Stressed? Burned out? Lonely? Dealing with a breakup? Conflict with a co-worker? Feeling down? The blanket recommendation for anyone going through a rough patch these days is to seek professional help, and many struggling Americans are doing just that.
Demand for mental-health services is skyrocketing, and the wait lists for therapists are long. Employers, schools and the Biden administration are taking various steps to increase access to mental-health services.
But what if I told you that talking to a professional about one’s psychological woes might not be the answer to every problem? Or that there might be times when therapy actually does more harm than good?
To be clear, I am a fan of therapy, and as a practicing psychiatrist for almost 20 years, I have witnessed many patients improve in treatment. However, the therapy-is-the-answer model is problematic for several reasons.
First, underlying the blanket recommendations for therapy is the belief that stress of any kind is harmful.
This line of thinking fails to recognize the growth that often accompanies challenging experiences. New research from the Youth Development Institute at the University of Georgia found that low to moderate levels of stress can help individuals develop resilience and reduce the risk of developing mental-health disorders such as depression and antisocial behaviors. According to the authors, stressful situations and environments prompt individuals to be resourceful and cognitively flexible, and as a result learn strategies and skills that help them overcome adversity and thrive.
Reflexively referring to therapy anyone who is going through a rough patch presumes fragility and pathologizes perfectly normal experiences of being human. Sadness, worry, discomfort and anxiety are part of life and not necessarily signs of dysfunction. It’s entirely natural to feel overwhelmed—or even bad—at times. It’s evidence that we’re alive and engaged. The idea that we require psychological treatment to cope with every negative emotion or challenge we encounter represents a particularly noxious strain of toxic positivity.
Second, the therapy-is-the-answer model assumes that all therapy is beneficial.
In fact, there is evidence that rehashing what is bothering you can actually worsen symptoms of anxiety and depression. Self-reflection, a cornerstone of many therapeutic interventions, is a slippery slope. If not careful, it can amplify self-focus and aggravate rumination—the clinical term for repetitive negative thoughts about what can, did or will go wrong. If therapy becomes an excuse to vent, and sessions are mostly used as an opportunity to air grievances, maladaptive rationalizations and unhealthy narratives may become even more entrenched.
Even after a major life event, inviting people to talk about their feelings isn’t always helpful. For instance, in the wake of a collective traumatic experience, crisis counselors are often summoned to conduct what is known as a psychological debriefing, where trauma-exposed individuals are encouraged to go around the room and talk about their thoughts, feelings and reactions to the incident.
While well intended, there is no evidence that debriefing interventions actually help. In fact, there is reason to believe that a debriefing session may do more harm than good. It’s possible that asking people to talk about their emotional experience too soon may make them feel even worse. It also can be further traumatizing.
A few years ago, I attended a talk given by a man who was severely burned during the 9/11 attack on the World Trade Center. He said that when he awoke from a medically induced coma months later, in pain and disfigured, he recalled being angry, upset and deeply sad. A few days later a psychiatrist arrived at his bedside, suggesting they talk about his trauma and asking if he was depressed. What he said next made me cringe. He said psychiatrists need to stop asking people who have been through hell to talk about their trauma and if they are depressed. “Of course we’re f—ing traumatized and depressed,” I recall him saying. How often had I been that psychiatrist, convinced that my clinical interventions were necessary to help someone navigate the unthinkable? The man told us that what he really needed at that time was to be with his friends and family, not a therapist. Talking is good—but when and with whom should be up to the individual.
A third limitation of the therapy-is-the-answer model is that it doesn’t take into account many other factors that contribute to well-being.
When the Harvard T.H. Chan School of Public Health report asked people about stress and what helped them feel strong, regularly spending time outdoors topped the list, followed by spending time on a hobby and exercising regularly. Also cited were getting a good night’s sleep, eating well and spending time with family and friends. Other mood-enhancing boosters were doing something for others, learning something new, doing something creative, meditating and using one’s strengths. Prescription medication and professional help made the list but hovered near the bottom.
Moreover, the therapy-is-the-answer model glosses over the social determinants of mental health such as education, the physical environment, safety, employment, and social support networks. A great deal of wellbeing lies beyond what is happening inside a person’s head. Opportunities, communities, and activities that foster growth and build positive resources are important contributors to mental health. More therapists and more therapy are not addressing the structural issues that are making people so miserable. As Desmond Tutu said, “There comes a point where we need to stop just pulling people out of the river. We need to go upstream and find out why they’re falling in.”
Would the world really be a happier place if every single person had a therapist? I don’t think so. Therapy can be helpful but we’re leaving a lot on the table if that is the only solution we have.
I wish you all the best,
Dr. Samantha Boardman