Three Persisting Misconceptions About Psychotherapy

The following is an excerpt from Dr. Michael Hurd’s most recent book, “Bad Therapy Good Therapy (And How to Tell the Difference)” available on this webiste:

From Oprah to Dr. Phil, from Venus to Mars and all the other self-proclaimed mental health panaceas, emotions and mainstream psychology have been relegated to the insipid feel-good platitudes of the daytime talk show. Three popular but dangerous misconceptions have emerged from all this:

Dangerous misconception #1: There are cures for all emotional problems.

In reality, there are no cures. A ‘cure’ would refer to a state in which the capacity or potential for any emotional difficulty is permanently eradicated. A cancer patient, for example, is considered cured when the growth has been removed from the body and does not return. A person suffering from an infection is considered cured when the offending biological organisms have been eliminated.

Can you seriously expect the same with anxiety or depression, no matter how advanced psychiatry and psychotherapy might become? Is there a state of existence where anxiety and/or depression can be eradicated, permanently, from human life? Of course not.

Occasional bouts of anxiety or depression are a natural part of life. The key is how to manage the anxiety and depression. The significance you assign to these emotions can determine just how prolonged these times of turmoil will be. One major purpose of psychotherapy is to help the individual better manage these feelings. Research has proven that the only categories of therapy that show quantifiable outcomes are cognitive-behavioral therapy and solution-focused therapy. Respectively, these two modalities help people put things into perspective, and help them take constructive action to get different results out of their lives.

Mental health treatment is kind of like dealing with the weather. If you live in a hurricane zone, you wouldn’t try to find a weather professional to help you eradicate the possibility of any future hurricanes. What you might do is find ways to fortify and strengthen your house. The same is true with mental health therapy, except we fortify the mind. Unfortunately, the expectations people usually bring to the process are phenomenally unrealistic. This is, by and large, a result of the notion spread by the psychiatric establishment and the media that all emotional pain can be cured, most often with a pill, and certainly with little to no effort.


Dangerous misconception #2: Psychiatric medication, when it works, leads to greater happiness.

For well over twenty years I have encountered people on psychiatric medications and antidepressants. Prozac, Xanax, Wellbutrin, Zoloft, Lexapro, Paxil, Buspar’I have seen pills come and go that were initially hailed as ‘ultimate cures’ for all that ails mankind. After all that time and experience, I can tell you that I have yet to see a single case where the individual is actually happier from taking pills. And much of the time, people experience little to no improvement, or they suffer from such undesirable side effects that they cease the medications altogether. In the minority of cases when a client feels that the medications have helped,  I ask them exactly what they mean by ‘helped.’ Interestingly enough, they report not so much an increase in happiness as what psychiatrists and psychologists call a ‘flattening of affect.’ What this means, in plain English, is less overall emotion.

There’s a price for everything, including psychiatric medication, and I don’t mean the fiscal cost. I mean the psychological cost of losing (or lessening) the capacity to feel anything while on medication. There might be a reduction in depression or anxiety (in cases where the medication actually works), but it’s almost always accompanied by an equally diminished capacity for joy and happiness.

This explains two things I hear all the time. One, the scenario in which the patient tells me, ‘My spouse/loved ones feel the medication is helping me, but I don’t feel any real difference.’ This is because the spouses/loved ones are looking to see less depression or less anxiety, while the patient is actually looking for an increase in happiness. The patient has the higher standard. The loved ones, on the other hand, simply want things calmed down.

The other thing I regularly see is people who refer themselves for therapy saying, ‘I guess the medication is helping me. I feel less depressed, but I’m still not happy.’ My job with such patients is now at cross-purposes with the medication: I have to try and help them learn to become happier in a context where they’re not feeling much of anything. My considered conclusion is that therapy and medication can rarely, if ever, work together.


Dangerous misconception #3: If I can only get [Johnny or Suzie] to a therapist, all will be well.

The decision to see a psychotherapist, a life coach or anything of that nature is profoundly personal. It’s different than going to the dentist, the eye doctor or the dermatologist. These things are personal, but require no real active thought on the part of the patient. Things are done to your teeth, eyes, skin, or whatever. Seeking psychological help involves an active choice and the willingness to initiate thought about certain aspects of one’s personal life and one’s relationships. This can be very important and helpful. However, it can’t be forced, manipulated, pressured or prodded by an outsider. If you maintain the fantasy that having your loved one talk to a therapist will somehow change him or her, and if he hasn’t first made the basic decision to initiate this form of thinking, it’s simply not going to happen. Thinking cannot be done to him. He might go through the motions of scheduling an appointment and telling you he did it, but this has nothing to do with the mental initiative to choose to think about oneself in the way required by good therapy.

If you still feel your loved one needs psychological help, the other thing to watch out for is arrogance. By arrogance I mean the irrational assumption that your negative views about your spouse (or whomever) are so correct and self-evident that any mental health professional will, upon meeting the loved one, see things exactly as you do. Wrong! Maybe your loved one is not as dysfunctional as you think—or maybe he is, but not for the reasons you might assume. And even in the unlikely event you are right, your complaints will not apply in the therapy office the way they do in your personal relationship with the client. People are usually different from one setting to the next, and the vast majority of people are on their best behavior when in a therapist’s office.

People interact differently in different situations. If your loved one is unreasonable towards you in daily life, but very reasonable towards the therapist, it might be due to problems in the interaction between you and your loved one.

I speak from experience when I say that part (or even all) of the problem might be you! Arrogance keeps people from seeing these things. That same arrogance encourages spouses and parents to ‘send’ their loved ones to therapy to ‘make them change,’ rather than trying to find out what the factors contributing to the problems may actually be.


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