophy tutors, and by no coincidence I've availed myself of their services in the past for similar interactions.

I've got a deep pool of healthy friends and and a great relationship with my romantic partner, but having a transaction interaction isn't possible with them and sometimes its just the thing I need.

Expand full comment

Also: some of us have mental health issues that make it difficult for us to make and maintain friendships, and give us problems that are hard to talk about to people who don't have experience working with neurodivergent types.

Expand full comment

Same here - guess is even more like 45-90 minutes each day with the wife...

That lets me start thinking about some men's claim, that marriage would be to expensive for the personal gain they get from having a wife instead of just a girlfriend or friend with benefits or similar constellations. These men could account the 'cost of having a wife' with the saved cost for a paid therapist (300 per week, 1400 per month, 15000 per year, 0.75 Million per life)

Expand full comment

"Should be able to" is doing a lot of work here.

Expand full comment

I think you could be reading too far into those words. I didn't mean to imply a moral duty, or assign blame. I'm just saying, it is good for people in so many ways if they have human relationships; it's lamentable that such relationships seem to be in decline; and I don't think therapy can fully make up the difference.

Expand full comment

100% agree with you there that therapy cannot fully make up the difference. Also that it's not designed to, and so all the more important that it not be seen as trying to.

Expand full comment

It’s not supposed to. That’s not what therapy is. It’s not a substitute for something else, it’s talking to a qualified professional who may be able to help you figure out why you feel certain ways. I talked to my friends about my problems for years, and I still do, but my friends weren’t qualified to refer me to getting diagnosed with Bipolar II and ADHD, something that happened way too late in life for me but might have happened sooner had I gone to therapy. My friends also aren’t qualified to help me recognise and deal with automatic negative thoughts, or to provide me with coping mechanisms when I get too low to do much of anything. I still talk to them and they still listen, and they talk to me, and we all support each other. But sometimes you don’t need a friend. Sometimes you need therapy.

Expand full comment

I wonder if "cultivating a network of friends with whom you can exchange informal but high-quality services, such as tech support or therapy" could be one of those useful milestones/life skills that makes therapy more useful for some people than others.

Expand full comment

Fuck, absolutely.

I think it's a lot worse with women for a bunch of social reasons - every woman I seriously dated had basically no close friends (to be fair introverts are my type, but come on). This would explain a LOT about the "men would rather..." meme, we just go out for a beer then inexplicably end up spilling our soul to a friend in the morning.

Expand full comment

That is almost the opposite of my anecdotal experience, that women discuss emotional issues and mental health with friends all the time, whereas it's very rare for me to do so with my male friends - I can in a crisis, but it feels very vulnerable in a way that talking about that stuff with female friends does not.

Expand full comment

I sometimes think that therapy replaces parts of a traditional community e. g. elders / aunts / priests etc.

Arguably a trained expert will be better than "local old person" though.

Expand full comment

If we could get a person who had formal training based on science, a mentored internship, and a decade of practice, then a friend's aunt would probably not be the best choice. But give me a mature elder who sees working with troubled people as part of their life work and who approaches the relationship with humility and affection over a first year college grad any day.

Expand full comment

Thomas Szasz explicitly compared psychotherapists to priests or "soul doctors".

Expand full comment

Local person seems to have a serious advantage in being embedded in your community. They might have more skin in the game because of this, and they have the advantage of actually experiencing many of the same situations you do (though through possibly very different eyes). Therapy feels designed to be *not* very overlapping with your day-to-day life (maybe this is somewhat of an illusion??), which could have it's own advantages (e.g. if your day-to-day life seems fucked up, with no one to turn to).

Expand full comment

This is my first comment on SSC. I have enjoyed reading Scott for years but prefer to lurk.

But coming across this post right now makes me feelmlike I ought to have the courage of my convictions.

I've spent a few thousand hours visiting the elderly, lonely, ill, crazy.

And at times I arranged to help others to do the same.

As you can tell by the handle I'm using I'm ambivalent on whether I'm actually interested in being taken seriously in the public sphere these days or not.

But I posted the following tweet today with serious intent. I've matched up the helpful with the needy before and I would guess need is no less now than before.

So even though I preferred my first post before Great Scott to be more polished under a more inspiring nom, if I don't post this now I will definitely rationalize not doing so.

If this speaks to you please DM on twitter.

https://twitter.com/running4fuhrer/status/1506677502059679752?t=zHEMJiP3d28f-p5g_HFr8g&s=19

Expand full comment

You know the old joke about how clients don’t pay prostitutes for the sex, they pay them to go away afterwards? Well, therapists can be a bit like that. Sure, my friends will listen to my troubles but then I have friends that heard my troubles! Paying someone who I don’t otherwise have any contact with can be useful.

Expand full comment

There's a level of friendship at which it won't bother you at all that they've heard your troubles. It's rare- I only have 2 friends that I'd tell *everything* to.

Expand full comment

It's often the case that I need to dump a lot of HARSH shit on someone whose job it is to hear that sort of thing, and who has the training and experience not to take it personally. That's not necessarily the easiest thing for a friend or loved one to hear.

I generally agree with your idea that the loss of social bonds is a bad problem, though.

Expand full comment

Another angle to remember is that a lot of people *do* have a supportive community they can talk to every day and get support and advice from, and that community is qAnon.

(Or whichever other extremist/stupid/dangerous community is your personal outgroup boogeyman.)

Therapists aren't *just* someone you can talk to, they're someone with certifications and training and education. If you're surrounded by smart and empathetic people with lots of time and compassion to talk things out with you, they may be better than the average therapist; but the average therapist is probably better than the average friend that the average person could talk to.

Expand full comment

As with another profession, I suspect the payment is to make sure they go away after.

Expand full comment

The people in your life are not trained specialists who know how to help you process trauma, schemas, cognitive patterns, etc.

Expand full comment

To quote the article, we're talking about "supportive therapy", which is "unstructured talking about your feelings and what's going on in your life". I honestly don't think you need any kind of occupational training to provide value by doing that. And what's more, I think the best, most helpful version of it will happen with people who actually know you, not with people you've paid, regardless of how good their training is.

Expand full comment

That depends on whether you have a mental illness or not, or trauma to process. I don't think your friend is necessarily going to be able to help you process trauma as effectively as a therapist, no matter how willing they are to be there for you and listen and take you seriously. "Supportive therapy" has structure and theory and modes of practice that a good therapist will adjust based on your needs, not just free form talking without any underlying method.

Expand full comment

This presupposes that these trained specialists are actually helpful. Increasing numbers of therapists and school counselors does not seem to have corresponded to an increasing level of mental health in the US.

Expand full comment

Only a few therapies are scientifically validated, and only for certain things.

There's no real evidence that any treatment for, say, gender dysphoria is at all helpful.

Conversely, we do have evidence that combination CBT and drug therapy can be effective as an intervention against depression.

I think part of the problem is overdiagnosis as well as the fact that psychology is really more of a proto-science.

Expand full comment

Yes it's very sad that most people don't have deep emotional connections they can talk about anything with but it doesn't make it any better to say that. This is kind of like saying everyone 'should' have loving homecooked meals whenever they want them, instead of having to go to restaurants to have a stranger cook for them.

Expand full comment

I think identifying the problem is an important part of finding a solution. I think most people in this thread chiming in about their personal experiences with therapy have said they've gotten something from it - great! But for the others who haven't, for any of the various reasons I've seen, we should try to understand how else we might be able to help them.

Also, if the increase in demand/provision of therapy is caused by a lack of emotional connection, that seems... significant? Worth remarking on? It's the kind of thing I come to this blog for, trying to get a little bit better of a lens into how the world works, even when it's not all that actionable.

Expand full comment

Therapy is much more than that. Some people can benefit from professional help from psychologists who have deeper knowledge of the issues they are going through. Talking to friends and family is not going to cut-it, instead, it needs to be a professional with deep psychological knowledge.

For example, I had a lot of insomnia caused by anxiety related to my life's issues, which include the fact I am asexual and I work in an extremely competitive field. Talking to family and friends for years only made it worse, then I talked to a PhD in psychology and combined with SSRIs, made an enormous difference.

Expand full comment

Don't know about others, but there's at least a few things I get out of therapy that I can't get out of normal human relationships. The obvious one is relationship issues themselves; complaining within a shared social circle is likely to have unwanted side effects, and as a relationship's duration lengthens, fewer and fewer acquaintances are not shared.

(in recent years, meta-politics has become a recurring theme too, because of universal politicization coupled with almost everyone I love going politically insane)

More generally, therapy provides a context in which I can speak without having to vet my words for impact first. I can make statements that are denotative without being enactive. It is slightly more possible to Just Say What I Mean[^1].

[^1]: https://thezvi.wordpress.com/2017/06/28/just-saying-what-you-mean-is-impossible/

Expand full comment

The part of this I find disquieting is that if you talk to your friends, they have an option to walk away or not put up with your bullshit if you are too self-centered, or just seem interested in validation and not *really* solving anything. That kind of cold water in the face can be useful, assuming you aren't too narcissistic to interpret it correctly.

But you can fire the therapist, and the therapist is motivated -- at some level, depending on their inherent ethics and level of financial need -- to avoid pissing you off enough that this happens. So it's possible for people to simply hire therapists[1] as courtiers, who will for $100/hour tell you that you're pretty much OK and you don't, in fact, need a kick in the ass to stop being such a jerk.

--------------

[1] Admittedly we would not call these very good therapists, but I'm confident they exist, because I've known people who shop for them, and they do find them.

Expand full comment

Oh, they definitely exist, and it's all too easy to end up with that kind of therapist even if you actively don't want to.

I've been to therapists a few times, usually prompted by "I can't stop doing X and it's destructive, please give me advice to help me stop" and they always just metaphorically pat me on the head and tell me I'm doing fine and I should stop beating myself up about it.

Expand full comment

I knew someone very well who was in that boat. She went to new therapists hoping for the best. "I already *know* I shouldn't do this, and at some level I want to stop, I just need some practical advice on how to do that." Like she wanted tips 'n' tricks, ideas for mind games she could play on herself that stood a better chance of working than those she could think up on her own[1]. She didn't think much of root causes analyses, because she'd say that's all very interesting academically, but I have a practical problem here, and knowing it got started with this or that experience when I was 11 doesn't do me a damn bit of good solving it.

Unfortunately she never really did find anyone that she thought had anything useful to say, and by and by she stopped trying. She got a grip on her problem on her own, more or less just through enormous strength of will and patience. She ended up being pretty disapointed in therapy per se, though.

------------

[1] I should say it was her notion, reasonably proved correct by her later experience, that all she needed was to establish a new habit, just *not do it* for a certain length of time, and then the need would dissipate. Sort of like quitting smoking.

Expand full comment

I often find myself in this position. I know what can fix my problems and achieve my goals; my issue is typically only ever *doing it*, as a matter of motivation and focus.

Expand full comment

That's fascinating. But unfamiliar to me. I don't really have a problem doing stuff I decide to do, even if it's painful or tedious. I'm quite capable of driving myself until physical collapse[1]. The problem for me in not getting stuff done is always not enough time or equivalently too much to do, overcommitment, or an OCD unwillingness to let something go when the return is diminishing to zero.

----------------

[1] Although there's no doubt a healthy slice of pure luck here, because I have never had to recover from a meth or crack habit, for example, which put far greater demands on the will than anything with which I've had to cope. I've never been shot at, either, and had to stand my ground or even advance. So I'm a long way from thinking I'm any better than guys who *have* had that challenge and buckled. I might, too.

Expand full comment

Well. I'll tell you why.

We don't have a lot of control over the families we are born into, that's the only family we know, and its hard to see into the intimate mechanics of other families. So, if your family is really messed up, you are probably not receiving important aspects of development, and you don't have the capacity to know what your missing.

I went to therapy because my parents are socially stunted people. I don't mean that in some glib, liberal, snotty way. They both faced social and financial poverty as children, and missed forming important social or emotional skills. I grew up in a house in which I was functioning way above my age since I was very young. Not only did I have to take care of myself, I often had to take care of my parents. Sounds really messed up - but I didn't know that! I was miserable and isolated because I also struggled with social relationships, and I couldn't know why (my parents never talked to me about relationships, just told me that all people were bad and disappointing). I tried to talk to lots of people about my parents, but there are very, very strong (I can not emphasize this enough) cultural norms about ungrateful children, suffering parents and respecting elders, so that many peers and adults will shut down those conversations. Which is to say, I repeated reached out and was denied.

I was lucky in my mid-twenties to go to a therapist. I was able to learn many social skills that I missed as a child. I learned how more typical, if still imperfect, families worked. I unlearned the norm that I had to be close to my parents no matter what, and learned about families that had broken dynamics. I chose a more distant, but more functional relationship with my parents, and I learned how to navigate that, as I didn't have a model of how to do it, and since my parents and society put constant pressure on me to act differently.

Its truly shocking to me, that although I have many Woke and pro-therapy friends that use therapy chatter all the time, that there is still this undercurrent of judgment for not getting along with my parents. Even with good friends, I still have to pull my punches and mostly talk about the sunny side of how our relationship is better. People do not, and willing will not, understand. Most people don't like to know ugly things.

If I had not gone to therapy, I'd be miserable. I wouldn't understand why my work relationships were always so challenging, I'd consistently choose poor dating partners, and I'd have the same relationship with my parents, which made me miserable. I used to have very low self esteem. Everything changed. I'm so glad I went.

Expand full comment

Near the end of 8th grade, I wrote a suicide note to a teacher. I had no intention of killing myself, but this brought the full force of the District Psychologist to bear on me. While the school called my mother (a worst-case scenario for me), this man walked around the outside of the schoolyard with me. He told me that we can choose our feelings and responses to things, and can choose to feel better.

I know from having lived in the world for a few decades that this is terrible advice. No depressed person needs to hear this. Universally unhelpful.

That advice CHANGED MY LIFE. I gave it a try...and it totally worked. Between 8th and 9th grade I went from a kid who cried almost every single day to being pretty happy and cheerful. It was a total revolution in my feelings. I mean, what?

Expand full comment