Psychotherapy in the Media Spotlight

It’s no secret that psychotherapy has had an image problem in the media. Real and fictional clinicians on TV and in the movies are regularly portrayed as jargon-spouting caricatures, or are often shown to break ethical codes without blinking, displaying more personal problems than their clients. But a bigger part of the problem may be that, on the whole, therapists haven’t done a particularly good job explaining what we do or how it works. So when The New York Times Magazine asked trauma expert Bessel van der Kolk if it could have a journalist follow him around for a month to observe his work, it seemed like a golden opportunity to present the latest advances in trauma treatment in one of mainstream journalism’s most highly respected forums.

Medical director of The Trauma Center in Boston, professor of psychiatry at Boston University, and director of the National Center for Child Traumatic Stress Complex Trauma Networker, Van der Kolk is recognized in the field for being a pioneer of once unconventional mind–body interventions, such as eye-movement desensitization and reprocessing (EMDR), neurofeedback, and yoga. Over the last 30 years, he has established a reputation as an iconoclastic critic of traditional approaches to trauma—especially Prolonged Exposure therapy, which he’s characterized as “among the worst possible treatments” for trauma, merely desensitizing people to their suffering, instead of healing them.

When he finally read the magazine cover story the Times published last May, he was in for a jolt. Instead of the sympathetic, informed portrayal he’d been expecting, it offered, at best, an ambivalent picture of his contributions and a skeptical perspective on the approaches he’s championed through his career. Although it quotes neuropsychologist Stephen Porges describing him as a “hero” for his “courageous” efforts to confront the conventional wisdom about trauma treatment, the article characterizes Van der Kolk as practicing a “hokey-sounding approach to therapy” and “a lead defender of repressed-memory therapy.” It also strongly implies that he’d been an expert witness in court cases on behalf of therapists accused of implanting false memories of early abuse, cases in which “entire lives were destroyed.”

Van der Kolk demanded the Times retract several of the key assertions in the piece, including its critique of his research on yoga and EMDR for the treatment of PTSD as lacking sufficient sample sizes and blind raters. He also vociferously refuted the idea that he’d ever been a “defender” of repressed-memory therapy, protesting that he’d merely testified on behalf of sexual-abuse victims of Catholic clergy when the lawyers had tried to discredit the plaintiffs by claiming they suffered from false memories implanted by their therapists. He even threatened to sue. In response, the Times issued a minor correction, stating that the articles they’d been able to review, in fact, met the standards of state-of-the-art scientific research, but implying that other studies may not. Otherwise, it stood by its reporting and refused to take further action. Neither the Times nor the author of the magazine article responded to requests to comment from the Networker.

Several months after the appearance of the Times piece, Van der Kolk himself sounds philosophical about his treatment in the feature. “Trauma evokes a lot of passion,” he says. “Passion to deny, and passion to assert. I see what happened with this article as a reflection of the incredible difficulties society has with staring trauma in the face and providing people with the facts of what happens, how bad it is, and how well treatments work.”

Janina Fisher, clinical psychologist and trauma expert, was struck by how the article emphasized the melodramatic in its portrayal of trauma treatment. “Bessel lends himself to the portrait of the cowboy, but what a shame that that’s how he got portrayed,” she said. “It really doesn’t represent the seriousness, purpose, and accomplishment in the field of trauma, both in his work and the work of others.” Of course, this may not be surprising, given that trauma work has raised more than a few eyebrows over the years with its embrace of clinical innovations that sometimes border on the bizarre. “When you’re talking about trauma treatment, you’re often talking about asking someone to revisit and think about the event that they’re spending all their time avoiding,” says Elana Newman, Research Director of the Dart Center for Journalism and Trauma at Columbia University. “It all sounds a little crazy, right? All treatments for trauma can be hard to understand and need to be broken down.”

The Times didn’t have to go far to find colleagues willing to be critical of Van der Kolk’s work, which indicates something not only about him, but the conflicts and politics of the profession itself. “People who are in this field—the scientists, the clinicians—have had to fight so hard for trauma to be taken seriously that sometimes we fight within ourselves about theoretical differences and minor disagreements,” says Newman. “The passion with which we fight about smaller differences can get amplified in the news.”

The hundreds of responses to the Times about the story demonstrated overwhelming support for Van der Kolk and unhappiness with the tone of the article and inaccuracies in its reporting. While it remains to be seen what, if any, long-term effect the piece will have, Van der Kolk believes it led several speakers to cancel their appearances at his annual conference this year, and cost him a consultation opportunity.

Van der Kolk was not the only person who felt misrepresented by the Times article. The dramatic centerpiece of the piece’s organizing narrative was an Iraqi war veteran named Eugene, who’s haunted by memories of killing an innocent man on security detail, and who Van der Kolk worked with at an Esalen workshop. The article suggests that the positive impact of his work with Van der Kolk, while immediately dramatic, was not sustained and that ultimately he was left more confused than illuminated by the experience. The last line of the article quotes him as saying, “I still have no idea what he did to me.” But Eugene offers a different view of his experience and insists that he was astonished to read details and facts that were simply fabricated. He recalls that when he corrected the Times fact checkers about the numerous details the article got wrong, they told him that there was only so much they could correct—they had a deadline. The Times refused to publish Eugene’s letter to the editor correcting the errors about his experience.

“The takeaway when I read the article was that I was confused by the experience and that it didn’t help, which just isn’t true,” he says. “When I spoke with the reporter, I said very positive things about the concrete ways that it helped me in terms of physical symptoms that disappeared, and also the fact Dr. Van der Kolk recommended people for me to work with afterward. He really spent some time finding a good recommendation for EMDR, and it really helps.”

Eugene expressed concern that the piece wound up depicting him as more hypnotized by Van der Kolk’s personality than an active participant in the work. “I don’t know where that came from,” he says, adding his concern that the article not only misrepresented him, but did a disservice to vets who need treatment. “Military people are very hesitant to talk about traumatic events,” he says. “It’s not easy to talk about what happened, so there’s a duty that goes along with reporting about them. It goes beyond what makes for good copy in a magazine article.”