Imagine that your car is smoking, shaking, and making ugly noises. When you take it to a repair shop, the manager is unusually direct. “We charge $100 an hour, and you’ll have to bring it in weekly so we can develop a working relationship,” he says. “We can’t tell you how long we’ll take to repair it, and we don’t provide estimates or guarantee our work, even for simple repairs like a flat tire or a bad alternator. Since the dropout rate is 20 to 40 percent, overall 30 to 50 percent of cars leave the shop no better than when they came in, and 10 to 20 percent leave in worse shape.”
You’d probably take your car somewhere else for service.
Yet that scenario is a pretty accurate picture of the state of psychotherapy. No wonder that for many suffering people, going to a “shrink” is a desperate and unaffordable last resort. Someone earning minimum wage would have to work a day and a half to pay for an hour of therapy. Not many jobs I can think of pay so well for such mediocre results.
I’ve been a participant-observer of the therapy scene for almost 60 years, and I know that the majority of therapists are sincere, hardworking, and well intentioned. I also recognize that some clients’ difficulties remain intractable to even the most skilled clinicians. The problem, in my view, is that most therapists haven’t been equipped with sufficient perspectives and behavioral-change skills to help people with even the simplest issues.
Moreover, most therapists…