What is Good Therapy? (Part 1)
Mental health issues in America continue to rise in spite of our best attempts to prevent and treat them. According to National Institute of Mental Health statistics, in 2022, there were an estimated 59 million adults in the United States with AMI (“any mental illness”). This number represents 23% of all U.S. adults (basically, 1 in 4 of us). In 2021, that number was 1 in 5.
Even though the stigma attached to mental health issues has lessened somewhat, the stigma attached to seeking treatment for mental health issues has not. We, the mental health experts, are partially to blame for this. We have historically not done a great job of informing the public about what treatments work and which ones do not. For example, the Society for Clinical Psychology (SCP), a division of the American Psychological Association (APA) lists 89 psychological treatments here that are considered to be “high quality.” Based on a set of criteria established by Tolin et al. (2015), a treatment is labeled very strong, strong, weak, or insufficient based on a systematic review of published meta-analyses of randomized controlled trials. That’s great! But I’ve never seen any of these discussed on TikTok, Instagram, Pinterest, or even LinkedIn, or anywhere outside of our tiny little academic circles, discussion boards, journal clubs, and professional associations. We have not communicated to real people in plain language what psychological treatment is, what it can do, and what it cannot. And if we don’t do it, someone else will.
I believe we are on the cusp of a new era of “mental health denialism” if we fail to maintain the trust of the public, especially now as misinformation runs rampant about the quality of our treatments and the motivations behind it (see my review of Abigail Shrier’s book “Bad Therapy”). The time is now to set the record straight about what good therapy is and is not. It’s time to discuss the potential harms of therapy and reinforce good therapy techniques and practices. It’s time to educate and create more informed consumers of mental healthcare. It’s time for a “good therapy” movement.
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 easily generalized or scaled because each person is a unique individual with a unique set of circumstances, genetics, and upbringing (however, I do believe there is a role for AI here).
Good therapy is evidence-informed, or evidence-based, depending on the nature of the problems we are trying to solve. The APA 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.
Good therapy 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.
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 therapists) 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.
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.
Why does this matter? Because 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.
In Part 2, I will further explore the essential elements of good therapy and the Good Therapy Method itself.
In Part 3, I will analyze our complicated relationship with therapy and what needs to change going forward if our work is to remain relevant and helpful in the future.
I hope you’ll join me and the #goodtherapy movement! Good therapists and those who want to preserve progress, this is our moment.
Be & Stay Well,
