Shirah Vollmer MD

The Musings of Dr. Vollmer

Marketing Psychotherapy

Posted by Dr. Vollmer on September 30, 2013


“But psychotherapy’s problems come as much from within as from without. Many therapists are contributing to the problem by failing to recognize and use evidence-based psychotherapies (and by sometimes proffering patently outlandish ideas). There has been a disappointing reluctance among psychotherapists to make the hard choices about which therapies are effective and which — like some old-fashioned Freudian therapies — should be abandoned.”


Here we go. Brandon A. Gaudiano is a clinical psychologist and assistant professor of psychiatry and human behavior at the Alpert Medical School at Brown University wrote this article in the Op-Ed section of the New York Times. I read it with glee, until I reached the sentence I quoted above. So begins my next rant about how psychiatry, and now psychology, has lost its way. Psychiatrists, as a group, are too quick to prescribe medications, particularly those trained post-Prozac, meaning after 1990. Psychologists, as a group, are too quick to deny the unconscious, and preach that if we just follow a cook-book, we can help people develop coping skills, and science, meaning scientific studies proves this to be true. Freud is quickly thrown around as the evidence that “old-fashioned psychiatrists” have to wake up to the new world. I, like many of my colleagues, who do not seem to have a loud enough voice in this discussion, want to say that you, the typical psychiatrist, and you the evidence-based psychologist are both missing an important component to your discussion. People mess up their own lives because of unconscious guilt, leading them to make decisions which ultimately lead to deep suffering. Without an understanding of unconscious guilt, those in the mental health field are missing the complexity of the human mind, and the difficulties people have, either responding to medication, or to “evidence-based therapies.” Now, my caveat, I am in favor of medication, and I enthusiastically prescribe them. I am also in favor of evidence-based psychotherapies, and I use tools that this data has given us. Having said that, I also appreciate that sometimes, not all the time, childhood traumas, lead to life-long struggles of happiness, connection, and joy. Freud said the goal of psychotherapy is to help people love and work. This goal is often obtained by reminding people that medications can help with anxiety and mood, and evidence-based psychotherapies can help with coping skills, but deep analytic thinking is needed to help you make better choices for yourself. Just this understanding that an unconscious exists can help people understand why their relationships are serially disturbed, why their friendships often go South, and why in each and every job, they seem to run into trouble with the politics. Thinking about patterns can help patients develop psychological tools to be curious about how they might be the author of their own bad experience, meaning they may have been victims as children, but as adults, they can become the writer of their journey, at least to some extent. Do I have scientific evidence to back me up? Nope. What I do have is over two decades of experience working with people, connecting with psychological pain, and understanding together, how the person might have landed there. This experience has taught me, and many of my colleagues, that this inquiry has led to better mental and physical health. Yes, I repeat, this is all anecdotal. No scientific data does not mean it is not true, it only means we have not been able to prove it yet. My student taught me that. That gives me hope.

8 Responses to “Marketing Psychotherapy”

  1. Ashana M said

    The evidence on psychotherapies most strongly says that all of it works more or less equally well. The strongest factor is not the specific methodology or the theory, but the relationship with the therapist. Which suggests to me that it’s neither about unconscious guilt nor about a specific treatment protocol that seems to alleviate many kinds of distress, but something that happens within the context of a relationship that is most important. Looking at unconscious guilt or learning mindfulness are just something to do together while having that relationship.

    • Shelly said

      Ashana, what you write is very interesting. How is the relationship with a therapist then different than with a really good friend with whom someone can speak openly and freely?

      • Ashana M said

        I don’t know. I wonder that as well. The effect size of psychotherapy is supposed to be about .8. So what is the effect size of marriage (one thing that actually does, statistically, make us happier)? What’s the effect size of having a dog? I don’t know if anyone has done those kinds of studies.

        But the difference might be having a goal as a part of therapy. Shared goals create stronger bonds. So, if you had a good friend to talk with openly and freely, you talked about feelings and causal events related to those feelings (because that also helps), and you had a shared goal, there might not be any difference in effectiveness. But many people who end up in therapy don’t have that kind of friend–and speaking for myself, I wouldn’t ask my friends to listen to some of the things I need to say. So it may be it’s difficult to get the helpful elements of therapy without the structure of therapy.

        Also, the research I’ve looked at has been about the effectiveness of psychotherapy for anxiety and depression–the most common complaints we seek treatment for. Other diagnoses might have very different response rates to psychotherapy.

    • Hi Ashana,
      I think that the relationship is key, but having said that, I would add on that the relationship helps to resolve unconscious guilt, because the positive feeling from the relationship often serves to layer over the negative self-esteem, often stemming from early guilt, which drags the person down. Thanks.

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