If the kids are not okay, it’s not because of ‘Bad Therapy’ -Book Review
Let’s face it. Our society has a complicated relationship with mental health and its treatment, which we can trace back almost all the way to its inception. We have cultivated an overly romanticized view of therapy and the real work involved due to countless mis-portrayals by movies and media and the veil of secrecy we’ve kept around the process in the service of privacy.
To her credit, I believe this is one of the things Abigail Shrier attempts to bring to light in her newest book, titled: “Bad Therapy: Why the Kids Aren’t Growing Up.” In the book, she offers her take on the current state of mental health care for children and adolescents in our country. As a therapist in practice for over 15 years, I find the book’s central argument—that the mental health industry is harming rather than healing our children— challenging, controversial, and misconstrued.
Ms. Shrier is an investigative journalist whose credentials include an education at Columbia, Oxford, and Yale. She is a former opinion columnist for the Wall Street Journal and author of the book, “Irreversible Damage: The Transgender Craze Seducing Our Daughters.” Her views have drawn praise from public and political figures, including Joe Rogan, Elon Musk, and J.D. Vance. Her opinions have sparked both interest and controversy.
There is no doubt that young adults have experienced a significant uptick of mental health concerns in recent years. The U.S. Surgeon General issued an advisory statement in 2021 calling attention to the issue and effectively declaring a youth mental health crisis. Multiple factors, including the rise of social media usage, the pandemic lockdowns, and overprotective (i.e., “helicopter”) parenting, have been cited. I don’t think anyone would disagree that something must be done, but Shrier’s approach of demonizing therapists and essentially de-legitimizing the mental health industry strikes me as perplexing and harmful. Indeed, Anna Nordberg’s review for Slate asserts: “The idea that children need less therapy, not more, may feel surprising when we are in the midst of a youth mental health crisis, and also, a therapist availability and affordability crisis.”
Shrier contends that the mental health industry has transformed the way we teach, treat, and raise our kids. Her main thesis is that the crisis our youth have found themselves in is a direct result of social emotional learning (“SEL”) curricula in schools, the “therapizing” of students, the rapid influx of counseling services in schools, the “gentle parenting” movement, empathy (yes, empathy), and mental health professionals themselves.
She argues that “most” therapeutic approaches have serious side effects and few proven benefits. She uses the example of “talking therapy,” which can induce rumination, trapping children in cycles of anxiety and depression. On this point, I largely agree. The prevailing notion that any therapy is better than no therapy is erroneous. Bad therapy can, at best, be ineffective, and at worst, harmful. Shrier spends the first few chapters explaining in detail the iatrogenic effects of therapy, which do exist. She is also correct when she says we currently do not have a system in place in the U.S. to offer any oversight or way to track these adverse reactions, or any reliable way to warn consumers about them. Which also means, we have no reliable way of differentiating “good therapists” from “bad therapists,” other than an individual’s personal vetting and opinion.
As a therapist, I am deeply dedicated to the well-being of my patients – their success is my success. I am a strong advocate for creating more informed consumers of mental health care, discussing what is effective and scientifically supported for what conditions. This includes equipping individuals with the right information to pursue the right kind of treatment with the right provider, and expanding access through accurate information. I am also deeply committed to reducing the stigma attached to seeking mental health treatment and minimizing barriers to quality care. Disparities exist, and the longer we wait to dispel the long-standing myths and misconceptions about the therapeutic process, insurers will remain reluctant to pay. Worse yet, our progress in reducing the stigma attached to seeking treatment will be eroded as individuals lose confidence in our ability to deliver effective results. Insurance reimbursement will remain perverse (i.e., incentivizing “sickness” to prove medical necessity) and many thousands of individuals who could benefit from treatment will never have access to it. There are scientifically-proven, very effective, non-medication based interventions available for serious and pervasive clinical problems, like anxiety, depression, and substance use that could benefit people who may be reluctant to seek them out. This is why myths and misinformation surrounding the therapeutic change process are so damaging and for whom the effects will be felt for generations.
While Shrier’s book is intended to shine a light on “bad therapy” practices, what she offers as a solution is akin to an outdated “pull yourself up by the bootstraps” approach and a return to a more “masculine” style of parenting (she does not define this, but offers examples of discipline and parenting strategies that align with an authoritative or an authoritarian approach). She does seem to endorse a handful of cognitive-behavioral therapy (CBT) strategies, but ultimately fails to fully and clearly differentiate pseudo-therapy from psychotherapy, or psychodynamic psychotherapy from “talk therapy” or cognitive-behavior therapy.
For that reason, perhaps it would be helpful here to define what makes therapy “good.” Good therapy is, quite simply, therapy that works. It cannot be generalized or scaled because each person is a unique individual with a unique set of circumstances, genetics, and upbringing. Good therapy is evidence-informed, or evidence-based, depending on the nature of the problems we are trying to solve. The American Psychological Association defines evidence-based practice (EBP) as the “integration of the best available research with clinical expertise in the context of patient characteristics, culture, and preferences.” Empirically-supported treatments (ESTs) refer to specific psychological treatments for a specific population or disorder (eg., individuals with Panic Disorder or OCD) that have been proven effective in controlled research studies. Good therapy combines the best techniques with the most scientific support for the individual in the room with their particular constellation of concerns and preferences. Good therapy is collaborative. It is active, not passive, and designed to bring about goal-driven, measurable, and observable changes. It is focused on finding solutions and achieving desired outcomes. It does not pathologize normal experiences. Good therapy fixes problems, not create them. Good therapy provides value. Yes, therapists need to make a living too, but extending treatment unnecessarily is not good or ethical therapy. Good therapy empowers patients. Good therapy does not reinforce reliance on the therapist. Good therapy does not coddle, but it does offer a kind and non-judgmental space, which is necessary for discovery and growth.
While Ms. Shrier raises important questions about the alarming rise of mental health issues among children despite the abundance of resources aimed at improving their wellbeing, I’m fearful that her message is lost somewhere between accusing therapists of incompetence and harm, accusing schools and educators of being overly-intrusive, and accusing parents of being, basically, too kind.
Still, the mental health field is ripe for disruption. I would love to see a greater emphasis on outcomes and measurement-based care (MBC) to incentivize improvement and recovery, trusted mental health content accessible and amplified online, and a more streamlined process for accessing quality care.
If Shrier’s book helps shine a light on the unsustainable status quo and catalyzes change, then I’m all for it. Anything that gets us talking more about mental health and mental health treatment, in my book, is a good thing.
Be & Stay Well,
