This paper first appeared in the Winter Issue of the 'Skeptical Adversaria' (the Newsletter of ASKE, the Association for Skeptical Enquiry), 2010, pp 2-3.
Some years ago I was suffering from increasing impairment in the vision of my left eye. The major symptom was blurring, particularly in bright light, and this made driving at night extra difficult. The problem was quickly diagnosed by my optician - clouding of the lens (a cataract) - and the remedy was straightforward, namely surgical replacement of the lens (the only effective treatment in my case). In due course I had the operation, which required only a local anaesthetic, in an outpatient clinic. It lasted less than 30 minutes and following a recovery period of a week or so it was clear (literally) that the condition was cured.
As a clinical and forensic psychologist, simply put, much of my work has been trying to help people change those ways of feeling, thinking and behaving that are blighting their lives and the lives of those around them, or recommending to other professionals how this might be achieved. Psychologists are not medically trained, so this work has to be undertaken without reference to any pharmacological strategies, which are the domain of the general practitioner or psychiatrist. Hence much of the work is at the level of human interaction - talking, listening, being empathic, instructing, offering guidance and advice, and so on. Commonly this takes place at meetings of just one hour a week.
Unlike eye surgery which, without training, none of us would have a clue how to start, most untrained people can do the above kind of work, or at least make a reasonable semblance of engaging in much of what is required. (A test would be to hire actors and see whether patients, clients and observers can tell them apart from the trained professionals.) I sometimes say that counselling and psychotherapy are easy to do but not easy to do well, and I have no doubt that they do require real skill, knowledge and training.
My experience of cataract surgery led me to think how wonderful it would be if psychotherapy were as cut and dried. But it will never be like this. Many people derive significant and lasting benefit from psychological therapy, but there are limitations on how effectively human beings can change through such means. Unlike a cataract, the diagnosis or formulation (a better term) is at best a vague generalisation or story; the likely outcome is difficult to predict for any given person (and what outcome is sought is not always clear-cut); and for many people therapy is only partially or temporarily effective. What progress is achieved in the therapeutic hour may be (and often is) undone during the rest of the week; hence I have never been impressed by claims that 'psychotherapy is just placebo'.
After having my eye surgery I was, in particular, struck by the thought that the salient components of the surgeon's behaviour during the operation - i.e. what he ought to be doing - are for the most part determined by the structure and properties of the eye. Of no consequence are his or her personal beliefs, qualities and philosophy on life, or, so I imagine, his or her philosophy and theories about the human eye. Perhaps a robot could perform the same operation (and for all I know perhaps they are doing so now).
This is all far from the case with psychological therapies. I do not think, however, that the limitations that I have described for psychological therapies are that different from those of medicine in general. Many problems and symptoms for which people consult their doctor have no clear-cut diagnosis or pathology, likewise an obvious treatment of choice which will cure the condition. Again, the outcome may be uncertain and for many conditions treatment may be more palliative than curative.
This state of affairs is one reason why there are so many treatments on offer for so many complaints and illnesses and why there appear to be no limits to the theories and beliefs that inform these practices. This is evident when one looks at what is on offer to people in different countries and cultures, but it is also evident in our own society - viz. alternative medicine. And this is certainly the case with psychotherapy; the very diverse nature of the presenting problems, their complexity and tenacity, the fact that their origins are not well understood, and the fact that there is seldom any quick fix that is of guaranteed (or almost guaranteed) efficacy collectively create the conditions for the generation of an extraordinary range of theories, claims and practices that come under the label 'psychotherapy'. Some of which, like alternative medical practices, are quite bizarre. And as with alternative medicine, adherents of the different methodologies, usually those practitioners outside the mainstream, often promote them as being astonishingly quick and effective, despite little objective evidence to warrant this claim. Even mainstream NHS psychotherapists, such as clinical psychologists, adhere to their own preferred schools of therapy and methodology; hence what kind of assessment and formulation a patient may receive and what kind of therapy is undertaken may depend on the individual to whom they are referred.
I was motivated to give further thought to all of this by a posting on ASKEnet that drew attention to a video on YouTube….
Update: this is no longer available but a similar, if not the identical, video, can be viewed at:
The speaker, a UK clinical psychologist, has developed a system of psychotherapy called Psychoanalytic Energy Psychotherapy (inspired by several other 'energy psychotherapies'). In the video he outlines what he calls 'the shadow self'.
This video is an eloquent demonstration, but not of any advanced understanding of the human mind and its afflictions; indeed the ideas are the kind of vague mumbo jumbo and psychobabble that goes back, in the western world, to the time of Mesmer at least. Rather it provides eloquent testimony to the ideas and assertions that I have been putting forward in this article.
Incidentally, several other videos are recommended on the site - you may find interesting the one on 'Proper energy flow, up-down' at: