The Therapeutic Industrial Complex

Key points

• Psychology in general and therapy in particular are more art than science.
• There are myriad roles that psychotherapists incarnate when we are in the office with a patient.
• “Religious man was born to be saved, psychological man is born to be pleased” stated Philip Rieff.
• There is a backlash emerging against the commercialization of therapy.

In 1986-1988 I studied with Philip Rieff, who twenty years prior had written the ironically entitled book The Triumph of the Therapeutic. His juxtaposition of our culture with pre-modern times is edifying: “Religious man was born to be saved, psychological man is born to be pleased.”

This observation names the shift from moral formation and communal obligation to self-experience, self-management, self-expression and the perpetual elusive quest to sate the hungry ghost of emotional satisfaction as the new organizing principle of modern life. Professor Rieff’s “triumph” is a Pyrrhic victory resulting in lives of self-absorption and estrangement as well as anxiety-provoking and depressing loneliness.

The Death of Therapy

The death of “therapy” – as older generations know it – thus refers to the demise of an older form of talk therapy, of the protocol initially established by Freudian psychoanalysis – one in which patients arrive in an office with fewer (or no) prefabricated categories and diagnostic self-identifications, without a plethora of impersonal acronymic albatrosses – ADHD, PTSD, OCD – and with a willingness to enter a process that requires a greater commitment than an AI search of symptoms.

What Professor Rieff foresaw is that therapeutic language would become the vocabulary through which our culture narrates personal aspiration, hope, frustration, disappointment and loss. Younger generations now learn psychology during everyday life, not by crashing into it through an unfathomable crisis or incomprehensible trauma; they assimilate this vocabulary in school and on social media platforms where therapeutic terminology now functions as a form of social currency.

The pandemic normalized two-dimensional intimacy and folded therapy into the same platform that hosts work meetings, social media, private text chains, as well as enables us to order food, make travel plans, shop, find romance, get news, troll and get trolled, do banking, enjoy critiques and gossip, and consume Netflix and pornography.

I am noticing online an emerging backlash against the commercialization of therapy that warrants discussion. As an insurance company provider, after my office expenses, I earn per hour about as much as a manager at Trader Joe’s. This is a race to the bottom engendered by a focus on corporate bottom-lines rather than patient well-being.

A Generation that Embraces Mental Health Diagnoses

A deeper shift may be Gen Z’s growing identification with diagnoses. The culture now rewards people for speaking fluently about themselves in therapeutic terms. Sometimes this produces genuine insight; sometimes it’s just branding. A diagnosis can help people feel recognized but it also risks becoming a permanent solution to a temporary problem.

Freudian psychoanalysis often took years of several sessions per week; there’s a trust-building and rapport-building component of in-person therapy (attachment) that is seldom discussed today when the primacy is placed on expediency and results. However, I believe that Freud also contributed to the current mess by positing psychology and psychoanalysis as “scientific.” For me, psychology in general and therapy in particular are more art than science. Also, if you notice, most psychological studies that attempt to be scientific – represent the general population (not just college volunteers), have a control group, are replicable – fail or are debunked within ten years. Just look at the recent backlash against IFS and Polyvagal Theory – two theories that are about as scientific as astrology.

For me, the benefits of therapy come from the encounter. “Mirror neurons do not fire via text message,” I wrote in my first book. The validation of emotional experiences requires 55 minutes of eye-contact, intentional facial affect mirroring and body language matching, plus pheromones, as well as a smidge of transference. AI can summarize and intellectually placate, but it cannot participate in the ethical and affective profundity of two human subjectivities authentically wrestling with emotions together in a safe space.

Long before other sociologists, Professor Rieff understood that therapy would become our culture’s dominant mode of self-understanding. What he did not anticipate was the speed with which AI would help create the Therapeutic Industrial Complex.

There are myriad roles that psychotherapists play when we are in the office with a patient: we validate emotional experiences, embody compassion, anchor presence, model authenticity, hold space for grief, alleviate shame, restore agency, embrace uncertainty, awaken curiosity, transmute fear, process disappointments, witness breakthroughs, refine narratives, reframe perspectives, explore blindspots, reveal self-deception, challenge assumptions, point out catastrophizing, resolve conflicts, ease frustrations, inspire transformations, moderate expectations, offer reality testing, note parapraxes, track patterns, set goals, support ideals, propose solutions, share tools, reinforce wins, empower—and yes, diagnose—as well as many many other things.

We need to disambiguate what is currently transpiring in psychology and therapy and have a candid discussion about the art of meaningful, satisfying relationships rather than the current rise of a “science” of algorithmically produced mental Band-Aids.

References

Previously Published on Psychology Today

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