Tuesday, February 27

Does Counseling Actually Help?

I began seeing a therapist in my late 20s after falling into a deep fog of bewilderment while living alone in New York and unsure of what to do next. Most trips had me sitting in a chair with a tissue box on the tiny table next to it, but there was also a sofa in the office, which I periodically reclined on as I struggled with what I was doing with my life and even what I was doing at that particular office.

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Therapy was still seen in some quarters at the time as a rarefied treatment reserved for the hopelessly neurotic. I felt ashamed that I didn’t seem to need it, even if the cost was above my means. It took up so much of my income that on sometimes I would daydream about the tiny Catskills house I could have if I had used that money to invest in any respectable mutual fund instead of those twice-weekly meetings.

Were they worthwhile? I am aware that counseling gave me solace, and I think whatever self-awareness I gained from it has been helpful. However, I also spent more time than I should have at that period of my life, I’m sure, in a clearly unhealthy relationship that my therapist and I spoke about nonstop, treating it like a specimen that needed to be examined rather than thrown away.

Despite my mixed feelings towards treatment, I had enough faith in it to go back several times and experiment with other more popular modalities, such as two forms of cognitive-behavioral therapy. In more recent times, I experimented with a type of treatment that required me to pinpoint the locations of my emotions on certain bodily parts in order to — uh, I don’t know what, but I seem to remember finding it intriguing at the time.

The stigma associated with treatment has diminished over time, particularly in the wake of the epidemic. Similar to a gym membership, it is now seen as a necessary form of self-care that is well worth the significant time and financial commitment. It has become normalized as a routine and healthy commitment. From 27 million in 2002 to 42 million in 2021, more individuals in the US sought mental health treatment in one way or another. Americans are becoming more and more receptive to the notion that therapy is a dependable means of improving their lives dramatically.

I tried to figure out just how therapy had (or had not) benefited me in the past as I recently explored going back to it, this time to help me deal with some significant life upheavals. That line of reasoning made me question what data there is to support the effectiveness of talk therapy in enhancing mental health.

Every now and then I attempted to bring up the matter with friends who were also in treatment, but they frequently appeared determined to change the topic or even react negatively. I got the impression that just bringing up the topic of study findings made individuals feel threatened or unimportant. In the face of the intangibles that enriched their life — a sudden epiphany, a fresh comprehension of an unreasonable rage, a new appreciation of another person’s perspective – what did some people study matter? Although I also believe that therapy has the power to transform lives, I was curious about the consistency with which it provides real solace from pain. Does therapy alleviate the excruciating symptoms that individuals suffer from, such as the dread that plagues anxious people or the sleeplessness that befalls depressed people? Is there really a cure with talking? And in what way, if at all?

The brilliant but dogmatic father of psychoanalysis, Sigmund Freud, was renowned for his disinterest in submitting his creation to formal investigation, seeing it as nothing more than bean-counting in comparison to his cerebral probes into the unconscious. Upon being presented with promising study findings, Freud expressed his disbelief in the confirmations, stating that the abundance of trustworthy observations supporting these claims renders them self-sufficient from experimental validation. Psychoanalytic circles maintained a certain degree of skepticism toward the scientific method well into the 20th century, according to Andrew Gerber, the president and medical director of a New Canaan, Connecticut, psychiatric treatment center, who pioneered the use of neuroimaging to study therapy efficacy. “Your analysis will cure you of the need to do research,” a supervising analyst told me when I completed my psychoanalytic training.

Formal psychoanalysis has mostly been replaced by less libido-focused talk therapies over time, such as cognitive-behavioral therapy, which teaches patients how to replace negative thought patterns with more positive ones, and psychodynamic therapy, a shorter-term approach that also focuses on defenses and habits formed earlier in life. Many types of talk therapy have already been the subject of hundreds of scientific trials, and the overwhelming body of evidence suggests that talk therapy is effective, increasing the likelihood that patients will see improvements in their mental health over those who do not get treatment.

When psychologists Mary Lee Smith and Gene V. Glass released the most statistically advanced investigation on the topic to that date in 1977, that conviction gathered strength. In a document dubbed a meta-analysis, a word Glass invented, they examined over 400 trials and discovered that, of the “neurotics” and “psychotics” who had received different forms of talk therapy, the average patient did better than 75% of those with identical diagnoses who were not treated. In the years that followed, the conclusion that treatment actually helps patients with anxiety, depression, and other common diseases was confirmed several times in analyses.