'Bad Therapy' Review
“When we were little, my brother and I were spanked. Our feelings were seldom consulted when consequential decisions about our lives were made — where we would attend school, whether we would show up at synagogue for major holidays, what sort of clothes fit the place and occasion. If we didn’t particularly relish the food set out for dinner, no alternative menu was forthcoming. If we lacked some critical right of self-expression — some essential exploration of a repressed identity — it never occurred to either of us. It would be years before anyone would regard these perfectly average markers of an eighties childhood as vectors of emotional injury.”
Abigail Shrier writes in Bad Therapy that when the generation she and I were born into, Generation X, reached adulthood, many of us started therapy and “explored our childhoods and learned to see our parents as emotionally stunted.” When we began having our own children, we “adopted a therapeutic approach to parenting. We learned to offer our kids the reason behind every rule and request. We never, ever spanked.” And we ensured that our children were the most therapized generation ever; indeed 40 percent of Gen Zers have seen a mental health professional, compared to 26 percent of Gen Xers.
And yet this generation appears to be less well-adjusted than preceding ones. She writes that adolescent mental illness has been rising since the 1950s, and between 1990 and 2007 the number of mentally ill children increased 35 times. Although overdiagnosis has certainly inflated these numbers, she points to the quadrupling of the adolescent suicide rate between 1950 and 1988 as evidence that the mental health of young people truly has deteriorated.
What gives? Why is the mental health of the most therapized generation so bad? Shrier acknowledges that there’s not a single cause. Referencing the writings of Jonathan Haidt and Jean Twenge, she avers that this generation has been adversely affected by such factors as the advent of social media and increasingly overprotective parenting styles. But “bad therapy,” she believes, is a big part of the problem, “bad therapy” referring to not just incompetent therapists but also misguided educators and activists. And the problem with bad therapy is not that it’s ineffective but that it’s iatrogenic, meaning that it unintentionally causes real harm.
Shrier spends the rest of the book detailing the many ways she believes that bad therapy is harming our children. I have an insider’s perspective on this topic, having spent several years working first as a school social worker and now as a psychotherapist in private practice. And I generally agree that the things Shrier considers “bad therapy” are indeed bad therapy. For example, I agree that it’s bad to “induce rumination” in your clients. But as I think about the therapists I’ve known, I doubt that any of them would disagree. And so when she explains why encouraging people to ruminate actually increases anxiety, I find myself wondering who exactly she’s talking about. I’m sure some therapists encourage rumination, but which ones and how prevalent is this? She doesn’t say.
Similarly, she writes that not pushing our children to confront their worries through behavioral exposure is harmful. Here she touts cognitive-behavioral therapy and its belief that “a kid’s extreme aversion to, say, dirt may be based on the false belief that dirt is harmful. The best way to demolish this maladaptive belief is for your kid to have direct and repeated contact with precisely the things she is afraid of.” And again, yes, I absolutely agree. Do most therapists, or at least an influential minority, believe differently? Answering this question is essential if Shrier wants to make a compelling case that bad therapy is causing significant societal problems, but this is not a question that she even asks.
Sometimes I get the feeling that she’s making straw-man arguments — for instance, when writing that it’s misleading to tell young people that emotions are a reliable source of information. “The anger you feel does not necessarily indicate that you are in the right or that someone treated you unfairly. You may feel envious of a friend, even though you would not actually want what he has. You may feel loved by someone who mistreats you or resent someone who’s treated you kindly. Feelings fool us all the time.” I believe that we should regard emotions as a source of information, but when I say this, I certainly don’t mean that emotions provide infallible information about the external world. What I mean is that emotions provide insight into our own psychological needs and that understanding these needs can help us to act in more adaptive ways. My view here is pretty widespread in the therapeutic community, and so I’m not sure if Shrier is distorting this viewpoint or responding to what someone actually said. Again, if someone said this, then who was it and how representative is their thinking?
At times she evinces a rudimentary understanding of emotions. Regularly asking children how they’re feeling, she writes, is harmful because this question tends to elicit negative feelings. She points to an interview she conducted with a professor who claimed that people rarely feel happy: “Nobody feels great. Never, never ever. Sit in the bus and look at the people opposite from you. They don’t look happy. Happiness is not the emotion of the day.” The professor then asked Shrier how she was feeling at that moment. She wanted to say “good,” but he then interjected, “You don’t feel happy in this moment. You are concentrating on the interview.” It’s undoubtedly true that we don’t spend most of our time feeling happy, but from that it doesn’t follow that we’re instead primarily feeling negative emotions. During the above interview, for instance, Shrier was concentrating on the professor and most likely feeling interest, itself an emotion and certainly not a negative one. And so it might be the case that, at least in many situations, it’s not helpful to ask children how they’re feeling, but her unsophisticated thinking here doesn’t allow her to cogently argue why this is the case.
Shrier makes some solid points when arguing that it can be hazardous when teachers act like therapists in the classroom, and she produces some documented examples of teacher-led emotional venting sessions that went awry. But she then makes some attacks on social-emotional curricula that are frankly ignorant. She targets Second Step, a cognitive-behavioral curriculum that aims to enhance young people’s emotional regulation, interpersonal, and problem-solving skills. One problem with this curriculum, she writes, is that “[i]t’s not at all clear that making friends is the kind of skill human beings can learn from a lecture or handout.” She adds that “[k]ids of every previous generation made friends without explicit instruction” and that interpersonal skills “are principally acquired through the real-life theater of trial and error.”
All of this is undoubtedly true, as the Second Step creators themselves have stated. I don’t think I’ve ever heard anyone claim that you can solely acquire social skills “from a lecture or handout.” But as someone who spent the 2020-21 school year teaching Second Step lessons to 3rd and 4th graders, I can tell you that there are many lessons in the curriculum that I myself did not learn from my real-life childhood experiences, invaluable life skills that I wish someone would have taught me. I spent week after week teaching these lessons and in time started to see some of my students implement different problem-solving and conflict-resolution skills in their real world interactions.
Shrier then turns up the dramatics when describing a Second Step homework assignment called “I Spy.” In the assignment, she writes, “seventh graders are encouraged to play a game that might as well be called Hero of the Soviet Union.” The assignment states: “You are a private investigator. You have been hired by an unnamed source to ‘spy’ on your family. The source wants to find out all the various feelings that one or more of your family members have while doing activities at home.” Students are instructed to pick one family member and to “[w]rite down what you observe about his or her facial expressions, body language, tone of voice, and what he or she says. Then based on these clues what he or she might be feeling.” They’re to then share and discuss their observations with the family member. Shrier never explicitly says what’s wrong with this activity. It seems to me that it’s simply reinforcing the concept, taught throughout the curriculum, that our emotions have physiological expressions and that knowing these physiological expressions can help us to better understand our own emotions as well as the emotions of others. Nothing, as far as I can tell, remotely sinister or communist.
Two chapters later, Shrier takes on the teachings of trauma guru Bessel van der Kolk. I have some interest in van der Kolk, having heard much about him but never read him, and part of me wanted to keep reading, but by this point, I was no longer sure that I could trust what she had to say. This is all so frustrating because there are certainly therapists and educators out there causing real damage, and we need more people questioning them. But we also need more people helping us to understand, not distort, what they’re actually saying. I’m not suggesting that Shrier’s distortions are intentional. I actually think she’s a tremendous writer, and I have found her perspective on many issues to be incredibly illuminating. Unfortunately, she gets too many things wrong in this book for me to recommend it.
Abigail Shrier writes in Bad Therapy that when the generation she and I were born into, Generation X, reached adulthood, many of us started therapy and “explored our childhoods and learned to see our parents as emotionally stunted.” When we began having our own children, we “adopted a therapeutic approach to parenting. We learned to offer our kids the reason behind every rule and request. We never, ever spanked.” And we ensured that our children were the most therapized generation ever; indeed 40 percent of Gen Zers have seen a mental health professional, compared to 26 percent of Gen Xers.
And yet this generation appears to be less well-adjusted than preceding ones. She writes that adolescent mental illness has been rising since the 1950s, and between 1990 and 2007 the number of mentally ill children increased 35 times. Although overdiagnosis has certainly inflated these numbers, she points to the quadrupling of the adolescent suicide rate between 1950 and 1988 as evidence that the mental health of young people truly has deteriorated.
What gives? Why is the mental health of the most therapized generation so bad? Shrier acknowledges that there’s not a single cause. Referencing the writings of Jonathan Haidt and Jean Twenge, she avers that this generation has been adversely affected by such factors as the advent of social media and increasingly overprotective parenting styles. But “bad therapy,” she believes, is a big part of the problem, “bad therapy” referring to not just incompetent therapists but also misguided educators and activists. And the problem with bad therapy is not that it’s ineffective but that it’s iatrogenic, meaning that it unintentionally causes real harm.
Shrier spends the rest of the book detailing the many ways she believes that bad therapy is harming our children. I have an insider’s perspective on this topic, having spent several years working first as a school social worker and now as a psychotherapist in private practice. And I generally agree that the things Shrier considers “bad therapy” are indeed bad therapy. For example, I agree that it’s bad to “induce rumination” in your clients. But as I think about the therapists I’ve known, I doubt that any of them would disagree. And so when she explains why encouraging people to ruminate actually increases anxiety, I find myself wondering who exactly she’s talking about. I’m sure some therapists encourage rumination, but which ones and how prevalent is this? She doesn’t say.
Similarly, she writes that not pushing our children to confront their worries through behavioral exposure is harmful. Here she touts cognitive-behavioral therapy and its belief that “a kid’s extreme aversion to, say, dirt may be based on the false belief that dirt is harmful. The best way to demolish this maladaptive belief is for your kid to have direct and repeated contact with precisely the things she is afraid of.” And again, yes, I absolutely agree. Do most therapists, or at least an influential minority, believe differently? Answering this question is essential if Shrier wants to make a compelling case that bad therapy is causing significant societal problems, but this is not a question that she even asks.
Sometimes I get the feeling that she’s making straw-man arguments — for instance, when writing that it’s misleading to tell young people that emotions are a reliable source of information. “The anger you feel does not necessarily indicate that you are in the right or that someone treated you unfairly. You may feel envious of a friend, even though you would not actually want what he has. You may feel loved by someone who mistreats you or resent someone who’s treated you kindly. Feelings fool us all the time.” I believe that we should regard emotions as a source of information, but when I say this, I certainly don’t mean that emotions provide infallible information about the external world. What I mean is that emotions provide insight into our own psychological needs and that understanding these needs can help us to act in more adaptive ways. My view here is pretty widespread in the therapeutic community, and so I’m not sure if Shrier is distorting this viewpoint or responding to what someone actually said. Again, if someone said this, then who was it and how representative is their thinking?
At times she evinces a rudimentary understanding of emotions. Regularly asking children how they’re feeling, she writes, is harmful because this question tends to elicit negative feelings. She points to an interview she conducted with a professor who claimed that people rarely feel happy: “Nobody feels great. Never, never ever. Sit in the bus and look at the people opposite from you. They don’t look happy. Happiness is not the emotion of the day.” The professor then asked Shrier how she was feeling at that moment. She wanted to say “good,” but he then interjected, “You don’t feel happy in this moment. You are concentrating on the interview.” It’s undoubtedly true that we don’t spend most of our time feeling happy, but from that it doesn’t follow that we’re instead primarily feeling negative emotions. During the above interview, for instance, Shrier was concentrating on the professor and most likely feeling interest, itself an emotion and certainly not a negative one. And so it might be the case that, at least in many situations, it’s not helpful to ask children how they’re feeling, but her unsophisticated thinking here doesn’t allow her to cogently argue why this is the case.
Shrier makes some solid points when arguing that it can be hazardous when teachers act like therapists in the classroom, and she produces some documented examples of teacher-led emotional venting sessions that went awry. But she then makes some attacks on social-emotional curricula that are frankly ignorant. She targets Second Step, a cognitive-behavioral curriculum that aims to enhance young people’s emotional regulation, interpersonal, and problem-solving skills. One problem with this curriculum, she writes, is that “[i]t’s not at all clear that making friends is the kind of skill human beings can learn from a lecture or handout.” She adds that “[k]ids of every previous generation made friends without explicit instruction” and that interpersonal skills “are principally acquired through the real-life theater of trial and error.”
All of this is undoubtedly true, as the Second Step creators themselves have stated. I don’t think I’ve ever heard anyone claim that you can solely acquire social skills “from a lecture or handout.” But as someone who spent the 2020-21 school year teaching Second Step lessons to 3rd and 4th graders, I can tell you that there are many lessons in the curriculum that I myself did not learn from my real-life childhood experiences, invaluable life skills that I wish someone would have taught me. I spent week after week teaching these lessons and in time started to see some of my students implement different problem-solving and conflict-resolution skills in their real world interactions.
Shrier then turns up the dramatics when describing a Second Step homework assignment called “I Spy.” In the assignment, she writes, “seventh graders are encouraged to play a game that might as well be called Hero of the Soviet Union.” The assignment states: “You are a private investigator. You have been hired by an unnamed source to ‘spy’ on your family. The source wants to find out all the various feelings that one or more of your family members have while doing activities at home.” Students are instructed to pick one family member and to “[w]rite down what you observe about his or her facial expressions, body language, tone of voice, and what he or she says. Then based on these clues what he or she might be feeling.” They’re to then share and discuss their observations with the family member. Shrier never explicitly says what’s wrong with this activity. It seems to me that it’s simply reinforcing the concept, taught throughout the curriculum, that our emotions have physiological expressions and that knowing these physiological expressions can help us to better understand our own emotions as well as the emotions of others. Nothing, as far as I can tell, remotely sinister or communist.
Two chapters later, Shrier takes on the teachings of trauma guru Bessel van der Kolk. I have some interest in van der Kolk, having heard much about him but never read him, and part of me wanted to keep reading, but by this point, I was no longer sure that I could trust what she had to say. This is all so frustrating because there are certainly therapists and educators out there causing real damage, and we need more people questioning them. But we also need more people helping us to understand, not distort, what they’re actually saying. I’m not suggesting that Shrier’s distortions are intentional. I actually think she’s a tremendous writer, and I have found her perspective on many issues to be incredibly illuminating. Unfortunately, she gets too many things wrong in this book for me to recommend it.
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