I certainly favor the development of meaningful relationships, but I don’t accept the notion that self-styled therapists are better able to accomplish this worthwhile goal than non-judgmental, non-hierarchical support groups bringing together people who confront similar problems in living. For without universally applicable, verifiable criteria for judging the efficacy of one form of treatment over another, whence do mental health professionals derive their supposedly superior insight, wisdom, and interpersonal skills? What gives them the right to pass judgment on the emotional well-being of their clients and to pin degrading psychiatric labels upon them (for insurance billing purposes)? The entire mental health industry is based on nothing but self-arrogated authority and false premises.

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Psychotherapy is just as absurd and potentially harmful as psychiatry, IF its practitioners think of themselves as medical providers treating brain diseases or personal problems. It is potentially transformational if practiced by folks who know themselves as professional relationship builders providing an artificial secure attachment “pit stop” where already whole but temporarily injured humans can heal their relational wounds before heading out to build the more interconnected world that we all need and deserve.

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Yours is an excellent summary of the numerous fallacies and self-serving rationalizations of the so-called mental health industry.
I would also recommend Dr. Jeffrey Masson’s book “Against Therapy: The Myth of Emotional Healing.”
There can be no such thing as psychotherapy in the literal sense, inasmuch as except for clearly verifiable neurological disorders, states of emotional distress labeled as mental disorders or illnesses have nothing to do with brain pathology, despite the many efforts undertaken over many decades to identify genetic defects, chemical imbalances, or damaged neural circuits. Without a body of credible findings obtained through careful, long-term, and repeatable experiments and testing (the various iterations of the ever-expanding DSM lack all scientific legitimacy in this regard), any criteria for assessing the effectiveness of a particular school of therapy (from among the several hundreds that currently exist) are necessarily wholly subjective and purely hypothetical.
As I once mentioned in a previous post, for several decades after the Second World War Freudian therapy was considered the gold standard of treatment for neuroses. Then Arthur Janov came on the scene in 1970 with his claim that Primal Therapy superseded all previous, supposedly ineffective modalities. And now CBT is lauded as the optimum panacea for those with problems in living (Thomas Szasz’s term). What can be the universally valid basis for evaluating the efficacy of these or any other treatments?

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Publication Bias: Epstein highlights the prevalence of publication bias in psychotherapy research, where studies with positive outcomes are more likely to be published, leading to an incomplete and potentially biased understanding of the effectiveness of various therapeutic approaches.

Lack of Rigor: He criticizes the methodological rigor of many studies in the field, noting flaws such as small sample sizes, inadequate control groups, and reliance on self-report measures, which undermine the validity and generalizability of findings.

Inconsistent Definitions and Measures: Epstein points out the lack of consistency in how terms are defined and measured across studies, making it difficult to compare results or draw meaningful conclusions about the effectiveness of different therapeutic interventions.

Overemphasis on Quantitative Research: He suggests that the dominance of quantitative research in the field may overshadow qualitative insights and fail to capture the complexities of human experience and the therapeutic process.

Subjectivity of Diagnosis: Epstein argues that psychiatric diagnoses are often based on subjective interpretations of symptoms rather than objective criteria, leading to inconsistency and variability in diagnosis across clinicians.

Lack of Validity: He suggests that many psychiatric diagnoses lack validity, meaning they do not accurately represent distinct, biologically-based disorders. This undermines the scientific basis of psychotherapy research that relies on these diagnoses as a framework for understanding and treating mental health issues.

Reliability Concerns: Epstein raises concerns about the reliability of psychiatric diagnoses, noting that different clinicians may reach different diagnoses for the same individual. This inconsistency undermines the reliability of research findings based on these diagnoses.

Impact on Treatment Efficacy: The reliance on questionable psychiatric diagnoses may also affect the efficacy of psychotherapy treatments, as interventions based on flawed diagnostic frameworks may not effectively address the underlying issues experienced by individuals seeking therapy.

There are other critics – again mostly ignored by the field – its a house of cards, profitable and useful to power as it helps to obfuscate a range of cultural disorders, that are magically turned into personal disorders and therefore helps to maintain a toxic status quo.

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Dear Javier, Your article provides an excellent background for what I tried to describe in my piece in Mad in America, Healing My Broken Story: The Power of Compassionate Relationships (Sept 8, 2023). I hope we can continue to communicate and share ideas.

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Thank you Michael!

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