Introduction

People are debating “therapy: good or bad?” again:

There are dozens of kinds of therapy: reliving your traumas, practicing mindfulness, analyzing dreams, uncovering your latent desire to have sex with your mother. But most people on both sides of this debate are talking about what psychiatrists call “supportive therapy” - unstructured talking about your feelings and what’s going on in your life.

I know the responsible thing to say is something like “this is helpful for some people but not others”. I will say that, in the end. But I have a lot of sympathy for the people debating it. I have such a strong intuition of “why would this possibly work?” that it’s always shocked me when other people say it does. And I know other people with such a strong intuition of “obviously this would work!” that it shocks them to hear other people even question it. Yet my patients seem to line up about half and half: some of them find therapy really great, others not helpful at all.

Whenever I try to understand this, I find myself coming back to this tweet: