As a clinical psychologist, I have watched with increasing curiosity as more articles critical of psychotherapy have appeared in The Sun. Now that psychotherapy-bashing seems to have reached a crescendo in “Replacing Therapy” [September 1992], I feel compelled to respond.

Certainly, many criticisms of psychotherapy are valid. Some psychotherapists encourage too much dependency in order to make money or to satisfy their own egos. Some don’t help the client create real change but instead offer only “symptom substitution.” Some have taken the “inner child” concept too far, infantilizing the client.

In response to many critiques of traditional psychotherapy from within the field, different approaches have been developed: family therapy, hypnotherapy, object-relations therapy (which emphasizes equality in the therapeutic relationship), and greater therapist self-disclosure.

So why the vehemence of Tom Rusk’s and D. Patrick Miller’s criticism? Apparently, they believe people with emotional problems would feel better if they would quit bitching and get on with life. Certainly, there are clients — especially those who haven’t been severely traumatized — who might profit from Rusk’s coaching methods. For others, however, the injuries are too profound, and Rusk’s challenge would only deepen their sense of hopelessness and shame.

Rusk suggests that most therapists withhold information about themselves from the client because of their authoritarian or elitist attitudes. This trivializes the heart of psychotherapy. Giving advice or disclosing something about yourself is the easy part. The harder, more profound, work is helping people who know what they should do, but who are unable to act in their own best interests. This is where the skill and patience and humility of the psychotherapist are so important.

In spite of what Miller suggests, many psychotherapists are open to being challenged. They question their methods and results, do pro bono work, value social activism individually and in their professional associations, and help their clients achieve real change. Miller’s assertion that most psychotherapies “encourage a degree of self-absorption that . . . depletes the very soul of the world” is chillingly reminiscent of some of the speeches I heard recently at the Republican National Convention.

Mark Weisberg, Ph.D.
Minneapolis, Minnesota

In a session between Tom Rusk and a patient, the patient says, “Listen, honey, you men are all the same.” Rusk comments, “I won’t tolerate being treated as a stereotype.” How can this man possibly make that statement? He spends his entire interview stereotyping therapists.

Joan Eric
Hicksville, New York

Tom Rusk, M.D. responds:

The surest way to deepen a client’s sense of hopelessness and shame is to diagnose his injuries as “too profound” for him to take on my fundamental challenge that “everyone can change, no matter how hard it is.” I see people who are terribly afraid to act, who feel very awkward, who need patience, enthusiastic coaching, and positive role modeling to get started and keep going. But I never see people being “unable” to act on their own behalf, as Dr. Weisberg suggests. This kind of superior, condemning judgment by therapists — no matter how kindly it is expressed — is precisely what dispirits and disempowers people seeking change in their lives.

I apologize to Joan Eric and anyone else who perceived my diagnosis of the chronic failings of psychotherapy as the stereotyping of all therapists. That was certainly not my intent. In discussing the therapeutic mainstream, I may indeed have failed to credit all the exceptions to the rule.

D. Patrick Miller responds:

The assertion Dr. Weisberg partially quotes and attributes to me was actually my summary of what previous critics have said about therapy. I doubt that these critics — chiefly Thomas Szasz, Jeffrey Masson, and James Hillman — would endorse many ideas from the Republican Convention.

Also, I said only that there is “some common sense” in these critics’ implication that troubled people should get on with life; and that “one doesn’t always find” Tom Rusk’s degree of personal openness in conventional therapists. These statements are not as extreme or exclusive as Dr. Weisberg has read them. For real vehemence in the criticism of therapy, I suggest he read Hillman and Masson.