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Pathologizing therapy 

Is the cure the problem?

Psychotherapy has taken another couple of hits from critics in the last few weeks. And I'm not surprised.

Longtime readers of this column know that my own decision to pursue doctoral studies in psychology was not motivated by confidence in the worth of psychotherapy. Indeed, after getting a master's degree and a few years of supervised experience, I became quite disenchanted with the way most therapy is taught, practiced and regulated.

So, finding alternative ways of working with the psyche was one motivation for studying the subject further. But I also wanted to understand how something so flawed has become such an institution of American life. My contention has long been that even if we are not actually in therapy, it is so much a part of our culture that we can't avoid thinking about ourselves and the world without the filter of professional psychology. Just tune in to Oprah to see what I mean.

The problem, as it seems to have become increasingly obvious, is that psychology is as much a construction of the culture as it is a contributor to it. That's basically the point of two recent essays on the subject. The first, "Off the Couch" by Meredith Maran, was published Feb. 17 in the online magazine salon.com. If I had to identify a publication at the forefront of the "anti-therapy" movement, it would be Salon. Generally, its essays on the subject are glib, as is this latest, and a bit too excited whenever a neuroscientist can provide a biological explanation for what has historically been blamed on bad parenting.

A classic example of the latter is the way schizophrenia was long blamed on detached mothers. Such a belief, since abandoned, reflected general misogyny in the culture. Even earlier, Freud formulated the dubious and misogynist notion that penis envy caused women psychological problems.

Maran's concern is something else: addiction to therapy. She makes many valid points about the way clinical psychology, as an industry, tends to pathologize ordinary problems and keep clients ensnared in its expensive web. She also correctly observes that therapy tends to direct people "inward" with such intensity that they withdraw from social activism. It's an obnoxious cliche of pop psychology that the best way to contribute to society is by self-improvement. In other words, narcissism trumps altruism.

But her essay, which follows 40 years of therapy, is also a remarkable demonstration of the very thing she critiques. She attacks therapy for its simplistic explanations, but doesn't seem aware that she has subscribed to another simplistic notion in America's culture of self-improvement: that you can call any repetitive behavior an "addiction" over which you are powerless.

Indeed, if you do some quick research on Maran, you learn that she earlier wrote a book inspired by her son, a drug addict. Therapy did not help him, she says, but finding Jesus did, and he in fact became a Baptist minister. In an interview with Maran and her son published a year earlier in Salon, the son vociferously blames his mother for his problems -- one of the processes she attacks in therapy -- and credits Jesus with his recovery.

Maran's essay is coded with 12-step expressions and theory. It's hard to resist the observation that by diagnosing herself as an addict she follows in her son's footsteps. But the diagnosis allows her to call therapy her problem -- a nice trick that ignores the concerns of early parenting and, at the same time, neatly absolves her of responsibility in her son's parenting. Unless I'm missing something, she doesn't have the breadth of insight of her Jesus-freak son, whose spiritual undertaking doesn't seem, to his mind, that it has eclipsed the importance of working through his anger with his mother in therapy.

It is certainly true that spiritual programs, including 12-step recovery, have greater success rates than therapy in the treatment of addicts. But it seems silly to classify yourself as an addict because the principles you borrow from 12-step theory help you break the habit of a form of personal growth you've outgrown. In effect, Maran makes the same step she repeatedly accuses therapy of making: basing the diagnosis on the most comfortable cure and thus ending up with a rather superficial view of the problem.

Typical of so many members of our pop psychology culture, she has simply placed a different icon on her altar of self-improvement -- which would be fine if she didn't eviscerate it by ignoring the spirituality central to recovery from addictions. She doesn't address, except in a personalistic way, why psychotherapy continues to captivate America and how it needs to change (or even be abandoned).

Another essay appeared March 11 in the New York Review of Books. Titled "The Trauma Trap," it compares a definitive new book, Remembering Trauma by Richard J. McNally, to a shockingly dishonest book that received the American Psychiatric Association's award for best publication on legal psychiatry in 1999. That essay, by Frederick Crews, goes to the heart of questions Maran barely skims. I will look at it next week.

Cliff Bostock, M.A., is in private practice. Reach him care of his website, www.soulworks.net, or at 404-525-4774.

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